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FOR PUBLIC DOMAIN ETEXTS*Ver.04.29.93*END* + + + + + +Etext prepared for Gutenberg by David Widger, widger@cecomet.net + + + + + +MEDICAL ESSAYS + +BY OLIVER WENDELL HOLMES + + + + +1842-1882 + + +CONTENTS: + +I. HOMEOPATHY AND ITS KINDRED DELUSIONS + +II. THE CONTAGIOUSNESS OF PUERPERAL FEVER + +III. CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE + +IV. BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE + +V. SCHOLASTIC AND BEDSIDE TEACHING + +VI. THE MEDICAL PROFESSION IN MASSACHUSETTS + +VII. THE YOUNG PRACTITIONER + +VIII. MEDICAL LIBRARIES + +IX. SOME OF MY EARLY TEACHERS + + + + + + +PREFACE. + +The character of the opposition which some of these papers have met +with suggests the inference that they contain really important, but +unwelcome truths. Negatives multiplied into each other change their +sign and become positives. Hostile criticisms meeting together are +often equivalent to praise, and the square of fault-finding turns out +to be the same thing as eulogy. + +But a writer has rarely so many enemies as it pleases him to believe. +Self-love leads us to overrate the numbers of our negative +constituency. The larger portion of my limited circle of readers +must be quite indifferent to, if not ignorant of, the adverse +opinions which have been expressed or recorded concerning any of +these Addresses or Essays now submitted to their own judgment. It is +proper, however, to inform them, that some of the positions +maintained in these pages have been unsparingly attacked, with +various degrees of ability, scholarship, and good-breeding. The tone +of criticism naturally changes with local conditions in different +parts of a country extended like our own, so that it is one of the +most convenient gauges of the partial movements in the direction of +civilization. It is satisfactory to add, that the views assailed +have also been unflinchingly defended by unsought champions, among +the ablest of whom it is pleasant to mention, at this moment of +political alienation, the Editor of the Charleston Medical Journal. + +"Currents and Counter-Currents" was written and delivered as an +Oration, a florid rhetorical composition, expressly intended to +secure the attention of an audience not easy to hold as listeners. +It succeeded in doing this, and also in being as curiously +misunderstood and misrepresented as if it had been a political +harangue. This gave it more local notoriety than it might otherwise +have attained, so that, as I learn, one ingenious person made use of +its title as an advertisement to a production of his own. + +The commonest mode of misrepresentation was this: qualified +propositions, the whole meaning of which depended on the +qualifications, were stripped of these and taken as absolute. Thus, +the attempt to establish a presumption against giving poisons to sick +persons was considered as equivalent to condemning the use of these +substances. The only important inference the writer has been able to +draw from the greater number of the refutations of his opinions which +have been kindly sent him, is that the preliminary education of the +Medical Profession is not always what it ought to be. + +One concession he is willing to make, whatever sacrifice of pride it +may involve. The story of Massasoit, which has furnished a coral, as +it were, for some teething critics, when subjected to a powerful +logical analysis, though correct in its essentials, proves to have +been told with exceptionable breadth of statement, and therefore (to +resume the metaphor) has been slightly rounded off at its edges, so +as to be smoother for any who may wish to bite upon it hereafter. In +other respects the Discourse has hardly been touched. It is only an +individual's expression, in his own way, of opinions entertained by +hundreds of the Medical Profession in every civilized country, and +has nothing in it which on revision the writer sees cause to retract +or modify. The superstitions it attacks lie at the very foundation +of Homoeopathy, and of almost every form of medical charlatanism. +Still the mere routinists and unthinking artisans in most callings +dislike whatever shakes the dust out of their traditions, and it may +be unreasonable to expect that Medicine will always prove an +exception to the rule. One half the opposition which the numerical +system of Louis has met with, as applied to the results of treatment, +has been owing to the fact that it showed the movements of disease to +be far more independent of the kind of practice pursued than was +agreeable to the pride of those whose self-confidence it abated. + +The statement, that medicines are more sparingly used in physicians' +families than in most others, admits of a very natural explanation, +without putting a harsh construction upon it, which it was not +intended to admit. Outside pressure is less felt in the physician's +own household; that is all. If this does not sometimes influence him +to give medicine, or what seems to be medicine, when among those who +have more confidence in drugging than his own family commonly has, +the learned Professor Dunglison is hereby requested to apologize for +his definition of the word Placebo, or to expunge it from his Medical +Dictionary. + +One thing is certain. A loud outcry on a slight touch reveals the +weak spot in a profession, as well as in a patient. It is a doubtful +policy to oppose the freest speech in those of our own number who are +trying to show us where they honestly believe our weakness lies. +Vast as are the advances of our Science and Art, may it not possibly +prove on examination that we retain other old barbarisms beside the +use of the astrological sign of Jupiter, with which we endeavor to +insure good luck to our prescriptions? Is it the act of a friend or +a foe to try to point them out to our brethren when asked to address +them, and is the speaker to subdue the constitutional habit of his +style to a given standard, under penalty of giving offence to a grave +assembly? + +Homoeopathy and its Kindred Delusions " was published nearly twenty +years ago, and has been long out of print, so that the author tried +in vain to procure a copy until the kindness of a friend supplied him +with the only one he has had for years. A foolish story reached his +ears that he was attempting to buy up stray copies for the sake of +suppressing it. This edition was in the press at that very time. + +Many of the arguments contained in the Lectures have lost whatever +novelty they may have possessed. All its predictions have been +submitted to the formidable test of time. They appear to have stood +it, so far, about as well as most uninspired prophecies; indeed, some +of them require much less accommodation than certain grave +commentators employ in their readings of the ancient Prophets. + +If some statistics recently published are correct, Homoeopathy has +made very slow progress in Europe. + +In all England, as it appears, there are hardly a fifth more +Homoeopathic practitioners than there are students attending Lectures +at the Massachusetts Medical College at the present time. In America +it has undoubtedly proved more popular and lucrative, yet how loose a +hold it has on the public confidence is shown by the fact that, when +a specially valued life, which has been played with by one of its +agents, is seriously threatened, the first thing we expect to hear is +that a regular practitioner is by the patient's bed, and the +Homoeopathic counsellor overruled or discarded. Again, how many of +the ardent and capricious persons who embraced Homoeopathy have run +the whole round of pretentious novelties;--have been boarded at +water-cure establishments, closeted with uterine and other +specialists, and finally wandered over seas to put themselves in +charge of foreign celebrities, who dosed them as lustily as they were +ever dosed before they took to globules! It will surprise many to +learn to what a shadow of a shade Homoeopathy has dwindled in the +hands of many of its noted practitioners. The itch-doctrine is +treated with contempt. Infinitesimal doses are replaced by full ones +whenever the fancy-practitioner chooses. Good Homoeopathic reasons +can be found for employing anything that anybody wants to employ. +Homoeopathy is now merely a name, an unproved theory, and a box of +pellets pretending to be specifics, which, as all of us know, fail +ignominiously in those cases where we would thankfully sacrifice all +our prejudices and give the world to have them true to their +promises. + +Homoeopathy has not died out so rapidly as Tractoration. Perhaps it +was well that it should not, for it has taught us a lesson of the +healing faculty of Nature which was needed, and for which many of us +have made proper acknowledgments. But it probably does more harm +than good to medical science at the present time, by keeping up the +delusion of treating everything by specifics,--the old barbarous +notion that sick people should feed on poisons [Lachesis, arrow- +poison, obtained from a serpent (Pulte). Crotalus horridus, +rattlesnake's venom (Neidhard). The less dangerous Pediculus capilis +is the favorite remedy of Dr. Mure, the English 'Apostle of +Homoeopathy." These are examples of the retrograde current setting +towards barbarism] against which a part of the Discourse at the +beginning of this volume is directed. + +The infinitesimal globules have not become a curiosity as yet, like +Perkins's Tractors. But time is a very elastic element in Geology +and Prophecy. If Daniel's seventy weeks mean four hundred and ninety +years, as the learned Prideaux and others have settled it that they +do, the "not many years" of my prediction may be stretched out a +generation or two beyond our time, if necessary, when the prophecy +will no doubt prove true. + +It might be fitting to add a few words with regard to the Essay on +the Contagiousness of Puerperal Fever. But the whole question I +consider to be now transferred from the domain of medical inquiry to +the consideration of Life Insurance agencies and Grand Juries. For +the justification of this somewhat sharply accented language I must +refer the reader to the paper itself for details which I regret to +have been forced to place on permanent record. + +BOSTON, January, 1861. + + + + +A SECOND PREFACE. + +These Lectures and Essays are arranged in the order corresponding to +the date of their delivery or publication. They must, of course, be +read with a constant reference to these dates, by such as care to +read them. I have not attempted to modernize their aspect or +character in presenting them, in this somewhat altered connection, to +the public. Several of them were contained in a former volume which +received its name from the Address called "Currents and Counter- +Currents." Some of those contained in the former volume have been +replaced by others. The Essay called "Mechanism of Vital Actions" +has been transferred to a distinct collection of Miscellaneous +essays, forming a separate volume. + +I had some intention of including with these papers an Essay on +Intermittent Fever in New England, which received one of the Boylston +prizes in 1837, and was published in the following year. But as this +was upon a subject of local interest, chiefly, and would have taken +up a good deal of room, I thought it best to leave it out, trusting +that the stray copies to be met with in musty book-shops would +sufficiently supply the not very extensive or urgent demand for a +paper almost half a century old. + +Some of these papers created a little stir when they first fell from +the press into the pool of public consciousness. They will slide in +very quietly now in this new edition, and find out for themselves +whether the waters are those of Lethe, or whether they are to live +for a time as not wholly unvalued reminiscences. + +March 21, 1883. + + + + +PREFACE TO THE NEW EDITION. + +These Essays are old enough now to go alone without staff or crutch +in the shape of Prefaces. A very few words may be a convenience to +the reader who takes up the book and wishes to know what he is likely +to find in it. + + + HOMOEOPATHY AND ITS KINDRED DELUSIONS. + +Homoeopathy has proved lucrative, and so long as it continues to be +so will surely exist,--as surely as astrology, palmistry, and other +methods of getting a living out of the weakness and credulity of +mankind and womankind. Though it has no pretensions to be considered +as belonging among the sciences, it may be looked upon by a +scientific man as a curious object of study among the vagaries of the +human mind. Its influence for good or the contrary may be made a +matter of calm investigation. I have studied it in the Essay before +the reader, under the aspect of an extravagant and purely imaginative +creation of its founder. Since that first essay was written, nearly +half a century ago, we have all had a chance to witness its practical +working. Two opposite inferences may be drawn from its doctrines and +practice. The first is that which is accepted by its disciples. +This is that all diseases are "cured" by drugs. The opposite +conclusion is drawn by a much larger number of persons. As they see +that patients are very commonly getting well under treatment by +infinitesimal drugging, which they consider equivalent to no +medication at all, they come to disbelieve in every form of drugging +and put their whole trust in "nature." Thus experience, + + "From seeming evil still educing good," + +has shown that the dealers in this preposterous system of pseudo- +therapeutics have cooperated with the wiser class of practitioners in +breaking up the system of over-dosing and over-drugging which has +been one of the standing reproaches of medical practice. While. +keeping up the miserable delusion that diseases were all to be +"cured" by drugging, Homoeopathy has been unintentionally showing +that they would very generally get well without any drugging at all. +In the mean time the newer doctrines of the "mind cure," the "faith +cure," and the rest are encroaching on the territory so long +monopolized by that most ingenious of the pseudo-sciences. It would +not be surprising if its whole ground should be taken possession of +by these new claimants with their flattering appeals to the +imaginative class of persons open to such attacks. Similia similabus +may prove fatally true for once, if Homoeopathy is killed out by its +new-born rivals. + +It takes a very moderate amount of erudition to unearth a charlatan +like the supposed father of the infinitesimal dosing system. The +real inventor of that specious trickery was an Irishman by the name +of Butler. The whole story is to be found in the "Ortus Medicinm" of +Van Helmont. I have given some account of his chapter "Butler" in +different articles, but I would refer the students of our +Homoeopathic educational institutions to the original, which they +will find very interesting and curious. + + + CURRENTS AND COUNTER-CURRENTS + +My attack on over-drugging brought out some hostile comments and +treatment. Thirty years ago I expressed myself with more vivacity +than I should show if I were writing on the same subjects today. +Some of my more lively remarks called out very sharp animadversion. +Thus my illustration of prevention as often better than treatment in +the mother's words to her child which had got a poisonous berry in +its mouth,--"Spit it out!" gave mortal offence to a well-known New +York practitioner and writer, who advised the Massachusetts Medical +Society to spit out the offending speaker. Worse than this was my +statement of my belief that if a ship-load of miscellaneous drugs, +with certain very important exceptions,--drugs, many of which were +then often given needlessly and in excess, as then used "could be +sunk to the bottom of the sea, it would be all the better for mankind +and all the worse for the fishes." This was too bad. The sentence +was misquoted, quoted without its qualifying conditions, and +frightened some of my worthy professional brethren as much as if I +had told them to throw all physic to the dogs. But for the +epigrammatic sting the sentiment would have been unnoticed as a +harmless overstatement at the very worst. + +Since this lecture was delivered a great and, as I think, beneficial +change has taken place in the practice of medicine. The habit of the +English "general practitioner" of making his profit out of the pills +and potions he administered was ruinous to professional advancement +and the dignity of the physician. When a half-starving medical man +felt that he must give his patient draught and boluses for which he +could charge him, he was in a pitiable position and too likely to +persuade himself that his drugs were useful to his patient because +they were profitable to him. This practice has prevailed a good deal +in America, and was doubtless the source in some measure of the +errors I combated. + + + THE CONTAGIOUSNESS OF PUERPERAL FEVER. + +This Essay was read before a small Association called "The Society +for Medical Improvement," and published in a Medical Journal which +lasted but a single year. It naturally attracted less attention than +it would have done if published in such a periodical as the "American +Journal of Medical Sciences." Still it had its effect, as I have +every reason to believe. I cannot doubt that it has saved the lives +of many young mothers by calling attention to the existence and +propagation of "Puerperal Fever as a Private Pestilence," and laying +down rules for taking the necessary precautions against it. The case +has long been decided in favor of the views I advocated, but, at the +time when I wrote two of the most celebrated professors of Obstetrics +in this country opposed my conclusions with all the weight of their +experience and position. + +This paper was written in a great heat and with passionate +indignation. If I touched it at all I might trim its rhetorical +exuberance, but I prefer to leave it all its original strength of +expression. I could not, if I had tried, have disguised the feelings +with which I regarded the attempt to put out of sight the frightful +facts which I brought forward and the necessary conclusions to which +they led. Of course the whole matter has been looked at in a new +point of view since the microbe as a vehicle of contagion has been +brought into light, and explained the mechanism of that which was +plain enough as a fact to all who were not blind or who did not shut +their eyes. + +O. W. H. + +BEVERLY Farms, Mass., August 3, 1891 + + + + + + +HOMOEOPATHY AND ITS KINDRED DELUSIONS +[Two lectures delivered before the Boston Society for the Diffusion +of Useful Knowledge. 1842.] + + +[When a physician attempts to convince a person, who has fallen into +the Homoeopathic delusion, of the emptiness of its pretensions, he is +often answered by a statement of cases in which its practitioners are +thought to have effected wonderful cures. The main object of the +first of these Lectures is to show, by abundant facts, that such +statements, made by persons unacquainted with the fluctuations of +disease and the fallacies of observation, are to be considered in +general as of little or no value in establishing the truth of a +medical doctrine or the utility of a method of practice. + +Those kind friends who suggest to a person suffering from a tedious +complaint, that he "Had better try Homoeopathy," are apt to enforce +their suggestion by adding, that "at any rate it can do no harm." +This may or may not be true as regards the individual. But it always +does very great harm to the community to encourage ignorance, error, +or deception in a profession which deals with the life and health of +our fellow-creatures. Whether or not those who countenance +Homoeopathy are guilty of this injustice towards others, the second +of these Lectures may afford them some means of determining. + +To deny that good effects may happen from the observance of diet and +regimen when prescribed by Homoeopathists as well as by others, would +be very unfair to them. But to suppose that men with minds so +constituted as to accept such statements and embrace such doctrines +as make up the so-called science of Homoeopathy are more competent +than others to regulate the circumstances which influence the human +body in health and disease, would be judging very harshly the average +capacity of ordinary practitioners. + +To deny that some patients may have been actually benefited through +the influence exerted upon their imaginations, would be to refuse to +Homoeopathy what all are willing to concede to every one of those +numerous modes of practice known to all intelligent persons by an +opprobrious title. + +So long as the body is affected through the mind, no audacious +device, even of the most manifestly dishonest character, can fail of +producing occasional good to those who yield it an implicit or even a +partial faith. The argument founded on this occasional good would be +as applicable in justifying the counterfeiter and giving circulation +to his base coin, on the ground that a spurious dollar had often +relieved a poor man's necessities. + +Homoeopathy has come before our public at a period when the growing +spirit of eclecticism has prepared many ingenious and honest minds to +listen to all new doctrines with a candor liable to degenerate into +weakness. It is not impossible that the pretended evolution of great +and mysterious virtues from infinitely attenuated atoms may have +enticed a few over-refining philosophers, who have slid into a vague +belief that matter subdivided grows less material, and approaches +nearer to a spiritual nature as it requires a more powerful +microscope for its detection. + +However this may be, some persons seem disposed to take the ground of +Menzel that the Laity must pass formal judgment between the Physician +and the Homoeopathist, as it once did between Luther and the +Romanists. The practitioner and the scholar must not, therefore, +smile at the amount of time and labor expended in these Lectures upon +this shadowy system; which, in the calm and serious judgment of many +of the wisest members of the medical profession, is not entitled by +anything it has ever said or done to the notoriety of a public +rebuke, still less to the honors of critical martyrdom.] + + +I + +I have selected four topics for this lecture, the first three of +which I shall touch but slightly, the last more fully. They are + +1. The Royal cure of the King's Evil, or Scrofula. + +2. The Weapon Ointment, and its twin absurdity, the Sympathetic +Powder. + +3. The Tar-water mania of Bishop Berkeley. + +4. The History of the Metallic Tractors, or Perkinism. + +The first two illustrate the ease with which numerous facts are +accumulated to prove the most fanciful and senseless extravagances. + +The third exhibits the entire insufficiency of exalted wisdom, +immaculate honesty, and vast general acquirements to make a good +physician of a great bishop. + +The fourth shows us the intimate machinery of an extinct delusion, +which flourished only forty years ago; drawn in all its details, as +being a rich and comparatively recent illustration of the +pretensions, the arguments, the patronage, by means of which windy +errors have long been, and will long continue to be, swollen into +transient consequence. All display in superfluous abundance the +boundless credulity and excitability of mankind upon subjects +connected with medicine. + +>From the time of Edward the Confessor to Queen Anne, the monarchs of +England were in the habit of touching those who were brought to them +suffering with the scrofula, for the cure of that distemper. William +the Third had good sense enough to discontinue the practice, but Anne +resumed it, and, among her other patients, performed the royal +operation upon a child, who, in spite of his, disease, grew up at +last into Samuel Johnson. After laying his hand upon the sufferers, +it was customary for the monarch to hang a gold piece around the neck +of each patient. Very strict precautions were adopted to prevent +those who thought more of the golden angel hung round the neck by a +white ribbon, than of relief of their bodily infirmities, from making +too many calls, as they sometimes attempted to do. According to the +statement of the advocates and contemporaries of this remedy, none +ever failed of receiving benefit unless their little faith and +credulity starved their merits. Some are said to have been cured +immediately on the very touch, others did not so easily get rid of +their swellings, until they were touched a second time. Several +cases are related, of persons who had been blind for several weeks, +and months, and obliged even to be led to Whitehall, yet recovered +their sight immediately upon being touched, so as to walk away +without any guide." So widely, at one period, was the belief +diffused, that, in the course of twelve years, nearly a hundred +thousand persons were touched by Charles the Second. Catholic +divines; in disputes upon the orthodoxy of their church, did not deny +that the power had descended to protestant princes;--Dr. Harpsfield, +in his " Ecclesiastical History of England," admitted it, and in +Wiseman's words, "when Bishop Tooker would make use of this Argument +to prove the Truth of our Church, Smitheus doth not thereupon go +about to deny the Matter of fact; nay, both he and Cope acknowledge +it." "I myself," says Wiseman, the best English surgical writer of +his day,[Edinburgh Medical and Surgical Journal, vol. iii. p. 103.] +--"I my self have been a frequent Eye-witness of many hundred of +Cures performed by his Majesties Touch alone, without any assistance +of Chirurgery; and those, many of them such as had tired out the +endeavours of able Chirurgeons before they came hither. It were +endless to recite what I myself have seen, and what I have received +acknowledgments of by Letter, not only from the severall parts of +this Nation, but also from Ireland, Scotland, Jersey, Garnsey. It is +needless also to remember what Miracles of this nature were performed +by the very Bloud of his late Majesty of Blessed memory, after whose +decollation by the inhuman Barbarity of the Regicides, the reliques +of that were gathered on Chips and in Handkerchieffs by the pious +Devotes, who could not but think so great a suffering in so +honourable and pious a Cause, would be attended by an extraordinary +assistance of God, and some more then ordinary a miracle: nor did +their Faith deceive them in this there point, being so many hundred +that found the benefit of it." [Severall Chirurgicall Treatises. +London.1676. p. 246.] + +Obstinate and incredulous men, as he tells us, accounted for these +cures in three ways: by the journey and change of air the patients +obtained in coming to London; by the influence of imagination; and +the wearing of gold. + +To these objections he answers, 1st. That many of those cured were +inhabitants of the city. 2d. That the subjects of treatment were +frequently infants. 3d. That sometimes silver was given, and +sometimes nothing, yet the patients were cured. + +A superstition resembling this probably exists at the present time in +some ignorant districts of England and this country. A writer in a +Medical Journal in the year 1807, speaks of a farmer in Devonshire, +who, being a ninth son of a ninth son, is thought endowed with +healing powers like those of ancient royalty, and who is accustomed +one day in every week to strike for the evil. + +I remember that one of my schoolmates told me, when a boy, of a +seventh son of a seventh son, somewhere in Essex County, who touched +for the scrofula, and who used to hang a silver fourpence halfpenny +about the neck of those who came to him, which fourpence halfpenny it +was solemnly affirmed became of a remarkably black color after having +been some time worn, and that his own brother had been subjected to +this extraordinary treatment; but I must add that my schoolmate drew +a bow of remarkable length, strength, and toughness for his tender +years. + +One of the most curious examples of the fallacy of popular belief and +the uncertainty of asserted facts in medical experience is to be +found in the history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT. + +Fabricius Hildanus, whose name is familiar to every surgical +scholar, and Lord Bacon, who frequently dipped a little into +medicine, are my principal authorities for the few circumstances I +shall mention regarding it. The Weapon Ointment was a preparation +used for the healing of wounds, but instead of its being applied to +them, the injured part was washed and bandaged, and the weapon with +which the wound was inflicted was carefully anointed with the +unguent. Empirics, ignorant barbers, and men of that sort, are said +to have especially employed it. Still there were not wanting some +among the more respectable members of the medical profession who +supported its claims. The composition of this ointment was +complicated, in the different formulae given by different +authorities; but some substances addressed to the imagination, rather +than the wound or weapon, entered into all. Such were portions of +mummy, of human blood, and of moss from the skull of a thief hung in +chains. + +Hildanus was a wise and learned man, one of the best surgeons of his +time. He was fully aware that a part of the real secret of the +Unguentum Armarium consisted in the washing and bandaging the wound +and then letting it alone. But he could not resist the solemn +assertions respecting its efficacy; he gave way before the outcry of +facts, and therefore, instead of denying all their pretensions, he +admitted and tried to account for them upon supernatural grounds. As +the virtue of those applications, he says, which are made to the +weapon cannot reach the wound, and as they can produce no effect +without contact, it follows, of necessity, that the Devil must have a +hand in the business; and as he is by far the most long headed and +experienced of practitioners, he cannot find this a matter of any +great difficulty. Hildanus himself reports, in detail, the case of a +lady who had received a moderate wound, for which the Unguentum +Armarium was employed without the slightest use. Yet instead of +receiving this flat case of failure as any evidence against the +remedy, he accounts for its not succeeding by the devout character of +the lady, and her freedom from that superstitious and over- +imaginative tendency which the Devil requires in those who are to be +benefited by his devices. + +Lord Bacon speaks of the Weapon Ointment, in his Natural History, as +having in its favor the testimony of men of credit, though, in his +own language, he himself "as yet is not fully inclined to believe +it." His remarks upon the asserted facts respecting it show a +mixture of wise suspicion and partial belief. He does not like the +precise directions given as to the circumstances under which the +animals from which some of the materials were obtained were to be +killed; for he thought it looked like a provision for an excuse in +case of failure, by laying the fault to the omission of some of these +circumstances. But he likes well that "they do not observe the +confecting of the Ointment under any certain constellation; which is +commonly the excuse of magical medicines, when they fail, that they +were not made under a fit figure of heaven." [This was a mistake, +however, since the two recipes given by Hildanus are both very +explicit as to the aspect of the heavens required for different +stages of the process.] "It was pretended that if the offending +weapon could not be had, it would serve the purpose to anoint a +wooden one made like it. "This," says Bacon, "I should doubt to be a +device to keep this strange form of cure in request and use; because +many times you cannot come by the weapon itself." And in closing his +remarks on the statements of the advocates of the ointment, he says, +"Lastly, it will cure a beast as well as a man, which I like best of +all the rest, because it subjecteth the matter to an easy trial." It +is worth remembering, that more than two hundred years ago, when an +absurd and fantastic remedy was asserted to possess wonderful power, +and when sensible persons ascribed its pretended influence to +imagination, it was boldly answered that the cure took place when the +wounded party did not know of the application made to the weapon, and +even when a brute animal was the subject of the experiment, and that +this assertion, he as we all know it was, came in such a shape as to +shake the incredulity of the keenest thinker of his time. The very +same assertion has been since repeated in favor of Perkinism, and, +since that, of Homoeopathy. + +The same essential idea as that of the Weapon Ointment reproduced +itself in the still more famous SYMPATHETIC POWDER. This Powder was +said to have the faculty, if applied to the blood-stained garments of +a wounded person, to cure his injuries, even though he were at a +great distance at the time. A friar, returning from the East, +brought the recipe to Europe somewhat before the middle of the +seventeenth century. The Grand Duke of Florence, in which city the +friar was residing, heard of his cures, and tried, but without +success, to obtain his secret. Sir Kenehn Digby, an Englishman well +known to fame, was fortunate enough to do him a favor, which wrought +upon his feelings and induced him to impart to his benefactor the +composition of his extraordinary Powder. This English knight was at +different periods of his life an admiral, a theologian, a critic, a +metaphysician, a politician, and a disciple of Alchemy. As is not +unfrequent with versatile and inflammable people, he caught fire at +the first spark of a new medical discovery, and no sooner got home to +England than he began to spread the conflagration. + +An opportunity soon offered itself to try the powers of the famous +powder. Mr. J. Howell, having been wounded in endeavoring to part +two of his friends who were fighting a duel, submitted himself to a +trial of the Sympathetic Powder. Four days after he received his +wounds, Sir Kenehn dipped one of Mr. Howell's gaiters in a solution +of the Powder, and immediately, it is said, the wounds, which were +very painful, grew easy, although the patient, who was conversing in +a corner of the chamber, had not, the least idea of what was doing +with his garter. He then returned home, leaving his garter in the +hands of Sir Kenelm, who had hung it up to dry, when Mr. Howell sent +his servant in a great hurry to tell him that his wounds were paining +him horribly; the garter was therefore replaced in the solution of +the Powder, and the patient got well after five or six days of its +continued immersion." + +King James First, his son Charles the First, the Duke of Buckingham, +then prime minister, and all the principal personages of the time, +were cognizant of this fact; and James himself, being curious to know +the secret of this remedy, asked it of Sir Kenelm, who revealed it to +him, and his Majesty had the opportunity of making several trials of +its efficacy, which all succeeded in a surprising manner." [Dict. +des Sciences Medieales.] + +The king's physician, Dr. Mayerne, was made master of the secret, +which he carried to France and communicated to the Duke of Mayenne, +who performed many cures by means of it, and taught it to his +surgeon, who, after the Duke's death, sold it to many distinguished +persons, by whose agency it soon ceased to be a secret. What was +this wonderful substance which so astonished kings, princes, dukes, +knights, and doctors? Nothing but powdered blue vitriol. But it was +made to undergo several processes that conferred on it extraordinary +virtues. Twice or thrice it was to be dissolved, filtered, and +crystallized. The crystals were to be laid in the sun during the +months of June, July, and August, taking care to turn them carefully +that all should be exposed. Then they were to be powdered, +triturated, and again exposed to the sun, again reduced to a very +fine powder, and secured in a vessel, while hot, from the sunshine. +If there seem anything remarkable in the fact of such astonishing +properties being developed by this process, it must be from our +short-sightedness, for common salt and charcoal develop powers quite +as marvellous after a certain number of thumps, stirs, and shakes, +from the hands of modern workers of miracles. In fact the Unguentum +Armarium and Sympathetic Powder resemble some more recent +prescriptions; the latter consisting in an infinite dilution of the +common dose in which remedies are given, and the two former in an +infinite dilution of the common distance at which they are applied. + +Whether philosophers, and more especially metaphysicians, have any +peculiar tendency to dabble in drugs and dose themselves with physic, +is a question which might suggest itself to the reader of their +biographies. + +When Bishop Berkeley visited the illustrious Malebranche at Paris, he +found him in his cell, cooking in a small pipkin a medicine for an +inflammation of the lungs, from which he was suffering; and the +disease, being unfortunately aggravated by the vehemence of their +discussion, or the contents of the pipkin, carried him off in the +course of a few days. Berkeley himself afforded a remarkable +illustration of a truth which has long been known to the members of +one of the learned professions, namely, that no amount of talent, or +of acquirements in other departments, can rescue from lamentable +folly those who, without something of the requisite preparation, +undertake to experiment with nostrums upon themselves and their +neighbors. The exalted character of Berkeley is thus drawn by Sir +James Mackintosh: Ancient learning, exact science, polished society, +modern literature, and the fine arts, contributed to adorn and enrich +the mind of this accomplished man. All his contemporaries agreed +with the satirist in ascribing + + "'To Berkeley every virtue under heaven.' + +"Even the discerning, fastidious, and turbulent Atterbury said, after +an interview with him, 'So much understanding, so much knowledge, so +much innocence, and such humility, I did not think had been the +portion of any but angels, till I saw this gentleman.'" + +But among the writings of this great and good man is an Essay of the +most curious character, illustrating his weakness upon the point in +question, and entitled, "Siris, a Chain of Philosophical Reflections +and Inquiries concerning the Virtues of TAR WATER, and divers other +Subjects,"--an essay which begins with a recipe for his favorite +fluid, and slides by gentle gradations into an examination of the +sublimest doctrines of Plato. To show how far a man of honesty and +benevolence, and with a mind of singular acuteness and depth, may be +run away with by a favorite notion on a subject which his habits and +education do not fit him to investigate, I shall give a short account +of this Essay, merely stating that as all the supposed virtues of Tar +Water, made public in successive editions of his treatise by so +illustrious an author, have not saved it from neglect and disgrace, +it may be fairly assumed that they were mainly imaginary. + +The bishop, as is usual in such cases, speaks of himself as +indispensably obliged, by the duty he owes to mankind, to make his +experience public. Now this was by no means evident, nor does it +follow in general, that because a man has formed a favorable opinion +of a person or a thing he has not the proper means of thoroughly +understanding, he shall be bound to print it, and thus give currency +to his impressions, which may be erroneous, and therefore injurious. +He would have done much better to have laid his impressions before +some experienced physicians and surgeons, such as Dr. Mead and Mr. +Cheselden, to have asked them to try his experiment over again, and +have been guided by their answers. But the good bishop got excited; +he pleased himself with the thought that he had discovered a great +panacea; and having once tasted the bewitching cup of self-quackery, +like many before and since his time, he was so infatuated with the +draught that he would insist on pouring it down the throats of his +neighbors and all mankind. + +The precious fluid was made by stirring a gallon of water with a +quart of tar, leaving it forty-eight hours, and pouring off the clear +water. Such was the specific which the great metaphysician +recommended for averting and curing all manner of diseases. It was, +if he might be believed, a preventive of the small-pox, and of great +use in the course of the disease. It was a cure for impurities of +the blood, coughs, pleurisy, peripneumony, erysipelas, asthma, +indigestion, carchexia, hysterics, dropsy, mortification, scurvy, and +hypochondria. It was of great use in gout and fevers, and was an +excellent preservative of the teeth and gums; answered all the +purpose of Elixir Proprietatis, Stoughton's drops, diet drinks, and +mineral waters; was particularly to be recommended to sea-faring +persons, ladies, and men of studious and sedentary lives; could never +be taken too long, but, on the contrary, produced advantages which +sometimes did not begin to show themselves for two or three months. + +"From my representing Tar Water as good for so many things," says +Berkeley, "some perhaps may conclude it is good for nothing. But +charity obligeth me to say what I know, and what I think, however it +may be taken. Men may censure and object as they please, but I +appeal to time and experiment. Effects misimputed, cases wrong told, +circumstances overlooked, perhaps, too, prejudices and partialities +against truth, may for a time prevail and keep her at the bottom of +her well, from whence nevertheless she emergeth sooner or later, and +strikes the eyes of all who do not keep them shut." I cannot resist +the temptation of illustrating the bishop's belief in the wonderful +powers of his remedy, by a few sentences from different parts of his +essay. "The hardness of stubbed vulgar constitutions renders them +insensible of a thousand things that fret and gall those delicate +people, who, as if their skin was peeled off, feel to the quick +everything that touches them. The tender nerves and low spirits of +such poor creatures would be much relieved by the use of Tar Water, +which might prolong and cheer their lives." "It [the Tar Water] may +be made stronger for brute beasts, as horses, in whose disorders I +have found it very useful." " This same water will also give +charitable relief to the ladies, who often want it more than the +parish poor; being many of them never able to make a good meal, and +sitting pale, puny, and forbidden, like ghosts, at their own table, +victims of vapors and indigestion." It does not appear among the +virtues of Tar Water that "children cried for it," as for some of our +modern remedies, but the bishop says, "I have known children take it +for above six months together with great benefit, and without any +inconvenience; and after long and repeated experience I do esteem it +a most excellent diet drink, fitted to all seasons and ages." After +mentioning its usefulness in febrile complaints, he says: "I have had +all this confirmed by my own experience in the late sickly season of +the year one thousand seven hundred and forty-one, having had twenty- +five fevers in my own family cured by this medicinal water, drunk +copiously." And to finish these extracts with a most important +suggestion for the improvement of the British nation: "It is much to +be lamented that our Insulars who act and think so much for +themselves, should yet, from grossness of air and diet, grow stupid +or doat sooner than other people, who, by virtue of elastic air, +water-drinking, and light food, preserve their faculties to extreme +old age; an advantage which may perhaps be approached, if not +equaled, even in these regions, by Tar Water, temperance, and early +hours." + +Berkeley died at the age of about seventy; he might have lived +longer, but his fatal illness was so sudden that there was not time +enough to stir up a quart of the panacea. He was an illustrious man, +but he held two very odd opinions; that tar water was everything, and +that the whole material universe was nothing. + + --------------------------- + +Most of those present have at some time in their lives heard mention +made of the METALLIC TRACTORS, invented by one Dr. Perkins, an +American, and formerly enjoying great repute for the cure of various +diseases. Many have seen or heard of a satirical poem, written by +one of our own countrymen also, about forty years since, and called +"Terrible Tractoration." The Metallic Tractors are now so utterly +abandoned that I have only by good fortune fallen upon a single one +of a pair, to show for the sake of illustration. For more than +thirty years this great discovery, which was to banish at least half +the evils which afflict humanity, has been sleeping undisturbed in +the grave of oblivion. Not a voice has, for this long period, been +raised in its favor; its noble and learned patrons, its public +institutions, its eloquent advocates, its brilliant promises are all +covered with the dust of silent neglect; and of the generation which +has sprung up since the period when it flourished, very few know +anything of its history, and hardly even the title which in its palmy +days it bore of PERKINISM. Taking it as settled, then, as no one +appears to answer for it, that Perkinism is entirely dead and gone, +that both in public and private, officially and individually, its +former adherents even allow it to be absolutely defunct, I select it +for anatomical examination. If this pretended discovery was made +public; if it was long kept before the public; if it was addressed to +the people of different countries; if it was formally investigated by +scientific men, and systematically adopted by benevolent persons, who +did everything in their power to diffuse the knowledge and practice +of it; if various collateral motives, such as interest and vanity, +were embarked in its cause; if, notwithstanding all these things, it +gradually sickened and died, then the conclusion seems a fair one, +that it did not deserve to live. Contrasting its failure with its +high pretensions, it is fair to call it an imposition; whether an +expressly fraudulent contrivance or not, some might be ready to +question. Everything historically shown to have happened concerning +the mode of promulgation, the wide diffusion, the apparent success of +this delusion, the respectability and enthusiasm of its advocates, is +of great interest in showing to what extent and by what means a +considerable part of the community may be led into the belief of that +which is to be eventually considered' as an idle folly. If there is +any existing folly, fraudulent or innocent in its origin, which +appeals to certain arguments for its support; provided that the very +same arguments can be shown to have been used for Perkinism with as +good reason, they will at once fall to the ground. Still more, if it +shall appear that the general course of any existing delusion bears a +strong resemblance to that of Perkinism, that the former is most +frequently advocated by the same class of persons who were +conspicuous in behalf of the latter, and treated with contempt or +opposed by the same kind of persons who thus treated Perkinism; if +the facts in favor of both have a similar aspect; if the motives of +their originators and propagators may be presumed to have been +similar; then there is every reason to suppose that the existing +folly will follow in the footsteps of the past, and after displaying +a given amount of cunning and credulity in those deceiving and +deceived, will drop from the public view like a fruit which has +ripened into spontaneous rottenness, and be succeeded by the fresh +bloom of some other delusion required by the same excitable portion +of the community. + +Dr. Elisha Perkins was born at Norwich, Connecticut, in the year +1740. He had practised his profession with a good local reputation +for many years, when he fell upon a course of experiments, as it is +related, which led to his great discovery. He conceived the idea +that metallic substances might have the effect of removing diseases, +if applied in a certain manner; a notion probably suggested by the +then recent experiments of Galvani, in which muscular contractions +were found to be produced by the contact of two metals with the +living fibre. It was in 1796 that his discovery was promulgated in +the shape of the Metallic Tractors, two pieces of metal, one +apparently iron and the other brass, about three inches long, blunt +at one end and pointed at the other. These instruments were applied +for the cure of different complaints, such as rheumatism, local +pains, inflammations, and even tumors, by drawing them over the +affected part very lightly for about twenty minutes. Dr. Perkins +took out a patent for his discovery, and travelled about the country +to diffuse the new practice. He soon found numerous advocates of his +discovery, many of them of high standing and influence. In the year +1798 the tractors had crossed the Atlantic, and were publicly +employed in the Royal Hospital at Copenhagen. About the same time +the son of the inventor, Mr. Benjamin Douglass Perkins, carried them +to London, where they soon attracted attention. The Danish +physicians published an account of their cases, containing numerous +instances of alleged success, in a respectable octavo volume. In the +year 1804 an establishment, honored with the name of the Perkinean +Institution, was founded in London. The transactions of this +institution were published in pamphlets, the Perkinean Society had +public dinners at the Crown and Anchor, and a poet celebrated their +medical triumph in strains like these : + + "See, pointed metals, blest with power t' appease + The ruthless rage of merciless disease, + O'er the frail part a subtle fluid pour, + Drenched with invisible Galvanic shower, + Till the arthritic staff and crutch forego, + And leap exulting like the bounding roe!" + +While all these things were going on, Mr. Benjamin Douglass Perkins +was calmly pocketing money, so that after some half a dozen years he +left the country with more than ten thousand pounds, which had been +paid him by the believers in Great Britain. But in spite of all this +success, and the number of those interested and committed in its +behalf, Perkinism soon began to decline, and in 1811 the Tractors are +spoken of by an intelligent writer as being almost forgotten. Such +was the origin and duration of this doctrine and practice, into the +history of which we will now look a little more narrowly. + +Let us see, then, by whose agency this delusion was established and +kept up; whether it was principally by those who were accustomed to +medical pursuits, or those whose habits and modes of reasoning were +different; whether it was with the approbation of those learned +bodies usually supposed to take an interest in scientific +discoveries, or only of individuals whose claims to distinction were +founded upon their position in society, or political station, or +literary eminence; whether the judicious or excitable classes entered +most deeply into it; whether, in short, the scientific men of that +time were deceived, or only intruded upon, and shouted down for the +moment by persons who had no particular call to invade their +precincts. + +Not much, perhaps, was to be expected of the Medical Profession in +the way of encouragement. One Dr. Fuller, who wrote in England, +himself a Perkinist, thus expressed his opinion: "It must be an +extraordinary exertion of virtue and humanity for a medical man, +whose livelihood depends either on the sale of drugs, or on receiving +a guinea for writing a prescription, which must relate to those +drugs, to say to his patient, 'You had better purchase a set of +Tractors to keep in your family; they will cure you without the +expense of my attendance, or the danger of the common medical +practice.' For very obvious reasons medical men must never be +expected to recommend the use of Perkinism. The Tractors must trust +for their patronage to the enlightened and philanthropic out of the +profession, or to medical men retired from practice, and who know of +no other interest than the luxury of relieving the distressed. And I +do not despair of seeing the day when but very few of this +description as well as private families will be without them." + +Whether the motives assigned by this medical man to his professional +brethren existed or not, it is true that Dr. Perkins did not gain a +great deal at their hands. The Connecticut Medical Society expelled +him in 1797 for violating their law against the use of nostrums, or +secret remedies. The leading English physicians appear to have +looked on with singular apathy or contempt at the miracles which it +was pretended were enacting in the hands of the apostles of the new +practice. In looking over the reviews of the time, I have found +little beyond brief occasional notices of their pretensions; the +columns of these journals being occupied with subjects of more +permanent interest. The state of things in London is best learned, +however, from the satirical poem to which I have already alluded as +having been written at the period referred to. This was entitled, +"Terrible Tractoration!! A Poetical Petition against Galvanizing +Trumpery and the Perkinistic Institution. Most respectfully +addressed to the Royal College of Physicians, by Christopher Caustic, +M. D., LL. D., A. S. S., Fellow of the Royal College of Physicians, +Aberdeen, and Honorary Member of no less than nineteen very learned +Societies." Two editions of this work were published in London in +the years 1803 and 1804, and one or two have been published in this +country. + +"Terrible Tractoration" is supposed, by those who never read it, to +be a satire upon the follies of Perkins and his followers. It is, on +the contrary, a most zealous defence of Perkinism, and a fierce +attack upon its opponents, most especially upon such of the medical +profession as treated the subject with neglect or ridicule. The +Royal College of Physicians was the more peculiar object of the +attack, but with this body, the editors of some of the leading +periodicals, and several physicians distinguished at that time, and +even now remembered for their services to science and humanity, were +involved in unsparing denunciations. The work is by no means of the +simply humorous character it might be supposed, but is overloaded +with notes of the most seriously polemical nature. Much of the +history of the subject, indeed, is to be looked for in this volume. + +It appears from this work that the principal members of the medical +profession, so far from hailing Mr. Benjamin Douglass Perkins as +another Harvey or Jenner, looked very coldly upon him and his +Tractors; and it is now evident that, though they were much abused +for so doing, they knew very well what they had to deal with, and +were altogether in the right. The delusion at last attracted such an +amount of attention as to induce Dr. Haygarth and some others of +respectable standing to institute some experiments which I shall +mention in their proper place, the result of which might have seemed +sufficient to show the emptiness of the whole contrivance. + +The Royal Society, that learned body which for ages has constituted +the best tribunal to which Britain can appeal in questions of +science, accepted Mr. Perkins's Tractors and the book written about +them, passed the customary vote of thanks, and never thought of +troubling itself further in the investigation of pretensions of such +an aspect. It is not to be denied that a considerable number of +physicians did avow themselves advocates of the new practice; but out +of the whole catalogue of those who were publicly proclaimed as such, +no one has ever been known, so far as I am aware, to the scientific +world, except in connection with the short-lived notoriety of +Perkinism. Who were the people, then, to whose activity, influence, +or standing with the community was owing all the temporary excitement +produced by the Metallic Tractors? + +First, those persons who had been induced to purchase a pair of +Tractors. These little bits of brass and iron, the intrinsic value +of which might, perhaps, amount to ninepence, were sold at five +guineas a pair! A man who has paid twenty-five dollars for his +whistle is apt to blow it louder and longer than other people. So it +appeared that when the "Perkinean Society" applied to the possessors +of Tractors in the metropolis to concur in the establishment of a +public institution for the use of these instruments upon the poor, +"it was found that only five out of above a hundred objected to +subscribe, on account of their want of confidence in the efficacy of +the practice; and these," the committee observes, "there is reason to +believe, never gave them a fair trial, probably never used them in +more than one case, and that perhaps a case in which the Tractors had +never been recommended as serviceable." "Purchasers of the +Tractors," said one of their ardent advocates, "would be among the +last to approve of them if they had reason to suppose themselves +defrauded of five guineas." He forgot poor Moses, with his "gross of +green spectacles, with silver rims and shagreen cases." "Dear +mother," cried the boy, "why won't you listen to reason? I had them +a dead bargain, or I should not have bought them. The silver rims +alone will sell for double the money." + +But it is an undeniable fact, that many persons of considerable +standing, and in some instances holding the most elevated positions +in society, openly patronized the new practice. In a translation of +a work entitled "Experiments with the Metallic Tractors," originally +published in Danish, thence rendered successively into German and +English, Mr. Benjamin Perkins, who edited the English edition, has +given a copious enumeration of the distinguished individuals, both in +America and Europe, whose patronage he enjoyed. He goes so far as to +signify that ROYALTY itself was to be included among the number. +When the Perkinean Institution was founded, no less a person than +Lord Rivers was elected President, and eleven other individuals of +distinction, among them Governor Franklin, son of Dr. Franklin, +figured as Vice-Presidents. Lord Henniker, a member of the Royal +Society, who is spoken of as a man of judgment and talents, +condescended to patronize the astonishing discovery, and at different +times bought three pairs of Tractors. When the Tractors were +introduced into Europe, a large number of testimonials accompanied +them from various distinguished characters in America, the list of +whom is given in the translation of the Danish work referred to as +follows: + +"Those who have individually stated cases, or who have presented +their names to the public as men who approved of this remedy, and +acknowledged themselves instrumental in circulating the Tractors, are +fifty-six in number; thirty-four of whom are physicians and surgeons, +and many of them of the first eminence, thirteen clergymen, most of +whom are doctors of divinity, and connected with the literary +institutions of America; among the remainder are two members of +Congress, one professor of natural philosophy in a college, etc., +etc." It seemed to be taken rather hardly by Mr. Perkins that the +translators of the work which he edited, in citing the names of the +advocates of the Metallic Practice, frequently omitted the honorary +titles which should have been annexed. The testimonials were +obtained by the Danish writer, from a pamphlet published in America, +in which these titles were given in full. Thus one of these +testimonials is from " John Tyler, Esq., a magistrate in the county +of New London, and late Brigadier-General of the militia in that +State." The "omission of the General's title" is the subject of +complaint, as if this title were sufficient evidence of the +commanding powers of one of the patrons of tractoration. A similar +complaint is made when "Calvin Goddard, Esq., of Plainfield, Attorney +at Law, and a member of the Legislature of the State of Connecticut," +is mentioned without his titular honors, and even on account of the +omission of the proper official titles belonging to "Nathan Pierce, +Esq., Governor and Manager of the Almshouse of Newburyport." These +instances show the great importance to be attached to civil and +military dignities, in qualifying their holders to judge of +scientific subjects, a truth which has not been overlooked by the +legitimate successors of the Perkinists. In Great Britain, the +Tractors were not less honored than in America, by the learned and +the illustrious. The "Perkinistic Committee" made this statement in +their report: "Mr. Perkins has annually laid before the public a +large collection of new cases communicated to him for that purpose by +disinterested and intelligent characters, from almost every quarter +of Great Britain. In regard to the competency of these vouchers, it +will be sufficient simply to state that, amongst others whose names +have been attached to their communications, are eight professors, in +four different universities, twenty-one regular Physicians, nineteen +Surgeons, thirty Clergymen, twelve of whom are Doctors of Divinity, +and numerous other characters of equal respectability." + +It cannot but excite our notice and surprise that the number of +clergymen both in America and Great Britain who thrust forward their +evidence on this medical topic was singularly large in proportion to +that of the members of the medical profession. Whole pages are +contributed by such worthies as the Rev. Dr. Trotter of Hans Place, +the Rear. Waring Willett, Chaplain to the Earl of Dunmore, the Rev. +Dr. Clarke, Chaplain to the Prince of Wales. The style of these +theologico-medical communications may be seen in the following from a +divine who was also professor in one of the colleges of New England. +"I have used the Tractors with success in several other cases in my +own family, and although, like Naaman the Syrian, I cannot tell why +the waters of Jordan should be better than Abana and Pharpar, rivers +of Damascus; yet since experience has proved them so, no reasoning +can change the opinion. Indeed, the causes of all common facts are, +we think, perfectly well known to us; and it is very probable, fifty +or a hundred years hence, we shall as well know why the Metallic +Tractors should in a few minutes remove violent pains, as we now know +why cantharides and opium will produce opposite effects, namely, we +shall know very little about either excepting facts." Fifty or a +hundred years hence! if he could have looked forward forty years, he +would have seen the descendants of the "Perkinistic" philosophers +swallowing infinitesimal globules, and knowing and caring as much +about the Tractors as the people at Saratoga Springs do about the +waters of Abana and Pharpar. + +I trust it will not be thought in any degree disrespectful to a +profession which we all honor, that I have mentioned the great zeal +of many clergymen in the cause of Perkinism. I hope, too, that I may +without offence suggest the causes which have often led them out of +their own province into one to which their education has no special +reference. The members of that profession ought to be, and commonly +are, persons of benevolent character. Their duties carry them into +the midst of families, and particularly at times when the members of +them are suffering from bodily illness. It is natural enough that a +strong desire should be excited to alleviate sufferings which may +have defied the efforts of professional skill; as natural that any +remedy which recommends itself to the belief or the fancy of the +spiritual physician should be applied with the hope of benefit; and +perfectly certain that the weakness of human nature, from which no +profession is exempt, will lead him to take the most flattering view +of its effects upon the patient; his own sagacity and judgment being +staked upon the success of the trial. The inventor of the Tractors +was aware of these truths. He therefore sent the Tractors +gratuitously to many clergymen, accompanied with a formal certificate +that the holder had become entitled to their possession by the +payment of five guineas. This was practised in our own neighborhood, +and I remember finding one of these certificates, so presented, which +proved that amongst the risks of infancy I had to encounter Perkins's +Tractors. Two clergymen of Boston and the vicinity, both well known +to local fame, gave in their testimony to the value of the +instruments thus presented to them; an unusually moderate proportion, +when it is remembered that to the common motives of which I have +spoken was added the seduction of a gift for which the profane public +was expected to pay so largely. + +It was remarkable, also, that Perkinism, which had so little success +with the medical and scientific part of the community, found great +favor in the eyes of its more lovely and less obstinate portion. +"The lady of Major Oxholin,"--I quote from Mr. Perkins's volume,-- +"having been lately in America, had seen and heard much of the great +effects of Perkinism. Influenced by a most benevolent disposition, +she brought these Tractors and the pamphlet with her to Europe, with +a laudable desire of extending their utility to her suffering +countrymen." Such was the channel by which the Tractors were +conveyed to Denmark, where they soon became the ruling passion. +The workmen, says a French writer, could not manufacture them fast +enough. Women carried them about their persons, and delighted in +bringing them into general use. To what extent the Tractors were +favored with the patronage of English and American ladies, it is of +course not easy to say, except on general principles, as their names +were not brought before the public. But one of Dr. Haygarth's +stories may lead us to conjecture that there was a class of female +practitioners who went about doing good with the Tractors in England +as well as in Denmark. A certain lady had the misfortune to have a +spot as big as a silver penny at the corner of her eye, caused by a +bruise, or some such injury. Another lady, who was a friend of hers, +and a strong believer in Perkinism, was very anxious to try the +effects of tractoration upon this unfortunate blemish. The patient +consented; the lady "produced the instruments, and, after drawing +them four or five times over the spot, declared that it changed to a +paler color, and on repeating the use of them a few minutes longer, +that it had almost vanished, and was scarcely visible, and departed +in high triumph at her success." The lady who underwent the +operation assured the narrator "that she looked in the glass +immediately after, and that not the least visible alteration had +taken place." + +It would be a very interesting question, what was the intellectual +character of those persons most conspicuous in behalf of the +Perkinistic delusion? Such an inquiry might bring to light some +principles which we could hereafter apply to the study of other +popular errors. But the obscurity into which nearly all these +enthusiasts have subsided renders the question easier to ask than to +answer. I believe it would have been found that most of these +persons were of ardent temperament and of considerable imagination, +and that their history would show that Perkinism was not the first +nor the last hobby-horse they rode furiously. Many of them may very +probably have been persons of more than common talent, of active and +ingenious minds, of versatile powers and various acquirements. Such, +for instance, was the estimable man to whom I have repeatedly +referred as a warm defender of tractoration, and a bitter assailant +of its enemies. The story tells itself in the biographical preface +to his poem. He went to London with the view of introducing a +hydraulic machine, which he and his Vermont friends regarded as a +very important invention. He found, however, that the machine was +already in common use in that metropolis. A brother Yankee, then in +London, had started the project of a mill, which was to be carried by +the water of the Thames. He was sanguine enough to purchase one +fifth of this concern, which also proved a failure. At about the +same period he wrote the work which proved the great excitement of +his mind upon the subject of the transient folly then before the +public. Originally a lawyer, he was in succession a mechanician, a +poet, and an editor, meeting with far less success in each of these +departments than usually attends men of less varied gifts, but of +more tranquil and phlegmatic composition. But who is ignorant that +there is a class of minds characterized by qualities like those I +have mentioned; minds with many bright and even beautiful traits; but +aimless and fickle as the butterfly; that settle upon every gayly- +colored illusion as it opens into flower, and flutter away to another +when the first has dropped its leaves, and stands naked in the icy +air of truth! + +Let us now look at the general tenor of the arguments addressed by +believers to sceptics and opponents. Foremost of all, emblazoned at +the head of every column, loudest shouted by every triumphant +disputant, held up as paramount to all other considerations, +stretched like an impenetrable shield to protect the weakest advocate +of the great cause against the weapons of the adversary, was that +omnipotent monosyllable which has been the patrimony of cheats and +the currency of dupes from time immemorial,--Facts! Facts ! Facts! +First came the published cases of the American clergymen, brigadier- +generals, almshouse governors, representatives, attorneys, and +esquires. Then came the published cases of the surgeons of +Copenhagen. Then followed reports of about one hundred and fifty +cases published in England, "demonstrating the efficacy of the +metallic practice in a variety of complaints both upon the human body +and on horses, etc." But the progress of facts in Great Britain did +not stop here. Let those who rely upon the numbers of their +testimonials, as being alone sufficient to prove the soundness and +stability of a medical novelty, digest the following from the report +of the Perkinistic Committee. "The cases published [in Great +Britain] amounted, in March last, the date of Mr. Perkins's last +publication, to about five thousand. Supposing that not more than +one cure in three hundred which the Tractors have performed has been +published, and the proportion is probably much greater, it will be +seen that the number, to March last, will have exceeded one million +five hundred thousand!" + +Next in order after the appeal to what were called facts, came a +series of arguments, which have been so long bruised and battered +round in the cause of every doctrine or pretension, new, monstrous, +or deliriously impossible, that each of them is as odiously familiar +to the scientific scholar as the faces of so many old acquaintances, +among the less reputable classes, to the officers of police. + +No doubt many of my hearers will recognize, in the following +passages, arguments they may have heard brought forward with +triumphant confidence in behalf of some doctrine not yet extinct. No +doubt some may have honestly thought they proved something; may have +used them with the purpose of convincing their friends, or of +silencing the opponents of their favorite doctrine, whatever that +might be. But any train of arguments which was contrived for +Perkinism, which was just as applicable to it as to any other new +doctrine in the same branch of science, and which was fully employed +against its adversaries forty years since, might, in common charity, +be suffered to slumber in the grave of Perkinism. Whether or not the +following sentences, taken literally from the work of Mr. Perkins, +were the originals of some of the idle propositions we hear bandied +about from time to time, let those who listen judge. + +The following is the test assumed for the new practice : "If diseases +are really removed, as those persons who have practised extensively +with the Tractors declare, it should seem there would be but little +doubt of their being generally adopted; but if the numerous reports +of their efficacy which have been published are forgeries, or are +unfounded, the practice ought to be crushed." To this I merely add, +it has been crushed. + +The following sentence applies to that a priori judging and uncandid +class of individuals who buy their dinners without tasting all the +food there is in the market. "On all discoveries there are persons +who, without descending to any inquiry into the truth, pretend to +know, as it were by intuition, that newly asserted facts are founded +in the grossest errors. These were those who knew that Harvey's +report of the circulation of the blood was a preposterous and +ridiculous suggestion, and in latter later days there were others who +knew that Franklin deserved reproach for declaring that points were +preferable to balls for protecting buildings from lightning." + +Again: "This unwarrantable mode of offering assertion for proof, so +unauthorized and even unprecedented except in the condemnation of a +Galileo, the persecution of a Copernicus, and a few other acts of +inquisitorial authority, in the times of ignorance and superstition, +affords but a lamentable instance of one of his remarks, that this is +far from being the Age of Reason." + +"The most valuable medicines in the Materia Medica act on principles +of which we are totally ignorant. None have ever yet been able to +explain how opium produces sleep, or how bark cures intermittent +fevers; and yet few, it is hoped, will be so absurd as to desist from +the use of these important articles because they know nothing of the +principle of their operations." Or if the argument is preferred, in +the eloquent language of the Perkinistic poet: + + "What though the CAUSES may not be explained, + Since these EFFECTS are duly ascertained, + Let not self-interest, prejudice, or pride, + Induce mankind to set the means aside; + Means which, though simple, are by + Heaven designed to alleviate the woes of human kind." + +This course of argument is so often employed, that it deserves to be +expanded a little, so that its length and breadth may be fairly seen. +A series of what are called facts is brought forward to prove some +very improbable doctrine. It is objected by judicious people, or +such as have devoted themselves to analogous subjects, that these +assumed facts are in direct opposition to all that is known of the +course of nature, that the universal experience of the past affords a +powerful presumption against their truth, and that in proportion to +the gravity of these objections, should be the number and competence +of the witnesses. The answer is a ready one. What do we know of the +mysteries of Nature? Do we understand the intricate machinery of the +Universe? When to this is added the never-failing quotation, + + "There are more things in heaven and earth, Horatio, + Than are dreamt of in your philosophy,"-- + +the question is thought to be finally disposed of. + +Take the case of astrology as an example. It is in itself strange +and incredible that the relations of the heavenly bodies to each +other at a given moment of time, perhaps half a century ago, should +have anything to do with my success or misfortune in any undertaking +of to-day. But what right have I to say it cannot be so? Can I bind +the sweet influences of Pleiades, or loose the bands of Orion? I do +not know by what mighty magic the planets roll in their fluid paths, +confined to circles as unchanging as if they were rings of steel, nor +why the great wave of ocean follows in a sleepless round upon the +skirts of moonlight; nor cam I say from any certain knowledge that +the phases of the heavenly bodies, or even the falling of the leaves +of the forest, or the manner in which the sands lie upon the sea- +shore, may not be knit up by invisible threads with the web of human +destiny. There is a class of minds much more ready to believe that +which is at first sight incredible, and because it is incredible, +than what is generally thought reasonable. Credo quia impossibile +est,--"I believe, because it is impossible,"--is an old paradoxical +expression which might be literally applied to this tribe of persons. +And they always succeed in finding something marvellous, to call out +the exercise of their robust faith. The old Cabalistic teachers +maintained that there was not a verse, line, word, or even letter in +the Bible which had not a special efficacy either to defend the +person who rightly employed it, or to injure his enemies; always +provided the original Hebrew was made use of. In the hands of modern +Cabalists every substance, no matter how inert, acquires wonderful +medicinal virtues, provided it be used in a proper state of purity +and subdivision. + +I have already mentioned the motives attributed by the Perkinists to +the Medical Profession, as preventing its members from receiving the +new but unwelcome truths. This accusation is repeated in different +forms and places, as, for instance, in the following passage: +"Will the medical man who has spent much money and labor in the +pursuit of the arcana of Physic, and on the exercise of which depends +his support in life, proclaim the inefficacy of his art, and +recommend a remedy to his patient which the most unlettered in +society can employ as advantageously as himself? and a remedy, too, +which, unlike the drops, the pills, the powders, etc., of the Materia +Medica, is inconsumable, and ever in readiness to be employed in +successive diseases?" + +As usual with these people, much indignation was expressed at any +parallel between their particular doctrine and practice and those of +their exploded predecessors. "The motives," says the disinterested +Mr. Perkins, "which must have impelled to this attempt at classing +the METALLIC PRACTICE with the most paltry of empyrical projects, are +but too thinly veiled to escape detection." + +To all these arguments was added, as a matter of course, an appeal to +the feelings of the benevolent in behalf of suffering humanity, in +the shape of a notice that the poor would be treated gratis. It is +pretty well understood that this gratuitous treatment of the poor +does not necessarily imply an excess of benevolence, any more than +the gratuitous distribution of a trader's shop-bills is an evidence +of remarkable generosity; in short, that it is one of those things +which honest men often do from the best motives, but which rogues and +impostors never fail to announce as one of their special +recommendations. It is astonishing to see how these things brighten +up at the touch of Mr. Perkins's poet: + + "Ye worthy, honored, philanthropic few, + The muse shall weave her brightest wreaths for you, + Who in Humanity's bland cause unite, + Nor heed the shaft by interest aimed or spite; + Like the great Pattern of Benevolence, + Hygeia's blessings to the poor dispense; + And though opposed by folly's servile brood, + ENJOY THE LUXURY OF DOING GOOD." + +Having thus sketched the history of Perkinism in its days of +prosperity; having seen how it sprung into being, and by what means +it maintained its influence, it only remains to tell the brief story +of its discomfiture and final downfall. The vast majority of the +sensible part of the medical profession were contented, so far as we +can judge, to let it die out of itself. It was in vain that the +advocates of this invaluable discovery exclaimed over their perverse +and interested obstinacy,--in vain that they called up the injured +ghosts of Harvey, Galileo, and Copernicus to shame that unbelieving +generation; the Baillies and the Heberdens,--men whose names have +come down to us as synonymous with honor and wisdom,--bore their +reproaches in meek silence, and left them unanswered to their fate. +There were some others, however, who, believing the public to labor +under a delusion, thought it worth while to see whether the charm +would be broken by an open trial of its virtue, as compared with that +of some less hallowed formula. It must be remembered that a peculiar +value was attached to the Metallic Tractors, as made and patented by +Mr. Perkins. Dr. Haygarth, of Bath, performed various experiments +upon patients afflicted with different complaints,--the patients +supposing that the real five-guinea Tractors were employed. Strange +to relate, he obtained equally wonderful effects with Tractors of +lead and of wood; with nails, pieces of bone, slate pencil, and +tobacco-pipe. Dr. Alderson employed sham Tractors made of wood, and +produced such effects upon five patients that they returned solemn +thanks in church for their cures. A single specimen of these cases +may stand for all of them. Ann Hill had suffered for some months +from pain in the right arm and shoulder. The Tractors (wooden ones) +were applied, and in the space of five minutes she expressed herself +relieved in the following apostrophe: "Bless me! why, who could have +thought it, that them little things could pull the pain from one. +Well, to be sure, the longer one lives, the more one sees; ah, dear!" + +These experiments did not result in the immediate extinction of +Perkinism. Doubtless they were a great comfort to many obstinate +unbelievers, and helped to settle some sceptical minds; but for the +real Perkinistic enthusiasts, it may be questioned whether they would +at that time have changed their opinion though one had risen from the +dead to assure them that it was an error. It perished without +violence, by an easy and natural process. Like the famous toy of +Mongolfier, it rose by means of heated air,--the fevered breath of +enthusiastic ignorance,--and when this grew cool, as it always does +in a little while, it collapsed and fell. + +And now, on reviewing the whole subject, how shall we account for the +extraordinary prevalence of the belief in Perkinism among a portion +of what is supposed to be the thinking part of the community? + +Could the cures have been real ones, produced by the principle of +ANIMAL MAGNETISM? To this it may be answered that the Perkinists +ridiculed the idea of approximating Mesmer and the founder of their +own doctrine, that nothing like the somnambulic condition seems to +have followed the use of the Tractors, and that neither the exertion +of the will nor the powers of the individual who operated seem to +have been considered of any consequence. Besides, the absolute +neglect into which the Tractors soon declined is good evidence that +they were incapable of affording any considerable and permanent +relief in the complaints for the cure of which they were applied. + +Of course a large number of apparent cures were due solely to nature; +which is true under every form of treatment, orthodox or empirical. +Of course many persons experienced at least temporary relief from the +strong impression made upon their minds by this novel and marvellous +method of treatment. + +Many, again, influenced by the sanguine hopes of those about them, +like dying people, who often say sincerely, from day to day, that +they are getting better, cheated themselves into a false and short- +lived belief that they were cured; and as happens in such cases, the +public never knew more than the first half of the story. + +When it was said to the Perkinists, that whatever effects they +produced were merely through the imagination, they declared (like the +advocates of the ROYAL TOUCH and the UNGUENTUM ARMARIUM that this +explanation was sufficiently disproved by the fact of numerous and +successful cures which had been witnessed in infants and brute +animals. Dr. Haygarth replied to this, that "in these cases it is +not the Patient, but the Observer, who is deceived by his own +imagination," and that such may be the fact, we have seen in the case +of the good lady who thought she had conjured away the spot from her +friend's countenance, when it remained just as before. + +As to the motives of the inventor and vender of the Tractors, the +facts must be allowed to speak for themselves. But when two little +bits of brass and iron are patented, as an invention, as the result +of numerous experiments, when people are led, or even allowed, to +infer that they are a peculiar compound, when they are artfully +associated with a new and brilliant discovery (which then happened to +be Galvanism), when they are sold at many hundred times their value, +and the seller prints his opinion that a Hospital will suffer +inconvenience, "unless it possesses many sets of the Tractors, and +these placed in the hands of the patients to practise on each other," +one cannot but suspect that they were contrived in the neighborhood +of a wooden nutmeg factory; that legs of ham in that region are not +made of the best mahogany; and that such as buy their cucumber seed +in that vicinity have to wait for the fruit as long as the Indians +for their crop of gunpowder. + + + --------------------------- + +The succeeding lecture will be devoted to an examination of the +doctrines of Samuel Hahnemann and his disciples; doctrines which some +consider new and others old; the common title of which is variously +known as Ho-moeopathy, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy, +and the claims of which are considered by some as infinitely +important, and by many as immeasurably ridiculous. + +I wish to state, for the sake of any who may be interested in the +subject, that I shall treat it, not by ridicule, but by argument; +perhaps with great freedom, but with good temper and in peaceable +language; with very little hope of reclaiming converts, with no +desire of making enemies, but with a firm belief that its pretensions +and assertions cannot stand before a single hour of calm +investigation. + + + + +II. + +It may be thought that a direct attack upon the pretensions of +HOMOEOPATHY is an uncalled-for aggression upon an unoffending +doctrine and its peaceful advocates. + +But a little inquiry will show that it has long assumed so hostile a +position with respect to the Medical Profession, that any trouble I, +or any other member of that profession, may choose to bestow upon it +may be considered merely as a matter of self-defence. It began with +an attempt to show the insignificance of all existing medical +knowledge. It not only laid claim to wonderful powers of its own, +but it declared the common practice to be attended with the most +positively injurious effects, that by it acute diseases are +aggravated, and chronic diseases rendered incurable. It has at +various times brought forward collections of figures having the air +of statistical documents, pretending to show a great proportional +mortality among the patients of the Medical Profession, as compared +with those treated according to its own rules. Not contented with +choosing a name of classical origin for itself, it invented one for +the whole community of innocent physicians, assuring them, to their +great surprise, that they were all ALLOPATHISTS, whether they knew it +or not, and including all the illustrious masters of the past, from +Hippocrates down to Hunter, under the same gratuitous title. The +line, then, has been drawn by the champions of the new doctrine; they +have lifted the lance, they have sounded the charge, and are +responsible for any little skirmishing which may happen. + +But, independently of any such grounds of active resistance, the +subject involves interests so disproportioned to its intrinsic +claims, that it is no more than an act of humanity to give it a +public examination. If the new doctrine is not truth, it is a +dangerous, a deadly error. If it is a mere illusion, and acquires +the same degree of influence that we have often seen obtained by +other illusions, there is not one of my audience who may not have +occasion to deplore the fatal credulity which listened to its +promises. + +I shall therefore undertake a sober examination of its principles, +its facts, and some points of its history. The limited time at my +disposal requires me to condense as much as possible what I have to +say, but I shall endeavor to be plain and direct in expressing it. +Not one statement shall be made which cannot be supported by +unimpeachable reference: not one word shall be uttered which I am not +as willing to print as to speak. I have no quibbles to utter, and I +shall stoop to answer none; but, with full faith in the sufficiency +of a plain statement of facts and reasons, I submit the subject to +the discernment of my audience. + + +The question may be asked in the outset,--Have you submitted the +doctrines you are professing to examine to the test of long-repeated +and careful experiment; have you tried to see whether they were true +or not? To this I answer, that it is abundantly evident, from what +has often happened, that it would be of no manner of use for me to +allege the results of any experiments I might have instituted. Again +and again have the most explicit statements been made by the most +competent persons of the utter failure of all their trials, and there +were the same abundant explanations offered as used to be for the +Unguentum Armarium arid the Metallic Tractors. I could by no +possibility perform any experiments the result of which could not be +easily explained away so as to be of no conclusive significance. +Besides, as arguments in favor of Homoeopathy are constantly +addressed to the public in journals, pamphlets, and even lectures, by +inexperienced dilettanti, the same channel must be open to all its +opponents. + +It is necessary, for the sake of those to whom the whole subject may +be new, to give in the smallest possible compass the substance of the +Homoeopathic Doctrine. Samuel Hahnemann, its founder, is a German +physician, now living in Paris," [Hahnemann died in 1843.] at the age +of eighty-seven years. In 1796 he published the first paper +containing his peculiar notions; in 1805 his first work on the +subject; in 1810 his somewhat famous "Organon of the Healing Art;" +the next year what he called the "Pure Materia Medica;" and in 1828 +his last work, the "Treatise on Chronic Diseases." He has therefore +been writing at intervals on his favorite subject for nearly half a +century. + +The one great doctrine which constitutes the basis of Homoeopathy as +a system is expressed by the Latin aphorism, + + "SIMILIA SIBIILIBUS CURANTUR," + +or like cures like, that is, diseases are cured by agents capable of +producing symptoms resembling those found in the disease under +treatment. A disease for Hahnemann consists essentially in a group +of symptoms. The proper medicine for any disease is the one which is +capable of producing a similar group of symptoms when given to a +healthy person. + +It is of course necessary to know what are the trains of symptoms +excited by different substances, when administered to persons in +health, if any such can be shown to exist. Hahnemann and his +disciples give catalogues of the symptoms which they affirm were +produced upon themselves or others by a large number of drugs which +they submitted to experiment. + +The second great fact which Hahnemann professes to have established +is the efficacy of medicinal substances reduced to a wonderful degree +of minuteness or dilution. The following account of his mode of +preparing his medicines is from his work on Chronic Diseases, which +has not, I believe, yet been translated into English. A grain of the +substance, if it is solid, a drop if it is liquid, is to be added to +about a third part of one hundred grains of sugar of milk in an +unglazed porcelain capsule which has had the polish removed from the +lower part of its cavity by rubbing it with wet sand; they are to be +mingled for an instant with a bone or horn spatula, and then rubbed +together for six minutes; then the mass is to be scraped together +from the mortar and pestle, which is to take four minutes; then to be +again rubbed for six minutes. Four minutes are then to be devoted to +scraping the powder into a heap, and the second third of the hundred +grains of sugar of milk to be added. Then they are to be stirred an +instant and rubbed six minutes,--again to be scraped together four +minutes and forcibly rubbed six; once more scraped together for four +minutes, when the last third of the hundred grains of sugar of milk +is to be added and mingled by stirring with the spatula; six minutes +of forcible rubbing, four of scraping together, and six more +(positively the last six) of rubbing, finish this part of the +process. + +Every grain of this powder contains the hundredth of a grain of the +medicinal substance mingled with the sugar of milk. If, therefore, a +grain of the powder just prepared is mingled with another hundred +grains of sugar of milk, and the process just described repeated, we +shall have a powder of which every grain contains the hundredth of +the hundredth, or the ten thousandth part of a grain of the medicinal +substance. Repeat the same process with the same quantity of fresh +sugar of milk, and every grain of your powder will contain the +millionth of a grain of the medicinal substance. When the powder is +of this strength, it is ready to employ in the further solutions and +dilutions to be made use of in practice. + +A grain of the powder is to be taken, a hundred drops of alcohol are +to be poured on it, the vial is to be slowly turned for a few +minutes, until the powder is dissolved, and two shakes are to be +given to it. On this point I will quote Hahnemann's own words. +"A long experience and multiplied observations upon the sick lead me +within the last few years to prefer giving only two shakes to +medicinal liquids, whereas I formerly used to give ten." The process +of dilution is carried on in the same way as the attenuation of the +powder was done; each successive dilution with alcohol reducing the +medicine to a hundredth part of the quantity of that which preceded +it. In this way the dilution of the original millionth of a grain of +medicine contained in the grain of powder operated on is carried +successively to the billionth, trillionth, quadrillionth, +quintillionth, and very often much higher fractional divisions. A +dose of any of these medicines is a minute fraction of a drop, +obtained by moistening with them one or more little globules of +sugar, of which Hahnemann says it takes about two hundred to weigh a +grain. + +As an instance of the strength of the medicines prescribed by +Hahnemann, I will mention carbonate of lime. He does not employ +common chalk, but prefers a little portion of the friable part of an +oystershell. Of this substance, carried to the sextillionth degree, +so much as one or two globules of the size mentioned can convey is a +common dose. But for persons of very delicate nerves it is proper +that the dilution should be carried to the decillionth degree. That +is, an important medicinal effect is to be expected from the two +hundredth or hundredth part of the millionth of the millionth of the +millionth of the millionth of the millionth of the millionth of the +millionth of the millionth of the millionth of the millionth of a +grain of oyster-shell. This is only the tenth degree of potency, but +some of his disciples profess to have obtained palpable effects from +much higher dilutions." + +The third great doctrine of Hahnemann is the following. Seven +eighths at least of all chronic diseases are produced by the +existence in the system of that infectious disorder known in the +language of science by the appellation of PSORA, but to the less +refined portion of the community by the name of ITCH. In the words +of Hahnemann's "Organon," "This Psora is the sole true and +fundamental cause that produces all the other countless forms of +disease, which, under the names of nervous debility, hysteria, +hypochondriasis, insanity, melancholy, idiocy, madness, epilepsy, and +spasms of all kinds, softening of the bones, or rickets, scoliosis +and cyphosis, caries, cancer, fungua haematodes, gout,--yellow +jaundice and cyanosis, dropsy,-- + +["The degrees of DILUTION must not be confounded with those of +POTENCY. Their relations may be seen by this table: + +lst dilution,--One hundredth of a drop or grain. + +2d " One ten thousandth. + +3d " One millionth, marked I. + +4th " One hundred millionth. + +5th " One ten thousand millionth. + +6th " One million millionth, or one billionth, marked II. + +7th " One hundred billionth. + +8th " One ten thousand billionth. + +9th " One million billionth, or one trillionth, marked III. + +10th " One hundred trillionth. + +11th " One ten thousand trillionth. + +12th " One million trillionth, or one quadrillionth, marked + IV.,--and so on indefinitely. + + +The large figures denote the degrees of POTENCY.] + + + +gastralgia, epistaxis, haemoptysis,--asthma and suppuration of the +lungs,--megrim, deafness, cataract and amaurosis,--paralysis, loss of +sense, pains of every kind, etc., appear in our pathology as so many +peculiar, distinct, and independent diseases." + +For the last three centuries, if the same authority may be trusted, +under the influence of the more refined personal habits which have +prevailed, and the application of various external remedies which +repel the affection from the skin; Psora has revealed itself in these +numerous forms of internal disease, instead of appearing, as in +former periods, under the aspect of an external malady. + +These are the three cardinal doctrines of Hahnemann, as laid down in +those standard works of Homoeopathy, the "Organon" and the "Treatise +on Chronic Diseases." + +Several other principles may be added, upon all of which he insists +with great force, and which are very generally received by his +disciples. + +1. Very little power is allowed to the curative efforts of nature. +Hahnemann goes so far as to say that no one has ever seen the simple +efforts of nature effect the durable recovery of a patient from a +chronic disease. In general, the Homoeopathist calls every recovery +which happens under his treatment a cure. + +2. Every medicinal substance must be administered in a state of the +most perfect purity, and uncombined with any other. The union of +several remedies in a single prescription destroys its utility, and, +according to the "Organon," frequently adds a new disease. + +3. A large number of substances commonly thought to be inert develop +great medicinal powers when prepared in the manner already described; +and a great proportion of them are ascertained to have specific +antidotes in case their excessive effects require to be neutralized. + +4. Diseases should be recognized, as far as possible, not by any of +the common names imposed upon them, as fever or epilepsy, but as +individual collections of symptoms, each of which differs from every +other collection. + +5. The symptoms of any complaint must be described with the most +minute exactness, and so far as possible in the patient's own words. +To illustrate the kind of circumstances the patient is expected to +record, I will mention one or two from the 313th page of the +"Treatise on Chronic Diseases,"--being the first one at which I +opened accidentally. + +"After dinner, disposition to sleep; the patient winks." + +"After dinner, prostration and feeling of weakness (nine days after +taking the remedy)." + +This remedy was that same oyster-shell which is to be prescribed +"fractions of the sextillionth or decillionth degree. According to +Hahnemann, the action of a single dose of the size mentioned does not +fully display itself in some cases until twenty-four or even thirty +days after it is taken, and in such instances has not exhausted its +good effects until towards the fortieth or fiftieth day,--before +which time it would be absurd and injurious to administer a new +remedy. + +So much for the doctrines of Hahnemann, which have been stated +without comment, or exaggeration of any of their features, very much +as any adherent of his opinions might have stated them, if obliged to +compress them into so narrow a space. + +Does Hahnemann himself represent Homoeopathy as it now exists? He +certainly ought to be its best representative, after having created +it, and devoted his life to it for half a century. He is spoken of +as the great physician of the time, in most, if not all Homoeopathic +works. If he is not authority on the subject of his own doctrines, +who is? So far as I am aware, not one tangible discovery in the +so-called science has ever been ascribed to any other observer; at +least, no general principle or law, of consequence enough to claim +any prominence in Homoeopathic works, has ever been pretended to have +originated with any of his illustrious disciples. He is one of the +only two Homoeopathic writers with whom, as I shall mention, the +Paris publisher will have anything to do upon his own account. The +other is Jahr, whose Manual is little more than a catalogue of +symptoms and remedies. If any persons choose to reject Hahnemann as +not in the main representing Homoeopathy, if they strike at his +authority, if they wink out of sight his deliberate and formally +announced results, it is an act of suicidal rashness; for upon his +sagacity and powers of observation, and experience, as embodied in +his works, and especially in his Materia Medica, repose the +foundations of Homoeopathy as a practical system. + +So far as I can learn from the conflicting statements made upon the +subject, the following is the present condition of belief. + +1. All of any note agree that the law Similia similibus is the only +fundamental principle in medicine. Of course if any man does not +agree to this the name Homoeopathist can no longer be applied to him +with propriety. + +2. The belief in and employment of the infinitesimal doses is +general, and in some places universal, among the advocates of +Homoeopathy; but a distinct movement has been made in Germany to get +rid of any restriction to the use of these doses, and to employ +medicines with the same license as other practitioners. + +3. The doctrine of the origin of most chronic diseases in Psora, +notwithstanding Hahnemann says it cost him twelve years of study and +research to establish the fact and its practical consequences, has +met with great neglect and even opposition from very many of his own +disciples. + +It is true, notwithstanding, that, throughout most of their writings +which I have seen, there runs a prevailing tone of great deference to +Hahnemann's opinions, a constant reference to his authority, a +general agreement with the minor points of his belief, and a pretence +of harmonious union in a common faith. [Those who will take the +trouble to look over Hull's Translation of Jahr's Manual may observe +how little comparative space is given to remedies resting upon any +other authority than that of Hahnemann.] + +Many persons, and most physicians and scientific men, would be +satisfied with the statement of these doctrines, and examine them no +further. They would consider it vastly more probable that any +observer in so fallacious and difficult a field of inquiry as +medicine had been led into error, or walked into it of his own +accord, than that such numerous and extraordinary facts had really +just come to light. They would feel a right to exercise the same +obduracy towards them as the French Institute is in the habit of +displaying when memoirs or models are offered to it relating to the +squaring of the circle or perpetual motion; which it is the rule to +pass over without notice. They would feel as astronomers and natural +philosophers must have felt when, some half a dozen years ago, an +unknown man came forward, and asked for an opportunity to demonstrate +to Arago and his colleagues that the moon and planets were at a +distance of a little more than a hundred miles from the earth. And +so they would not even look into Homoeopathy, though all its +advocates should exclaim in the words of Mr. Benjamin Douglass +Perkins, vender of the Metallic Tractors, that "On all discoveries +there are persons who, without descending to any inquiry into the +truth, pretend to know, as it were by intuition, that newly asserted +facts are founded in the grossest errors." And they would lay their +heads upon their pillows with a perfectly clear conscience, although +they were assured that they were behaving in the same way that people +of old did towards Harvey, Galileo, and Copernicus, the identical +great names which were invoked by Mr. Benjamin Douglass Perkins. + +But experience has shown that the character of these assertions is +not sufficient to deter many, from examining their claims to belief. +I therefore lean but very slightly on the extravagance and extreme +apparent singularity of their pretensions. I might have omitted +them, but on the whole it seemed more just to the claims of my +argument to suggest the vast complication of improbabilities involved +in the statements enumerated. Every one must of course judge for +himself as to the weight of these objections, which are by no means +brought forward as a proof of the extravagance of Homoeopathy, but +simply as entitled to a brief consideration before the facts of the +case are submitted to our scrutiny. + +The three great asserted discoveries of Hahnemann are entirely +unconnected with and independent of each other. Were there any +natural relation between them it would seem probable enough that the +discovery of the first would have led to that of the others. But +assuming it to be a fact that diseases are cured by remedies capable +of producing symptoms like their own, no manifest relation exists +between this fact and the next assertion, namely, the power of the +infinitesimal doses. And allowing both these to be true, neither has +the remotest affinity to the third new doctrine, that which declares +seven eighths of all chronic diseases to be owing to Psora. + +This want of any obvious relation between Hahnemann's three cardinal +doctrines appears to be self-evident upon inspection. But if, as is +often true with his disciples, they prefer the authority of one of +their own number, I will refer them to Dr. Trinks's paper on the +present state of Homoeopathy in Europe, with which, of course, they +are familiar, as his name is mentioned as one of the most prominent +champions of their faith, in their American official organ. It would +be a fact without a parallel in the history, not merely of medicine, +but of science, that three such unconnected and astonishing +discoveries, each of them a complete revolution of all that ages of +the most varied experience had been taught to believe, should spring +full formed from the brain of a single individual. + +Let us look a moment at the first of his doctrines. Improbable +though it may seem to some, there is no essential absurdity involved +in the proposition that diseases yield to remedies capable of +producing like symptoms. There are, on the other hand, some +analogies which lend a degree of plausibility to the statement. +There are well-ascertained facts, known from the earliest periods of +medicine, showing that, under certain circumstances, the very +medicine which, from its known effects, one would expect to aggravate +the disease, may contribute to its relief. I may be permitted to +allude, in the most general way, to the case in which the spontaneous +efforts of an overtasked stomach are quieted by the agency of a drug +which that organ refuses to entertain upon any terms. But that every +cure ever performed by medicine should have been founded upon this +principle, although without the knowledge of a physician; that the +Homoeopathic axiom is, as Hahnemann asserts, "the sole law of nature +in therapeutics," a law of which nothing more than a transient +glimpse ever presented itself to the innumerable host of medical +observers, is a dogma of such sweeping extent, and pregnant novelty, +that it demands a corresponding breadth and depth of unquestionable +facts to cover its vast pretensions. + +So much ridicule has been thrown upon the pretended powers of the +minute doses that I shall only touch upon this point for the purpose +of conveying, by illustrations, some shadow of ideas far transcending +the powers of the imagination to realize. It must be remembered that +these comparisons are not matters susceptible of dispute, being +founded on simple arithmetical computations, level to the capacity of +any intelligent schoolboy. A person who once wrote a very small +pamphlet made some show of objecting to calculations of thus kind, on +the ground that the highest dilutions could easily be made with a few +ounces of alcohol. But he should have remembered that at every +successive dilution he lays aside or throws away ninety-nine +hundredths of the fluid on which he is operating, and that, although +he begins with a drop, he only prepares a millionth, billionth, +trillionth, and similar fractions of it, all of which, added +together, would constitute but a vastly minute portion of the drop +with which he began. But now let us suppose we take one single drop +of the Tincture of Camomile, and that the whole of this were to be +carried through the common series of dilutions. + +A calculation nearly like the following was made by Dr. Panvini, and +may be readily followed in its essential particulars by any one who +chooses. + +For the first dilution it would take 100 drops of alcohol. + +For the second dilution it would take 10;000 drops, or about a pint. + +For the third dilution it would take 100 pints. + +For the fourth dilution it would take 10,000 pints, or more than +1,000 gallons, and so on to the ninth dilution, which would take ten +billion gallons, which he computed would fill the basin of Lake +Agnano, a body of water two miles in circumference. The twelfth +dilution would of course fill a million such lakes. By the time the +seventeenth degree of dilution should be reached, the alcohol +required would equal in quantity the waters of ten thousand Adriatic +seas. Trifling errors must be expected, but they are as likely to be +on one side as the other, and any little matter like Lake Superior or +the Caspian would be but a drop in the bucket. + +Swallowers of globules, one of your little pellets, moistened in the +mingled waves of one million lakes of alcohol, each two miles in +circumference, with which had been blended that one drop of Tincture +of Camomile, would be of precisely the strength recommended for that +medicine in your favorite Jahr's Manual, against the most sudden, +frightful, and fatal diseases!" [In the French edition of 1834, the +proper doses of the medicines are mentioned, and Camomile is marked +IV. Why are the doses omitted in Hull's Translation, except in three +instances out of the whole two hundred remedies, notwithstanding the +promise in the preface that "some remarks upon the doses used may be +found at the head of each medicine"? Possibly because it makes no +difference whether they are employed in one Homoeopathic dose or +another; but then it is very singular that such precise directions +were formerly given in the same work, and that Hahnemann's +"experience" should have led him to draw the nice distinctions we +have seen in a former part of this Lecture (p. 44).] + +And proceeding on the common data, I have just made a calculation +which shows that this single drop of Tincture of Camomile, given in +the quantity ordered by Jahr's Manual, would have supplied every +individual of the whole human family, past and present, with more +than five billion doses each, the action of each dose lasting about +four days. + +Yet this is given only at the quadrillionth, or fourth degree of +potency, and various substances are frequently administered at the +decillionth or tenth degree, and occasionally at still higher +attenuations with professed medicinal results. Is there not in this +as great an exception to all the hitherto received laws of nature as +in the miracle of the loaves and fishes? Ask this question of a +Homoeopathist, and he will answer by referring to the effects +produced by a very minute portion of vaccine matter, or the +extraordinary diffusion of odors. But the vaccine matter is one of +those substances called morbid poisons, of which it is a peculiar +character to multiply themselves, when introduced into the system, as +a seed does in the soil. Therefore the hundredth part of a grain of +the vaccine matter, if no more than this is employed, soon increases +in quantity, until, in the course of about a week, it is a grain or +more, and can be removed in considerable drops. And what is a very +curious illustration of Homoeopathy, it does not produce its most. +characteristic effects until it is already in sufficient quantity not +merely to be visible, but to be collected for further use. The +thoughtlessness which can allow an inference to be extended from a +product of disease possessing this susceptibility of multiplication +when conveyed into the living body, to substances of inorganic +origin, such as silex or sulphur, would be capable of arguing that a +pebble may produce a mountain, because an acorn can become a forest. + +As to the analogy to be found between the alleged action of the +infinitely attenuated doses, and the effects of some odorous +substances which possess the extraordinary power of diffusing their +imponderable emanations through a very wide space, however it may be +abused in argument, and rapidly as it evaporates on examination, it +is not like that just mentioned, wholly without meaning. The fact of +the vast diffusion of some odors, as that of musk or the rose, for +instance, has long been cited as the most remarkable illustration of +the divisibility of matter, and the nicety of the senses. And if +this were compared with the effects of a very minute dose of morphia +on the whole system, or the sudden and fatal impression of a single +drop of prussic acid, or, with what comes still nearer, the poisonous +influence of an atmosphere impregnated with invisible malaria, we +should find in each of these examples an evidence of the degree to +which nature, in some few instances, concentrates powerful qualities +in minute or subtile forms of matter. But if a man comes to me with +a pestle and mortar in his hand, and tells me that he will take a +little speck of some substance which nobody ever thought to have any +smell at all, as, for instance, a grain of chalk or of charcoal, and +that he will, after an hour or two of rubbing and scraping, develop +in a portion of it an odor which, if the whole grain were used, would +be capable of pervading an apartment, a house, a village, a province, +an empire, nay, the entire atmosphere of this broad planet upon which +we tread; and that from each of fifty or sixty substances he can in +this way develop a distinct and hitherto unknown odor: and if he +tries to show that all this is rendered quite reasonable by the +analogy of musk and roses, I shall certainly be justified in +considering him incapable of reasoning, and beyond the reach of my +argument. What if, instead of this, he professes to develop new and +wonderful medicinal powers from the same speck of chalk or charcoal, +in such proportions as would impregnate every pond, lake, river, sea, +and ocean of our globe, and appeals to the same analogy in favor of +the probability of his assertion. + +All this may be true, notwithstanding these considerations. But so +extraordinary would be the fact, that a single atom of substances +which a child might swallow without harm by the teaspoonful could, by +an easy mechanical process, be made to develop such inconceivable +powers, that nothing but the strictest agreement of the most cautious +experimenters, secured by every guaranty that they were honest and +faithful, appealing to repeated experiments in public, with every +precaution to guard against error, and with the most plain and +peremptory results, should induce us to lend any credence to such +pretensions. + +The third doctrine, that Psora, the other name of which you remember, +is the cause of the great majority of chronic diseases, is a +startling one, to say the least. That an affection always recognized +as a very unpleasant personal companion, but generally regarded as a +mere temporary incommodity, readily yielding to treatment in those +unfortunate enough to suffer from it, and hardly known among the +better classes of society, should be all at once found out by a +German physician to be the great scourge of mankind, the cause of +their severest bodily and mental calamities, cancer and consumption, +idiocy and madness, must excite our unqualified surprise. And when +the originator of this singular truth ascribes, as in the page now +open before me, the declining health of a disgraced courtier, the +chronic malady of a bereaved mother, even the melancholy of the love- +sick and slighted maiden, to nothing more nor less than the +insignificant, unseemly, and almost unmentionable ITCH, does it not +seem as if the very soil upon which we stand were dissolving into +chaos, over the earthquake-heaving of discovery? + +And when one man claims to have established these three independent +truths, which are about as remote from each other as the discovery of +the law of gravitation, the invention of printing, and that of the +mariner's compass, unless the facts in their favor are overwhelming +and unanimous, the question naturally arises, Is not this man +deceiving himself, or trying to deceive others? + +I proceed to examine the proofs of the leading ideas of Hahnemann and +his school. + + +In order to show the axiom, similia similibus curantur (or like is +cured by like), to be the basis of the healing art,--"the sole law of +nature in therapeutics,"--it is necessary, + +1. That the symptoms produced by drugs in healthy persons should be +faithfully studied and recorded. + +2. That drugs should be shown to be always capable of curing those +diseases most like their own symptoms. + +3. That remedies should be shown not to cure diseases when they do +not produce symptoms resembling those presented in these diseases. + + +1. The effects of drugs upon healthy persons have been studied by +Hahnemann and his associates. Their results were made known in his +Materia Medica, a work in three large volumes in the French +translation, published about eight years ago. The mode of +experimentation appears to have been, to take the substance on trial, +either in common or minute doses, and then to set down every little +sensation, every little movement of mind or body, which occurred +within many succeeding hours or days, as being produced solely by the +substance employed. When I have enumerated some of the symptoms +attributed to the power of the drugs taken, you will be able to judge +how much value is to be ascribed to the assertions of such observers. + +The following list was taken literally from the Materia Medica of +Hahnemann, by my friend M. Vernois, for whose accuracy I am willing +to be responsible. He has given seven pages of these symptoms, not +selected, but taken at hazard from the French translation of the +work. I shall be very brief in my citations. + +"After stooping some time, sense of painful weight about the head +upon resuming the erect posture." + +"An itching, tickling sensation at the outer edge of the palm of the +left hand, which obliges the person to scratch." The medicine was +acetate of lime, and as the action of the globule taken is said to +last twenty-eight days, you may judge how many such symptoms as the +last might be supposed to happen. + +Among the symptoms attributed to muriatic acid are these: a catarrh, +sighing, pimples; "after having written a long time with the back a +little bent over, violent pain in the back and shoulder-blades, as if +from a strain,"--"dreams which are not remembered,--disposition to +mental dejection,--wakefulness before and after midnight." + +I might extend this catalogue almost indefinitely. I have not cited +these specimens with any view to exciting a sense of the ridiculous, +which many others of those mentioned would not fail to do, but to +show that the common accidents of sensation, the little bodily +inconveniences to which all of us are subject, are seriously and +systematically ascribed to whatever medicine may have been exhibited, +even in the minute doses I have mentioned, whole days or weeks +previously. + +To these are added all the symptoms ever said by anybody, whether +deserving confidence or not, as I shall hereafter illustrate, to be +produced by the substance in question. + +The effects of sixty-four medicinal substances, ascertained by one or +both of these methods, are enumerated in the Materia Medica of +Hahnemann, which may be considered as the basis of practical +Homoeopathy. In the Manual of Jahr, which is the common guide, so +far as I know, of those who practise Homoeopathy in these regions, +two hundred remedies are enumerated, many of which, however, have +never been employed in practice. In at least one edition there were +no means of distinguishing those which had been tried upon the sick +from the others. It is true that marks have been added in the +edition employed here, which serve to distinguish them; but what are +we to think of a standard practical author on Materia Medica, who at +one time omits to designate the proper doses of his remedies, and at +another to let us have any means of knowing whether a remedy has ever +been tried or not, while he is recommending its employment in the +most critical and threatening diseases? + +I think that, from what I have shown of the character of Hahnemann's +experiments, it would be a satisfaction to any candid inquirer to +know whether other persons, to whose assertions he could look with +confidence, confirm these pretended facts. Now there are many +individuals, long and well known to the scientific world, who have +tried these experiments upon healthy subjects, and utterly deny that +their effects have at all corresponded to Hahnemann's assertions. + +I will take, for instance, the statements of Andral (and I am not +referring to his well-known public experiments in his hospital as to +the result of his own trials. This distinguished physician is +Professor of Medicine in the School of Paris, and one of the most +widely known and valued authors upon practical and theoretical +subjects the profession can claim in any country. He is a man of +great kindness of character, a most liberal eclectic by nature and +habit, of unquestioned integrity, and is called, in the leading +article of the first number of the "Homoepathic Examiner," "an +eminent and very enlightened allopathist." Assisted by a number of +other persons in good health, he experimented on the effects of +cinchona, aconite, sulphur, arnica, and the other most highly +extolled remedies. His experiments lasted a year, and he stated +publicly to the Academy of Medicine that they never produced the +slightest appearance of the symptoms attributed to them. The results +of a man like this, so extensively known as one of the most +philosophical and candid, as well as brilliant of instructors, and +whose admirable abilities and signal liberality are generally +conceded, ought to be of great weight in deciding the question. + +M. Double, a well-known medical writer and a physician of high +standing in Paris, had occasion so long ago as 1801, before he had +heard of Homoeopathy, to make experiments upon Cinchona, or Peruvian +bark. He and several others took the drug in every kind of dose for +four months, and the fever it is pretended by Hahnemann to excite +never was produced. + +M. Bonnet, President of the Royal Society of Medicine of Bordeaux, +had occasion to observe many soldiers during the Peninsular War, who +made use of Cinchona as a preservative against different diseases, +but he never found it to produce the pretended paroxysms. + +If any objection were made to evidence of this kind, I would refer to +the express experiments on many of the Homoeopathic substances, which +were given to healthy persons with every precaution as to diet and +regimen, by M. Louis Fleury, without being followed by the slightest +of the pretended consequences. And let me mention as a curious fact, +that the same quantity of arsenic given to one animal in the common +form of the unprepared powder, and to another after having been +rubbed up into six hundred globules, offered no particular difference +of activity in the two cases. + +This is a strange contradiction to the doctrine of the development of +what they call dynamic power, by means of friction and subdivision. + +In 1835 a public challenge was offered to the best known Homoeopathic +physician in Paris to select any ten substances asserted to produce +the most striking effects; to prepare them himself; to choose one by +lot without knowing which of them he had taken, and try it upon +himself or any intelligent and devoted Homoeopatbist, and, waiting +his own time, to come forward and tell what substance had been +employed. The challenge was at first accepted, but the acceptance +retracted before the time of trial arrived. + +>From all this I think it fair to conclude that the catalogues of +symptoms attributed in Homoeopathic works to the influence of various +drugs upon healthy persons are not entitled to any confidence. + + +2. It is necessary to show, in the next place, that medicinal +substances are always capable of curing diseases most like their own +symptoms. For facts relating to this question we must look to two +sources; the recorded experience of the medical profession in +general, and the results of trials made according to Homoeopathic +principles, and capable of testing the truth of the doctrine. + +No person, that I am aware of, has ever denied that in some cases +there exists a resemblance between the effects of a remedy and the +symptoms of diseases in which it is beneficial. This has been +recognized, as Hahnemann himself has shown, from the time of +Hippocrates. But according to the records of the medical profession, +as they have been hitherto interpreted, this is true of only a very +small proportion of useful remedies. Nor has it ever been considered +as an established truth that the efficacy of even these few remedies +was in any definite ratio to their power of producing symptoms more +or less like those they cured. + +Such was the state of opinion when Hahnemann came forward with the +proposition that all the cases of successful treatment found in the +works of all preceding medical writers were to be ascribed solely to +the operation of the Homoeopathic principle, which had effected the +cure, although without the physician's knowledge that this was the +real secret. And strange as it may seem, he was enabled to give such +a degree of plausibility to this assertion, that any person not +acquainted somewhat with medical literature, not quite familiar, I +should rather say, with the relative value of medical evidence, +according to the sources whence it is derived, would be almost +frightened into the belief, at seeing the pages upon pages of Latin +names he has summoned as his witnesses. + +It has hitherto been customary, when examining the writings of +authors of preceding ages, upon subjects as to which they were less +enlightened than ourselves, and which they were very liable to +misrepresent, to exercise some little discretion; to discriminate, in +some measure, between writers deserving confidence and those not +entitled to it. But there is not the least appearance of any such +delicacy on the part of Hahnemann. A large majority of the names of +old authors he cites are wholly unknown to science. With some of +them I have been long acquainted, and I know that their accounts of +diseases are no more to be trusted than their contemporary Ambroise +Pare's stories of mermen, and similar absurdities. But if my +judgment is rejected, as being a prejudiced one, I can refer to +Cullen, who mentioned three of Hahnemann's authors in one sentence, +as being "not necessarily bad authorities; but certainly such when +they delivered very improbable events;" and as this was said more +than half a century ago, it could not have had any reference to +Hahnemann. But although not the slightest sign of discrimination is +visible in his quotations,--although for him a handful of chaff from +Schenck is all the same thing as a measure of wheat from Morgagni,-- +there is a formidable display of authorities, and an abundant proof +of ingenious researches to be found in each of the great works of +Hahnemann with which I am familiar."[Some painful surmises might +arise as to the erudition of Hahnemann's English Translator, who +makes two individuals of "Zacutus, Lucitanus," as well as respecting +that of the conductors of an American Homoeopathic periodical, who +suffer the name of the world-renowned Cardanus to be spelt Cardamus +in at least three places, were not this gross ignorance of course +attributable only to the printer.] + +It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has +proved many of Hahnemann's quotations from old authors to be +adulterate and false. What particular instances he has pointed out I +have no means of learning. And it is probably wholly impossible on +this side of the Atlantic, and even in most of the public libraries +of Europe, to find anything more than a small fraction of the +innumerable obscure publications which the neglect of grocers and +trunkmakers has spared to be ransacked by the all-devouring genius of +Homoeopathy. I have endeavored to verify such passages as my own +library afforded me the means of doing. For some I have looked in +vain, for want, as I am willing to believe, of more exact references. +But this I am able to affirm, that, out of the very small number +which I have been able, to trace back to their original authors, I +have found two to be wrongly quoted, one of them being a gross +misrepresentation. + +The first is from the ancient Roman author, Caelius Aurelianus; the +second from the venerable folio of Forestus. Hahnemann uses the +following expressions,--if he is not misrepresented in the English +Translation of the "Organon ": "Asclepiades on one occasion cured an +inflammation of the brain by administering a small quantity of wine." +After correcting the erroneous reference of the Translator, I can +find no such case alluded to in the chapter. But Caelius Aurelianus +mentions two modes of treatment employed by Asclepiades, into both of +which the use of wine entered, as being in the highest degree +irrational and dangerous." [Caelius Aurel. De Morb. Acut. et +Chron. lib. I. cap. xv. not xvi. Amsterdam. Wetstein, 1755.] + +In speaking of the oil of anise-seed, Hahnemann says that Forestus +observed violent colic caused by its administration. But, as the +author tells the story, a young man took, by the counsel of a +surgeon, an acrid and virulent medicine, the name of which is not +given, which brought on a most cruel fit of the gripes and colic. +After this another surgeon was called, who gave him oil of anise-seed +and wine, which increased his suffering." [Observ. et Curat. Med. +lib. XXZ obs. xiii. Frankfort, 1614.] Now if this was the +Homoeopathic remedy, as Hahnemann pretends, it might be a fair +question why the young man was not cured by it. But it is a much +graver question why a man who has shrewdness and learning enough to +go so far after his facts, should think it right to treat them with +such astonishing negligence or such artful unfairness. + +Even if every word he had pretended to take from his old authorities +were to be found in them, even if the authority of every one of these +authors were beyond question, the looseness with which they are used +to prove whatever Hahnemann chooses is beyond the bounds of +credibility. Let me give one instance to illustrate the character of +this man's mind. Hahnemann asserts, in a note annexed to the 110th +paragraph of the "Organon," that the smell of the rose will cause +certain persons to faint. And he says in the text that substances +which produce peculiar effects of this nature on particular +constitutions cure the same symptoms in people in general. Then in +another note to the same paragraph he quotes the following fact from +one of the last sources one would have looked to for medical +information, the Byzantine Historians. + +"It was by these means" (i.e. Homoeopathically) that the Princess +Eudosia with rose-water restored a person who had fainted!" + +Is it possible that a man who is guilty of such pedantic folly as +this,--a man who can see a confirmation of his doctrine in such a +recovery as this,--a recovery which is happening every day, from a +breath of air, a drop or two of water, untying a bonnet-string, +loosening a stay-lace, and which can hardly help happening, whatever +is done,--is it possible that a man, of whose pages, not here and +there one, but hundreds upon hundreds are loaded with such +trivialities, is the Newton, the Columbus, the Harvey of the +nineteenth century! + +The whole process of demonstration he employs is this. An experiment +is instituted with some drug upon one or more healthy persons. +Everything that happens for a number of days or weeks is, as we have +seen, set down as an effect of the medicine. Old volumes are then +ransacked promiscuously, and every morbid sensation or change that +anybody ever said was produced by the drug in question is added to +the list of symptoms. By one or both of these methods, each of the +sixty-four substances enumerated by Hahnemann is shown to produce a +very large number of symptoms, the lowest in his scale being ninety- +seven, and the highest fourteen hundred and ninety-one. And having +made out this list respecting any drug, a catalogue which, as you may +observe in any Homoeopathic manual, contains various symptoms +belonging to every organ of the body, what can be easier than to find +alleged cures in every medical author which can at once be attributed +to the Homoeopathic principle; still more if the grave of +extinguished credulity is called upon to give up its dead bones as +living witnesses; and worst of all, if the monuments of the past are +to be mutilated in favor of "the sole law of Nature in therapeutics"? + +There are a few familiar facts of which great use has been made as an +entering wedge for the Homoeopathic doctrine. They have been +suffered to pass current so long that it is time they should be +nailed to the counter, a little operation which I undertake, with +perfect cheerfulness, to perform for them. + +The first is a supposed illustration of the Homoeopathic law found in +the precept given for the treatment of parts which have been frozen, +by friction with snow or similar means. But we deceive ourselves by +names, if we suppose the frozen part to be treated by cold, and not +by heat. The snow may even be actually warmer than the part to which +it is applied. But even if it were at the same temperature when +applied, it never did and never could do the least good to a frozen +part, except as a mode of regulating the application of what? of +heat. But the heat must be applied gradually, just as food must be +given a little at a time to those perishing with hunger. If the +patient were brought into a warm room, heat would be applied very +rapidly, were not something interposed to prevent this, and allow its +gradual admission. Snow or iced water is exactly what is wanted; it +is not cold to the part; it is very possibly warm, on the contrary, +for these terms are relative, and if it does not melt and let the +heat in, or is not taken away, the part will remain frozen up until +doomsday. Now the treatment of a frozen limb by heat, in large or +small quantities, is not Homoeopathy. + +The next supposed illustration of the Homoeopathic law is the alleged +successful management of burns, by holding them to the fire. This is +a popular mode of treating those burns which are of too little +consequence to require any more efficacious remedy, and would +inevitably get well of themselves, without any trouble being bestowed +upon them. It produces a most acute pain in the part, which is +followed by some loss of sensibility, as happens with the eye after +exposure to strong light, and the ear after being subjected to very +intense sounds. This is all it is capable of doing, and all further +notions of its efficacy must be attributed merely to the vulgar love +of paradox. If this example affords any comfort to the +Homoeopathist, it seems as cruel to deprive him of it as it would be +to convince the mistress of the smoke-jack or the flatiron that the +fire does not literally "draw the fire out," which is her hypothesis. + +But if it were true that frost-bites were cured by cold and burns by +heat, it would be subversive, so far as it went, of the great +principle of Homoeopathy. + +For you will remember that this principle is that Like cures Like, +and not that Same cures Same; that there is resemblance and not +identity between the symptoms of the disease and those produced by +the drug which cures it, and none have been readier to insist upon +this distinction than the Homoeopathists themselves. For if Same +cures Same, then every poison must be its own antidote,--which is +neither a part of their theory nor their so-called experience. They +have been asked often enough, why it was that arsenic could not cure +the mischief which arsenic had caused, and why the infectious cause +of small-pox did not remedy the disease it had produced, and then +the; were ready enough to see the distinction I have pointed out. O +no! it was not the hair of the same dog, but only of one very much +like him! + +A third instance in proof of the Homoeopathic law is sought for in +the acknowledged efficacy of vaccination. And how does the law apply +to this? It is granted by the advocates of Homoeopathy that there is +a resemblance between the effects of the vaccine virus on a person in +health and the symptoms of small-pox. Therefore, according to the +rule, the vaccine virus will cure the small-pox, which, as everybody +knows, is entirely untrue. But it prevents small-pox, say the +Homoeopathists. Yes, and so does small-pox prevent itself from ever +happening again, and we know just as much of the principle involved +in the one case as in the other. For this is only one of a series of +facts which we are wholly unable to explain. Small-pox, measles, +scarlet-fever, hooping-cough, protect those who have them once from +future attacks; but nettle-rash and catarrh and lung fever, each of +which is just as Homoeopathic to itself as any one of the others, +have no such preservative power. We are obliged to accept the fact, +unexplained, and we can do no more for vaccination than for the rest. + + +I come now to the most directly practical point connected with the +subject, namely,-- + +What is the state of the evidence as to the efficacy of the proper +Homoeopathic treatment in the cure of diseases. + +As the treatment adopted by the Homoeopathists has been almost +universally by means of the infinitesimal doses, the question of +their efficacy is thrown open, in common with that of the truth of +their fundamental axiom, as both are tested in practice. + +We must look for facts as to the actual working of Homoeopathy to +three sources. + +1. The statements of the unprofessional public. + +2. The assertions of Homoeopathic practitioners. + +3. The results of trials by competent and honest physicians, not +pledged to the system. + +I think, after what we have seen of medical facts, as they are +represented by incompetent persons, we are disposed to attribute +little value to all statements of wonderful cures, coming from those +who have never been accustomed to watch the caprices of disease, and +have not cooled down their young enthusiasm by the habit of tranquil +observation. Those who know nothing of the natural progress of a +malady, of its ordinary duration, of its various modes of +terminating, of its liability to accidental complications, of the +signs which mark its insignificance or severity, of what is to be +expected of it when left to itself, of how much or how little is to +be anticipated from remedies, those who know nothing or next to +nothing of all these things, and who are in a great state of +excitement from benevolence, sympathy, or zeal for a new medical +discovery, can hardly be expected to be sound judges of facts which +have misled so many sagacious men, who have spent their lives in the +daily study and observation of them. I believe that, after having +drawn the portrait of defunct Perkinism, with its five thousand +printed cures, and its million and a half computed ones, its miracles +blazoned about through America, Denmark, and England; after relating +that forty years ago women carried the Tractors about in their +pockets, and workmen could not make them fast enough for the public +demand; and then showing you, as a curiosity, a single one of these +instruments, an odd one of a pair, which I obtained only by a lucky +accident, so utterly lost is the memory of all their wonderful +achievements; I believe, after all this, I need not waste time in +showing that medical accuracy is not to be looked for in the florid +reports of benevolent associations, the assertions of illustrious +patrons, the lax effusions of daily journals, or the effervescent +gossip of the tea-table. + +Dr. Hering, whose name is somewhat familiar to the champions of +Homoeopathy, has said that "the new healing art is not to be judged +by its success in isolated cases only, but according to its success +in general, its innate truth, and the incontrovertible nature of its +innate principles." + +We have seen something of "the incontrovertible nature of its innate +principles," and it seems probable, on the whole, that its success in +general must be made up of its success in isolated cases. Some +attempts have been made, however, to finish the whole matter by +sweeping statistical documents, which are intended to prove its +triumphant success over the common practice. + +It is well known to those who have had the good fortune to see the +"Homoeopathic Examiner," that this journal led off, in its first +number, with a grand display of everything the newly imported +doctrine had to show for itself. It is well remarked, on the twenty- +third page of this article, that "the comparison of bills of +mortality among an equal number of sick, treated by divers methods, +is a most poor and lame way to get at conclusions touching principles +of the healing art." In confirmation of which, the author proceeds +upon the twenty-fifth page to prove the superiority of the +Homoeopathic treatment of cholera, by precisely these very bills of +mortality. Now, every intelligent physician is aware that the poison +of cholera differed so much in its activity at different times and, +places, that it was next to impossible to form any opinion as to the +results of treatment, unless every precaution was taken to secure the +most perfectly corresponding conditions in the patients treated, and +hardly even then. Of course, then, a Russian Admiral, by the name of +Mordvinov, backed by a number of so-called physicians practising in +Russian villages, is singularly competent to the task of settling the +whole question of the utility of this or that kind of treatment; to +prove that, if not more than eight and a half per cent. of those +attacked with the disease perished, the rest owed their immunity to +Hahnemann. I can remember when more than a hundred patients in a +public institution were attacked with what, I doubt not, many +Homoeopathic physicians (to say nothing of Homoeopathic admirals) +would have called cholera, and not one of them died, though treated +in the common way, and it is my firm belief that, if such a result +had followed the administration of the omnipotent globules, it would +have been in the mouth of every adept in Europe, from Quin of London +to Spohr of Gandersheim. No longer ago than yesterday, in one of the +most widely circulated papers of this city, there was published an +assertion that the mortality in several Homoeopathic Hospitals was +not quite five in a hundred, whereas, in what are called by the +writer Allopathic Hospitals, it is said to be eleven in a hundred. +An honest man should be ashamed of such an argumentum ad ignorantiam. +The mortality of a hospital depends not merely on the treatment of +the patients, but on the class of diseases it is in the habit of +receiving, on the place where it is, on the season, and many other +circumstances. For instance, there are many hospitals in the great +cities of Europe that receive few diseases of a nature to endanger +life, and, on the other hand, there are others where dangerous +diseases are accumulated out of the common proportion. Thus, in the +wards of Louis, at the Hospital of La Pitie, a vast number of +patients in the last stages of consumption were constantly entering, +to swell the mortality of that hospital. It was because he was known +to pay particular attention to the diseases of the chest that +patients laboring under those fatal affections to an incurable extent +were so constantly coming in upon him. It is always a miserable +appeal to the thoughtlessness of the vulgar, to allege the naked fact +of the less comparative mortality in the practice of one hospital or +of one physician than another, as an evidence of the superiority of +their treatment. Other things being equal, it must always be +expected that those institutions and individuals enjoying to the +highest degree the confidence of the community will lose the largest +proportion of their patients; for the simple reason that they will +naturally be looked to by those suffering from the gravest class of +diseases; that many, who know that they are affected with mortal +disease, will choose to die under their care or shelter, while the +subjects of trifling maladies, and merely troublesome symptoms, amuse +themselves to any extent among the fancy practitioners. When, +therefore, Dr. Mublenbein, as stated in the "Homoeopathic Examiner," +and quoted in yesterday's "Daily Advertiser," asserts that the +mortality among his patients is only one per cent. since he has +practised Homoeopathy, whereas it was six per cent. when he employed +the common mode of practice, I am convinced by this, his own +statement, that the citizens of Brunswick, whenever they are +seriously sick, take good care not to send for Dr. Muhlenbein! + +It is evidently impossible that I should attempt, within the compass +of a single lecture, any detailed examination of the very numerous +cases reported in the Homoeopathic Treatises and Journals. Having +been in the habit of receiving the French "Archives of Homoeopathic +Medicine" until the premature decease of that Journal, I have had the +opportunity of becoming acquainted somewhat with the style of these +documents, and experiencing whatever degree of conviction they were +calculated to produce. Although of course I do not wish any value to +be assumed for my opinion, such as it is, I consider that you are +entitled to hear it. So far, then, as I am acquainted with the +general character of the cases reported by the Homoeopathic +physicians, they would for the most part be considered as wholly +undeserving a place in any English, French, or American periodical of +high standing, if, instead of favoring the doctrine they were +intended to support, they were brought forward to prove the efficacy +of any common remedy administered by any common practitioner. There +are occasional exceptions to this remark; but the general truth of it +is rendered probable by the fact that these cases are always, or +almost always, written with the single object of showing the efficacy +of the medicine used, or the skill of the practitioner, and it is +recognized as a general rule that such cases deserve very little +confidence. Yet they may sound well enough, one at a time, to those +who are not fully aware of the fallacies of medical evidence. Let me +state a case in illustration. Nobody doubts that some patients +recover under every form of practice. Probably all are willing to +allow that a large majority, for instance, ninety in a hundred, of +such cases as a physician is called to in daily practice, would +recover, sooner or later, with more or less difficulty, provided +nothing were done to interfere seriously with the efforts of nature. + +Suppose, then, a physician who has a hundred patients prescribes to +each of them pills made of some entirely inert substance, as starch, +for instance. Ninety of them get well, or if he chooses to use such +language, he cures ninety of them. It is evident, according to the +doctrine of chances, that there must be a considerable number of +coincidences between the relief of the patient and the administration +of the remedy. It is altogether probable that there will happen two +or three very striking coincidences out of the whole ninety cases, in +which it would seem evident that the medicine produced the relief, +though it had, as we assumed, nothing to do with it. Now suppose +that the physician publishes these cases, will they not have a +plausible appearance of proving that which, as we granted at the +outset, was entirely false? Suppose that instead of pills of starch +he employs microscopic sugarplums, with the five' million billion +trillionth part of a suspicion of aconite or pulsatilla, and then +publishes his successful cases, through the leaden lips of the press, +or the living ones of his female acquaintances,--does that make the +impression a less erroneous one? But so it is that in Homoeopathic +works and journals and gossip one can never, or next to never, find +anything but successful cases, which might do very well as a proof of +superior skill, did it not prove as much for the swindling +advertisers whose certificates disgrace so many of our newspapers. +How long will it take mankind to learn that while they listen to "the +speaking hundreds and units, who make the world ring "with the +pretended triumphs they have witnessed, the "dumb millions" of +deluded and injured victims are paying the daily forfeit of their +misplaced confidence! + +I am sorry to see, also, that a degree of ignorance as to the natural +course of diseases is often shown in these published cases, which, +although it may not be detected by the unprofessional reader, conveys +an unpleasant impression to those who are acquainted with the +subject. Thus a young woman affected with jaundice is mentioned in +the German "Annals of Clinical Homoeopathy" as having been cured in +twenty-nine days by pulsatilla and nux vomica. Rummel, a well-known +writer of the same school, speaks of curing a case of jaundice in +thirty-four days by Homoeopathic doses of pulsatilla, aconite, and +cinchona. I happened to have a case in my own household, a few weeks +since, which lasted about ten days, and this was longer than I have +repeatedly seen it in hospital practice, so that it was nothing to +boast of. + +Dr. Munneche of Lichtenburg in Saxony is called to a patient with +sprained ankle who had been a fortnight under the common treatment. +The patient gets well by the use of arnica in a little more than a +month longer, and this extraordinary fact is published in the French +"Archives of Homoeopathic Medicine." + +In the same Journal is recorded the case of a patient who with +nothing more, so far as any proof goes, than inluenza, gets down to +her shop upon the sixth day. + +And again, the cool way in which everything favorable in a case is +set down by these people entirely to their treatment, may be seen in +a case of croup reported in the "Homoeopathic Gazette " of Leipsic, +in which leeches, blistering, inhalation of hot vapor, and powerful +internal medicine had been employed, and yet the merit was all +attributed to one drop of some Homoeopathic fluid. + +I need not multiply these quotations, which illustrate the grounds of +an opinion which the time does not allow me to justify more at +length; other such cases are lying open before me; there is no end to +them if more were wanted; for nothing is necessary but to look into +any of the numerous broken-down Journals of Homoeopathy, the volumes +of which may be found on the shelves of those curious in such +matters. + +A number of public trials of Homoeopathy have been made in different +parts of the world. Six of these are mentioned in the Manifesto of +the "Homoeopathic Examiner." Now to suppose that any trial can +absolutely silence people, would be to forget the whole experience of +the past. Dr. Haygarth and Dr. Alderson could not stop the sale of +the five-guinea Tractors, although they proved that they could work +the same miracles with pieces of wood and tobacco-pipe. It takes +time for truth to operate as well as Homoeopathic globules. Many +persons thought the results of these trials were decisive enough of +the nullity of the treatment; those who wish to see the kind of +special pleading and evasion by which it is attempted to cover +results which, stated by the "Homoeopathic Examiner" itself, look +exceedingly like a miserable failure, may consult the opening +flourish of that Journal. I had not the intention to speak of these +public trials at all, having abundant other evidence on the point. +But I think it best, on the whole, to mention two of them in a few +words,--that instituted at Naples and that of Andral. + +There have been few names in the medical profession, for the last +half century, so widely known throughout the world of science as that +of M. Esquirol, whose life was devoted to the treatment of insanity, +and who was without a rival in that department of practical medicine. +It is from an analysis communicated by him to the "Gazette Medicale +de Paris" that I derive my acquaintance with the account of the trial +at Naples by Dr. Panvini, physician to the Hospital della Pace. This +account seems to be entirely deserving of credit. Ten patients were +set apart, and not allowed to take any medicine at all,--much against +the wish of the Homoeopathic physician. All of them got well, and of +course all of them would have been claimed as triumphs if they had +been submitted to the treatment. Six other slight cases (each of +which is specified) got well under the Homoeopathic treatment, none +of its asserted specific effects being manifested. + +All the rest were cases of grave disease; and so far as the trial, +which was interrupted about the fortieth day, extended, the patients +grew worse, or received no benefit. A case is reported on the page +before me of a soldier affected with acute inflammation in the chest, +who took successively aconite, bryonia, nux vomica, and pulsatilla, +and after thirty-eight days of treatment remained without any +important change in his disease. The Homoeopathic physician who +treated these patients was M. de Horatiis, who had the previous year +been announcing his wonderful cures. And M. Esquirol asserted to the +Academy of Medicine in 1835, that this M. de Horatiis, who is one of +the prominent personages in the "Examiner's" Manifesto published in +1840, had subsequently renounced Homoeopathy. I may remark, by the +way, that this same periodical, which is so very easy in explaining +away the results of these trials, makes a mistake of only six years +or a little more as to the time when this at Naples was instituted. + +M. Andral, the "eminent and very enlightened allopathist " of the +"Homoeopathic Examiner," made the following statement in March, 1835, +to the Academy of Medicine: "I have submitted this doctrine to +experiment; I can reckon at this time from one hundred and thirty to +one hundred and forty cases, recorded with perfect fairness, in a +great hospital, under the eye of numerous witnesses; to avoid every +objection--I obtained my remedies of M. Guibourt, who keeps a +Homoeopathic pharmacy, and whose strict exactness is well known; the +regimen has been scrupulously observed, and I obtained from the +sisters attached to the hospital a special regimen, such as Hahnemann +orders. I was told, however, some months since, that I had not been +faithful to all the rules of the doctrine. I therefore took the +trouble to begin again; I have studied the practice of the Parisian +Homoeopathists, as I had studied their books, and I became convinced +that they treated their patients as I had treated mine, and I affirm +that I have been as rigorously exact in the treatment as any other +person." + +And he expressly asserts the entire nullity of the influence of all +the Homoeopathic remedies tried by him in modifying, so far as he +could observe, the progress or termination of diseases. It deserves +notice that he experimented with the most boasted substances,-- +cinchona, aconite, mercury, bryonia, belladonna. Aconite, for +instance, he says he administered in more than forty cases of that +collection of feverish symptoms in which it exerts so much power, +according to Hahnemann, and in not one of them did it have the +slightest influence, the pulse and heat remaining as before. + +These statements look pretty honest, and would seem hard to be +explained away, but it is calmly said that he "did not know enough of +the method to select the remedies with any tolerable precision." +["Homoeopathic Examiner, vol. i. p. 22. +"Nothing is left to the caprice of the physician. (In a word, +instead of being dependent upon blind chance, that there is an +infallible law, guided by which; the physician MUST select the proper +remedies.') "Ibid., in a notice of Menzel's paper.] Who are they +that practice Homoeopathy, and say this of a man with the Materia +Medica of Hahnemann lying before him? Who are they that send these +same globules, on which he experimented, accompanied by a little +book, into families, whose members are thought competent to employ +them, when they deny any such capacity to a man whose life has been +passed at the bedside of patients, the most prominent teacher in the +first Medical Faculty in the world, the consulting physician of the +King of France, and one of the most renowned practical writers, not +merely of his nation, but of his age? I leave the quibbles by which +such persons would try to creep out from under the crushing weight of +these conclusions to the unfortunates who suppose that a reply is +equivalent to an answer. + +Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris, +invited two Homoeopathic practitioners to experiment in his wards. +One of these was Curie, now of London, whose works are on the +counters of some of our bookstores, and probably in the hands of some +of my audience. This gentleman, whom Dr. Baillie declares to be an +enlightened man, and perfectly sincere in his convictions, brought +his own medicines from the pharmacy which furnished Hahnemann +himself, and employed them for four or five months upon patients in +his ward, and with results equally unsatisfactory, as appears from +Dr. Baillie's statement at a meeting of the Academy of Medicine. And +a similar experiment was permitted by the Clinical Professor of the +Hotel Dieu of Lyons, with the same complete failure. + +But these are old and prejudiced practitioners. Very well, then take +the statement of Dr. Fleury, a most intelligent young physician, who +treated homoeopathically more than fifty patients, suffering from +diseases which it was not dangerous to treat in this way, taking +every kind of precaution as to regimen, removal of disturbing +influences, and the state of the atmosphere, insisted upon by the +most vigorous partisans of the doctrine, and found not the slightest +effect produced by the medicines. And more than this, read nine of +these cases, which he has published, as I have just done, and observe +the absolute nullity of aconite, belladonna, and bryonia, against the +symptoms over which they are pretended to exert such palpable, such +obvious, such astonishing influences. In the view of these +statements, it is impossible not to realize the entire futility of +attempting to silence this asserted science by the flattest and most +peremptory results of experiment. Were all the hospital physicians +of Europe and America to devote themselves, for the requisite period, +to this sole pursuit, and were their results to be unanimous as to +the total worthlessness of the whole system in practice, this +slippery delusion would slide through their fingers without the +slightest discomposure, when, as they supposed, they had crushed +every joint in its tortuous and trailing body. + + +3. I have said, that to show the truth of the Homoeopathic doctrine, +as announced by Hahnemann, it would be necessary to show, in the +third place, that remedies never cure diseases when they are not +capable of producing similar symptoms! The burden of this somewhat +comprehensive demonstration lying entirely upon the advocates of this +doctrine, it may be left to their mature reflections. + + +It entered into my original plan to treat of the doctrine relating to +Psora, or itch,--an almost insane conception, which I am glad to get +rid of, for this is a subject one does not care to handle without +gloves. I am saved this trouble, however, by finding that many of +the disciples of Hahnemann, those disciples the very gospel of whose +faith stands upon his word, make very light of his authority on this +point, although he himself says, "It has cost me twelve years of +study and research to trace out the source of this incredible number +of chronic affections, to discover this great truth, which remained +concealed from all my predecessors and contemporaries, to establish +the basis of its demonstration, and find out, at the same time, the +curative medicines that were fit to combat this hydra in all its +different forms." + +But, in the face of all this, the following remarks are made by +Wolff, of Dresden, whose essays, according to the editor of the +"Homoeopathic Examiner," "represent the opinions of a large majority +of Homoeopathists in Europe." + +"It cannot be unknown to any one at all familiar with Homoeopathic +literature, that Hahnemann's idea of tracing the large majority of +chronic diseases to actual itch has met with the greatest opposition +from Homoeopathic physicians themselves." And again, "If the Psoric +theory has led to no proper schism, the reason is to be found in the +fact that it is almost without any influence in practice." + +We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Duke +of Baden," and a "distinguished" Homoeopathist, actually asked +Hahnemann for the proof that chronic diseases, such as dropsy, for +instance, never arise from any other cause than itch; and that, +according to common report, the venerable sage was highly incensed +(fort courrouce) with Dr. Hartmann, of Leipsic, another +"distinguished" Homoeopathist, for maintaining that they certainly +did arise from other causes. + +And Dr. Fielitz, in the "Homoeopathic Gazette" of Leipsic, after +saying, in a good-natured way, that Psora is the Devil in medicine, +and that physicians are divided on this point into diabolists and +exorcists, declares that, according to a remark of Hahnemann, the +whole civilized world is affected with Psora. I must therefore +disappoint any advocate of Hahnemann who may honor me with his +presence, by not attacking a doctrine on which some of the disciples +of his creed would be very happy to have its adversaries waste their +time and strength. I will not meddle with this excrescence, which, +though often used in time of peace, would be dropped, like the limb +of a shell-fish, the moment it was assailed; time is too precious, +and the harvest of living extravagances nods too heavily to my +sickle, that I should blunt it upon straw and stubble. + +I will close the subject with a brief examination of some of the +statements made in Homoeopathic works, and more particularly in the +brilliant Manifesto of the "Examiner," before referred to. And +first, it is there stated under the head of "Homoeopathic +Literature," that "SEVEN HUNDRED volumes have been issued from the +press developing the peculiarities of the system, and many of them +possessed of a scientific character that savans know well how to +respect." If my assertion were proper evidence in the case, I should +declare, that, having seen a good many of these publications, from +the year 1834, when I bought the work of the Rev. Thomas Everest," +[Dr. Curie speaks of this silly pamphlet as having been published in +1835.] to within a few weeks, when I received my last importation of +Homaeopathic literature, I have found that all, with a very few +exceptions, were stitched pamphlets varying from twenty or thirty +pages to somewhat less than a hundred, and generally resembling each +other as much as so many spelling-books. + +But not being evidence in the case, I will give you the testimony of +Dr. Trinks, of Dresden, who flourishes on the fifteenth page of the +same Manifesto as one of the most distinguished among the +Homoeopathists of Europe. I translate the sentence literally from +the "Archives de la Medecine Homoeopathique." + +"The literature of Homoeopathy, if that honorable name must be +applied to all kinds of book-making, has been degraded to the +condition of the humblest servitude. Productions without talent, +without spirit, without discrimination, flat and pitiful eulogies, +exaggerations surpassing the limits of the most robust faith, +invectives against such as dared to doubt the dogmas which had been +proclaimed, or catalogues of remedies; of such materials is it +composed! From distance to distance only, have appeared some memoirs +useful to science or practice, which appear as so many green oases in +the midst of this literary desert." + +It is a very natural as well as a curious question to ask, What has +been the success of Homoeopathy in the different countries of Europe, +and what is its present condition? + +The greatest reliance of the advocates of Homoeopathy is of course on +Germany. We know very little of its medical schools, its medical +doctrines, or its medical men, compared with those of England and +France. And, therefore, when an intelligent traveller gives a direct +account from personal inspection of the miserable condition of the +Homoeopathic hospital at Leipsic, the first established in Europe, +and the first on the list of the ever-memorable Manifesto, it is easy +enough answer or elude the fact by citing various hard names of +"distinguished " practitioners, which sound just as well to the +uninformed public as if they were Meckel, or Tiedemann, or +Langenbeck. Dr. Leo-Wolf, who, to be sure, is opposed to +Homoeopathy, but who is a scholar, and ought to know something of his +own countrymen, assures us that "Dr. Kopp is the only German +Homoeopathist, if we can call him so, who has been distinguished as +an author and practitioner before he examined this method." And Dr. +Lee, the same gentleman in whose travels the paragraph relating to +the Leipsic Hospital is to be found, says the same thing. And I will +cheerfully expose myself to any impertinent remark which it might +suggest, to assure my audience that I never heard or saw one +authentic Homoeopathic name of any country in Europe, which I had +ever heard mentioned before as connected with medical science by a +single word or deed sufficient to make it in any degree familiar to +my ears, unless Arnold of Heidelberg is the anatomist who discovered +a little nervous centre, called the otic ganglion. But you need ask +no better proof of who and what the German adherents of this doctrine +must be, than the testimony of a German Homoeopathist as to the +wretched character of the works they manufacture to enforce its +claims. + +As for the act of this or that government tolerating or encouraging +Homoeopathy, every person of common intelligence knows that it is a +mere form granted or denied according to the general principles of +policy adopted in different states, or the degree of influence which +some few persons who have adopted it may happen to have at court. +What may be the value of certain pompous titles with which many of +the advocates of Homoeopathy are honored, it might be disrespectful +to question. But in the mean time the judicious inquirer may ponder +over an extract which I translate from a paper relating to a +personage well known to the community as Williams the Oculist, with +whom I had the honor of crossing the Atlantic some years since, and +who himself handed me two copies of the paper in question. + +"To say that he was oculist of Louis XVIII. and of Charles X., and +that he now enjoys the same title with respect to His Majesty, Louis +Philippe, and the King of the Belgians, is unquestionably to say a +great deal; and yet it is one of the least of his titles to public +confidence. His reputation rests upon a basis more substantial even +than the numerous diplomas with which he is provided, than the +membership of the different medical societies which have chosen him +as their associate," etc., etc. + +And as to one more point, it is time that the public should fully +understand that the common method of supporting barefaced imposture +at the present day, both in Europe and in this country, consists in +trumping up "Dispensaries," " Colleges of Health," and other +advertising charitable clap-traps, which use the poor as decoy-ducks +for the rich, and the proprietors of which have a strong predilection +for the title of "Professor." These names, therefore, have come to +be of little or no value as evidence of the good character, still +less of the high pretensions of those who invoke their authority. +Nor does it follow, even when a chair is founded in connection with a +well-known institution, that it has either a salary or an occupant; +so that it may be, and probably is, a mere harmless piece of +toleration on the part of the government if a Professorship of +Homoeopathy is really in existence at Jena or Heidelberg. And +finally, in order to correct the error of any who might suppose that +the whole Medical Profession of Germany has long since fallen into +the delusions of Hahnemann, I will quote two lines which a celebrated +anatomist and surgeon (whose name will occur again in this lecture in +connection with a very pleasing letter) addressed to the French +Academy of Medicine in 1835. "I happened to be in Germany some +months since, at a meeting of nearly six hundred physicians; one of +them wished to bring up the question of Homoeopathy; they would not +even listen to him." This may have been very impolite and bigoted, +but that is not precisely the point in reference to which I mention +the circumstance. + +But if we cannot easily get at Germany, we can very easily obtain +exact information from France and England. I took the trouble to +write some months ago to two friends in Paris, in whom I could place +confidence, for information upon the subject. One of them answered +briefly to the effect that nothing was said about it. When the late +Curator of the Lowell Institute, at his request, asked about the +works upon the subject, he was told that they had remained a long +time on the shelves quite unsalable, and never spoken of. + +The other gentleman, ["Dr. Henry T. Bigelow, now Professor of +Surgery in Harvard University.] whose name is well known to my +audience, and who needs no commendation of mine, had the kindness to +procure for me many publications upon the subject, and some +information which sets the whole matter at rest, so far as Paris is +concerned. He went directly to the Baillieres, the principal and +almost the only publishers of all the Homoeopathic books and journals +in that city. The following facts were taken by him from the +account-books of this publishing firm. Four Homoeopathic Journals +have been published in Paris; three of them by the Baillieres. + +The reception they met with may be judged of by showing the number of +subscribers to each on the books of the publishing firm. + +A Review published by some other house, which lasted one year, and +had about fifty subscribers, appeared in 1834, 1835. + +There were only four Journals of Homoeopathy ever published in Paris. +The Baillieres informed my correspondent that the sale of +Homoeopathic books was much less than formerly, and that consequently +they should undertake to publish no new books upon the subject, +except those of Jahr or Hahnemann. "This man," says my +correspondent,--referring to one of the brothers,--"the publisher and +headquarters of Homoeopathy in Paris, informs me that it is going +down in England and Germany as well as in Paris." For all the facts +he had stated he pledged himself as responsible. + +Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and +since then has been going down. + +Louis told my correspondent that no person of distinction in Paris +had embraced Homoeopathy, and that it was declining. If you ask who +Louis is, I refer you to the well-known Homoeopathist, Peschier of +Geneva, who says, addressing him, "I respect no one more than +yourself; the feeling which guides your researches, your labors, and +your pen, is so honorable and rare, that I could not but bow down +before it; and I own, if there were any allopathist who inspired me +with higher veneration, it would be him and not yourself whom I +should address." + +Among the names of "Distinguished Homoeopathists," however, displayed +in imposing columns, in the index of the "Homoeopathic Examiner," are +those of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the +world of science, and the last of them identified with some of the +most valuable contributions which anatomical knowledge has received +since the commencement of the present century. One Dr. Chrysaora, +who stands sponsor for many facts in that Journal, makes the +following statement among the rest: "Professors, who are esteemed +among the most distinguished of the Faculty (Faculty de Medicine), +both as to knowledge and reputation, have openly confessed the power +of Homoeopathia in forms of disease where the ordinary method of +practice proved totally insufficient. It affords me the highest +pleasure to select from among these gentlemen, Marjolin, Amussat, and +Breschet." + +Here is a literal translation of an original letter, now in my +possession, from one of these Homoeopathists to my correspondent:-- + +"DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER: + +"You have had the kindness to inform me in your letter that a new +American Journal, the 'New World,' has made use of my name in +support of the pretended Homoeopathic doctrines, and that I am +represented as one of the warmest partisans of Homoeopathy in France. + +"I am vastly surprised at the reputation manufactured for me upon the +new continent; but I am obliged, in deference to truth, to reject it +with my whole energy. I spurn far from me everything which relates +to that charlatanism called Homoeopathy, for these pretended +doctrines cannot endure the scrutiny of wise and enlightened persons, +who are guided by honorable sentiments in the practice of the noblest +of arts. + +"PARIS, 3d November, 1841:" + +I am, etc., etc., + +"G. BRESCHET, + +"Professor in the Faculty of Medicine, Member of the Institute, +Surgeon of Hotel Dieu, and Consulting Surgeon to the King, etc. + +I first saw M. Breschet's name mentioned in that Journal + +Concerning Amussat, my correspondent writes, that he was informed by +Madame Hahnemann, who converses in French more readily than her +husband, and therefore often speaks for him, that "he was not a +physician, neither Homoeopathist nor Allopathist, but that he was the +surgeon of their own establishment; that is, performed as a surgeon +all the operations they had occasion for in their practice." + +I regret not having made any inquiries as to Marjolin, who, I doubt +not, would strike his ponderous snuff-box until it resounded like the +Grecian horse, at hearing such a doctrine associated with his +respectable name. I was not aware, when writing to Paris, that this +worthy Professor, whose lectures I long attended, was included in +these audacious claims; but after the specimens I have given of the +accuracy of the foreign correspondence of the "Homoeopathic +Examiner," any further information I might obtain would seem so +superfluous as hardly to be worth the postage. + +Homoeopathy may be said, then, to be in a sufficiently miserable +condition in Paris. Yet there lives, and there has lived for years, +the illustrious Samuel Hahnemann, who himself assured my +correspondent that no place offered the advantages of Paris in its +investigation, by reason of the attention there paid to it. + +In England, it appears by the statement of Dr. Curie in October, +1839, about eight years after its introduction into the country, that +there were eighteen Homoeopathic physicians in the United Kingdom, of +whom only three were to be found out of London, and that many of +these practised Homoeopathy in secret. + +It will be seen, therefore, that, according to the recent statement +of one of its leading English advocates, Homoeopathy had obtained not +quite half as many practical disciples in England as Perkinism could +show for itself in a somewhat less period from the time of its first +promulgation in that country. + +Dr. Curie's letter, dated London, October 30, 1839, says there is +"one in Dublin, Dr. Luther; at Glasgow, Dr. Scott." The +"distinguished" Chrysaora writes from Paris, dating October 20, 1839, +"On the other hand, Homoeopathy is commencing to make an inroad into +England by the way of Ireland. At Dublin, distinguished physicians +have already embraced the new system, and a great part of the +nobility and gentry of that city have emancipated themselves from the +English fashion and professional authority." + +But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize +Homoeopathy; the Queen Dowager Adelaide has been treated by a +Homoeopathic physician. "Jarley is the delight of the nobility and +gentry." "The Royal Family are the patrons of Jarley." + +Let me ask if a Marquis and a Knight are better than two Lords, and +if the Dowager of Royalty is better than Royalty itself, all of which +illustrious dignities were claimed in behalf of Benjamin Douglass +Perkins? + +But if the balance is thought too evenly suspended in this case, +another instance can be given in which the evidence of British +noblemen and their ladies is shown to be as valuable in establishing +the character of a medical man or doctrine, as would be the testimony +of the Marquis of Waterford concerning the present condition and +prospects of missionary enterprise. I have before me an octavo +volume of more than four hundred pages, in which, among much similar +matter, I find highly commendatory letters from the Marchioness of +Ormond, Lady Harriet Kavanagh, the Countess of Buckinghamshire, the +Right Hon. Viscount Ingestre, M. P., and the Most Noble, the Marquis +of Sligo,--all addressed to "John St. John Long, Esq," a wretched +charlatan, twice tried for, and once convicted of, manslaughter at +the Old Bailey. + +This poor creature, too, like all of his tribe, speaks of the medical +profession as a great confederation of bigoted monopolists. He, too, +says that "If an innovator should appear, holding out hope to those +in despair, and curing disorders which the faculty have recorded as +irremediable, he is at once, and without inquiry, denounced as an +empiric and an impostor." He, too, cites the inevitable names of +Galileo and Harvey, and refers to the feelings excited by the great +discovery of Jenner. From the treatment of the great astronomer who +was visited with the punishment of other heretics by the +ecclesiastical authorities of a Catholic country some centuries +since, there is no very direct inference to be drawn to the medical +profession of the present time. His name should be babbled no +longer, after having been placarded for the hundredth time in the +pages of St. John Long. But if we are doomed to see constant +reference to the names of Harvey and Jenner in every worthless +pamphlet containing the prospectus of some new trick upon the public, +let us, once for all, stare the facts in the face, and see how the +discoveries of these great men were actually received by the medical +profession. + +In 1628, Harvey published his first work upon the circulation. His +doctrines were a complete revolution of the prevailing opinions of +all antiquity. They immediately found both champions and opponents; +of which last, one only, Riolanus, seemed to Harvey worthy of an +answer, on account of his "rank, fame, and learning." Controversy in +science, as in religion, was not, in those days, carried on with all +the courtesy which our present habits demand, and it is possible that +some hard words may have been applied to Harvey, as it is very +certain that he used the most contemptuous expressions towards +others. + +Harvey declares in his second letter to Riolanus, "Since the first +discovery of the circulation, hardly a day, or a moment, has passed +without my hearing it both well and ill spoken of; some attack it +with great hostility, others defend it with high encomiums; one party +believe that I have abundantly proved the truth of the doctrine +against all the weight of opposing arguments, by experiments, +observations, and dissections; others think it not yet sufficiently +cleared up, and free from objections." Two really eminent +Professors, Plempius of Louvain, and Walaeus of Leyden, were among +its early advocates. + +The opinions sanctioned by the authority of long ages, and the names +of Hippocrates and Galen, dissolved away, gradually, but certainly, +before the demonstrations of Harvey. Twenty-four years after the +publication of his first work, and six years before his death, his +bust in marble was placed in the Hall of the College of Physicians, +with a suitable inscription recording his discoveries. + +Two years after this he was unanimously invited to accept the +Presidency of that body; and he lived to see his doctrine +established, and all reputable opposition withdrawn. + +There were many circumstances connected with the discovery of Dr. +Jenner which were of a nature to excite repugnance and opposition. +The practice of inoculation for the small-pox had already disarmed +that disease of many of its terrors. The introduction of a +contagious disease from a brute creature into the human system +naturally struck the public mind with a sensation of disgust and +apprehension, and a part of the medical public may have shared these +feelings. I find that Jenner's discovery of vaccination was made +public in June, 1798. In July of the same year the celebrated +surgeon, Mr. Cline, vaccinated a child with virus received from Dr. +Jenner, and in communicating the success of this experiment, he +mentions that Dr. Lister, formerly of the Small-Pox Hospital, and +himself, are convinced of the efficacy of the cow-pox. In November +of the same year, Dr. Pearson published his "Inquiry," containing the +testimony of numerous practitioners in different parts of the +kingdom, to the efficacy of the practice. Dr. HAYGARTH, who was so +conspicuous in exposing the follies of Perkinism, was among the very +earliest to express his opinion in favor of vaccination. In 1801, +Dr. Lettsom mentions the circumstance "as being to the honor of the +medical professors, that they have very generally encouraged this +salutary practice, although it is certainly calculated to lessen +their pecuniary advantages by its tendency to extirpate a fertile +source of professional practice." + +In the same year the Medical Committee of Paris spoke of vaccination +in a public letter, as "the most brilliant and most important +discovery of the eighteenth century." The Directors of a Society for +the Extermination of the Small-Pox, in a Report dated October 1st, +1807, "congratulate the public on the very favorable opinion which +the Royal College of Physicians of London, after a most minute and +laborious investigation made by the command of his Majesty, have a +second time expressed on the subject of vaccination, in their Report +laid before the House of Commons, in the last session of Parliament; +in consequence of which the sum of twenty thousand pounds was voted +to Dr. Jenner, as a remuneration for his discovery, in addition to +ten thousand pounds before granted." (In June, 1802.) + +These and similar accusations, so often brought up against the +Medical Profession, are only one mode in which is manifested a spirit +of opposition not merely to medical science, but to all science, and +to all sound knowledge. It is a spirit which neither understands +itself nor the object at which it is aiming. It gropes among the +loose records of the past, and the floating fables of the moment, to +glean a few truths or falsehoods tending to prove, if they prove +anything, that the persons who have passed their lives in the study +of a branch of knowledge the very essence of which must always +consist in long and accurate observation, are less competent to judge +of new doctrines in their own department than the rest of the +community. It belongs to the clown in society, the destructive in +politics, and the rogue in practice. + +The name of Harvey, whose great discovery was the legitimate result +of his severe training and patient study, should be mentioned only to +check the pretensions of presumptuous ignorance. The example of +Jenner, who gave his inestimable secret, the result of twenty-two +years of experiment and researches, unpurchased, to the public,-- +when, as was said in Parliament, he might have made a hundred +thousand pounds by it as well as any smaller sum,--should be referred +to only to rebuke the selfish venders of secret remedies, among whom +his early history obliges us reluctantly to record Samuel Hahnemann. +Those who speak of the great body of physicians as if they were +united in a league to support the superannuated notions of the past +against the progress of improvement, have read the history of +medicine to little purpose. The prevalent failing of this profession +has been, on the contrary, to lend a too credulous ear to ambitious +and plausible innovators. If at the present time ten years of public +notoriety have passed over any doctrine professing to be of +importance in medical science, and if it has not succeeded in raising +up a powerful body of able, learned, and ingenious advocates for its +claims, the fault must be in the doctrine and not in the medical +profession. + +Homoeopathy has had a still more extended period of trial than this, +and we have seen with what results. It only remains to throw out a +few conjectures as to the particular manner in which it is to break +up and disappear. + +1. The confidence of the few believers in this delusion will never +survive the loss of friends who may die of any acute disease, under a +treatment such as that prescribed by Homoeopathy. It is doubtful how +far cases of this kind will be trusted to its tender mercies, but +wherever it acquires any considerable foothold, such cases must come, +and with them the ruin of those who practise it, should any highly +valued life be thus sacrificed. + +2. After its novelty has worn out, the ardent and capricious +individuals who constitute the most prominent class of its patrons +will return to visible doses, were it only for the sake of a change. + +3. The Semi-Homoeopathic practitioner will gradually withdraw from +the rotten half of his business and try to make the public forget his +connection with it. + +4. The ultra Homoeopathist will either recant and try to rejoin the +medical profession; or he will embrace some newer and if possible +equally extravagant doctrine; or he will stick to his colors and go +down with his sinking doctrine. Very few will pursue the course last +mentioned. + +A single fact may serve to point out in what direction there will +probably be a movement of the dissolving atoms of Homoeopathy. On +the 13th page of the too frequently cited Manifesto of the "Examiner" +I read the following stately paragraph: + +"Bigelius, M. D., physician to the Emperor of Russia, whose elevated +reputation is well known in Europe, has been an acknowledged advocate +of Hahnemann's doctrines for several years. He abandoned Allopathia +for Homoeopathia." The date of this statement is January, 1840. I +find on looking at the booksellers' catalogues that one Bigel, or +Bigelius, to speak more classically, has been at various times +publishing Homoeopathic books for some years. + +Again, on looking into the " Encyclographie des Sciences Medicales " +for April, 1840, I find a work entitled " Manual of HYDROSUDOPATHY, +or the Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel, +Physician of the School of Strasburg, Member of the Medico- +Chirurgical Institute of Naples, of the Academy of St. Petersburg,-- +Assessor of the College of the Empire of Russia, Physician of his +late Imperial Highness the Grand Duke Constantine, Chevalier of the +Legion of Honor, etc." Hydrosudopathy or Hydropathy, as it is +sometimes called, is a new medical doctrine or practice which has +sprung up in Germany since Homoeopathy, which it bids fair to drive +out of the market, if, as Dr. Bigel says, fourteen physicians +afflicted with diseases which defied themselves and their colleagues +came to Graefenberg, in the year 1836 alone, and were cured. Now Dr. +Bigel, "whose elevated reputation is well known in Europe," writes as +follows: "The reader will not fail to see in this defence of the +curative method of Graefenberg a profession of medical faith, and he +will be correct in so doing." And his work closes with the following +sentence, worthy of so distinguished an individual: "We believe, with +religion, that the water of baptism purifies the soul from its +original sin; let us believe also, with experience, that it is for +our corporeal sins the redeemer of the human body." If Bigel, +Physician to the late Grand Duke Constantine, is identical with Bigel +whom the "Examiner" calls Physician to the Emperor of Russia, it +appears that he is now actively engaged in throwing cold water at +once upon his patients and the future prospects of Homoeopathy. + +If, as must be admitted, no one of Hahnemann's doctrines is received +with tolerable unanimity among his disciples, except the central +axiom, Similia similibus curantur; if this axiom itself relies mainly +for its support upon the folly and trickery of Hahnemann, what can we +think of those who announce themselves ready to relinquish all the +accumulated treasures of our art, to trifle with life upon the +strength of these fantastic theories? What shall we think of +professed practitioners of medicine, if, in the words of Jahr, "from +ignorance, for their personal convenience, or through charlatanism, +they treat their patients one day Homoeopathically and the next +Allopathically; " if they parade their pretended new science before +the unguarded portion of the community; if they suffer their names to +be coupled with it wherever it may gain a credulous patient; and deny +all responsibility for its character, refuse all argument for its +doctrines, allege no palliation for the ignorance and deception +interwoven with every thread of its flimsy tissue, when they are +questioned by those competent to judge and entitled to an answer? + +Such is the pretended science of Homoeopathy, to which you are asked +to trust your lives and the lives of those dearest to you. A mingled +mass of perverse ingenuity, of tinsel erudition, of imbecile +credulity, and of artful misrepresentation, too often mingled in +practice, if we may trust the authority of its founder, with +heartless and shameless imposition. Because it is suffered so often +to appeal unanswered to the public, because it has its journals, its +patrons, its apostles, some are weak enough to suppose it can escape +the inevitable doom of utter disgrace and oblivion. Not many years +can pass away before the same curiosity excited by one of Perkins's +Tractors will be awakened at the sight of one of the Infinitesimal +Globules. If it should claim a longer existence, it can only be by +falling into the hands of the sordid wretches who wring their bread +from the cold grasp of disease and death in the hovels of ignorant +poverty. + +As one humble member of a profession which for more than two thousand +years has devoted itself to the pursuit of the best earthly interests +of mankind, always assailed and insulted from without by such as are +ignorant of its infinite perplexities and labors, always striving in +unequal contest with the hundred-armed giant who walks in the +noonday, and sleeps not in the midnight, yet still toiling, not +merely for itself and the present moment, but for the race and the +future, I have lifted my voice against this lifeless delusion, +rolling its shapeless bulk into the path of a noble science it is too +weak to strike, or to injure. + + + + + + +THE CONTAGIOUSNESS OF PUERPERAL FEVER +Printed in 1843; reprinted with additions, 1855. + + +THE POINT AT ISSUE. + + +THE AFFIRMATIVE. + +"The disease known as Puerperal Fever is so far contagious as to be +frequently carried from patient to patient by physicians and nurses." +O. W. Holmes, 1843. + + +THE NEGATIVE. + +"The result of the whole discussion will, I trust, serve, not only to +exalt your views of the value and dignity of our profession, but to +divest your minds of the overpowering dread that you can ever become, +especially to woman, under the extremely interesting circumstances of +gestation and parturition, the minister of evil; that you can ever +convey, in any possible manner, a horrible virus, so destructive in +its effects, and so mysterious in its operations as that attributed +to puerperal fever." --Professor Hodge, +1852. + +"I prefer to attribute them to accident, or Providence, of which I +can form a conception, rather than to a contagion of which I cannot +form any clear idea, at least as to this particular malady."-- +Professor Meigs, 1852. + +" . . . in the propagation of which they have no more to do, than +with the propagation of cholera from Jessore to San Francisco, and +from Mauritius to St. Petersburg."--Professor Meigs, 1854. + + --------------------- + +"I arrived at that certainty in the matter, that I could venture to +foretell what women would be affected with the disease, upon hearing +by what midwife they were to be delivered, or by what nurse they were +to be attended, during their lying-in; and, almost in every instance, +my prediction was verified." --Gordon, 1795. + +"A certain number of deaths is caused every year by the contagion of +puerperal fever, communicated by the nurses and medical attendants." +Farr, in Fifth Annual Report of Registrar-General of England, 1843. + +". . . boards of health, if such exist, or, without them, the +medical institutions of a country, should have the power of coercing, +or of inflicting some kind of punishment on those who recklessly go +from cases of puerperal fevers to parturient or puerperal females, +without using due precaution; and who, having been shown the risk, +criminally encounter it, and convey pestilence and death to the +persons they are employed to aid in the most interesting and +suffering period of female existence." --Copland's Medical +Dictionary, Art. Puerperal States and Diseases, 1852. + +"We conceive it unnecessary to go into detail to prove the contagious +nature of this disease, as there are few, if any, American +practitioners who do not believe in this doctrine." --Dr. Lee, in +Additions to Article last cited. + + ----------------------- + +[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion +arose in a Medical Society of which I was a member, involving the +subject of a certain supposed cause of disease, about which something +was known, a good deal suspected, and not a little feared. The +discussion was suggested by a case, reported at the preceding +meeting, of a physician who made an examination of the body of a +patient who had died with puerperal fever, and who himself died in +less than a week, apparently in consequence of a wound received at +the examination, having attended several women in confinement in the +mean time, all of whom, as it was alleged, were attacked with +puerperal fever. + +Whatever apprehensions and beliefs were entertained, it was plain +that a fuller knowledge of the facts relating to the subject would be +acceptable to all present. I therefore felt that it would be doing a +good service to look into the best records I could find, and inquire +of the most trustworthy practitioners I knew, to learn what +experience had to teach in the matter, and arrived at the results +contained in the following pages. + +The Essay was read before the Boston Society for Medical Improvement, +and, at the request of the Society, printed in the "New England +Quarterly Journal of Medicine and Surgery" for April, 1843. As this +Journal never obtained a large circulation, and ceased to be +published after a year's existence, and as the few copies I had +struck off separately were soon lost sight of among the friends to +whom they were sent, the Essay can hardly be said to have been fully +brought before the Profession. + +The subject of this Paper has the same profound interest for me at +the present moment as it had when I was first collecting the terrible +evidence out of which, as it seems to me, the commonest exercise of +reason could not help shaping the truth it involved. It is not +merely on account of the bearing of the question,--if there is a +question,--on all that is most sacred in human life and happiness, +that the subject cannot lose its interest. It is because it seems +evident that a fair statement of the facts must produce its proper +influence on a very large proportion of well-constituted and +unprejudiced minds. Individuals may, here and there, resist the +practical bearing of the evidence on their own feelings or interests; +some may fail to see its meaning, as some persons may be found who +cannot tell red from green; but I cannot doubt that most readers will +be satisfied and convinced, to loathing, long before they have +finished the dark obituary calendar laid before them. + +I do not know that I shall ever again have so good an opportunity of +being useful as was granted me by the raising of the question which +produced this Essay. For I have abundant evidence that it has made +many practitioners more cautious in their relations with puerperal +females, and I have no doubt it will do so still, if it has a chance +of being read, though it should call out a hundred counterblasts, +proving to the satisfaction of their authors that it proved nothing. +And for my part, I had rather rescue one mother from being poisoned +by her attendant, than claim to have saved forty out of fifty +patients to whom I had carried the disease. Thus, I am willing to +avail myself of any hint coming from without to offer this paper once +more to the press. The occasion has presented itself, as will be +seen, in a convenient if not in a flattering form. + + +I send this Essay again to the MEDICAL PROFESSION, without the change +of a word or syllable. I find, on reviewing it, that it anticipates +and eliminates those secondary questions which cannot be entertained +for a moment until the one great point of fact is peremptorily +settled. In its very statement of the doctrine maintained it avoids +all discussion of the nature of the disease "known as puerperal +fever," and all the somewhat stale philology of the word contagion. +It mentions, fairly enough, the names of sceptics, or unbelievers as +to the reality of personal transmission; of Dewees, of Tonnelle, of +Duges, of Baudelocque, and others; of course, not including those +whose works were then unwritten or unpublished; nor enumerating all +the Continental writers who, in ignorance of the great mass of +evidence accumulated by British practitioners, could hardly be called +well informed on this subject. It meets all the array of negative +cases,--those in which disease did not follow exposure,--by the +striking example of small-pox, which, although one of the most +contagious of diseases, is subject to the most remarkable +irregularities and seeming caprices in its transmission. It makes +full allowance for other causes besides personal transmission, +especially for epidemic influences. It allows for the possibility of +different modes of conveyance of the destructive principle. It +recognizes and supports the belief that a series of cases may +originate from a single primitive source which affects each new +patient in turn; and especially from cases of Erysipelas. It does +not undertake to discuss the theoretical aspect of the subject; that +is a secondary matter of consideration. Where facts are numerous, +and unquestionable, and unequivocal in their significance, theory +must follow them as it best may, keeping time with their step, and +not go before them, marching to the sound of its own drum and +trumpet. Having thus narrowed its area to a limited practical +platform of discussion, a matter of life and death, and not of +phrases or theories, it covers every inch of it with a mass of +evidence which I conceive a Committee of Husbands, who can count +coincidences and draw conclusions as well as a Synod of Accoucheurs, +would justly consider as affording ample reasons for an unceremonious +dismissal of a practitioner (if it is conceivable that such a step +could be waited for), after five or six funerals had marked the path +of his daily visits, while other practitioners were not thus +escorted. To the Profession, therefore, I submit the paper in its +original form, and leave it to take care of itself. + +To the MEDICAL STUDENTS, into whose hands this Essay may fall, some +words of introduction may be appropriate, and perhaps, to a small +number of them, necessary. There are some among them who, from +youth, or want of training, are easily bewildered and confused in any +conflict of opinions into which their studies lead them. They are +liable to lose sight of the main question in collateral issues, and +to be run away with by suggestive speculations. They confound belief +with evidence, often trusting the first because it is expressed with +energy, and slighting the latter because it is calm and +unimpassioned. They are not satisfied with proof; they cannot +believe a point is settled so long as everybody is not silenced. +They have not learned that error is got out of the minds that cherish +it, as the taenia is removed from the body, one joint, or a few +joints at a time, for the most part, rarely the whole evil at once. +They naturally have faith in their instructors, turning to them for +truth, and taking what they may choose to give them; babes in +knowledge, not yet able to tell the breast from the bottle, pumping +away for the milk of truth at all that offers, were it nothing better +than a Professor's shrivelled forefinger. + +In the earliest and embryonic stage of professional development, any +violent impression on the instructor's mind is apt to be followed by +some lasting effect on that of the pupil. No mother's mark is more +permanent than the mental naevi and moles, and excrescences, and +mutilations, that students carry with them out of the lecture-room, +if once the teeming intellect which nourishes theirs has been scared +from its propriety by any misshapen fantasy. Even an impatient or +petulant expression, which to a philosopher would be a mere index of +the low state of amiability of the speaker at the moment of its +utterance, may pass into the young mind as an element of its future +constitution, to injure its temper or corrupt its judgment. It is a +duty, therefore, which we owe to this younger class of students, to +clear any important truth which may have been rendered questionable +in their minds by such language, or any truth-teller against whom +they may have been prejudiced by hasty epithets, from the impressions +such words have left. Until this is done, they are not ready for the +question, where there is a question, for them to decide. Even if we +ourselves are the subjects of the prejudice, there seems to be no +impropriety in showing that this prejudice is local or personal, and +not an acknowledged conviction with the public at large. It may be +necessary to break through our usual habits of reserve to do this, +but this is the fault of the position in which others have placed us. + +Two widely-known and highly-esteemed practitioners, Professors in two +of the largest Medical Schools of the Union, teaching the branch of +art which includes the Diseases of Women, and therefore speaking with +authority; addressing in their lectures and printed publications +large numbers of young men, many of them in the tenderest immaturity +of knowledge, have recently taken ground in a formal way against the +doctrine maintained in this paper: + +On the Non-Contagious Character of Puerperal Fever: An Introductory +Lecture. By Hugh L. Hodge, M. D., Professor of Obstetrics in the +University of Pennsylvania. Delivered Monday, October 11, 1852. +Philadelphia, 1852. + +On the Nature, Signs, and Treatment of Childbed Fevers : in a Series +of Letters addressed to the Students of his Class. By Charles D. +Meigs, M. D., Professor of Midwifery and the Diseases of Women and +Children in Jefferson Medical College, Philadelphia, etc., etc. +Philadelphia, 1854. Letter VI. + + +The first of the two publications, Dr. Hodge's Lecture, while its +theoretical considerations and negative experiences do not seem to me +to require any further notice than such as lay ready for them in my +Essay written long before, is, I am pleased to say, unobjectionable +in tone and language, and may be read without offence. + +This can hardly be said of the chapter of Dr. Meigs's volume which +treats of Contagion in Childbed Fever. There are expressions used in +it which might well put a stop to all scientific discussions, were +they to form the current coin in our exchange of opinions. I leave +the "very young gentlemen," whose careful expositions of the results +of practice in more than six thousand cases are characterized as "the +jejune and fizenless dreamings of sophomore writers," to the +sympathies of those "dear young friends," and "dear young gentlemen," +who will judge how much to value their instructor's counsel to think +for themselves, knowing what they are to expect if they happen not to +think as he does. + +One unpalatable expression I suppose the laws of construction oblige +me to appropriate to myself, as my reward for a certain amount of +labor bestowed on the investigation of a very important question of +evidence, and a statement of my own practical conclusions. I take no +offence, and attempt no retort. No man makes a quarrel with me over +the counterpane that covers a mother, with her new-born infant at her +breast. There is no epithet in the vocabulary of slight and sarcasm +that can reach my personal sensibilities in such a controversy. Only +just so far as a disrespectful phrase may turn the student aside from +the examination of the evidence, by discrediting or dishonoring the +witness, does it call for any word of notice. + +I appeal from the disparaging language by which the Professor in the +Jefferson School of Philadelphia world dispose of my claims to be +listened to. I appeal, not to the vote of the Society for Medical +Improvement, although this was an unusual evidence of interest in the +paper in question, for it was a vote passed among my own townsmen; +nor to the opinion of any American, for none know better than the +Professors in the great Schools of Philadelphia how cheaply the +praise of native contemporary criticism is obtained. I appeal to the +recorded opinions of those whom I do not know, and who do not know +me, nor care for me, except for the truth that I may have uttered; to +Copland, in his "Medical Dictionary," who has spoken of my Essay in +phrases to which the pamphlets of American "scribblers" are seldom +used from European authorities; to Ramsbotham, whose compendious +eulogy is all that self-love could ask; to the "Fifth Annual Report" +of the Registrar-General of England, in which the second-hand +abstract of my Essay figures largely, and not without favorable +comment, in an important appended paper. These testimonies, half +forgotten until this circumstance recalled them, are dragged into the +light, not in a paroxysm of vanity, but to show that there may be +food for thought in the small pamphlet which the Philadelphia Teacher +treats so lightly. They were at least unsought for, and would never +have been proclaimed but for the sake of securing the privilege of a +decent and unprejudiced hearing. + +I will take it for granted that they have so far counterpoised the +depreciating language of my fellow-countryman and fellow-teacher as +to gain me a reader here and there among the youthful class of +students I am now addressing. It is only for their sake that I think +it necessary to analyze, or explain, or illustrate, or corroborate +any portion of the following Essay. But I know that nothing can be +made too plain for beginners; and as I do not expect the +practitioner, or even the more mature student, to take the trouble to +follow me through an Introduction which I consider wholly unnecessary +and superfluous for them, I shall not hesitate to stoop to the most +elementary simplicity for the benefit of the younger student. I do +this more willingly because it affords a good opportunity, as it +seems to me, of exercising the untrained mind in that medical logic +which does not seem to have been either taught or practised in our +schools of late, to the extent that might be desired. + +I will now exhibit, in a series of propositions reduced to their +simplest expression, the same essential statements and conclusions as +are contained in the Essay, with such commentaries and explanations +as may be profitable to the inexperienced class of readers addressed. + + +I. It has been long believed, by many competent observers, that +Puerperal Fever (so called) is sometimes carried from patient to +patient by medical assistants. + +II. The express object of this Essay is to prove that it is so +carried. + +III. In order to prove this point, it is not necessary to consult +any medical theorist as to whether or not it is consistent with his +preconceived notions that such a mode of transfer should exist. + +IV. If the medical theorist insists on being consulted, and we see +fit to indulge him, he cannot be allowed to assume that the alleged +laws of contagion, deduced from observation in other diseases, shall +be cited to disprove the alleged laws deduced from observation in +this. Science would never make progress under such conditions. +Neither the long incubation of hydrophobia, nor the protecting power +of vaccination, would ever have been admitted, if the results of +observation in these affections had been rejected as contradictory to +the previously ascertained laws of contagion. + +V. The disease in question is not a common one; producing, on the +average, about three deaths in a thousand births, according to the +English Registration returns which I have examined. + +VI. When an unusually large number of cases of this disease occur +about the same time, it is inferred, therefore, that there exists +some special cause for this increased frequency. If the disease +prevails extensively over a wide region of country, it is attributed +without dispute to an epidemic influence. If it prevails in a single +locality, as in a hospital, and not elsewhere, this is considered +proof that some local cause is there active in its production. + +VII. When a large number of cases of this disease occur in rapid +succession, in one individual's ordinary practice, and few or none +elsewhere, these cases appearing in scattered localities, in patients +of the same average condition as those who escape under the care of +others, there is the same reason for connecting the cause of the +disease with the person in this instance, as with the place in that +last mentioned. + +VIII. Many series of cases, answering to these conditions, are given +in this Essay, and many others will be referred to which have +occurred since it was written. + +IX. The alleged results of observation may be set aside; first, +because the so-called facts are in their own nature equivocal; +secondly, because they stand on insufficient authority; thirdly, +because they are not sufficiently numerous. But, in this case, the +disease is one of striking and well-marked character; the witnesses +are experts, interested in denying and disbelieving the facts; the +number of consecutive cases in many instances frightful, and the +number of series of cases such that I have no room for many of them +except by mere reference. + +X. These results of observation, being admitted, may, we will +suppose, be interpreted in different methods. Thus the coincidences +may be considered the effect of chance. I have had the chances +calculated by a competent person, that a given practitioner, A., +shall have sixteen fatal cases in a month, on the following data: +A. to average attendance upon two hundred and fifty births in a year; +three deaths in one thousand births to be assumed as the average from +puerperal fever; no epidemic to be at the time prevailing. It +follows, from the answer given me, that if we suppose every one of +the five hundred thousand annual births of England to have been +recorded during the last half-century, there would not be one chance +in a million million million millions that one such series should be +noted. No possible fractional error in this calculation can render +the chance a working probability. Applied to dozens of series of +various lengths, it is obviously an absurdity. Chance, therefore, is +out of the question as an explanation of the admitted coincidences. + +XI. There is, therefore, some relation of cause and effect between +the physician's presence and the patient's disease. + +XII. Until it is proved to what removable condition attaching to the +attendant the disease is owing, he is bound to stay away from his +patients so soon as he finds himself singled out to be tracked by the +disease. How long, and with what other precautions, I have +suggested, without dictating, at the close of my Essay. If the +physician does not at once act on any reasonable suspicion of his +being the medium of transfer, the families where he is engaged, if +they are allowed to know the facts, should decline his services for +the time. His feelings on the occasion, however interesting to +himself, should not be even named in this connection. A physician +who talks about ceremony and gratitude, and services rendered, and +the treatment he got, surely forgets himself; it is impossible that +he should seriously think of these small matters where there is even +a question whether he may not carry disease, and death, and +bereavement into any one of "his families," as they are sometimes +called. + + +I will now point out to the young student the mode in which he may +relieve his mind of any confusion, or possibly, if very young, any +doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised +in his mind. + +The most prominent ideas of the Letter are, first, that the +transmissible nature of puerperal fever appears improbable, and, +secondly, that it would be very inconvenient to the writer. +Dr. Woodville, Physician to the Small-Pox and Inoculation Hospital in +London, found it improbable, and exceedingly inconvenient to himself, +that cow pox should prevent small-pox; but Dr. Jenner took the +liberty to prove the fact, notwithstanding. + +I will first call the young student's attention to the show of +negative facts (exposure without subsequent disease), of which much +seems to be thought. And I may at the same time refer him to Dr. +Hodge's Lecture, where he will find the same kind of facts and +reasoning. Let him now take up Watson's Lectures, the good sense and +spirit of which have made his book a universal favorite, and open to +the chapter on Continued Fever. He will find a paragraph containing +the following sentence: "A man might say, 'I was in the battle of +Waterloo, and saw many men around me fall down and die, and it was +said that they were struck down by musket-balls; but I know better +than that, for I was there all the time, and so were many of my +friends, and we were never hit by any musket-balls. Musket-balls, +therefore, could not have been the cause of the deaths we witnessed.' +And if, like contagion, they were not palpable to the senses, such a +person might go on to affirm that no proof existed of there being any +such thing as musket-balls." Now let the student turn back to the +chapter on Hydrophobia in the same volume. He will find that John +Hunter knew a case in which, of twenty-one persons bitten, only one +died of the disease. He will find that one dog at Charenton was +bitten at different times by thirty different mad dogs, and outlived +it all. Is there no such thing, then, as hydrophobia? Would one +take no especial precautions if his wife, about to become a mother, +had been bitten by a rabid animal, because so many escape? Or let +him look at "Underwood on Diseases of Children,"[Philadelphia, 1842, +p. 244, note.] and he will find the case of a young woman who was +inoculated eight times in thirty days, at the same time attending +several children with smallpox, and yet was not infected. But seven +weeks afterwards she took the disease and died. + +It would seem as if the force of this argument could hardly fail to +be seen, if it were granted that every one of these series of cases +were so reported as to prove that there could have been no transfer +of disease. There is not one of them so reported, in the Lecture or +the Letter, as to prove that the disease may not have been carried by +the practitioner. I strongly suspect that it was so carried in some +of these cases, but from the character of the very imperfect evidence +the question can never be settled without further disclosures. + +Although the Letter is, as I have implied, principally taken up with +secondary and collateral questions, and might therefore be set aside +as in the main irrelevant, I am willing, for the student's sake, to +touch some of these questions briefly, as an illustration of its +logical character. + +The first thing to be done, as I thought when I wrote my Essay, was +to throw out all discussions of the word contagion, and this I did +effectually by the careful wording of my statement of the subject to +be discussed. My object was not to settle the etymology or +definition of a word, but to show that women had often died in +childbed, poisoned in some way by their medical attendants. On the +other point, I, at least, have no controversy with anybody, and I +think the student will do well to avoid it in this connection. If I +must define my position, however, as well as the term in question, I +am contented with Worcester's definition; provided always this avowal +do not open another side controversy on the merits of his Dictionary, +which Dr. Meigs has not cited, as compared with Webster's, which he +has. + +I cannot see the propriety of insisting that all the laws of the +eruptive fevers must necessarily hold true of this peculiar disease +of puerperal women. If there were any such propriety, the laws of +the eruptive fevers must at least be stated correctly. It is not +true, for instance, as Dr. Meigs states, that contagion is "no +respecter of persons;" that "it attacks all individuals alike." To +give one example: Dr. Gregory, of the Small-Pox Hospital, who ought +to know, says that persons pass through life apparently insensible to +or unsusceptible of the small-pox virus, and that the same persons do +not take the vaccine disease. + +As to the short time of incubation, of which so much is made, we have +no right to decide beforehand whether it shall be long or short, in +the cases we are considering. A dissection wound may produce +symptoms of poisoning in six hours; the bite of a rabid animal may +take as many months. + +After the student has read the case in Dr. Meigs's 136th paragraph, +and the following one, in which he exclaims against the idea of +contagion, because the patient, delivered on the 26th of December, +was attacked in twenty-four hours, and died on the third day, let him +read what happened at the "Black Assizes" of 1577 and 1750. In the +first case, six hundred persons sickened the same night of the +exposure, and three hundred more in three days. [Elliotson's +Practice, p. 298.] Of those attacked in the latter year, the +exposure being on the 11th of May, Alderman Lambert died on the 13th, +Under-Sheriff Cox on the 14th, and many of note before the +20th. But these are old stories. Let the student listen then to Dr. +Gerhard, whose reputation as a cautious observer he may be supposed +to know. "The nurse was shaving a man, who died in a few hours after +his entrance; he inhaled his breath, which had a nauseous taste, and +in an hour afterwards was taken with nausea, cephalalgia, and singing +of the ears. From that moment the attack began, and assumed a severe +character. The assistant was supporting another patient, who died +soon afterwards; he felt the pungent heat upon his skin, and was +taken immediately with the symptoms of typhus."[Am. Jour. Med. +Sciences, Feb. 1837, p. 299.] It is by notes of cases, rather +than notes of admiration, that we must be guided, when we study the +Revised Statutes of Nature, as laid down from the curule chairs of +Medicine. + +Let the student read Dr. Meigs's 140th paragraph soberly, and then +remember, that not only does he infer, suspect, and surmise, but he +actually asserts (page 154, "there was poison in the house," because +three out of five patients admitted into a ward had puerperal fever +and died. Have I not as much right to draw a positive inference from +"Dr. A.'s " seventy exclusive cases as he from the three cases in the +ward of the Dublin Hospital? All practical medicine, and all action +in common affairs, is founded on inferences. How does Dr. Meigs know +that the patients he bled in puerperal fever would not have all got +well if he had not bled them? + +"You see a man discharge a gun at another; you see the flash, you +hear the report, you see the person fall a lifeless corpse; and you +infer, from all these circumstances, that there was a ball discharged +from the gun, which entered his body and caused his death, because +such is the usual and natural cause of such an effect. But you did +not see the ball leave the gun, pass through the air, and enter the +body of the slain; and your testimony to the fact of killing is, +therefore, only inferential,--in other words, circumstantial. It is +possible that no ball was in the gun; and we infer that there was, +only because we cannot account for death on any other supposition." +[Chief Justice Gibson, in Am. Law Journal, vol. vi. p. 123.] + +"The question always comes to this: Is the circumstance of +intercourse with the sick followed by the appearance of the disease +in a proportion of cases so much greater than any other circumstance +common to any portion of the inhabitants of the place under +observation, as to make it inconceivable that the succession of cases +occurring in persons having that intercourse should have been the +result of chance? If so, the inference is unavoidable, that that +intercourse must have acted as a cause of the disease. All +observations which do not bear strictly on that point are irrelevant, +and, in the case of an epidemic first appearing in a town or +district, a succession of two cases is sometimes sufficient to +furnish evidence which, on the principle I have stated, is nearly +irresistible." + +Possibly an inexperienced youth may be awe-struck by the quotation +from Cuvier. These words, or their equivalent, are certainly to be +found in his Introduction. So are the words "top not come down"! +to be found in the Bible, and they were as much meant for the ladies' +head-dresses as the words of Cuvier were meant to make clinical +observation wait for a permit from anybody to look with its eyes and +count on its fingers. Let the inquiring youth read the whole +Introduction, and he will see what they mean. + +I intend no breach of courtesy, but this is a proper place to warn +the student against skimming the prefaces and introductions of works +for mottoes and embellishments to his thesis. He cannot learn +anatomy by thrusting an exploring needle into the body. He will be +very liable to misquote his author's meaning while he is picking off +his outside sentences. He may make as great a blunder as that simple +prince who praised the conductor of his orchestra for the piece just +before the overture; the musician was too good a courtier to tell him +that it was only the tuning of the instruments. + +To the six propositions in the 142d paragraph, and the remarks about +"specific" diseases, the answer, if any is necessary, seems very +simple. An inflammation of a serous membrane may give rise to +secretions which act as a poison, whether that be a "specific" poison +or not, as Dr. Homer has told his young readers, and as dissectors +know too well; and that poison may produce its symptoms in a few +hours after the system has received it, as any may see in Druitt's +"Surgery," if they care to look. Puerperal peritonitis may produce +such a poison, and puerperal women may be very sensible to its +influences, conveyed by contact or exhalation. Whether this is so or +not, facts alone can determine, and to facts we have had recourse to +settle it. + +The following statement is made by Dr. Meigs in his 142d paragraph, +and developed more at length, with rhetorical amplifications, in the +134th. "No human being, save a pregnant or parturient woman, is +susceptible to the poison." This statement is wholly incorrect, as I +am sorry to have to point out to a Teacher in Dr. Meigs's position. +I do not object to the erudition which quotes Willis and Fernelius, +the last of whom was pleasantly said to have "preserved the dregs of +the Arabs in the honey of his Latinity." But I could wish that more +modern authorities had not been overlooked. On this point, for +instance, among the numerous facts disproving the statement, the +"American Journal of Medical Sciences," published not far from his +lecture-room, would have presented him with a respectable catalog of +such cases. Thus he might refer to Mr. Storrs's paper "On the +Contagious Effects of Puerperal Fever on the Male Subject; or on +Persons not Childbearing"(Jan. 1846), or to Dr. Reid's case (April, +1846), or to Dr. Barron's statement of the children's dying of +peritonitis in an epidemic of puerperal fever at the Philadelphia +Hospital (Oct. 1842), or to various instances cited in Dr. +Kneeland's article (April, 186). Or, if he would have referred to +the "New York Journal," he might have seen Prof. Austin Flint's +cases. Or, if he had honored my Essay so far, he might have found +striking instances of the same kind in the first of the new series of +cases there reported and elsewhere. I do not see the bearing of his +proposition, if it were true. But it is one of those assertions that +fall in a moment before a slight examination of the facts; and I +confess my surprise, that a professor who lectures on the Diseases of +Women should have ventured to make it. + +Nearly seven pages are devoted to showing that I was wrong in saying +I would not be "understood to imply that there exists a doubt in the +mind of any well-informed member of the medical profession as to the +fact that puerperal fever is sometimes communicated from one person +to another, both directly and indirectly." I will devote seven lines +to these seven pages, which seven lines, if I may say it without +offence, are, as it seems to me, six more than are strictly +necessary. + +The following authors are cited as sceptics by Dr. Meigs : +Dewees. --I cited the same passage. Did not know half the facts. +Robert Lee. --Believes the disease is sometimes communicable by +contagion. Tonnelle, Baudelocque. Both cited by me. Jacquemier. +--Published three years after my Essay. Kiwisch. Behindhand in +knowledge of Puerperal Fever." [B. & F. Med. Rev. Jan. 1842.] +Paul Dubois. --Scanzoni. + +These Continental writers not well informed on this point.[See Dr. +Simpson's Remarks at Meeting of Edin. Med. Chir. Soc. (Am. Jour. +Oct. 1851.)] + +The story of Von Busch is of interest and value, but there is nothing +in it which need perplex the student. It is not pretended that the +disease is always, or even, it may be, in the majority of cases, +carried about by attendants; only that it is so carried in certain +cases. That it may have local and epidemic causes, as well as that +depending on personal transmission, is not disputed. Remember how +small-pox often disappears from a community in spite of its +contagious character, and the necessary exposure of many persons to +those suffering from it; in both diseases contagion is only one of +the coefficients of the disease. + +I have already spoken of the possibility that Dr. Meigs may have been +the medium of transfer of puerperal fever in some of the cases he has +briefly catalogued. Of Dr. Rutter's cases I do not know how to +speak. I only ask the student to read the facts stated by Dr. +Condie, as given in my Essay, and say whether or not a man should +allow his wife to be attended by a practitioner in whose hands +"scarcely a female that has been delivered for weeks past has escaped +an attack," "while no instance of the disease has occurred in the +patients of any other accoucheur practising in the same district." +If I understand Dr. Meigs and Dr. Hodge, they would not warn the +physician or spare the patient under such circumstances. They would +"go on," if I understand them, not to seven, or seventy, only, but to +seventy times seven, if they could find patients. If this is not +what they mean, may we respectfully ask them to state what they do +mean, to their next classes, in the name of humanity, if not of +science! + +I might repeat the question asked concerning Dr. Rutter's cases, with +reference to those reported by Dr. Roberton. Perhaps, however, the +student would like to know the opinion of a person in the habit of +working at matters of this kind in a practical point of view. To +satisfy him on this ground, I addressed the following question to the +President of one of our principal Insurance Companies, leaving Dr. +Meigs's book and my Essay in his hands at the same time. + +Question. "If such facts as Roberton's cases were before you, and +the attendant had had ten, or even five fatal cases, or three, or two +even, would you, or would you not, if insuring the life of the next +patient to be taken care of by that attendant, expect an extra +premium over that of an average case of childbirth?" + +Answer. " Of course I should require a very large extra premium, if +I would take take risk at all." + +But I do not choose to add the expressions of indignation which the +examination of the facts before him called out. I was satisfied from +the effect they produced on him, that if all the hideous catalogues +of cases now accumulated were fully brought to the knowledge of the +public, nothing, since the days of Burke and Hare, has raised such a +cry of horror as would be shrieked in the ears of the Profession. + +Dr. Meigs has elsewhere invoked "Providence" as the alternative of +accident, to account for the "coincidences." ("Obstetrics," Phil. +1852, p. 631.) If so, Providence either acts through the agency of +secondary causes, as in other diseases, or not. If through such +causes, let us find out what they are, as we try to do in other +cases. It may be true that offences, or diseases, will come, but +"woe unto him through whom they come," if we catch him in the +voluntary or careless act of bringing them! But if Providence does +not act through secondary causes in this particular sphere of +etiology, then why does Dr. Meigs take such pains to reason so +extensively about the laws of contagion, which, on that supposition, +have no more to do with this case than with the plague which +destroyed the people after David had numbered them? Above all, what +becomes of the theological aspect of the question, when he asserts +that a practitioner was "only unlucky in meeting with the epidemic +cases?" ( Op. cit. p. 633.) We do not deny that the God of battles +decides the fate of nations; but we like to have the biggest +squadrons on our side, and we are particular that our soldiers should +not only say their prayers, but also keep their powder dry. We do +not deny the agency of Providence in the disaster at Norwalk, but we +turn off the engineer, and charge the Company five thousand dollars +apiece for every life that is sacrificed. + +Why a grand jury should not bring in a bill against a physician who +switches off a score of women one after the other along his private +track, when he knows that there is a black gulf at the end of it, +down which they are to plunge, while the great highway is clear, is +more than I can answer. It is not by laying the open draw to +Providence that he is to escape the charge of manslaughter. + +To finish with all these lesser matters of question, I am unable to +see why a female must necessarily be unattended in her confinement, +because she declines the services of a particular practitioner. In +all the series of cases mentioned, the death-carrying attendant was +surrounded by others not tracked by disease and its consequences. +Which, I would ask, is worse,--to call in another, even a rival +practitioner, or to submit an unsuspecting female to a risk which an +Insurance Company would have nothing to do with? + +I do not expect ever to return to this subject. There is a point of +mental saturation, beyond which argument cannot be forced without +breeding impatient, if not harsh, feelings towards those who refuse +to be convinced. If I have so far manifested neither, it is well to +stop here, and leave the rest to those younger friends who may have +more stomach for the dregs of a stale argument. + +The extent of my prefatory remarks may lead some to think that I +attach too much importance to my own Essay. Others may wonder that I +should expend so many words upon the two productions referred to, the +Letter and the Lecture. I do consider my Essay of much importance so +long as the doctrine it maintains is treated as a question, and so +long as any important part of the defence of that doctrine is thought +to rest on its evidence or arguments. I cannot treat as +insignificant any opinions bearing on life, and interests dearer than +life, proclaimed yearly to hundreds of young men, who will carry them +to their legitimate results in practice. + +The teachings of the two Professors in the great schools of +Philadelphia are sure to be listened to, not only by their immediate +pupils, but by the Profession at large. I am too much in earnest for +either humility or vanity, but I do entreat those who hold the keys +of life and death to listen to me also for this once. I ask no +personal favor; but I beg to be heard in behalf of the women whose +lives are at stake, until some stronger voice shall plead for them. + +I trust that I have made the issue perfectly distinct and +intelligible. And let it be remembered that this is no subject to be +smoothed over by nicely adjusted phrases of half-assent and half- +censure divided between the parties. The balance must be struck +boldly and the result declared plainly. If I have been hasty, +presumptuous, ill-informed, illogical; if my array of facts means +nothing; if there is no reason for any caution in the view of these +facts; let me be told so on such authority that I must believe it, +and I will be silent henceforth, recognizing that my mind is in a +state of disorganization. If the doctrine I have maintained is a +mournful truth; if to disbelieve it, and to practise on this +disbelief, and to teach others so to disbelieve and practise, is to +carry desolation, and to charter others to carry it, into confiding +families, let it be proclaimed as plainly what is to be thought of +the teachings of those who sneer at the alleged dangers, and scout +the very idea of precaution. Let it be remembered that persons are +nothing in this matter; better that twenty pamphleteers should be +silenced, or as many professors unseated, than that one mother's life +should be taken. There is no quarrel here between men, but there is +deadly incompatibility and exterminating warfare between doctrines. +Coincidences, meaning nothing, though a man have a monopoly of the +disease for weeks or months; or cause and effect, the cause being in +some way connected with the person; this is the question. If I am +wrong, let me be put down by such a rebuke as no rash declaimer has +received since there has been a public opinion in the medical +profession of America; if I am right, let doctrines which lead to +professional homicide be no longer taught from the chairs of those +two great Institutions. Indifference will not do here; our +Journalists and Committees have no right to take up their pages with +minute anatomy and tediously detailed cases, while it is a question +whether or not the "blackdeath" of child-bed is to be scattered +broadcast by the agency of the mother's friend and adviser. Let the +men who mould opinions look to it; if there is any voluntary +blindness, any interested oversight, any culpable negligence, even, +in such a matter, and the facts shall reach the public ear; the +pestilence-carrier of the lying-in chamber must look to God for +pardon, for man will never forgive him. + + + THE CONTAGIOUSNESS OF PUERPERAL FEVER. + +In collecting, enforcing, and adding to the evidence accumulated upon +this most serious subject, I would not be understood to imply that +there exists a doubt in the mind of any well-informed member of the +medical profession as to the fact that puerperal fever is sometimes +communicated from one person to another, both directly and +indirectly. In the present state of our knowledge upon this point I +should consider such doubts merely as a proof that the sceptic had +either not examined the evidence, or, having examined it, refused to +accept its plain and unavoidable consequences. I should be sorry to +think, with Dr. Rigby, that it was a case of "oblique vision;" I +should be unwilling to force home the argumentum ad hominem of Dr. +Blundell, but I would not consent to make a question of a momentous +fact which is no longer to be considered as a subject for trivial +discussions, but to be acted upon with silent promptitude. It +signifies nothing that wise and experienced practitioners have +sometimes doubted the reality of the danger in question; no man has +the right to doubt it any longer. No negative facts, no opposing +opinions, be they what they may, or whose they may, can form any +answer to the series of cases now within the reach of all who choose +to explore the records of medical science. + +If there are some who conceive that any important end would be +answered by recording such opinions, or by collecting the history of +all the cases they could find in which no evidence of the influence +of contagion existed, I believe they are in error. Suppose a few +writers of authority can be found to profess a disbelief in +contagion,--and they are very few compared with those who think +differently,--is it quite clear that they formed their opinions on a +view of all the facts, or is it not apparent that they relied mostly +on their own solitary experience? Still further, of those whose +names are quoted, is it not true that scarcely a single one could by +any possibility have known the half or the tenth of the facts bearing +on the subject which have reached such a frightful amount within the +last few years? Again, as to the utility of negative facts, as we +may briefly call them,--instances, namely, in which exposure has not +been followed by disease,--although, like other truths, they may be +worth knowing, I do not see that they are like to shed any important +light upon the subject before us. Every such instance requires a +good deal of circumstantial explanation before it can be accepted. +It is not enough that a practitioner should have had a single case of +puerperal fever not followed by others. It must be known whether he +attended others while this case was in progress, whether he went +directly from one chamber to others, whether he took any, and what +precautions. It is important to know that several women were exposed +to infection derived from the patient, so that allowance may be made +for want of predisposition. Now if of negative facts so sifted there +could be accumulated a hundred for every one plain instance of +communication here recorded, I trust it need not be said that we are +bound to guard and watch over the hundredth tenant of our fold, +though the ninety and nine may be sure of escaping the wolf at its +entrance. If any one is disposed, then, to take a hundred instances +of lives endangered or sacrificed out of those I have mentioned, and +make it reasonably clear that within a similar time and compass ten +thousand escaped the same exposure, I shall thank him for his +industry, but I must be permitted to hold to my own practical +conclusions, and beg him to adopt or at least to examine them also. +Children that walk in calico before open fires are not always burned +to death; the instances to the contrary may be worth recording; but +by no means if they are to be used as arguments against woollen +frocks and high fenders. + +I am not sure that this paper will escape another remark which it +might be wished were founded in justice. It may be said that the +facts are too generally known and acknowledged to require any formal +argument or exposition, that there is nothing new in the positions +advanced, and no need of laying additional statements before the +Profession. But on turning to two works, one almost universally, and +the other extensively appealed to as authority in this country, I see +ample reason to overlook this objection. In the last edition of +Dewees's Treatise on the "Diseases of Females," it is expressly said, +"In this country, under no circumstance that puerperal fever has +appeared hitherto, does it afford the slightest ground for the belief +that it is contagious." In the "Philadelphia Practice of Midwifery" +not one word can be found in the chapter devoted to this disease +which would lead the reader to suspect that the idea of contagion had +ever been entertained. It seems proper, therefore, to remind those +who are in the habit of referring to these works for guidance, that +there may possibly be some sources of danger they have slighted or +omitted, quite as important as a trifling irregularity of diet, or a +confined state of the bowels, and that whatever confidence a +physician may have in his own mode of treatment, his services are of +questionable value whenever he carries the bane as well as the +antidote about his person. + +The practical point to be illustrated is the following: + +The disease known as Puerperal Fever is so far contagious as to be +frequently carried from patient to patient by physicians and nurses. + + +Let me begin by throwing out certain incidental questions, which, +without being absolutely essential, would render the subject more +complicated, and by making such concessions and assumptions as may be +fairly supposed to be without the pale of discussion. + +1. It is granted that all the forms of what is called puerperal +fever may not be, and probably are not, equally contagious or +infectious. I do not enter into the distinctions which have been +drawn by authors, because the facts do not appear to me sufficient to +establish any absolute line of demarcation between such forms as may +be propagated by contagion and those which are never so propagated. +This general result I shall only support by the authority of Dr. +Ramsbotham, who gives, as the result of his experience, that the same +symptoms belong to what he calls the infectious and the sporadic +forms of the disease, and the opinion of Armstrong in his original +Essay. If others can show any such distinction, I leave it to them +to do it. But there are cases enough that show the prevalence of the +disease among the patients of a single practitioner when it was in no +degree epidemic, in the proper sense of the term. I may refer to +those of Mr. Roberton and of Dr. Peirson, hereafter to be cited, as +examples. + +2. I shall not enter into any dispute about the particular mode of +infection, whether it be by the atmosphere the physician carries +about him into the sick-chamber, or by the direct application of the +virus to the absorbing surfaces with which his hand comes in contact. +Many facts and opinions are in favor of each of these modes of +transmission. But it is obvious that in the majority of cases it +must be impossible to decide by which of these channels the disease +is conveyed, from the nature of the intercourse between the physician +and the patient. + +3. It is not pretended that the contagion of puerperal fever must +always be followed by the disease. It is true of all contagious +diseases, that they frequently spare those who appear to be fully +submitted to their influence. Even the vaccine virus, fresh from the +subject, fails every day to produce its legitimate effect, though +every precaution is taken to insure its action. This is still more +remarkably the case with scarlet fever and some other diseases. + +4. It is granted that the disease may be produced and variously +modified by many causes besides contagion, and more especially by +epidemic and endemic influences. But this is not peculiar to the +disease in question. There is no doubt that small-pox is propagated +to a great extent by contagion, yet it goes through the same periods +of periodical increase and diminution which have been remarked in +puerperal fever. If the question is asked how we are to reconcile +the great variations in the mortality of puerperal fever in different +seasons and places with the supposition of contagion, I will answer +it by another question from Mr. Farr's letter to the Registrar- +General. He makes the statement that "five die weekly of small-pox +in the metropolis when the disease is not epidemic,"--and adds, "The +problem for solution is,-- Why do the five deaths become 10, 15, 20, +31, 58, 88, weekly, and then progressively fall through the same +measured steps?" + +5. I take it for granted, that if it can be shown that great numbers +of lives have been and are sacrificed to ignorance or blindness on +this point, no other error of which physicians or nurses may be +occasionally suspected will be alleged in palliation of this; but +that whenever and wherever they can be shown to carry disease and +death instead of health and safety, the common instincts of humanity +will silence every attempt to explain away their responsibility. + + +The treatise of Dr. Gordon of Aberdeen was published in the year +1795, being among the earlier special works upon the disease. Apart +of his testimony has been occasionally copied into other works, but +his expressions are so clear, his experience is given with such manly +distinctness and disinterested honesty, that it may be quoted as a +model which might have been often followed with advantage. + +"This disease seized such women only as were visited, or delivered by +a practitioner, or taken care of by a nurse, who had previously +attended patients affected with the disease." + +"I had evident proofs of its infectious nature, and that the +infection was as readily communicated as that of the small-pox or +measles, and operated more speedily than any other infection with +which I am acquainted." + +"I had evident proofs that every person who had been with a patient +in the puerperal fever became charged with an atmosphere of +infection, which was communicated to every pregnant woman who +happened to come within its sphere. This is not an assertion, but a +fact, admitting of demonstration, as may be seen by a perusal of the +foregoing table,"--referring to a table of seventy-seven cases, in +many of which the channel of propagation was evident. + +He adds, "It is a disagreeable declaration for me to mention, that I +myself was the means of carrying the infection to a great number of +women." He then enumerates a number of instances in which the +disease was conveyed by midwives and others to the neighboring +villages, and declares that "these facts fully prove that the cause +of the puerperal fever, of which I treat, was a specific contagion, +or infection, altogether unconnected with a noxious constitution of +the atmosphere." + +But his most terrible evidence is given in these words: "I ARRIVED AT +THAT CERTAINTY IN THE MATTER, THAT I COULD VENTURE TO FORETELL WHAT +WOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT +MIDWIFE THEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE +ATTENDED, DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE, MY +PREDICTION WAS VERIFIED." + +Even previously to Gordon, Mr. White of Manchester had said, "I am +acquainted with two gentlemen in another town, where the whole +business of midwifery is divided betwixt them, and it is very +remarkable that one of them loses several patients every year of the +puerperal fever, and the other never so much as meets with the +disorder,"--a difference which he seems to attribute to their various +modes of treatment. [On the Management of Lying-in Women, p. 120.] + +Dr. Armstrong has given a number of instances in his Essay on +Puerperal Fever, of the prevalence of the disease among the patients +of a single practitioner. At Sunderland, "in all, forty-three cases +occurred from the 1st of January to the 1st of October, when the +disease ceased; and of this number forty were witnessed by Mr. +Gregson and his assistant, Mr. Gregory, the remainder having been +separately seen by three accoucheurs." There is appended to the +London edition of this Essay, a letter from Mr. Gregson, in which +that gentleman says, in reference to the great number of cases +occurring in his practice, "The cause of this I cannot pretend fully +to explain, but I should be wanting in common liberality if I were to +make any hesitation in asserting, that the disease which appeared in +my practice was highly contagious, and communicable from one +puerperal woman to another." "It is customary among the lower and +middle ranks of people to make frequent personal visits to puerperal +women resident in the same neighborhood, and I have ample evidence +for affirming that the infection of the disease was often carried +about in that manner; and, however painful to my feelings, I must in +candor declare, that it is very probable the contagion was conveyed, +in some instances, by myself, though I took every possible care to +prevent such a thing from happening, the moment that I ascertained +that the distemper was infectious." Dr. Armstrong goes on to mention +six other instances within his knowledge, in which the disease had at +different times and places been limited, in the same singular manner, +to the practice of individuals, while it existed scarcely if at all +among the patients of others around them. Two of the gentlemen +became so convinced of their conveying the contagion, that they +withdrew for a time from practice. + +I find a brief notice, in an American Journal, of another series of +cases, first mentioned by Mr. Davies, in the "Medical Repository." +This gentleman stated his conviction that the disease is contagious. + +"In the autumn of 1822 he met with twelve cases, while his medical +friends in the neighborhood did not meet with any, ' or at least very +few.' He could attribute this circumstance to no other cause than +his having been present at the examination, after death, of two +cases, some time previous, and of his having imparted the disease to +his patients, notwithstanding every precaution.'" + +Dr. Gooch says, "It is not uncommon for the greater number of cases +to occur in the practice of one man, whilst the other practitioners +of the neighborhood, who are not more skilful or more busy, meet with +few or none. A practitioner opened the body of a woman who had died +of puerperal fever, and continued to wear the same clothes. A lady +whom he delivered a few days afterwards was attacked with and died of +a similar disease; two more of his lying-in patients, in rapid +succession, met with the same fate; struck by the thought, that he +might have carried contagion in his clothes, he instantly changed +them, and met with no more cases of the kind.' A woman in the +country, who was employed as washerwoman and nurse, washed the linen +of one who had died of puerperal fever; the next lying-in patient she +nursed died of the same disease; a third nursed by her met with the +same fate, till the neighborhood, getting afraid of her, ceased to +employ her." + +In the winter of the year 1824, "Several instances occurred of its +prevalence among the patients of particular practitioners, whilst +others who were equally busy met with few or none. One instance of +this kind was very remarkable. A general practitioner, in large +midwifery practice, lost so many patients from puerperal fever, that +he determined to deliver no more for some time, but that his partner +should attend in his place. This plan was pursued for one month, +during which not a case of the disease occurred in their practice. +The elder practitioner, being then sufficiently recovered, returned +to his practice, but the first patient he attended was attacked by +the disease and died. A physician, who met him in consultation soon +afterwards, about a case of a different kind, and who knew nothing of +his misfortune, asked him whether puerperal fever was at all +prevalent in his neighborhood, on which he burst into tears, and +related the above circumstances. + +"Among the cases which I saw this season in consultation, four +occurred in one month in the practice of one medical man, and all of +them terminated fatally." [Lond. Med. Gaz. May 2, 1835.] + +Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that he +had known the disease spread through a particular district, or be +confined to the practice of a particular person, almost every patient +being attacked with it, while others had not a single case. It +seemed capable, he thought, of conveyance, not only by common modes; +but through the dress of the attendants upon the patient. + +In a letter to be found in the "London Medical Gazette"for January, +1840, Mr. Roberton of Manchester makes the statement which I here +give in a somewhat condensed form. + +A midwife delivered a woman on the 4th of December, 1830, who died +soon after with the symptoms of puerperal fever. In one month from +this date the same midwife delivered thirty women, residing in +different parts of an extensive suburb, of which number sixteen +caught the disease and all died. These were the only cases which had +occurred for a considerable time in Manchester. The other midwives +connected with the same charitable institution as the woman already +mentioned are twenty-five in number, and deliver, on an average, +ninety women a week, or about three hundred and eighty a month. None +of these women had a case of puerperal fever. "Yet all this time +this woman was crossing the other midwives in every direction, scores +of the patients of the charity being delivered by them in the very +same quarters where her cases of fever were happening." + +Mr. Roberton remarks, that little more than half the women she +delivered during this month took the fever; that on some days all +escaped, on others only one or more out of three or four; a +circumstance similar to what is seen in other infectious maladies. + +Dr. Blundell says, "Those who have never made the experiment can have +but a faint conception how difficult it is to obtain the exact truth +respecting any occurrence in which feelings and interests are +concerned. Omitting particulars, then, I content myself with +remarking, generally, that from more than one district I have +received accounts of the prevalence of puerperal fever in the +practice of some individuals, while its occurrence in that of others, +in the same neighborhood, was not observed. Some, as I have been +told, have lost ten, twelve, or a greater number of patients, in +scarcely broken succession; like their evil genius, the puerperal +fever has seemed to stalk behind them wherever they went. Some have +deemed it prudent to retire for a time from practice. In fine, that +this fever may occur spontaneously, I admit; that its infectious +nature may be plausibly disputed, I do not deny; but I add, +considerately, that in my own family I had rather that those I +esteemed the most should be delivered, unaided, in a stable, by the +manger-side, than that they should receive the best help, in the +fairest apartment, but exposed to the vapors of this pitiless +disease. Gossiping friends, wet-nurses, monthly nurses, the +practitioner himself, these are the channels by which, as I suspect, +the infection is principally conveyed." + +At a meeting of the Royal Medical and Chirurgical Society, Dr. King +mentioned that some years since a practitioner at Woolwich lost +sixteen patients from puerperal fever in the same year. He was +compelled to give up practice for one or two years, his business +being divided among the neighboring practitioners. No case of +puerperal fever occurred afterwards, neither had any of the +neighboring surgeons any cases of this disease. + +At the same meeting Mr. Hutchinson mentioned the occurrence of three +consecutive cases of puerperal fever, followed subsequently by two +others, all in the practice of one accoucheur.[Lancet, May 2, 1840.] + +Dr. Lee makes the following statement: "In the last two weeks of +September, 1827, five fatal cases of uterine inflammation came under +our observation. All the individuals so attacked had been attended +in labor by the same midwife, and no example of a febrile or +inflammatory disease of a serious nature occurred during that period +among the other patients of the Westminster General Dispensary, who +had been attended by the other midwives belonging to that +institution." + +The recurrence of long series of cases like those I have cited, +reported by those most interested to disbelieve in contagion, +scattered along through an interval of half a century, might have +been thought sufficient to satisfy the minds of all inquirers that +here was something more than a singular coincidence. But if, on a +more extended observation, it should be found that the same ominous +groups of cases clustering about individual practitioners were +observed in a remote country, at different times, and in widely +separated regions, it would seem incredible that any should be found +too prejudiced or indolent to accept the solemn truth knelled into +their ears by the funeral bells from both sides of the ocean,--the +plain conclusion that the physician and the disease entered, hand in +hand, into the chamber of the unsuspecting patient. + +That such series of cases have been observed in this country, and in +this neighborhood, I proceed to show. + +In Dr. Francis's "Notes to Denman's Midwifery," a passage is cited +from Dr. Hosack, in which he refers to certain puerperal cases which +proved fatal to several lying-in women, and in some of which the +disease was supposed to be conveyed by the accoucheurs themselves. + +A writer in the "New York Medical and Physical Journal" for October, +1829, in speaking of the occurrence of puerperal fever, confined to +one man's practice, remarks, "We have known cases of this kind occur, +though rarely, in New York." + +I mention these little hints about the occurrence of such cases, +partly because they are the first I have met with in American medical +literature, but more especially because they serve to remind us that +behind the fearful array of published facts there lies a dark list of +similar events, unwritten in the records of science, but long +remembered by many a desolated fireside. + +Certainly nothing can be more open and explicit than the account +given by Dr. Peirson of Salem, of the cases seen by him. In the +first nineteen days of January, 1829, he had five consecutive cases +of puerperal fever, every patient he attended being attacked, and the +three first cases proving fatal. In March of the same year he had +two moderate cases, in June, another case, and in July, another, +which proved fatal. "Up to this period," he remarks, "I am not +informed that a single case had occurred in the practice of any other +physician. Since that period I have had no fatal case in my +practice, although I have had several dangerous cases. I have +attended in all twenty cases of this disease, of which four have been +fatal. I am not aware that there has been any other case in the town +of distinct puerperal peritonitis, although I am willing to admit my +information may be very defective on this point. I have been told of +some I 'mixed cases,' and 'morbid affections after delivery.'" + +In the "Quarterly Summary of the Transactions of the College of +Physicians of Philadelphia" may be found some most extraordinary +developments respecting a series of cases occurring in the practice +of a member of that body. + +Dr. Condie called the attention of the Society to the prevalence, at +the present time, of puerperal fever of a peculiarly insidious and +malignant character. "In the practice of one gentleman extensively +engaged as an obstetrician, nearly every female he has attended in +confinement, during several weeks past, within the above limits" (the +southern sections and neighboring districts), "had been attacked by +the fever." + +"An important query presents itself, the Doctor observed, in +reference to the particular form of fever now prevalent. Is it, +namely, capable of being propagated by contagion, and is a physician +who has been in attendance upon a case of the disease warranted in +continuing, without interruption, his practice as an obstetrician? +Dr. C., although not a believer in the contagious character of many +of those affections generally supposed to be propagated in this +manner, has nevertheless become convinced by the facts that have +fallen under his notice, that the puerperal fever now prevailing is +capable of being communicated by contagion. How otherwise can be +explained the very curious circumstance of the disease in one +district being exclusively confined to the practice of a single +physician, a Fellow of this College, extensively engaged in +obstetrical practice,--while no instance of the disease has occurred +in the patients under the care of any other accoucheur practising +within the same district; scarcely a female that has been delivered +for weeks past has escaped an attack?" + +Dr. Rutter, the practitioner referred to, "observed that, after the +occurrence of a number of cases of the disease in his practice, he +had left the city and remained absent for a week, but on returning, +no article of clothing he then wore having been used by him before, +one of the very first cases of parturition he attended was followed +by an attack of the fever, and terminated fatally; he cannot, +readily, therefore, believe in the transmission of the disease from +female to female, in the person or clothes of the physician." + +The meeting at which these remarks were made was held on the 3d of +May, 1842. In a letter dated December 20, 1842, addressed to Dr. +Meigs, and to be found in the "Medical Examiner," he speaks of +"those horrible cases of puerperal fever, some of which you did me +the favor to see with me during the past summer," and talks of his +experience in the disease, "now numbering nearly seventy cases, all +of which have occurred within less than a twelvemonth past." + +And Dr. Meigs asserts, on the same page, "Indeed, I believe that his +practice in that department of the profession was greater than that +of any other gentleman, which was probably the cause of his seeing a +greater number of the cases." This from a professor of midwifery, +who some time ago assured a gentleman whom he met in consultation, +that the night on which they met was the eighteenth in succession +that he himself had been summoned from his repose, seems hardly +satisfactory. + +I must call the attention of the inquirer most particularly to the +(Quarterly Report above referred to, and the letters of Dr. Meigs and +Dr. Rutter, to be found in the "Medical Examiner." Whatever +impression they may produce upon his mind, I trust they will at least +convince him that there is some reason for looking into this +apparently uninviting subject. + +At a meeting of the College of Physicians just mentioned, Dr. +Warrington stated, that a few days after assisting at an autopsy of +puerperal peritonitis, in which he laded out the contents of the +abdominal cavity with his hands, he was called upon to deliver three +women in rapid succession. All of these women were attacked with +different forms of what is commonly called puerperal fever. Soon +after these he saw two other patients, both on the same day, with the +same disease. Of these five patients two died. + +At the same meeting, Dr. West mentioned a fact related to him by Dr. +Samuel Jackson of Northumberland. Seven females, delivered by Dr. +Jackson in rapid succession, while practising in Northumberland +County, were all attacked with puerperal fever, and five of them +died. "Women," he said, "who had expected me to attend upon them, +now becoming alarmed, removed out of my reach, and others sent for a +physician residing several miles distant. These women, as well as +those attended by midwives; all did well; nor did we hear of any +deaths in child-bed within a radius of fifty miles, excepting two, +and these I afterwards ascertained to have been caused by other +diseases." He underwent, as he thought, a thorough purification, and +still his next patient was attacked with the disease and died. He +was led to suspect that the contagion might have been carried in the +gloves which he had worn in attendance upon the previous cases. Two +months or more after this he had two other cases. He could find +nothing to account for these, unless it were the instruments for +giving enemata, which had been used in two of the former cases, and +were employed by these patients. When the first case occurred, he +was attending and dressing a limb extensively mortified from +erysipelas, and went immediately to the accouchement with his clothes +and gloves most thoroughly imbued with its efluvia. And here I may +mention, that this very Dr. Samuel Jackson of Northumberland is one +of Dr. Dewees's authorities against contagion. + +The three following statements are now for the first time given to +the public. All of the cases referred to occurred within this State, +and two of the three series in Boston and its immediate vicinity. + +I. The first is a series of cases which took place during the last +spring in a town at some distance from this neighborhood. A +physician of that town, Dr. C., had the following consecutive cases. + +No. 1, delivered March 20, died March 24. + " 2, " April 9, " April 14. + " 3, " " 10, " " 14. + " 4, " " 11, " " 18. + " 5, " " 27, " May 3. + " 6, " " 28, had some symptoms,(recovered.) + " 7, " May 8, had some symptoms,(also recovered.) + +These were the only cases attended by this physician during the +period referred to. "They were all attended by him until their +termination, with the exception of the patient No. 6, who fell into +the hands of another physician on the 2d of May. (Dr. C. left town +for a few days at this time.) Dr. C. attended cases immediately +before and after the above-named periods, none of which, however, +presented any peculiar symptoms of the disease. + +About the 1st of July he attended another patient in a neighboring +village, who died two or three days after delivery. + +The first patient, it is stated, was delivered on the 20th of March. +"On the 19th, Dr. C. made the autopsy of a man who died suddenly, +sick only forty-eight hours; had oedema of the thigh, and gangrene +extending from a little above the ankle into the cavity of the +abdomen." Dr. C. wounded himself, very slightly, in the right hand +during the autopsy. The hand was quite painful the night following, +during his attendance on the patient No. 1. He did not see this +patient after the 20th, being confined to the house, and very sick +from the wound just mentioned, from this time until the 3d of April. + +Several cases of erysipelas occurred in the house where the autopsy +mentioned above took place, soon after the examination. There were +also many cases of erysipelas in town at the time of the fatal +puerperal cases which have been mentioned. + +The nurse who laid out the body of the patient No. 3 was taken on the +evening of the same day with sore throat and erysipelas, and died in +ten days from the first attack. + +The nurse who laid out the body of the patient No. 4 was taken on the +day following with symptoms like those of this patient, and died in a +week, without any external marks of erysipelas. + +"No other cases of similar character with those of Dr. C. occurred in +the practice of any of the physicians in the town or vicinity at the +time. Deaths following confinement have occurred in the practice of +other physicians during the past year, but they were not cases of +puerperal fever. No post-mortem examinations were held in any of +these puerperal cases." + +Some additional statements in this letter are deserving of insertion. + +"A physician attended a woman in the immediate neighborhood of the +cases numbered 2, 3, and 4. This patient was confined the morning of +March 1st, and died on the night of March 7th. It is doubtful +whether this should be considered a case of puerperal fever. She had +suffered from canker, indigestion, and diarrhoea for a year previous +to her delivery. Her complaints were much aggravated for two or +three months previous to delivery; she had become greatly emaciated, +and weakened to such an extent that it had not been expected that she +would long survive her confinement, if indeed she reached that +period. Her labor was easy enough; she flowed a good deal, seemed +exceedingly prostrated, had ringing in the ears, and other symptoms +of exhaustion; the pulse was quick and small. On the second and +third day there was some tenderness and tumefaction of the abdomen, +which increased somewhat on the fourth and fifth. He had cases in +midwifery before and after this, which presented nothing peculiar." + +It is also mentioned in the same letter, that another physician had a +case during the last summer and another last fall, both of which +recovered. + +Another gentleman reports a case last December, a second case five +weeks, and another three weeks since. All these recovered. A case +also occurred very recently in the practice of a physician in the +village where the eighth patient of Dr. C. resides, which proved +fatal. "This patient had some patches of erysipelas on the legs and +arms. The same physician has delivered three cases since, which have +all done well. There have been no other cases in this town or its +vicinity recently. There have been some few cases of erysipelas." +It deserves notice that the partner of Dr. C., who attended the +autopsy of the man above mentioned and took an active part in it; who +also suffered very slightly from a prick under the thumb-nail +received during the examination, had twelve cases of midwifery +between March 26th and April 12th, all of which did well, and +presented no peculiar symptoms. It should also be stated, that +during these seventeen days he was in attendance on all the cases of +erysipelas in the house where the autopsy had been performed. + +I owe these facts to the prompt kindness of a gentleman whose +intelligence and character are sufficient guaranty for their +accuracy. + +The two following letters were addressed to my friend Dr. Scorer, by +the gentleman in whose practice the cases of puerperal fever +occurred. His name renders it unnecessary to refer more particularly +to these gentlemen, who on their part have manifested the most +perfect freedom and courtesy in affording these accounts of their +painful experience. + + +"January 28, 1843. + +II. . . . "The time to which you allude was in 1830. The first +case was in February, during a very cold time. She was confined the +4th, and died the 12th. Between the 10th and 28th of this month, I +attended six women in labor, all of whom did well except the last, as +also two who were confined March 1st and 5th. Mrs. E., confined +February 28th, sickened, and died March 8th. The next day, 9th, I +inspected the body, and the night after attended a lady, Mrs. B., who +sickened, and died 16th. The 10th, I attended another, Mrs. G., who +sickened, but recovered. March 16th, I went from Mrs. G.'s room to +attend a Mrs. H., who sickened, and died 21st. The 17th, I inspected +Mrs. B. On the 19th, I went directly from Mrs. H.'s room to attend +another lady, Mrs. G., who also sickened, and died 22d. While Mrs. +B. was sick, on 15th, I went directly from her room a few rods, and +attended another woman, who was not sick. Up to 20th of this month I +wore the same clothes. I now refused to attend any labor, and did +not till April 21st, when, having thoroughly cleansed myself, I +resumed my practice, and had no more puerperal fever. + +"The cases were not confined to a narrow space. The two nearest were +half a mile from each other, and half that distance from my +residence. The others were from two to three miles apart, and nearly +that distance from my residence. There were no other cases in their +immediate vicinity which came to my knowledge. The general health of +all the women was pretty good, and all the labors as good as common, +except the first. This woman, in consequence of my not arriving in +season, and the child being half-born at some time before I arrived, +was very much exposed to the cold at the time of confinement, and +afterwards, being confined in a very open, cold room. Of the six +cases you perceive only one recovered. + +"In the winter of 1817 two of my patients had puerperal fever, one +very badly, the other not so badly. Both recovered. One other had +swelled leg, or phlegmasia dolens, and one or two others did not +recover as well as usual. + +"In the summer of 1835 another disastrous period occurred in my +practice. July 1st, I attended a lady in labor, who was afterwards +quite ill and feverish; but at the time I did not consider her case a +decided puerperal fever. On the 8th, I attended one who did well. +On the 12th, one who was seriously sick. This was also an equivocal +case, apparently arising from constipation and irritation of the +rectum. These women were ten miles apart and five from my residence. +On 15th and 20th, two who did well. On 25th, I attended another. +This was a severe labor, and followed by unequivocal puerperal fever, +or peritonitis. She recovered. August 2d and 3d, in about twenty- +four hours I attended four persons. Two of them did very well; one +was attacked with some of the common symptoms, which however subsided +in a day or two, and the other had decided puerperal fever, but +recovered. This woman resided five miles from me. Up to this time I +wore the same coat. All my other clothes had frequently been +changed. On 6th, I attended two women, one of whom was not sick at +all; but the other, Mrs. L., was afterwards taken ill. On 10th, I +attended a lady, who did very well. I had previously changed all my +clothes, and had no garment on which had been in a puerperal room. +On 12th, I was called to Mrs. S., in labor. While she was ill, I +left her to visit Mrs. L., one of the ladies who was confined on 6th. +Mrs. L. had been more unwell than usual, but I had not considered +her case anything more than common till this visit. I had on a +surtout at this visit, which, on my return to Mrs. S., I left in +another room. Mrs. S. was delivered on 13th with forceps. These +women both died of decided puerperal fever. + +"While I attended these women in their fevers, I changed my clothes, +and washed my hands in a solution of chloride of lime after each +visit. I attended seven women in labor during this period, all of +whom recovered without sickness. + +"In my practice I have had several single cases of puerperal fever, +some of whom have died and some have recovered. Until the year 1830 +I had no suspicion that the disease could be communicated from one +patient to another by a nurse or midwife; but I now think the +foregoing facts strongly favor that idea. I was so much convinced of +this fact, that I adopted the plan before related. + +"I believe my own health was as good as usual at each of the above +periods. I have no recollections to the contrary. + +"I believe I have answered all your questions. I have been more +particular on some points perhaps than necessary; but I thought you +could form your own opinion better than to take mine. In 1830 I +wrote to Dr. Charming a more particular statement of my cases. If I +have not answered your questions sufficiently, perhaps Dr. C. may +have my letter to him, and you can find your answer there." [In a +letter to myself, this gentleman also stated, "I do not recollect +that there was any erysipelas or any other disease particularly +prevalent at the time."] + + +"BOSTON, February 3, 1843. + +III. "MY DEAR SIR,--I received a note from you last evening, +requesting me to answer certain questions therein proposed, touching +the cases of puerperal fever which came under my observation the past +summer. It gives me pleasure to comply with your request, so far as +it is in my power so to do, but, owing to the hurry in preparing for +a journey, the notes of the cases I had then taken were lost or +mislaid. The principal facts, however, are too vivid upon my +recollection to be soon forgotten. I think, therefore, that I shall +be able to give you all the information you may require. + +"All the cases that occurred in my practice took place between the +7th of May and the 17th of June 1842. + +"They were not confined to any particular part of the city. The +first two cases were patients residing at the South End, the next was +at the extreme North End, one living in Sea Street and the other in +Roxbury. The following is the order in which they occurred: + +"Case 1. Mrs._____ was confined on the 7th of May, at 5 o'clock, +P. M., after a natural labor of six hours. At 12 o'clock at night, +on the 9th (thirty-one hours after confinement), she was taken with +severe chill, previous to which she was as comfortable as women +usually are under the circumstances. She died on the 10th. + +"Case 2. Mrs._____ was confined on the 10th of June (four weeks +after Mrs. C.), at 11 A. M., after a natural, but somewhat severe +labor of five hours. At 7 o'clock, on the morning of the 11th, she +had a chill. Died on the 12th. + +"Case 3. Mrs._____ , confined on the 14th of June, was comfortable +until the 18th, when symptoms of puerperal fever were manifest. She +died on the 20th. + +"Case 4. Mrs._____ , confined June 17th, at 5 o'clock, A. M., was +doing well until the morning of the 19th. She died on the evening of +the 21st. + +"Case 5. Mrs._____ was confined with her fifth child on the 17th of +June, at 6 o'clock in the evening. This patient had been attacked +with puerperal fever, at three of her previous confinements, but the +disease yielded to depletion and other remedies without difficulty. +This time, I regret to say, I was not so fortunate. She was not +attacked, as were the other patients, with a chill, but complained of +extreme pain in abdomen, and tenderness on pressure, almost from the +moment of her confinement. In this as in the other cases, the +disease resisted all remedies, and she died in great distress on the +22d of the same month. Owing to the extreme heat of the season, and +my own indisposition, none of the subjects were examined after death. +Dr. Channing, who was in attendance with me on the three last cases, +proposed to have a post-mortem examination of the subject of case No. +5, but from some cause which I do not now recollect it was not +obtained. + +"You wish to know whether I wore the same clothes when attending the +different cases. I cannot positively say, but I should think I did +not, as the weather became warmer after the first two cases; I +therefore think it probable that I made a change of at least a part +of my dress. I have had no other case of puerperal fever in my own +practice for three years, save those above related, and I do not +remember to have lost a patient before with this disease. While +absent, last July, I visited two patients sick with puerperal fever, +with a friend of mine in the country. Both of them recovered. + +"The cases that I have recorded were not confined to any particular +constitution or temperament, but it seized upon the strong and the +weak, the old and the young,--one being over forty years, and the +youngest under eighteen years of age . . . . If the disease is of +an erysipelatous nature, as many suppose, contagionists may perhaps +find some ground for their belief in the fact, that, for two weeks +previous to my first case of puerperal fever, I had been attending a +severe case of erysipelas, and the infection may have been conveyed +through me to the patient; but, on the other hand, why is not this +the case with other physicians, or with the same physician at all +times, for since my return from the country I have had a more +inveterate case of erysipelas than ever before, and no difficulty +whatever has attended any of my midwifery cases?" + + +I am assured, on unquestionable authority, that "About three years +since, a gentleman in extensive midwifery business, in a neighboring +State, lost in the course of a few weeks eight patients in child-bed, +seven of them being undoubted cases of puerperal fever. No other +physician of the town lost a single patient of this disease during +the same period." And from what I have heard in conversation with +some of our most experienced practitioners, I am inclined to think +many cases of the kind might be brought to light by extensive +inquiry. + + +This long catalogue of melancholy histories assumes a still darker +aspect when we remember how kindly nature deals with the parturient +female, when she is not immersed in the virulent atmosphere of an +impure lying-in hospital, or poisoned in her chamber by the +unsuspected breath of contagion. From all causes together, not more +than four deaths in a thousand births and miscarriages happened in +England and Wales during the period embraced by the first Report of +the Registrar-General." In the second Report the mortality was shown +to be about five in one thousand. In the Dublin Lying-in Hospital, +during the seven years of Dr. Collins's mastership, there was one +case of puerperal fever to 178 deliveries, or less than six to the +thousand, and one death from this disease in 278 cases, or between +three and four to the thousand a yet during this period the disease +was endemic in the hospital, and might have gone on to rival the +horrors of the pestilence of the Maternite, had not the poison been +destroyed by a thorough purification. + +In private practice, leaving out of view the cases that are to be +ascribed to the self-acting system of propagation, it would seem that +the disease must be far from common. Mr. White of Manchester says, +"Out of the whole number of lying-in patients whom I have delivered +(and I may safely call it a great one), I have never lost one, nor to +the best of my recollection has one been greatly endangered, by the +puerperal, miliary, low nervous, putrid malignant, or milk fever." +Dr. Joseph Clarke informed Dr. Collins, that in the course of forty- +five years' most extensive practice he lost but four patients from +this disease. One of the most eminent practitioners of Glasgow, who +has been engaged in very extensive practice for upwards of a quarter +of a century, testifies that he never saw more than twelve cases of +real puerperal fever.[Lancet, May 4, 1833] + +I have myself been told by two gentlemen practising in this city, and +having for many years a large midwifery business, that they had +neither of them lost a patient from this disease, and by one of them +that he had only seen it in consultation with other physicians. In +five hundred cases of midwifery, of which Dr. Storer has given an +abstract in the first number of this Journal, there was only one +instance of fatal puerperal peritonitis. + +In the view of these facts, it does appear a singular coincidence, +that one man or woman should have ten, twenty, thirty, or seventy +cases of this rare disease following his or her footsteps with the +keenness of a beagle, through the streets and lanes of a crowded +city, while the scores that cross the same paths on the same errands +know it only by name. It is a series of similar coincidences which +has led us to consider the dagger, the musket, and certain innocent- +looking white powders as having some little claim to be regarded as +dangerous. It is the practical inattention to similar coincidences +which has given rise to the unpleasant but often necessary documents +called indictments, which has sharpened a form of the cephalotome +sometimes employed in the case of adults, and adjusted that +modification of the fillet which delivers the world of those who +happen to be too much in the way while such striking coincidences are +taking place. + +I shall now mention a few instances in which the disease appears to +have been conveyed by the process of direct inoculation. + +Dr. Campbell of Edinburgh states that in October, 1821, he assisted +at the post-mortem examination of a patient who died with puerperal +fever. He carried the pelvic viscera in his pocket to the class- +room. The same evening he attended a woman in labor without +previously changing his clothes; this patient died. The next morning +he delivered a woman with the forceps; she died also, and of many +others who were seized with the disease within a few weeks, three +shared the same fate in succession. + +In June, 1823, he assisted some of his pupils at the autopsy of a +case of puerperal fever. He was unable to wash his hands with proper +care, for want of the necessary accommodations. On getting home he +found that two patients required his assistance. He went without +further ablution, or changing his clothes; both these patients died +with puerperal fever. This same Dr. Campbell is one of Dr. +Churchill's authorities against contagion. + +Mr. Roberton says that in one instance within his knowledge a +practitioner passed the catheter for a patient with puerperal fever +late in the evening; the same night he attended a lady who had the +symptoms of the disease on the second day. In another instance a +surgeon was called while in the act of inspecting the body of a woman +who had died of this fever, to attend a labor; within forty-eight +hours this patient was seized with the fever.' + +On the 16th of March, 1831, a medical practitioner examined the body +of a woman who had died a few days after delivery, from puerperal +peritonitis. On the evening of the 17th he delivered a patient, who +was seized with puerperal fever on the 19th, and died on the 24th. +Between this period and the 6th of April, the same practitioner +attended two other patients, both of whom were attacked with the same +disease and died. + +In the autumn of 1829 a physician was present at the examination of a +case of puerperal fever, dissected out the organs, and assisted in +sewing up the body. He had scarcely reached home when he was +summoned to attend a young lady in labor. In sixteen hours she was +attacked with the symptoms of puerperal fever, and narrowly escaped +with her life. + +In December, 1830, a midwife, who had attended two fatal cases of +puerperal fever at the British Lying-in Hospital, examined a patient +who had just been admitted, to ascertain if labor had commenced. +This patient remained two days in the expectation that labor would +come on, when she returned home and was then suddenly taken in labor +and delivered before she could set out for the hospital. She went on +favorably for two days, and was then taken with puerperal fever and +died in thirty-six hours. + +"A young practitioner, contrary to advice, examined the body of a +patient who had died from puerperal fever; there was no epidemic at +the time; the case appeared to be purely sporadic. He delivered +three other women shortly afterwards; they all died with puerperal +fever, the symptoms of which broke out very soon after labor. The +patients of his colleague did well, except one, where he assisted to +remove some coagula from the uterus; she was attacked in the same +manner as those whom he had attended, and died also." The writer in +the "British and Foreign Medical Review," from whom I quote this +statement,--and who is no other than Dr. Rigby, adds, "We trust that +this fact alone will forever silence such doubts, and stamp the well- +merited epithet of 'criminal,' as above quoted, upon such attempts." +[Brit. and For. Medical Review for Jan. 1842, p. 112.] + +>From the cases given by Mr. Ingleby, I select the following. Two +gentlemen, after having been engaged in conducting the post-mortem +examination of a case of puerperal fever, went in the same dress, +each respectively, to a case of midwifery. "The one patient was +seized with the rigor about thirty hours afterwards. The other +patient was seized with a rigor the third morning after delivery. +One recovered, one died." [Edin. Med. and Surg. Journal, April, +1838.] + +One of these same gentlemen attended another woman in the same +clothes two days after the autopsy referred to. "The rigor did not +take place until the evening of the fifth day from the first visit. +Result fatal." These cases belonged to a series of seven, the first +of which was thought to have originated in a case of erysipelas. +"Several cases of a mild character followed the foregoing seven, and +their nature being now most unequivocal, my friend declined visiting +all midwifery cases for a time, and there was no recurrence of the +disease." These cases occurred in 1833. Five of them proved fatal. +Mr. Ingleby gives another series of seven eases which occurred to a +practitioner in 1836, the first of which was also attributed to his +having opened several erysipelatous abscesses a short time +previously. + +I need not refer to the case lately read before this Society, in +which a physician went, soon after performing an autopsy of a case of +puerperal fever, to a woman in labor, who was seized with the same +disease and perished. The forfeit of that error has been already +paid. + +At a meeting of the Medical and Chirurgical Society before referred +to, Dr. Merriman related an instance occurring in his own practice, +which excites a reasonable suspicion that two lives were sacrificed +to a still less dangerous experiment. He was at the examination of a +case of puerperal fever at two o'clock in the afternoon. He took +care not to touch the body. At nine o'clock the same evening he +attended a woman in labor; she was so nearly delivered that he had +scarcely anything to do. The next morning she had severe rigors, and +in forty-eight hours she was a corpse. Her infant had erysipelas and +died in two days. [Lancet, May 2, 1840.] + +In connection with the facts which have been stated, it seems proper +to allude to the dangerous and often fatal effects which have +followed from wounds received in the post-mortem examination of +patients who have died of puerperal fever. The fact that such wounds +are attended with peculiar risk has been long noticed. I find that +Chaussier was in the habit of cautioning his students against the +danger to which they were exposed in these dissections. [Stein, L'Art +d'Accoucher, 1794; Dict. des Sciences Medicales, art. "Puerperal."] +The head pharmacien of the Hotel Dieu, in his analysis of the fluid +effused in puerperal peritonitis, says that practitioners are +convinced of its deleterious qualities, and that it is very dangerous +to apply it to the denuded skin. [Journal de Pharmacie, January, +1836.] Sir Benjamin Brodie speaks of it as being well known that the +inoculation of lymph or pus from the peritoneum of a puerperal +patient is often attended with dangerous and even fatal symptoms. +Three cases in confirmation of this statement, two of them fatal, +have been reported to this Society within a few months. + +Of about fifty cases of injuries of this kind, of various degrees of +severity, which I have collected from different sources, at least +twelve were instances of infection from puerperal peritonitis. Some +of the others are so stated as to render it probable that they may +have been of the same nature. Five other cases were of peritoneal +inflammation; three in males. Three were what was called enteritis, +in one instance complicated with erysipelas; but it is well known +that this term has been often used to signify inflammation of the +peritoneum covering the intestines. On the other hand, no case of +typhus or typhoid fever is mentioned as giving rise to dangerous +consequences, with the exception of the single instance of an +undertaker mentioned by Mr. Travers, who seems to have been poisoned +by a fluid which exuded from the body. The other accidents were +produced by dissection, or some other mode of contact with bodies of +patients who had died of various affections. They also differed much +in severity, the cases of puerperal origin being among the most +formidable and fatal. Now a moment's reflection will show that the +number of cases of serious consequences ensuing from the dissection +of the bodies of those who had perished of puerperal fever is so +vastly disproportioned to the relatively small number of autopsies +made in this complaint as compared with typhus or pneumonia (from +which last disease not one case of poisoning happened), and still +more from all diseases put together, that the conclusion is +irresistible that a most fearful morbid poison is often generated in +the course of this disease. Whether or not it is sui generis, +confined to this disease, or produced in some others, as, for +instance, erysipelas, I need, not stop to inquire. + +In connection with this may be taken the following statement of Dr. +Rigby. "That the discharges from a patient under puerperal fever are +in the highest degree contagious we have abundant evidence in the +history of lying-in hospitals. The puerperal abscesses are also +contagious, and may be communicated to healthy lying-in women by +washing with the same sponge; this fact has been repeatedly proved in +the Vienna Hospital; but they are equally communicable to women not +pregnant; on more than one occasion the women engaged in washing the +soiled bed-linen of the General Lying-in Hospital have been attacked +with abscess in the fingers or hands, attended with rapidly spreading +inflammation of the cellular tissue." + +Now add to all this the undisputed fact, that within the walls of +lying-in hospitals there is often generated a miasm, palpable as the +chlorine used to destroy it, tenacious so as in some cases almost to +defy extirpation, deadly in some institutions as the plague; which +has killed women in a private hospital of London so fast that they +were buried two in one coffin to conceal its horrors; which enabled +Tonnelle to record two hundred and twenty-two autopsies at the +Maternite of Paris; which has led Dr. Lee to express his deliberate +conviction that the loss of life occasioned by these institutions +completely defeats the objects of their founders; and out of this +train of cumulative evidence, the multiplied groups of cases +clustering about individuals, the deadly results of autopsies, the +inoculation by fluids from the living patient, the murderous poison +of hospitals, -does there not result a conclusion that laughs all +sophistry to scorn, and renders all argument an insult? + +I have had occasion to mention some instances in which there was an +apparent relation between puerperal fever and erysipelas. The length +to which this paper has extended does not allow me to enter into the +consideration of this most important subject. I will only say, that +the evidence appears to me altogether satisfactory that some most +fatal series of puerperal fever have been produced by an infection +originating in the matter or effluvia of erysipelas. In evidence of +some connection between the two diseases, I need not go back to the +older authors, as Pouteau or Gordon, but will content myself with +giving the following references, with their dates; from which it will +be seen that the testimony has been constantly coming before the +profession for the last few years. + +"London Cyclopaedia of Practical Medicine," article Puerperal Fever, +1833. + +Mr. Ceeley's Account of the Puerperal Fever at Aylesbury. "Lancet," +1835. + +Dr. Ramsbotham's Lecture. "London Medical Gazette," 1835. + +Mr. Yates Ackerly's Letter in the same Journal, 1838. + +Mr. Ingleby on Epidemic Puerperal Fever. "Edinburgh Medical and +Surgical Journal," 1838. + +Mr. Paley's Letter. "London Medical Gazette," 1839. + +Remarks at the Medical and Chirurgical Society. "Lancet," 1840. + +Dr. Rigby's "System of Midwifery." 1841. + +"Nunneley on Erysipelas,"--a work which contains a large number of +references on the subject. 1841. + +"British and Foreign Quarterly Review," 1842. + +Dr. S. Jackson of Northumberland, as already quoted from the Summary +of the College of Physicians, 1842. + +And lastly, a startling series of cases by Mr. Storrs of Doncaster, +to be, found in the "American Journal of the Medical Sciences" for +January, 1843. + +The relation of puerperal fever with other continued fevers would +seem to be remote and rarely obvious. Hey refers to two cases of +synochus occurring in the Royal Infirmary of Edinburgh, in women who +had attended upon puerperal patients. Dr. Collins refers to several +instances in which puerperal fever has appeared to originate from a +continued proximity to patients suffering with typhus. + +Such occurrences as those just mentioned, though most important to be +remembered and guarded against, hardly attract our notice in the +midst of the gloomy facts by which they are surrounded. Of these +facts, at the risk of fatiguing repetitions, I have summoned a +sufficient number, as I believe, to convince the most incredulous +that every attempt to disguise the truth which underlies them all is +useless. + +It is true that some of the historians of the disease, especially +Hulme, Hull, and Leake, in England; Tonnelle, Duges, and Baudelocque, +in France, profess not to have found puerperal fever contagious. At +the most they give us mere negative facts, worthless against an +extent of evidence which now overlaps the widest range of doubt, and +doubles upon itself in the redundancy of superfluous demonstration. +Examined in detail, this and much of the show of testimony brought up +to stare the daylight of conviction out of countenance, proves to be +in a great measure unmeaning and inapplicable, as might be easily +shown were it necessary. Nor do I feel the necessity of enforcing +the conclusion which arises spontaneously from the facts which have +been enumerated, by formally citing the opinions of those grave +authorities who have for the last half-century been sounding the +unwelcome truth it has cost so many lives to establish. + +"It is to the British practitioner," says Dr. Rigby, "that we are +indebted for strongly insisting upon this important and dangerous +character of puerperal fever." + +The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton, +Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee, +Ingleby, Locock, Abercrombie, Alison; Travers, Rigby, and Watson, +many of whose writings I have already referred to, may have some +influence with those who prefer the weight of authorities to the +simple deductions of their own reason from the facts laid before +them. A few Continental writers have adopted similar conclusions. It +gives me pleasure to remember, that while the doctrine has been +unceremoniously discredited in one of the leading Journals, and made +very light of by teachers in two of the principal Medical Schools, of +this country, Dr. Channing has for many years inculcated, and +enforced by examples, the danger to be apprehended and the +precautions to be taken in the disease under consideration. + +I have no wish to express any harsh feeling with regard to the +painful subject which has come before us. If there are any so far +excited by the story of these dreadful events that they ask for some +word of indignant remonstrance to show that science does not turn the +hearts of its followers into ice or stone, let me remind them that +such words have been uttered by those who speak with an authority I +could not claim. It is as a lesson rather than as a reproach that I +call up the memory of these irreparable errors and wrongs. No tongue +can tell the heart-breaking calamity they have caused; they have +closed the eyes just opened upon a new world of love and happiness; +they have bowed the strength of manhood into the dust; they have cast +the helplessness of infancy into the stranger's arms, or bequeathed +it, with less cruelty, the death of its dying parent. There is no +tone deep enough for regret, and no voice loud enough for warning. +The woman about to become a mother, or with her new-born infant upon +her bosom, should be the object of trembling care and sympathy +wherever she bears her tender burden, or stretches her aching limbs. +The very outcast of the streets has pity upon her sister in +degradation, when the seal of promised maternity is impressed upon +her. The remorseless vengeance of the law, brought down upon its +victim by a machinery as sure as destiny, is arrested in its fall at +a word which reveals her transient claim for mercy. The solemn +prayer of the liturgy singles out her sorrows from the multiplied +trials of life, to plead for her in the hour of peril. God forbid +that any member of the profession to which she trusts her life, +doubly precious at that eventful period, should hazard it +negligently, unadvisedly, or selfishly! + +There may be some among those whom I address who are disposed to ask +the question, What course are we to follow in relation to this +matter? The facts are before them, and the answer must be left to +their own judgment and conscience. If any should care to know my own +conclusions, they are the following; and in taking the liberty to +state them very freely and broadly, I would ask the inquirer to +examine them as freely in the light of the evidence which has been +laid before him. + +1. A physician holding himself in readiness to attend cases of +midwifery should never take any active part in the post-mortem +examination of cases of puerperal fever. + +2. If a physician is present at such autopsies, he should use +thorough ablution, change every article of dress, and allow twenty- +four hours or more to elapse before attending to any case of +midwifery. It may be well to extend the same caution to cases of +simple peritonitis. + +3. Similar precautions should be taken after the autopsy or surgical +treatment of cases of erysipelas, if the physician is obliged to +unite such offices with his obstetrical duties, which is in the +highest degree inexpedient. + +4. On the occurrence of a single case of puerperal fever in his +practice, the physician is bound to consider the next female he +attends in labor, unless some weeks at least have elapsed, as in +danger of being infected by him, and it is his duty to take every +precaution to diminish her risk of disease and death. + +5. If within a short period two cases of puerperal fever happen +close to each other, in the practice of the same physician, the +disease not existing or prevailing in the neighborhood, he would do +wisely to relinquish his obstetrical practice for at least one month, +and endeavor to free himself by every available means from any +noxious influence he may carry about with him. + +6. The occurrence of three or more closely connected cases, in the +practice of one individual, no others existing in the neighborhood, +and no other sufficient cause being alleged for the coincidence, is +prima facie evidence that he is the vehicle of contagion. + +7. It is the duty of the physician to take every precaution that the +disease shall not be introduced by nurses or other assistants, by +making proper inquiries concerning them, and giving timely warning of +every suspected source of danger. + +8. Whatever indulgence may be granted to those who have heretofore +been the ignorant causes of so much misery, the time has come when +the existence of a private pestilence in the sphere of a single +physician should be looked upon, not as a misfortune, but a crime; +and in the knowledge of such occurrences the duties of the +practitioner to his profession should give way to his paramount +obligations to society. + + +ADDITIONAL REFERENCES AND CASES. + +Fifth Annual Report of the Registrar-General of England, + +1843. Appendix. Letter from William Farr, Esq. --Several new series +of cases are given in the Letter of Mr. Stows, contained in the +Appendix to this Report. Mr. Stows suggests precautions similar to +those I have laid down, and these precautions are strongly enforced +by Mr. Farr, who is, therefore, obnoxious to the same criticisms as +myself. + +Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844.- +Cases of puerperal fever seeming to originate in erysipelas. + +Elkington, of Birmingham, in Provincial Med. Journal, cited in Am. +Journ. Med. Se. for April, 1844.--Six cases in less than a +fortnight, seeming to originate in a case of erysipelas. + +West's Reports, in Brit. and For. Med. Review for October, 1845, +and January, 1847.--Affection of the arm, resembling malignant +pustule, after removing the placenta of a patient who died from +puerperal fever. Reference to cases at Wurzburg, as proving +contagion, and to Keiller's cases in the Monthly Journal for +February, 1846, as showing connection of puerperal fever and +erysipelas. + +Kneeland. --Contagiousness of Puerperal Fever. Am. Jour. Med. +Se., January, 1846. Also, Connection between Puerperal Fever and +Epidemic Erysipelas. Ibid., April, 1846. + +Robert Storrs. --Contagious Effects of Puerperal Fever on the Male +Subject; or on Persons not Child-bearing. (From Provincial Med. and +Surg. Journal.) Am. Jour. Med. Sc., January, 184,6. Numerous +cases. See also Dr. Reid's case in same Journal for April, 1846. + +Routh's paper in Proc. of Royal Med. Chir. Soc., Am. Jour. Med. +Sc., April, 1849, also in B. and F. Med. Chir. Review, April, +1850. + +Hill, of Leuchars. --A Series of Cases illustrating the Contagious +Nature of Erysipelas and of Puerperal Fever, and their Intimate +Pathological Connection. (From Monthly Journal of Med. Sc.) Am. +Jour. Med. Se., July, 1850. + +Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, +from inoculation with different morbid secretions.) Am. Jour. Med. +Se., October, 1850. + +Arneth. Paper read before the National Academy of Medicine. Annales +d'Hygiene, Tome LXV. 2e Partie. (Means of Disinfection proposed by +M. "Semmeliveis" (Semmelweiss.) Lotions of chloride of lime and use +of nail-brush before admission to lying-in wards. Alleged sudden and +great decrease of mortality from puerperal fever. Cause of disease +attributed to inoculation with cadaveric matters.) See also Routh's +paper, mentioned above. + +Moir. Remarks at a meeting of the Edinburgh Medico-Chirurgical +Society. Refers to cases of Dr. Kellie, of Leith. Sixteen in +succession, all fatal. Also to several instances of individual +pupils having had a succession of cases in various quarters of the +town, while others, practising as extensively in the same localities, +had none. Also to several special cases not mentioned elsewhere. +Am. Jour. Med. Se. for October, 1851. (From New Monthly Journal +of Med. Science.) + +Simpson. --Observations at a Meeting of the Edinburgh Obstetrical +Society. (An "eminent gentleman," according to Dr. Meigs, whose +"name is as well known in America as in (his) native land." +Obstetrics. Phil. 1852, pp. 368, 375.) The student is referred to +this paper for a valuable resume of many of the facts, and the +necessary inferences, relating to this subject. Also for another +series of cases, Mr. Sidey's, five or six in rapid succession. +Dr. Simpson attended the dissection of two of Dr. Sidey's cases, and +freely handled the diseased parts. His next four child-bed patients +were affected with puerperal fever, and it was the first time he had +seen it in practice. As Dr. Simpson is a gentleman (Dr. Meigs, as +above), and as "a gentleman's hands are clean " (Dr. Meigs' Sixth +Letter), it follows that a gentleman with clean hands may carry the +disease. Am. Jour. Med. Sc., October, 1851. + +Peddle. --The five or six cases of Dr. Sidey, followed by the four of +Dr. Simpson, did not end the series. A practitioner in Leith having +examined in Dr. Simpson's house, a portion of the uterus obtained +from one of the patients, had immediately afterwards three fatal +cases of puerperal fever. Dr. Veddie referred to two distinct +series of consecutive cases in his own practice. He had since taken +precautions, and not met with any such cases. Am. Jour. Med. Sc., +October, 1851. + +Copland. Considers it proved that puerperal fever maybe propagated +by the hands and the clothes, or either, of a third person, the bed- +clothes or body-clothes of a patient. Mentions a new series of +cases, one of which he saw, with the practitioner who had attended +them. She was the sixth he had had within a few days. All died. +Dr. Copland insisted that contagion had caused these cases; advised +precautionary measures, and the practitioner had no other cases for a +considerable time. Considers it criminal, after the evidence +adduced,--which he could have quadrupled,--and the weight of +authority brought forward, for a practitioner to be the medium of +transmitting contagion and death to his patients. Dr. Copland lays +down rules similar to those suggested by myself, and is therefore +entitled to the same epithet for so doing. Medical Dictionary, New +York, 1852. Article, Puerperal States and Diseases. + +If there is any appetite for facts so craving as to be yet +unappeased,--Lesotho, necdum satiata,--more can be obtained. +Dr. Hodge remarks that "the frequency and importance of this +singular circumstance (that the disease is occasionally more +prevalent with one practitioner than another) has been exceedingly +overrated." More than thirty strings of cases, more than two hundred +and fifty sufferers from puerperal fever, more than one hundred and +thirty deaths appear as the results of a sparing estimate of such +among the facts I have gleaned as could be numerically valued. These +facts constitute, we may take it for granted, but a small fraction of +those that have actually occurred. The number of them might be +greater, but "'t is enough, 't will serve," in Mercutio's modest +phrase, so far as frequency is concerned. For a just estimate of the +importance of the singular circumstance, it might be proper to +consult the languid survivors, the widowed husbands, and the +motherless children, as well as "the unfortunate accoucheur." + + + + + + +III + +CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE + +An Address delivered before the Massachusetts Medical Society, at the +Annual Meeting, May 30, 1860. + + "Facultate magis quam violentia. + HIPPOCRATES. + +Our Annual Meeting never fails to teach us at least one lesson. The +art whose province it is to heal and to save cannot protect its own +ranks from the inroads of disease and the waste of the Destroyer. + +Seventeen of our associates have been taken from us since our last +Anniversary. Most of them followed their calling in the villages or +towns that lie among the hills or along the inland streams. Only +those who have lived the kindly, mutually dependent life of the +country, can tell how near the physician who is the main reliance in +sickness of all the families throughout a thinly settled region comes +to the hearts of the people among whom he labors, how they value him +while living, how they cherish his memory when dead. For these +friends of ours who have gone before, there is now no more toil; they +start from their slumbers no more at the cry of pain; they sally +forth no more into the storms; they ride no longer over the lonely +roads that knew them so well; their wheels are rusting on their axles +or rolling with other burdens; their watchful eyes are closed to all +the sorrows they lived to soothe. Not one of these was famous in the +great world; some were almost unknown beyond their own immediate +circle. But they have left behind them that loving remembrance which +is better than fame, and if their epitaphs are chiselled briefly in +stone, they are written at full length on living tablets in a +thousand homes to which they carried their ever-welcome aid and +sympathy. + +One whom we have lost, very widely known and honored, was a leading +practitioner of this city. His image can hardly be dimmed in your +recollection, as he stood before you only three years ago, filling +the same place with which I am now honored. To speak of him at all +worthily, would be to write the history of professional success, won +without special aid at starting, by toil, patience, good sense, pure +character, and pleasing manners; won in a straight uphill ascent, +without one breathing-space until he sat down, not to rest, but to +die. If prayers could have shielded him from the stroke, if love +could have drawn forth the weapon, and skill could have healed the +wound, this passing tribute might have been left to other lips and to +another generation. + +Let us hope that our dead have at last found that rest which neither +summer nor winter, nor day nor night, had granted to their unending +earthly labors! And let us remember that our duties to our brethren +do not cease when they become unable to share our toils, or leave +behind them in want and woe those whom their labor had supported. It +is honorable to the Profession that it has organized an Association a +for the relief of its suffering members and their families; it owes +this tribute to the ill-rewarded industry and sacrifices of its less +fortunate brothers who wear out health and life in the service of +humanity. I have great pleasure in referring to this excellent +movement, which gives our liberal profession a chance to show its +liberality, and serves to unite us all, the successful and those whom +fortune has cast down, in the bonds of a true brotherhood. + +A medical man, as he goes about his daily business after twenty years +of practice, is apt to suppose that he treats his patients according +to the teachings of his experience. No doubt this is true to some +extent; to what extent depending much on the qualities of the +individual. But it is easy to prove that the prescriptions of even +wise physicians are very commonly founded on something quite +different from experience. Experience must be based on the permanent +facts of nature. But a glance at the prevalent modes of treatment of +any two successive generations will show that there is a changeable +as well as a permanent element in the art of healing; not merely +changeable as diseases vary, or as new remedies are introduced, but +changeable by the going out of fashion of special remedies, by the +decadence of a popular theory from which their fitness was deduced, +or other cause not more significant. There is no reason to suppose +that the present time is essentially different in this respect from +any other. Much, therefore, which is now very commonly considered to +be the result of experience, will be recognized in the next, or in +some succeeding generation, as no such result at all, but as a +foregone conclusion, based on some prevalent belief or fashion of the +time. + +There are, of course, in every calling, those who go about the work +of the day before them, doing it according to the rules of their +craft, and asking no questions of the past or of the future, or of +the aim and end to which their special labor is contributing. These +often consider and call themselves practical men. They pull the oars +of society, and have no leisure to watch the currents running this or +that way; let theorists and philosophers attend to them. In the mean +time, however, these currents are carrying the practical men, too, +and all their work may be thrown away, and worse than thrown away, if +they do not take knowledge of them and get out of the wrong ones and +into the right ones as soon as they may. Sir Edward Parry and his +party were going straight towards the pole in one of their arctic +expeditions, travelling at the rate of ten miles a day. But the ice +over which they travelled was drifting straight towards the equator, +at the rate of twelve miles a day, and yet no man among them would +have known that he was travelling two miles a day backward unless he +had lifted his eyes from the track in which he was plodding. It is +not only going backward that the plain practical workman is liable +to, if he will not look up and look around; he may go forward to ends +he little dreams of. It is a simple business for a mason to build up +a niche in a wall; but what if, a hundred years afterwards when the +wall is torn down, the skeleton of a murdered man drop out of the +niche? It was a plain practical piece of carpentry for a Jewish +artisan to fit two pieces of timber together according to the legal +pattern in the time of Pontius Pilate; he asked no questions, +perhaps, but we know what burden the cross bore on the morrow! And +so, with subtler tools than trowels or axes, the statesman who works +in policy without principle, the theologian who works in forms +without a soul, the physician who, calling himself a practical man, +refuses to recognize the larger laws which govern his changing +practice, may all find that they have been building truth into the +wall, and hanging humanity upon the cross. + +The truth is, that medicine, professedly founded on observation, is +as sensitive to outside influences, political, religious, +philosophical, imaginative, as is the barometer to the changes of +atmospheric density. Theoretically it ought to go on its own +straightforward inductive path, without regard to changes of +government or to fluctuations of public opinion. But look a moment +while I clash a few facts together, and see if some sparks do not +reveal by their light a closer relation between the Medical Sciences +and the conditions of Society and the general thought of the time, +than would at first be suspected. + +Observe the coincidences between certain great political and +intellectual periods and the appearance of illustrious medical +reformers and teachers. It was in the age of Pericles, of Socrates, +of Plato, of Phidias, that Hippocrates gave to medical knowledge the +form which it retained for twenty centuries. With the world- +conquering Alexander, the world-embracing Aristotle, appropriating +anatomy and physiology, among his manifold spoils of study, marched +abreast of his royal pupil to wider conquests. Under the same +Ptolemies who founded the Alexandrian Library and Museum, and ordered +the Septuagint version of the Hebrew Scriptures, the infallible +Herophilus ["Contradicere Herophilo in anatomicis, est contradicere +evangelium," was a saying of Fallopius.] made those six hundred +dissections of which Tertullian accused him, and the sagacious +Erasistratus introduced his mild antiphlogistic treatment in +opposition to the polypharmacy and antidotal practice of his time. +It is significant that the large-minded Galen should have been the +physician and friend of the imperial philosopher Marcus Aurelius. +The Arabs gave laws in various branches of knowledge to those whom +their arms had invaded, or the terror of their spreading dominion had +reached, and the point from which they started was, as Humboldt +acknowledges, "the study of medicine, by which they long ruled the +Christian Schools," and to which they added the department of +chemical pharmacy. + +Look at Vesalius, the contemporary of Luther. Who can fail to see +one common spirit in the radical ecclesiastic and the reforming +court-physician? Both still to some extent under the dominion of the +letter: Luther holding to the real presence; Vesalius actually +causing to be drawn and engraved two muscles which he knew were not +found in the human subject, because they had been described by Galen, +from dissections of the lower animals. Both breaking through old +traditions in the search of truth; one, knife in hand, at the risk of +life and reputation, the other at the risk of fire and fagot, with +that mightier weapon which all the devils could not silence, though +they had been thicker than the tiles on the house-tops. How much the +physician of the Catholic Charles V. had in common with the great +religious destructive, may be guessed by the relish with which he +tells the story how certain Pavian students exhumed the body of an +"elegans scortum," or lovely dame of ill repute, the favorite of a +monk of the order of St. Anthony, who does not seem to have resisted +temptation so well as the founder of his order. We have always +ranked the physician Rabelais among the early reformers, but I do not +know that Vesalius has ever been thanked for his hit at the morals of +the religious orders, or for turning to the good of science what was +intended for the "benefit of clergy." + +Our unfortunate medical brother, Michael Servetus, the spiritual +patient to whom the theological moxa was applied over the entire +surface for the cure of his heresy, came very near anticipating +Harvey. The same quickened thought of the time which led him to +dispute the dogma of the Church, opened his mind to the facts which +contradicted the dogmas of the Faculty. + +Harvey himself was but the posthumous child of the great Elizabethan +period. Bacon was at once his teacher and his patient. The founder +of the new inductive philosophy had only been dead two years when the +treatise on the Circulation, the first-fruit of the Restoration of +Science, was given to the world. + +And is it to be looked at as a mere accidental coincidence, that +while Napoleon was modernizing the political world, Bichat was +revolutionizing the science of life and the art that is based upon +it; that while the young general was scaling the Alps, the young +surgeon was climbing the steeper summits of unexplored nature; that +the same year read the announcement of those admirable "Researches on +Life and Death," and the bulletins of the battle of Marengo? + +If we come to our own country, who can fail to recognize that +Benjamin Rush, the most conspicuous of American physicians, was the +intellectual offspring of the movement which produced the Revolution? +"The same hand," says one of his biographers," which subscribed the +declaration of the political independence of these States, +accomplished their emancipation from medical systems formed in +foreign countries, and wholly unsuitable to the state of diseases in +America." + +Following this general course of remark, I propose to indicate in a +few words the direction of the main intellectual current of the time, +and to point out more particularly some of the eddies which tend to +keep the science and art of medicine from moving with it, or even to +carry them backwards. + +The two dominant words of our time are law and average, both pointing +to the uniformity of the order of being in which we live. Statistics +have tabulated everything,--population, growth, wealth, crime, +disease. We have shaded maps showing the geographical distribution +of larceny and suicide. Analysis and classification have been at +work upon all tangible and visible objects. The Positive Philosophy +of Comte has only given expression to the observing and computing +mind of the nineteenth century. + +In the mean time, the great stronghold of intellectual conservatism, +traditional belief, has been assailed by facts which would have been +indicted as blasphemy but a few generations ago. Those new tables of +the law, placed in the hands of the geologist by the same living God +who spoke from Sinai to the Israelites of old, have remodelled the +beliefs of half the civilized world. The solemn scepticism of +science has replaced the sneering doubts of witty philosophers. The +more positive knowledge we gain, the more we incline to question all +that has been received without absolute proof. + +As a matter of course, this movement has its partial reactions. The +province of faith is claimed as a port free of entry to unsupported +individual convictions. The tendency to question is met by the +unanalyzing instinct of reverence. The old church calls back its +frightened truants. Some who have lost their hereditary religious +belief find a resource in the revelations of Spiritualism. By a +parallel movement, some of those who have become medical infidels +pass over to the mystic band of believers in the fancied miracles of +Homoeopathy. + +Under these influences transmitted to, or at least shared by, the +medical profession, the old question between "Nature," so called, and +"Art," or professional tradition, has reappeared with new interest. +I say the old question, for Hippocrates stated the case on the side +of "Nature" more than two thousand years ago. Miss Florence +Nightingale,--and if I name her next to the august Father of the +Healing Art, its noblest daughter well deserves that place of honor, +--Miss Florence Nightingale begins her late volume with a paraphrase +of his statement. But from a very early time to this there has +always been a strong party against "Nature." Themison called the +practice of Hippocrates "a meditation upon death." Dr. Rush says: +"It is impossible to calculate the mischief which Hippocrates, has +done, by first marking Nature with his name and afterwards letting +her loose upon sick people. Millions have perished by her hands in +all ages and countries." Sir John Forbes, whose defence of "Nature" +in disease you all know, and to the testimonial in whose honor four +of your Presidents have contributed, has been recently greeted, on +retiring from the profession, with a wish that his retirement had +been twenty years sooner, and the opinion that no man had done so +much to destroy the confidence of the public in the medical +profession. + +In this Society we have had the Hippocratic and the Themisonic side +fairly represented. The treatise of one of your early Presidents on +the Mercurial Treatment is familiar to my older listeners. Others +who have held the same office have been noted for the boldness of +their practice, and even for partiality to the use of complex +medication. + +On the side of "Nature" we have had, first of all, that remarkable +discourse on Self-Limited Diseases, [On Self-Limited Diseases. A +Discourse delivered before the Massachusetts Medical Society, at +their Annual Meeting, May 27, 1835. By Jacob Bigelow, M. D.] which +has given the key-note to the prevailing medical tendency of this +neighborhood, at least, for the quarter of a century since it was +delivered. Nor have we forgotten the address delivered at +Springfield twenty years later, [Search out the Secrets, of Nature. +By Augustus A. Gould, M. D. Read at the Annual Meeting, June 27, +1855.] full of good sense and useful suggestions, to one of which +suggestions we owe the learned, impartial, judicious, well-written +Prize Essay of Dr. Worthington Hooker. [Rational Therapeutics. A +Prize Essay. By Worthington Hooker, M. D., of New Haven. Boston. +1857.] We should not omit from the list the important address of +another of our colleagues, [On the Treatment of Compound and +Complicated Fractures. By William J. Walker, M. D. Read at the +Annual Meeting, May 29, 1845.] showing by numerous cases the power of +Nature in healing compound fractures to be much greater than is +frequently supposed,--affording, indeed, more striking illustrations +than can be obtained from the history of visceral disease, of the +supreme wisdom, forethought, and adaptive dexterity of that divine +Architect, as shown in repairing the shattered columns which support +the living temple of the body. + +We who are on the side of "Nature" please ourselves with the idea +that we are in the great current in which the true intelligence of +the time is moving. We believe that some who oppose, or fear, or +denounce our movement are themselves caught in various eddies that +set back against the truth. And we do most earnestly desire and most +actively strive, that Medicine, which, it is painful to remember, has +been spoken of as "the withered branch of science" at a meeting of +the British Association, shall be at length brought fully to share, +if not to lead, the great wave of knowledge which rolls with the +tides that circle the globe. + +If there is any State or city which might claim to be the American +headquarters of the nature-trusting heresy, provided it be one, that +State is Massachusetts, and that city is its capital. The effect +which these doctrines have upon the confidence reposed in the +profession is a matter of opinion. For myself, I do not believe this +confidence can be impaired by any investigations which tend to limit +the application of troublesome, painful, uncertain, or dangerous +remedies. Nay, I will venture to say this, that if every specific +were to fail utterly, if the cinchona trees all died out, and the +arsenic mines were exhausted, and the sulphur regions were burned up, +if every drug from the vegetable, animal, and mineral kingdom were to +disappear from the market, a body of enlightened men, organized as a +distinct profession, would be required just as much as now, and +respected and trusted as now, whose province should be to guard +against the causes of disease, to eliminate them if possible when +still present, to order all the conditions of the patient so as to +favor the efforts of the system to right itself, and to give those +predictions of the course of disease which only experience can +warrant, and which in so many cases relieve the exaggerated fears of +sufferers and their friends, or warn them in season of impending +danger. Great as the loss would be if certain active remedies could +no longer be obtained, it would leave the medical profession the most +essential part of it's duties, and all, and more than all, its +present share of honors; for it would be the death-blow to +charlatanism, which depends for its success almost entirely on drugs, +or at least on a nomenclature that suggests them. + +There is no offence, then, or danger in expressing the opinion, that, +after all which has been said, the community is still overdosed: The +best proof of it is, that no families take so little medicine as +those of doctors, except those of apothecaries, and that old +practitioners are more sparing of active medicines than younger +ones." [Dr. James Jackson has kindly permitted me to make the +following extract from a letter just received by him from Sir James +Clark, and dated May 26, 1860: "As a physician advances in age, he +generally, I think, places less confidence in the ordinary medical +treatment than he did, not only during his early, but even his middle +period of life."] The conclusion from these facts is one which the +least promising of Dr. Howe's pupils in the mental department could +hardly help drawing. + +Part of the blame of over-medication must, I fear, rest with the +profession, for yielding to the tendency to self-delusion, which +seems inseparable from the practice of the art of healing. I need +only touch on the common modes of misunderstanding or misapplying the +evidence of nature. + +First, there is the natural incapacity for sound observation, which +is like a faulty ear in music. We see this in many persons who know +a good deal about books, but who are not sharp-sighted enough to buy +a horse or deal with human diseases. + +Secondly, there is in some persons a singular inability to weigh the +value of testimony; of which, I think, from a pretty careful +examination of his books, Hahnemann affords the best specimen outside +the walls of Bedlam. + +The inveterate logical errors to which physicians have always been +subject are chiefly these: + +The mode of inference per enumerationem simplicem, in scholastic +phrase; that is, counting only their favorable cases. This is the +old trick illustrated in Lord Bacon's story of the gifts of the +shipwrecked people, hung up in the temple. --Behold! they vowed these +gifts to the altar, and the gods saved them. Ay, said a doubting +bystander, but how many made vows of gifts and were shipwrecked +notwithstanding? The numerical system is the best corrective of this +and similar errors. The arguments commonly brought against its +application to all matters of medical observation, treatment +included, seem to apply rather to the tabulation of facts ill +observed, or improperly classified, than to the method itself. + +The post hoc ergo propter hoc error: he got well after taking my +medicine; therefore in consequence of taking it. + +The false induction from genuine facts of observation, leading to the +construction of theories which are then deductively applied in the +face of the results of direct observation. The school of Broussais +has furnished us with a good example of this error. + +And lastly, the error which Sir Thomas Browne calls giving "a reason +of the golden tooth;" that is, assuming a falsehood as a fact, and +giving reasons for it, commonly fanciful ones, as is constantly done +by that class of incompetent observers who find their "golden tooth" +in the fabulous effects of the homoeopathie materia medica,--which +consists of sugar of milk and a nomenclature. + +Another portion of the blame rests with the public itself, which +insists on being poisoned. Somebody buys all the quack medicines +that build palaces for the mushroom, say rather, the toadstool +millionaires. Who is it? These people have a constituency of +millions. The popular belief is all but universal that sick persons +should feed on noxious substances. One of our members was called not +long since to a man with a terribly sore mouth. On inquiry he found +that the man had picked up a box of unknown pills, in Howard Street, +and had proceeded to take them, on general principles, pills being +good for people. They happened to contain mercury, and hence the +trouble for which he consulted our associate. + +The outside pressure, therefore, is immense upon the physician, +tending to force him to active treatment of some kind. Certain old +superstitions, still lingering in the mind of the public, and not yet +utterly expelled from that of the profession, are at the bottom of +this, or contribute to it largely. One of the most ancient is, that +disease is a malignant agency, or entity, to be driven out of the +body by offensive substances, as the smoke of the fish's heart and +liver drove the devil out of Tobit's bridal chamber, according to the +Apochrypha. Epileptics used to suck the blood from the wounds of +dying gladiators. [Plinii Hist. Mundi. lib. xxviii. c. 4.] The +Hon. Robert Boyle's little book was published some twenty or thirty +years before our late President, Dr. Holyoke, was born. [A Collection +of Choice and Safe Remedies. The Fifth Edition, corrected. London, +1712. Dr. Holyoke was born in 1728.] In it he recommends, as +internal medicines, most of the substances commonly used as +fertilizers of the soil. His "Album Graecum" is best left +untranslated, and his "Zebethum Occidentale" is still more +transcendentally unmentionable except in a strange dialect. It +sounds odiously to us to hear him recommend for dysentery a powder +made from "the sole of an old shoe worn by some man that walks much." +Perhaps nobody here ever heard of tying a stocking, which had been +worn during the day, round the neck at night for a sore throat. The +same idea of virtue in unlovely secretions! [The idea is very +ancient. "Sordes hominis" "Sudore et oleo medicinam facientibus." +--Plin. xxviii. 4.] + +Even now the Homoeopathists have been introducing the venom of +serpents, under the learned title of Lachesis, and outraging human +nature with infusions of the pediculus capitis; that is, of course, +as we understand their dilutions, the names of these things; for if a +fine-tooth-comb insect were drowned in Lake Superior, we cannot agree +with them in thinking that every drop of its waters would be +impregnated with all the pedicular virtues they so highly value. +They know what they are doing. They are appealing to the detestable +old superstitious presumption in favor of whatever is nauseous and +noxious as being good for the sick. + +Again, we all occasionally meet persons stained with nitrate of +silver, given for epilepsy. Read what Dr. Martin says, about the way +in which it came to be used, in his excellent address before the +Norfolk County Medical Society, and the evidence I can show, but have +not time for now, and then say what you think of the practice which +on such presumptions turns a white man as blue as the double-tattooed +King of the Cannibal Islands! [Note A.] + +If medical superstitions have fought their way down through all the +rationalism and scepticism of the nineteenth century, of course the +theories of the schools, supported by great names, adopted into the +popular belief and incorporated with the general mass of +misapprehension with reference to disease, must be expected to meet +us at every turn in the shape of bad practice founded on false +doctrine. A French patient complains that his blood heats him, and +expects his doctor to bleed him. An English or American one says he +is bilious, and will not be easy without a dose of calomel. A doctor +looks at a patient's tongue, sees it coated, and says the stomach is +foul; his head full of the old saburral notion which the extreme +inflammation-doctrine of Broussais did so much to root out, but which +still leads, probably, to much needless and injurious wrong of the +stomach and bowels by evacuants, when all they want is to be let +alone. It is so hard to get anything out of the dead hand of medical +tradition! The mortmain of theorists extinct in science clings as +close as that of ecclesiastics defunct in law. + +One practical hint may not be out of place here. It seems to be +sometimes forgotten, by those who must know the fact, that the tongue +is very different, anatomically and physiologically, from the +stomach. Its condition does not in the least imply a similar one of +the stomach, which is a very different structure, covered with a +different kind of epithelium, and furnished with entirely different +secretions. A silversmith will, for a dollar, make a small hoe, of +solid silver, which will last for centuries, and will give a patient +more comfort, used for the removal of the accumulated epithelium and +fungous growths which constitute the "fur," than many a prescription +with a split-footed Rx before it, addressed to the parts out of +reach. + +I think more of this little implement on account of its agency in +saving the Colony at Plymouth in the year 1623. Edward Winslow heard +that Massasoit was sick and like to die. He found him with a +houseful of people about him, women rubbing his arms and legs, and +friends "making such a hellish noise" as they probably thought would +scare away the devil of sickness. Winslow gave him some conserve, +washed his mouth, scraped his tongue, which was in a horrid state, +got down some drink, made him some broth, dosed him with an infusion +of strawberry leaves and sassafras root, and had the satisfaction of +seeing him rapidly recover. Massasoit, full of gratitude, revealed +the plot which had been formed to destroy the colonists, whereupon +the Governor ordered Captain Miles Standish to see to them; who +thereupon, as everybody remembers, stabbed Pecksuot with his own +knife, broke up the plot, saved the colony, and thus rendered +Massachusetts and the Massachusetts Medical Society a possibility, as +they now are a fact before us. So much for this parenthesis of the +tongue-scraper, which helped to save the young colony from a much +more serious scrape, and may save the Union yet, if a Presidential +candidate should happen to be taken sick as Massasoit was, and his +tongue wanted cleaning,--which process would not hurt a good many +politicians, with or without a typhoid fever. + +Again, see how the "bilious" theory works in every-day life here and +now, illustrated by a case from actual life. A youthful +practitioner, whose last molars have not been a great while cut, +meets an experienced and noted physician in consultation. This is +the case. A slender, lymphatic young woman is suckling two lusty +twins, the intervals of suction being occupied on her part with +palpitations, headaches, giddiness, throbbing in the head, and +various nervous symptoms, her cheeks meantime getting bloodless, and +her strength running away in company with her milk. The old +experienced physician, seeing the yellowish waxy look which is common +in anaemic patients, considers it a "bilious" case, and is for giving +a rousing emetic. Of course, he has to be wheedled out of this, a +recipe is written for beefsteaks and porter, the twins are +ignominiously expelled from the anaemic bosom, and forced to take +prematurely to the bottle, and this prolific mother is saved for +future usefulness in the line of maternity. + +The practice of making a profit on the medicine ordered has been held +up to reprobation by one at least of the orators who have preceded +me. That the effect of this has been ruinous in English practice I +cannot doubt, and that in this country the standard of practice was +in former generations lowered through the same agency is not +unlikely. I have seen an old account-book in which the physician +charged an extra price for gilding his rich patients' pills. If all +medicine were very costly, and the expense of it always came out of +the physician's fee, it would really be a less objectionable +arrangement than this other most pernicious one. He would naturally +think twice before he gave an emetic or cathartic which evacuated his +own pocket, and be sparing of the cholagogues that emptied the +biliary ducts of his own wallet, unless he were sure they were +needed. If there is any temptation, it should not be in favor of +giving noxious agents, as it clearly must be in the case of English +druggists and "General Practitioners." The complaint against the +other course is a very old one. Pliny, inspired with as truly Roman +horror of quackery as the elder Cato,--who declared that the Greek +doctors had sworn to exterminate all barbarians, including the +Romans, with their drugs, but is said to have physicked his own wife +to death, notwithstanding,--Pliny says, in so many words, that the +cerates and cataplasms, plasters, collyria, and antidotes, so +abundant in his time, as in more recent days, were mere tricks to +make money. + + +A pretty strong eddy, then, or rather many eddies, setting constantly +back from the current of sober observation of nature, in the +direction of old superstitions and fancies, of exploded theories, of +old ways of making money, which are very slow to pass out of fashion + +But there are other special American influences which we are bound to +take cognizance of. If I wished to show a student the difficulties +of getting at truth from medical experience, I would give him the +history of epilepsy to read. If I wished him to understand the +tendencies of the American medical mind, its sanguine enterprise, its +self-confidence, its audacious handling of Nature, its impatience +with her old-fashioned ways of taking time to get a sick man well, I +would make him read the life and writings of Benjamin Rush. Dr. Rush +thought and said that there were twenty times more intellect and a +hundred times more knowledge in the country in 1799 than before the +Revolution. His own mind was in a perpetual state of exaltation +produced by the stirring scenes in which he had taken a part, and the +quickened life of the time in which he lived. It was not the state +to favor sound, calm observation. He was impatient, and Nature is +profoundly imperturbable. We may adjust the beating of our hearts to +her pendulum if we will and can, but we may be very sure that she +will not change the pendulum's rate of going because our hearts are +palpitating. He thought he had mastered yellow-fever. "Thank God," +he said, "out of one hundred patients whom I have visited or +prescribed for this day, I have lost none." Where was all his legacy +of knowledge when Norfolk was decimated? Where was it when the blue +flies were buzzing over the coffins of the unburied dead piled up in +the cemetery of New Orleans, at the edge of the huge trenches yawning +to receive them? + +One such instance will do as well as twenty. Dr. Rush must have been +a charming teacher, as he was an admirable man. He was observing, +rather than a sound observer; eminently observing, curious, even, +about all manner of things. But he could not help feeling as if +Nature had been a good deal shaken by the Declaration of +Independence, and that American art was getting to be rather too much +for her,--especially as illustrated in his own practice. He taught +thousands of American students, he gave a direction to the medical +mind of the country more than any other one man; perhaps he typifies +it better than any other. It has clearly tended to extravagance in +remedies and trust in remedies, as in everything else. How could a +people which has a revolution once in four years, which has contrived +the Bowie-knife and the revolver, which has chewed the juice out of +all the superlatives in the language in Fourth of July orations, and +so used up its epithets in the rhetoric of abuse that it takes two +great quarto dictionaries to supply the demand; which insists in +sending out yachts and horses and boys to out-sail, out-run, out- +fight, and checkmate all the rest of creation; how could such a +people be content with any but "heroic" practice"? What wonder that +the stars and stripes wave over doses of ninety grains of sulphate of +quinine, [More strictly, ninety-six grains in two hours. Dunglison's +Practice, 1842, vol. ii. p. 520. Eighty grains in one dose. +Ibid. p. 536. Ninety-six grains of sulphate of quinine are equal +to eight ounces of good bark. --Wood & Bache.] and that the American +eagle screams with delight to see three drachms of calomel given at a +single mouthful? + +Add to this the great number of Medical Journals, all useful, we +hope, most of them necessary, we trust, many of them excellently well +conducted, but which must find something to fill their columns, and +so print all the new plans of treatment and new remedies they can get +hold of, as the newspapers, from a similar necessity, print the +shocking catastrophes and terrible murders. + +Besides all this, here are we, the great body of teachers in the +numberless medical schools of the Union, some of us lecturing to +crowds who clap and stamp in the cities, some of us wandering over +the country, like other professional fertilizers, to fecundate the +minds of less demonstrative audiences at various scientific stations; +all of us talking habitually to those supposed to know less than +ourselves, and loving to claim as much for our art as we can, not to +say for our own schools, and possibly indirectly for our own +practical skill. Hence that annual crop of introductory lectures; +the useful blossoming into the ornamental, as the cabbage becomes +glorified in the cauliflower; that lecture-room literature of +adjectives, that declamatory exaggeration, that splendid show of +erudition borrowed from D'Israeli, and credited to Lord Bacon and the +rest, which have suggested to our friends of the Medical Journals an +occasional epigram at our expense. Hence the tendency in these +productions, and in medical lectures generally, to overstate the +efficacy of favorite methods of cure, and hence the premium offered +for showy talkers rather than sagacious observers, for the men of +adjectives rather than of nouns substantive in the more ambitious of +these institutions. + +Such are some of the eddies in which we are liable to become involved +and carried back out of the broad stream of philosophical, or, in +other words, truth-loving, investigations. The causes of disease, in +the mean time, have been less earnestly studied in the eagerness of +the search for remedies. Speak softly! Women have been borne out +from an old-world hospital, two in one coffin, that the horrors of +their prison-house might not be known, while the very men who were +discussing the treatment of the disease were stupidly conveying the +infection from bed to bed, as rat-killers carry their poisons from +one household to another. Do not some of you remember that I have +had to fight this private-pestilence question against a scepticism +which sneered in the face of a mass of evidence such as the calm +statisticians of the Insurance office could not listen to without +horror and indignation? [The Contagiousness of Puerperal Fever."-N. +E. Quan Jour. of Medicine and Surgery, April, 1843. Reprinted, +with Additions. Boston: Ticknor & Fields. 1855.] Have we forgotten +what is told in one of the books published under our own sanction, +that a simple measure of ventilation, proposed by Dr. John Clark, had +saved more than sixteen thousand children's lives in a single +hospital? How long would it have taken small doses of calomel and +rhubarb to save as many children? These may be useful in prudent +hands, but how insignificant compared to the great hygienic +conditions! Causes, causes, and again causes,--more and more we fall +back on these as the chief objects of our attention. The shortest +system of medical practice that I know of is the oldest, but not the +worst. It is older than Hippocrates, older than Chiron the Centaur. +Nature taught it to the first mother when she saw her first-born +child putting some ugly pebble or lurid berry into its mouth. I know +not in what language it was spoken, but I know that in English it +would sound thus: Spit it out! + +Art can do something more than say this. It can sometimes reach the +pebble or berry after it has been swallowed. But the great thing is +to keep these things out of children's mouths, and as soon as they +are beyond our reach, to be reasonable and patient with Nature, who +means well, but does not like to hurry, and who took nine calendar +months, more or less, to every mother's son among us, before she +thought he was fit to he shown to the public. + +Suffer me now to lay down a few propositions, whether old or new it +matters little, not for your immediate acceptance, nor yet for your +hasty rejection, but for your calm consideration. + +But first, there are a number of terms which we are in the habit of +using in a vague though not unintelligible way, and which it is as +well now to define. These terms are the tools with which we are to +work, and the first thing is to sharpen them. It is nothing to us +that they have been sharpened a thousand times before; they always +get dull in the using, and every new workman has a right to carry +them to the grindstone and sharpen them to suit himself. + +Nature, in medical language, as opposed to Art, means trust in the +reactions of the living system against, ordinary normal impressions. + +Art, in the same language, as opposed to Nature, means an intentional +resort to extraordinary abnormal impressions for the relief of +disease. + +The reaction of the living system is the essence of both. Food is +nothing, if there is no digestive act to respond to it. We cannot +raise a blister on a dead man, or hope that a carminative forced +between his lips will produce its ordinary happy effect. + +Disease, dis-ease,--disturbed quiet, uncomfortableness,--means +imperfect or abnormal reaction of the living system, and its more or +less permanent results. + +Food, in its largest sense, is whatever helps to build up the normal +structures, or to maintain their natural actions. + +Medicine, in distinction from food, is every unnatural or noxious +agent applied for the relief of disease. + +Physic means properly the Natural art, and Physician is only the +Greek synonyme of Naturalist. + +With these few explanations I proceed to unfold the propositions I +have mentioned. + +Disease and death, if we may judge by the records of creation, are +inherently and essentially necessary in the present order of things. +A perfect intelligence, trained by a perfect education, could do no +more than keep the laws of the physical and spiritual universe. An +imperfect intelligence, imperfectly taught,--and this is the +condition of our finite humanity,--will certainly fail to keep all +these laws perfectly. Disease is one of the penalties of one of the +forms of such failure. It is prefigured in the perturbations of the +planets, in the disintegration of the elemental masses; it has left +its traces in the fossil organisms of extinct creations. [Professor +Agassiz has kindly handed me the following note: "There are abnormal +structures in animals of all ages anterior to the creation of +mankind. Malformed specimens of Crinoids are known from the Triassic +and Jurassic deposits. Malformed and diseased bones of tertiary +mammalia have been collected in the caverns of Gailenreuth with +traces of healing."] + +But it is especially the prerogative, I had almost said privilege, of +educated and domesticated beings, from man down to the potato, +serving to teach them, and such as train them, the laws of life, and +to get rid of those who will not mind or cannot be kept subject to +these laws. + +Disease, being always an effect, is always in exact proportion to the +sum of its causes, as much in the case of Spigelius, who dies of a +scratch, as in that of the man who recovers after an iron bar has +been shot through his brain. The one prevalent failing of the +medical art is to neglect the causes and quarrel with the effect. + +There are certain general facts which include a good deal of what is +called and treated as disease. Thus, there are two opposite +movements of life to be seen in cities and elsewhere, belonging to +races which, from various persistent causes, are breeding down and +tending to run out, and to races which are breeding up, or +accumulating vital capital,--a descending and an ascending series. +Let me give an example of each; and that I may incidentally remove a +common impression about this country as compared with the Old World, +an impression which got tipsy with conceit and staggered into the +attitude of a formal proposition in the work of Dr. Robert Knox, I +will illustrate the downward movement from English experience, and +the upward movement from a family history belonging to this immediate +neighborhood. + +Miss Nightingale speaks of "the fact so often seen of a +great-grandmother, who was a tower of physical vigor, descending into +a grandmother perhaps a little less vigorous, but still sound as a +bell, and healthy to the core, into a mother languid and confined to +her carriage and house; and lastly into a daughter sickly and +confined to her bed." So much for the descending English series; now +for the ascending American series. + +Something more than one hundred and thirty years ago there graduated +at Harvard College a delicate youth, who lived an invalid life and +died at the age of about fifty. His two children were both of +moderate physical power, and one of them diminutive in stature. The +next generation rose in physical development, and reached eighty +years of age and more in some of its members. The fourth generation +was of fair average endowment. The fifth generation, great-great- +grandchildren of the slender invalid, are several of, them of +extraordinary bodily and mental power; large in stature, formidable +alike with their brains and their arms, organized on a more extensive +scale than either of their parents. + +This brief account illustrates incidentally the fallacy of the +universal-degeneration theory applied to American life; the same on +which one of our countrymen has lately brought some very forcible +facts to bear in a muscular discussion of which we have heard rather +more than is good for us. But the two series, American and English, +ascending and descending, were adduced with the main purpose of +showing the immense difference of vital endowments in different +strains of blood; a difference to which all ordinary medication is in +all probability a matter of comparatively trivial purport. Many +affections which art has to strive against might be easily shown to +be vital to the well-being of society. Hydrocephalus, tabes +mesenterica, and other similar maladies, are natural agencies which +cut off the children of races that are sinking below the decent +minimum which nature has established as the condition of viability, +before they reach the age of reproduction. They are really not so +much diseases, as manifestations of congenital incapacity for life; +the race would be ruined if art could ever learn always to preserve +the individuals subject to them. We must do the best we can for +them, but we ought also to know what these "diseases" mean. + +Again, invalidism is the normal state of many organizations. It can +be changed to disease, but never to absolute health by medicinal +appliances. There are many ladies, ancient and recent, who are +perpetually taking remedies for irremediable pains and aches. They +ought to have headaches and back-aches and stomach-aches; they are +not well if they do not have them. To expect them to live without +frequent twinges is like expecting a doctor's old chaise to go +without creaking; if it did, we might be sure the springs were +broken. There is no doubt that the constant demand for medicinal +remedies from patients of this class leads to their over-use; often +in the case of cathartics, sometimes in that of opiates. I have been +told by an intelligent practitioner in a Western town, that the +constant prescription of opiates by certain physicians in his +vicinity has rendered the habitual use of that drug in all that +region very prevalent; more common, I should think, than alcoholic +drunkenness in the most intemperate localities of which I have known +anything. A frightful endemic demoralization betrays itself in the +frequency with which the haggard features and drooping shoulders of +the opium-drunkards are met with in the streets. + +The next proposition I would ask you to consider is this: +The presumption always is that every noxious agent, including +medicines proper, which hurts a well man, hurts a sick one. +[ Note B.] + +Let me illustrate this proposition before you decide upon it. If it +were known that a prize-fighter were to have a drastic purgative +administered two or three days before a contest, or a large blister +applied to his back, no one will question that it would affect the +betting on his side unfavorably; we will say to the amount of five +per cent. Now the drain upon the resources of the system produced in +such a case must be at its minimum, for the subject is a powerful +man, in the prime of life, and in admirable condition. If the drug +or the blister takes five per cent. from his force of resistance, it +will take at least as large a fraction from any invalid. But this +invalid has to fight a champion who strikes hard but cannot be hit in +return, who will press him sharply for breath, but will never pant +himself while the wind can whistle through his fleshless ribs. The +suffering combatant is liable to want all his stamina, and five per +cent. may lose him the battle. + +All noxious agents, all appliances which are not natural food or +stimuli, all medicines proper, cost a patient, on the average, five +per cent. of his vital force, let us say. Twenty times as much waste +of force produced by any of them, that is, would exactly kill him, +nothing less than kill him, and nothing more. If this, or something +like this, is true, then all these medications are, prima facie, +injurious. + +In the game of Life-or-Death, Rouge et Noir, as played between the +Doctor and the Sexton, this five per cent., this certain small injury +entering into the chances is clearly the sexton's perquisite for +keeping the green table, over which the game is played, and where he +hoards up his gains. Suppose a blister to diminish a man's pain, +effusion or dyspnoea to the saving of twenty per cent. in vital +force; his profit from it is fifteen, in that case, for it always +hurts him five to begin with, according to our previous assumption. + +Presumptions are of vast importance in medicine, as in law. A man is +presumed innocent until he is proved guilty. A medicine--that is, a +noxious agent, like a blister, a seton, an emetic, or a cathartic-- +should always be presumed to be hurtful. It always is directly +hurtful; it may sometimes be indirectly beneficial. If this +presumption were established, and disease always assumed to be the +innocent victim of circumstances, and not punishable by medicines, +that is, noxious agents, or poisons, until the contrary was shown, we +should not so frequently hear the remark commonly, perhaps +erroneously, attributed to Sir Astley Cooper, but often repeated by +sensible persons, that, on the whole, more harm than good is done by +medication. Throw out opium, which the Creator himself seems to +prescribe, for we often see the scarlet poppy growing in the +cornfields, as if it were foreseen that wherever there is hunger to +be fed there must also be pain to be soothed; throw out a few +specifics which our art did not discover, and is hardly needed to +apply [ Note C.]; throw out wine, which is a food, and the vapors +which produce the miracle of anaesthesia, and I firmly believe that +if the whole materia medica, as now used, could be sunk to the bottom +of the sea, it would be all the better for mankind,--and all the +worse for the fishes. + +But to justify this proposition, I must add that the injuries +inflicted by over-medication are to a great extent masked by disease. +Dr. Hooker believes that the typhus syncopatia of a preceding +generation in New England "was often in fact a brandy and opium +disease." How is a physician to distinguish the irritation produced +by his blister from that caused by the inflammation it was meant to +cure? How can he tell the exhaustion produced by his evacuants from +the collapse belonging to the disease they were meant to remove? + +Lastly, medication without insuring favorable hygienic conditions is +like amputation without ligatures. I had a chance to learn this well +of old, when physician to the Broad Street district of the Boston +Dispensary. There, there was no help for the utter want of wholesome +conditions, and if anybody got well under my care, it must have been +in virtue of the rough-and-tumble constitution which emerges from the +struggle for life in the street gutters, rather than by the aid of my +prescriptions. + +But if the materia medica were lost overboard, how much more pains +would be taken in ordering all the circumstances surrounding the +patient (as can be done everywhere out of the crowded pauper +districts), than are taken now by too many who think they do their +duty and earn their money when they write a recipe for a patient left +in an atmosphere of domestic malaria, or to the most negligent kind +of nursing! I confess that I should think my chance of recovery from +illness less with Hippocrates for my physician and Mrs. Gamp for my +nurse, than if I were in the hands of Hahnemann himself, with +Florence Nightingale or good Rebecca Taylor to care for me. + +If I am right in maintaining that the presumption is always against +the use of noxious agents in disease, and if any whom I might +influence should adopt this as a principle of practice, they will +often find themselves embarrassed by the imperative demand of +patients and their friends for such agents where a case is not made +out against this standing presumption. I must be permitted to say, +that I think the French, a not wholly uncivilized people, are in +advance of the English and ourselves in the art of prescribing for +the sick without hurting them. And I do confess that I think their +varied ptisans and syrups are as much preferable to the mineral +regimen of bug-poison and ratsbane, so long in favor on the other +side of the Channel, as their art of preparing food for the table to +the rude cookery of those hard-feeding and much-dosing islanders. +We want a reorganized cuisine of invalidism perhaps as much as the +culinary, reform, for which our lyceum lecturers, and others who live +much at hotels and taverns, are so urgent. Will you think I am +disrespectful if I ask whether, even in Massachusetts, a dose of +calomel is not sometimes given by a physician on the same principle +as that upon which a landlord occasionally prescribes bacon and +eggs,--because he cannot think of anything else quite so handy? I +leave my suggestion of borrowing a hint from French practice to your +mature consideration. + +I may, however, call your attention, briefly, to the singular fact, +that English and American practitioners are apt to accuse French +medical practice of inertness, and French surgical practice of +unnecessary activity. Thus, Dr. Bostock considers French medical +treatment, with certain exceptions, as "decidedly less effective" +than that of his own country." Mr. S. Cooper, again, defends the +simple British practice of procuring union by the first intention +against the attacks of M. Roux and Baron Larrey. [Cooper's Surg. +Diet. art. "Wounds." Yet Mr. John Bell gives the French surgeons +credit for introducing this doctrine of adhesion, and accuses +O'Halloran of "rudeness and ignorance," and "bold, uncivil language," +in disputing their teaching. Princ. of Surgery, vol. i. p. 42. +Mr. Hunter succeeded at last in naturalizing the doctrine and +practice, but even he had to struggle against the perpetual jealousy +of rivals, and died at length assassinated by an insult.] We have +often heard similar opinions maintained by our own countrymen. While +Anglo-American criticism blows hot or cold on the two departments of +French practice, it is not, I hope, indecent to question whether all +the wisdom is necessarily with us in both cases. + +Our art has had two or three lessons which have a deep meaning to +those who are willing to read them honestly. The use of water- +dressings in surgery completed the series of reforms by which was +abolished the "coarse and cruel practice" of the older surgeons, who +with their dressings and acrid balsams, their tents and leaden tubes, +"absolutely delayed the cure." The doctrine of Broussais, transient +as was its empire, reversed the practice of half of Christendom for a +season, and taught its hasty disciples to shun their old favorite +remedies as mortal poisons. This was not enough permanently to shift +the presumption about drugs where it belonged, and so at last, just +as the sympathetic powder and the Unguentum Armarium came in a +superstitious age to kill out the abuses of external over-medication, +the solemn farce of Homoeopathy was enacted in the face of our own +too credulous civilization, that under shelter of its pretences the +"inward bruises" of over-drugged viscera might be allowed to heal by +the first intention. Its lesson we must accept, whether we will or +not; its follies we are tired of talking about. The security of the +medical profession against this and all similar fancies is in the +average constitution of the human. mind with regard to the laws of +evidence. + +My friends and brothers in Art! There is nothing to be feared from +the utterance of any seeming heresy to which you may have listened. +I cannot compromise your collective wisdom. If I have strained the +truth one hair's breadth for the sake of an epigram or an antithesis, +you are accustomed to count the normal pulse-beats of sound judgment, +and know full well how to recognize the fever-throbs of conceit and +the nervous palpitations of rhetoric. + +The freedom with which each of us speaks his thought in this +presence, belongs in part to the assured position of the Profession +in our Commonwealth, to the attitude of Science, which is always +fearless, and to the genius of the soil on which we stand, from which +Nature withheld the fatal gift of malaria only to fill it with +exhalations that breed the fever of inquiry in our blood and in our +brain. But mainly we owe the large license of speech we enjoy to +those influences and privileges common to us all as self-governing +Americans. + +This Republic is the chosen home of minorities, of the less power in +the presence of the greater. It is a common error to speak of our +distinction as consisting in the rule of the majority. Majorities, +the greater material powers, have always ruled before. The history +of most countries has been that of majorities, mounted majorities, +clad in iron, armed with death treading down the tenfold more +numerous minorities. In the old civilizations they root themselves +like oaks in the soil; men must live in their shadow or cut them +down. With us the majority is only the flower of the passing noon, +and the minority is the bud which may open in the next morning's sun. +We must be tolerant, for the thought which stammers on a single +tongue today may organize itself in the growing consciousness of the +time, and come back to us like the voice of the multitudinous waves +of the ocean on the morrow. + +Twenty-five years have passed since one of your honored Presidents +spoke to this Society of certain limitations to the power of our Art, +now very generally conceded. Some were troubled, some were almost +angry, thinking the Profession might suffer from such concessions. +It has certainly not suffered here; if, as some affirm, it has lost +respect anywhere, it was probably for other, and no doubt sufficient +reasons. + +Since that time the civilization of this planet has changed hands. +Strike out of existence at this moment every person who was breathing +on that day, May 27, 1835, and every institution of society, every +art and every science would remain intact and complete in the living +that would be left. Every idea the world then held has been since +dissolved and recrystallized. + +We are repeating the same process. Not to make silver shrines for +our old divinities, even though by this craft we should have our +wealth, was this Society organized and carried on by the good men and +true who went before us. Not for this, but to melt the gold out of +the past, though its dross should fly in dust to all the winds of +heaven, to save all our old treasures of knowledge and mine deeply +for new, to cultivate that mutual respect of which outward courtesy +is the sign, to work together, to feel together, to take counsel +together, and to stand together for the truth, now, always, here, +everywhere; for this our fathers instituted, and we accept, the +offices and duties of this time-honored Society. + + + + + + + +BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE. + +An Introductory Lecture delivered before the Medical Class +of Harvard University, November 6, 1861. + + +[This Lecture appears as it would have been delivered had the time +allowed been less strictly, limited. Passages necessarily omitted +have been restored, and points briefly touched have been more fully +considered. A few notes have been added for the benefit of that +limited class of students who care to track an author through the +highways and by-ways of his reading. I owe my thanks to several of +my professional brethren who have communicated with me on subjects +with which they are familiar; especially to Dr. John Dean, for the +opportunity of profiting by his unpublished labors, and to Dr. Hasket +Derby, for information and references to recent authorities relating +to the anatomy and physiology of the eye.] + + +The entrance upon a new course of Lectures is always a period of +interest to instructors and pupils. As the birth of a child to a +parent, so is the advent of a new class to a teacher. As the light +of the untried world to the infant, so is the dawning of the light +resting over the unexplored realms of science to the student. In the +name of the Faculty I welcome you, Gentlemen of the Medical Class, +new-born babes of science, or lustier nurslings, to this morning of +your medical life, and to the arms and the bosom of this ancient +University. Fourteen years ago I stood in this place for the first +time to address those who occupied these benches. As I recall these +past seasons of our joint labors, I feel that they have been on the +whole prosperous, and not undeserving of their prosperity. + +For it has been my privilege to be associated with a body of true and +faithful workers; I cannot praise them freely to their faces, or I +should be proud to discourse of the harmonious diligence and the +noble spirit in which they have toiled together, not merely to teach +their several branches, but to elevate the whole standard of +teaching. + +I may speak with less restraint of those gentlemen who have aided me +in the most laborious part of my daily duties, the Demonstrators, to +whom the successive classes have owed so much of their instruction. +They rise before me, the dead and the living, in the midst of the +most grateful recollections. The fair, manly face and stately figure +of my friend, Dr. Samuel Parkman, himself fit for the highest offices +of teaching, yet willing to be my faithful assistant in the time of +need, come back to me with the long sigh of regret for his early loss +to our earthly companionship. Every year I speak the eulogy of Dr. +Ainsworth's patient toil as I show his elaborate preparations: When I +take down my "American Cyclopaedia" and borrow instruction from the +learned articles of Dr. Kneeland, I cease to regret that his +indefatigable and intelligent industry was turned into a broader +channel. And what can I say too cordial of my long associated +companion and friend, Dr. Hodges, whose admirable skill, working +through the swiftest and surest fingers that ever held a scalpel +among us, has delighted class after class, and filled our Museum with +monuments which will convey his name to unborn generations? + +This day belongs, however, not to myself and my recollections, but to +all of us who teach and all of you who listen, whether experts in our +specialties or aliens to their mysteries, or timid neophytes just +entering the portals of the hall of science. Look in with me, then, +while I attempt to throw some rays into its interior, which shall +illuminate a few of its pillars and cornices, and show at the same +time how many niches and alcoves remain in darkness. + + +SCIENCE is the topography of ignorance. From a few elevated points +we triangulate vast spaces, inclosing infinite unknown details. We +cast the lead, and draw up a little sand from abysses we may never +reach with our dredges. + +The best part of our knowledge is that which teaches us where +knowledge leaves off and ignorance begins. Nothing more clearly +separates a vulgar from a superior mind, than the confusion in the +first between the little that it truly knows, on the one hand, and +what it half knows and what it thinks it knows on the other. + +That which is true of every subject is especially true of the branch +of knowledge which deals with living beings. Their existence is a +perpetual death and reanimation. Their identity is only an idea, for +we put off our bodies many times during our lives, and dress in new +suits of bones and muscles. + + "Thou art not thyself; + For thou exist'st on many a thousand grains + That issue out of dust." + +If it is true that we understand ourselves but imperfectly in health, +this truth is more signally manifested in disease, where natural +actions imperfectly understood, disturbed in an obscure way by half- +seen causes, are creeping and winding along in the dark toward their +destined issue, sometimes using our remedies as safe stepping-stones, +occasionally, it may be, stumbling over them as obstacles. + +I propose in this lecture to show you some points of contact between +our ignorance and our knowledge in several of the branches upon the +study of which you are entering. I may teach you a very little +directly, but I hope much more from the trains of thought I shall +suggest. Do not expect too much ground to be covered in this rapid +survey. Our task is only that of sending out a few pickets under the +starry flag of science to the edge of that dark domain where the +ensigns of the obstinate rebel, Ignorance, are flying undisputed. We +are not making a reconnoissance in force, still less advancing with +the main column. But here are a few roads along which we have to +march together, and we wish to see clearly how far our lines extend, +and where the enemy's outposts begin. + +Before touching the branches of knowledge that deal with organization +and vital functions, let us glance at that science which meets you at +the threshold of your study, and prepares you in some measure to deal +with the more complex problems of the living laboratory. + + +CHEMISTRY. includes the art of separating and combining the elements +of matter, and the study of the changes produced by these operations. +We can hardly say too much of what it has contributed to our +knowledge of the universe and our power of dealing with its +materials. It has given us a catalogue raisonne of the substances +found upon our planet, and shown how everything living and dead is +put together from them. It is accomplishing wonders before us every +day, such as Arabian story-tellers used to string together in their +fables. It spreads the, sensitive film on the artificial retina +which looks upon us through the optician's lens for a few seconds, +and fixes an image that will outlive its original. It questions the +light of the sun, and detects the vaporized metals floating around +the great luminary,--iron, sodium, lithium, and the rest,--as if the +chemist of our remote planet could fill his bell-glasses from its +fiery atmosphere. It lends the power which flashes our messages in +thrills that leave the lazy chariot of day behind them. It seals up +a few dark grains in iron vases, and lo! at the touch of a single +spark, rises in smoke and flame a mighty Afrit with a voice like +thunder and an arm that shatters like an earthquake. The dreams of +Oriental fancy have become the sober facts of our every-day life, and +the chemist is the magician to whom we owe them. + +To return to the colder scientific aspect of chemistry. It has shown +us how bodies stand affected to each other through an almost +boundless range of combinations. It has given us a most ingenious +theory to account for certain fixed relations in these combinations. +It has successfully eliminated a great number of proximate compounds, +more or less stable, from organic structures. It has invented others +which form the basis of long series of well-known composite +substances. In fact, we are perhaps becoming overburdened with our +list of proximate principles, demonstrated and hypothetical. + +How much nearer have we come to the secret of force than Lully and +Geber and the whole crew of juggling alchemists? We have learned a +great deal about the how, what have we learned about the why? + +Why does iron rust, while gold remains untarnished, and gold +amalgamate, while iron refuses the alliance of mercury? + +The alchemists called gold Sol, the sun, and iron Mars, and pleased +themselves with fancied relations between these substances and the +heavenly bodies, by which they pretended to explain the facts they +observed. Some of their superstitions have lingered in practical +medicine to the present day, but chemistry has grown wise enough to +confess the fact of absolute ignorance. + +What is it that makes common salt crystallize in the form of cubes, +and saltpetre in the shape of six-sided prisms? We see no reason why +it should not have been just the other way, salt in prisms and +saltpetre in cubes, or why either should take an exact geometrical +outline, any more than coagulating albumen. + +But although we had given up attempting to explain the essential +nature of affinities and of crystalline types, we might have supposed +that we had at least fixed the identity of the substances with which +we deal, and determined the laws of their combination. All at once +we find that a simple substance changes face, puts off its +characteristic qualities and resumes them at will;--not merely when +we liquefy or vaporize a solid, or reverse the process; but that a +solid is literally transformed into another solid under our own eyes. +We thought we knew phosphorus. We warm a portion of it sealed in an +empty tube, for about a week. It has become a brown infusible +substance, which does not shine in the dark nor oxidate in the air. +We heat it to 500 F., and it becomes common phosphorus again. We +transmute sulphur in the same singular way. Nature, you know, gives +us carbon in the shape of coal and in that of the diamond. It is +easy to call these changes by the name allotropism, but not the less +do they confound our hasty generalizations. + +These facts of allotropism have some corollaries connected with them +rather startling to us of the nineteenth century. There may be other +transmutations possible besides those of phosphorus and sulphur. +When Dr. Prout, in 1840, talked about azote and carbon being "formed" +in the living system, it was looked upon as one of those freaks of +fancy to which philosophers, like other men, are subject. But when +Professor Faraday, in 1851, says, at a meeting of the British +Association, that "his hopes are in the direction of proving that +bodies called simple were really compounds, and may be formed +artificially as soon as we are masters of the laws influencing their +combinations,"--when he comes forward and says that he has tried +experiments at transmutation, and means, if his life is spared, to +try them again,--how can we be surprised at the popular story of +1861, that Louis Napoleon has established a gold-factory and is +glutting the mints of Europe with bullion of his own making? + +And so with reference to the law of combinations. The old maxim was, +Corpora non agunt nisi soluta. If two substances, a and b, are +inclosed in a glass vessel, c, we do not expect the glass to change +them, unless a or b or the compound a b has the power of dissolving +the glass. But if for a I take oxygen, for b hydrogen, and for c a +piece of spongy platinum, I find the first two combine with the +common signs of combustion and form water, the third in the mean time +undergoing no perceptible change. It has played the part of the +unwedded priest, who marries a pair without taking a fee or having +any further relation with the parties. We call this catalysis, +catalytic action, the action of presence, or by what learned name we +choose. Give what name to it we will, it is a manifestation of power +which crosses our established laws of combination at a very open +angle of intersection. I think we may find an analogy for it in +electrical induction, the disturbance of the equilibrium of the +electricity of a body by the approach of a charged body to it, +without interchange of electrical conditions between the two bodies. +But an analogy is not an explanation, and why a few drops of yeast +should change a saccharine mixture to carbonic acid and alcohol,--a +little leaven leavening the whole lump,--not by combining with it, +but by setting a movement at work, we not only cannot explain, but +the fact is such an exception to the recognized laws of combination +that Liebig is unwilling to admit the new force at all to which +Berzelius had given the name so generally accepted. + +The phenomena of isomerism, or identity of composition and +proportions of constituents with difference of qualities, and of +isomorphism, or identity of form in crystals which have one element +substituted for another, were equally surprises to science; and +although the mechanism by which they are brought about can be to a +certain extent explained by a reference to the hypothetical atoms of +which the elements are constituted, yet this is only turning the +difficulty into a fraction with an infinitesimal denominator and an +infinite numerator. + +So far we have studied the working of force and its seeming anomalies +in purely chemical phenomena. But we soon find that chemical force +is developed by various other physical agencies,--by heat, by light, +by electricity, by magnetism, by mechanical agencies; and, vice +versa, that chemical action develops heat, light, electricity, +magnetism, mechanical force, as we see in our matches, galvanic +batteries, and explosive compounds. Proceeding with our experiments, +we find that every kind of force is capable of producing all other +kinds, or, in Mr. Faraday's language, that "the various forms under +which the forces of matter are made manifest have a common origin, +or, in other words, are so directly related and mutually dependent +that they are convertible one into another." + +Out of this doctrine naturally springs that of the conservation of +force, so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr. +Faraday. This idea is no novelty, though it seems so at first sight. +It was maintained and disputed among the giants of philosophy. +Des Cartes and Leibnitz denied that any new motion originated in +nature, or that any ever ceased to exist; all motion being in a +circle, passing from one body to another, one losing what the other +gained. Newton, on the other hand, believed that new motions were +generated and existing ones destroyed. On the first supposition, +there is a fixed amount of force always circulating in the universe. +On the second, the total amount may be increasing or diminishing. +You will find in the "Annual of Scientific Discovery" for 1858 a very +interesting lecture by Professor Helmholtz of Bonn, in which it is +maintained that a certain portion of force is lost in every natural +process, being converted into unchangeable heat, so that the universe +will come to a stand-still at last, all force passing into heat, and +all heat into a state of equilibrium. + +The doctrines of the convertibility or specific equivalence of the +various forms of force, and of its conservation, which is its logical +consequence, are very generally accepted, as I believe, at the +present time, among physicists. We are naturally led to the +question, What is the nature of force? The three illustrious +philosophers just referred to agree in attributing the general +movements of the universe to the immediate Divine action. The +doctrine of "preestablished harmony" was an especial contrivance of +Leibnitz to remove the Creator from unworthy association with the +less divine acts of living beings. Obsolete as this expression +sounds to our ears, the phrase laws of the universe, which we use so +constantly with a wider application, appears to me essentially +identical with it. + +Force does not admit of explanation, nor of proper definition, any +more than the hypothetical substratum of matter. If we assume the +Infinite as omnipresent, omniscient, omnipotent, we cannot suppose +Him excluded from any part of His creation, except from rebellious +souls which voluntarily exclude Him by the exercise of their fatal +prerogative of free-will. Force, then, is the act of immanent +Divinity. I find no meaning in mechanical explanations. Newton's +hypothesis of an ether filling the heavenly spaces does not, I +confess, help my conceptions. I will, and the muscles of my vocal +organs shape my speech. God wills, and the universe articulates His +power, wisdom, and goodness. That is all I know. There is no bridge +my mind can throw from the "immaterial " cause to the "material" +effect. + +The problem of force meets us everywhere, and I prefer to encounter +it in the world of physical phenomena before reaching that of living +actions. It is only the name for the incomprehensible cause of +certain changes known to our consciousness, and assumed to be outside +of it. For me it is the Deity Himself in action. + +I can therefore see a large significance in the somewhat bold +language of Burdach : "There is for me but one miracle, that of +infinite existence, and but one mystery, the manner in which the +finite proceeds from the infinite. So soon as we recognize this +incomprehensible act as the general and primordial miracle, of which +our reason perceives the necessity, but the manner of which our +intelligence cannot grasp, so soon as we contemplate the nature known +to us by experience in this light, there is for us no other +impenetrable miracle or mystery." + +Let us turn to a branch of knowledge which deals with certainties up +to the limit of the senses, and is involved in no speculations beyond +them. In certain points of view, HUMAN ANATOMY may be considered an +almost exhausted science. From time to time some small organ which +had escaped earlier observers has been pointed out,--such parts as +the tensor tarsi, the otic ganglion, or the Pacinian bodies; but some +of our best anatomical works are those which have been classic for +many generations. The plates of the bones in Vesalius, three +centuries old, are still masterpieces of accuracy, as of art. The +magnificent work of Albinus on the muscles, published in 1747, is +still supreme in its department, as the constant references of the +most thorough recent treatise on the subject, that of Theile, +sufficiently show. More has been done in unravelling the mysteries +of the fasciae, but there has been a tendency to overdo this kind of +material analysis. Alexander Thomson split them up into cobwebs, as +you may see in the plates to Velpeau's Surgical Anatomy. I well +remember how he used to shake his head over the coarse work of Scarpa +and Astley Cooper,--as if Denner, who painted the separate hairs of +the beard and pores of the skin in his portraits, had spoken lightly +of the pictures of Rubens and Vandyk. + +Not only has little been added to the catalogue of parts, but some +things long known had become half-forgotten. Louis and others +confounded the solitary glands of the lower part of the small +intestine with those which "the great Brunner," as Haller calls him, +described in 1687 as being found in the duodenum. The display of the +fibrous structure of the brain seemed a novelty as shown by +Spurzheim. One is startled to find the method anticipated by Raymond +Vieussens nearly two centuries ago. I can hardly think Gordon had +ever looked at his figures, though he names their author, when he +wrote the captious and sneering article which attracted so much +attention in the pages of the "Edinburgh Review." + +This is the place, if anywhere, to mention any observations I could +pretend to have made in the course of my teaching the structure of +the human body. I can make no better show than most of my +predecessors in this well-reaped field. The nucleated cells found +connected with the cancellated structure of the bones, which I first +pointed out and had figured in 1847, and have shown yearly from that +time to the present, and the fossa masseterica, a shallow concavity +on the ramus of the lower jaw, for the lodgment of the masseter +muscle, which acquires significance when examined by the side of the +deep cavity on the corresponding part in some carnivora to which it +answers, may perhaps be claimed as deserving attention. I have also +pleased myself by making a special group of the six radiating muscles +which diverge from the spine of the axis, or second cervical +vertebra, and by giving to it the name stella musculosa nuchaee. But +this scanty catalogue is only an evidence that one may teach long and +see little that has not been noted by those who have gone before him. +Of course I do not think it necessary to include rare, but already +described anomalies, such as the episternal bones, the rectus +sternalis, and other interesting exceptional formations I have +encountered, which have shown a curious tendency to present +themselves several times in the same season, perhaps because the +first specimen found calls our attention to any we may subsequently +meet with. + +The anatomy of the scalpel and the amphitheatre was, then, becoming +an exhausted branch of investigation. But during the present century +the study of the human body has changed its old aspect, and become +fertile in new observations. This rejuvenescence was effected by +means of two principal agencies,--new methods and a new instrument. + +Descriptive anatomy, as known from an early date, is to the body what +geography is to the planet. Now geography was pretty well known so +long ago as when Arrowsmith, who was born in 1750, published his +admirable maps. But in that same year was born Werner, who taught a +new way of studying the earth, since become familiar to us all under +the name of Geology. + +What geology has done for our knowledge of the earth, has been done +for our knowledge of the body by that method of study to which is +given the name of General Anatomy. It studies, not the organs as +such, but the elements out of which the organs are constructed. It +is the geology of the body, as that is the general anatomy of the +earth. The extraordinary genius of Bichat, to whom more than any +other we owe this new method of study, does not require Mr. Buckle's +testimony to impress the practitioner with the importance of its +achievements. I have heard a very wise physician question whether +any important result had accrued to practical medicine from Harvey's +discovery of the circulation. But Anatomy, Physiology, and Pathology +have received a new light from this novel method of contemplating the +living structures, which has had a vast influence in enabling the +practitioner at least to distinguish and predict the course of +disease. We know as well what differences to expect in the habits of +a mucous and of a serous membrane, as what mineral substances to look +for in the chalk or the coal measures. You have only to read +Cullen's description of inflammation of the lungs or of the bowels, +and compare it with such as you may find in Laennec or Watson, to see +the immense gain which diagnosis and prognosis have derived from +general anatomy. + +The second new method of studying the human structure, beginning with +the labors of Scarpa, Burns, and Colles, grew up principally during +the first third of this century. It does not deal with organs, as +did the earlier anatomists, nor with tissues, after the manner of +Bichat. It maps the whole surface of the body into an arbitrary +number of regions, and studies each region successively from the +surface to the bone, or beneath it. This hardly deserves the name of +a science, although Velpeau has dignified it with that title, but it +furnishes an admirable practical way for the surgeon who has to +operate on a particular region of the body to study that region. If +we are buying a farm, we are not content with the State map or a +geological chart including the estate in question. We demand an +exact survey of that particular property, so that we may know what we +are dealing with. This is just what regional, or, as it is sometimes +called, surgical anatomy, does for the surgeon with reference to the +part on which his skill is to be exercised. It enables him to see +with the mind's eye through the opaque tissues down to the bone on +which they lie, as if the skin were transparent as the cornea, and +the organs it covers translucent as the gelatinous pulp of a medusa. + +It is curious that the Japanese should have anticipated Europe in a +kind of rude regional anatomy. I have seen a manikin of Japanese +make traced all over with lines, and points marking their +intersection. By this their doctors are guided in the performance of +acupuncture, marking the safe places to thrust in needles, as we buoy +out our ship-channels, and doubtless indicating to learned eyes the +spots where incautious meddling had led to those little accidents of +shipwreck to which patients are unfortunately liable. + +A change of method, then, has given us General and Regional Anatomy. +These, too, have been worked so thoroughly, that, if not exhausted, +they have at least become to a great extent fixed and positive +branches of knowledge. But the first of them, General Anatomy, would +never, have reached this positive condition but for the introduction +of that, instrument which I have mentioned as the second great aid to +modern progress. + +This instrument is the achromatic microscope. For the history of the +successive steps by which it became the effective scientific +implement we now possess, I must refer you to the work of Mr. +Quekett, to an excellent article in the "Penny Cyclopaedia," or to +that of Sir David Brewster in the "Encyclopaedia Britannica." It is +a most interesting piece of scientific history, which shows how the +problem which Biot in 1821 pronounced insolvable was in the course of +a few years practically solved, with a success equal to that which +Dollond had long before obtained with the telescope. It is enough +for our purpose that we are now in possession of an instrument freed +from all confusions and illusions, which magnifies a thousand +diameters,--a million times in surface,--without serious distortion +or discoloration of its object. + +A quarter of a century ago, or a little more, an instructor would not +have hesitated to put John Bell's "Anatomy" and Bostock's +"Physiology" into a student's hands, as good authority on their +respective subjects. Let us not be unjust to either of these +authors. John Bell is the liveliest medical writer that I can +remember who has written since the days of delightful old Ambroise +Pare. His picturesque descriptions and bold figures are as good now +as they ever were, and his book can never become obsolete. But +listen to what John Bell says of the microscope : + +"Philosophers of the last age had been at infinite pains to find the +ultimate fibre of muscles, thinking to discover its properties in its +form; but they saw just in proportion to the glasses which they used, +or to their practice and skill in that art, which is now almost +forsaken." + +Dr. Bostock's work, neglected as it is, is one which I value very +highly as a really learned compilation, full of original references. +But Dr. Bostock says: "Much as the naturalist has been indebted to +the microscope, by bringing into view many beings of which he could +not otherwise have ascertained the existence, the physiologist has +not yet derived any great benefit from the instrument." + +These are only specimens of the manner in which the microscope and +its results were generally regarded by the generation just preceding +our own. + +I have referred you to the proper authorities for the account of +those improvements which about the year 1830 rendered the compound +microscope an efficient and trustworthy instrument. It was now for +the first time that a true general anatomy became possible. As early +as 1816 Treviranus had attempted to resolve the tissues, of which +Bichat had admitted no less than twenty-one, into their simple +microscopic elements. How could such an attempt succeed, Henle well +asks, at a time when the most extensively diffused of all the +tissues, the areolar, was not at all understood? All that method +could do had been accomplished by Bichat and his followers. It was +for the optician to take the next step. The future of anatomy and +physiology, as an enthusiastic micrologist of the time said, was in +the hands of Messrs. Schieck and Pistor, famous opticians of Berlin. + +In those earlier days of which I am speaking, all the points of +minute anatomy were involved in obscurity. Some found globules +everywhere, some fibres. Students disputed whether the conjunctiva +extended over the cornea or not, and worried themselves over Gaultier +de Claubry's stratified layers of the skin, or Breschet's +blennogenous and chromatogenous organs. The dartos was a puzzle, the +central spinal canal a myth, the decidua clothed in fable as much as +the golden fleece. The structure of bone, now so beautifully made +out,--even that of the teeth, in which old Leeuwenhoek, peeping with +his octogenarian eyes through the minute lenses wrought with his own +hands, had long ago seen the "pipes," as he called them,--was hardly +known at all. The minute structure of the viscera lay in the mists +of an uncertain microscopic vision. The intimate recesses of the +animal system were to the students of anatomy what the anterior of +Africa long was to geographers, and the stories of microscopic +explorers were as much sneered at as those of Bruce or Du Chailly, +and with better reason. + +Now what have we come to in our own day? In the first place, the +minute structure of all the organs has been made out in the most +satisfactory way. The special arrangements of the vessels and the +ducts of all the glands, of the air-tubes and vesicles of the lungs, +of the parts which make up the skin and other membranes, all the +details of those complex parenchymatous organs which had confounded +investigation so long, have been lifted out of the invisible into the +sight of all observers. It is fair to mention here, that we owe a +great deal to the art of minute injection, by which we are enabled to +trace the smallest vessels in the midst of the tissues where they are +distributed. This is an old artifice of anatomists. The famous +Ruysch, who died a hundred and thirty years ago, showed that each of +the viscera has its terminal vessels arranged in its own peculiar +way; the same fact which you may see illustrated in Gerber's figures +after the minute injections of Berres. I hope to show you many +specimens of this kind in the microscope, the work of English and +American hands. Professor Agassiz allows me also to make use of a +very rich collection of injected preparations sent him by Professor +Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition +of which I had a number of microscopes made expressly, by Mr. Grunow, +during the past season. All this illustrates what has been done for +the elucidation of the intimate details of formation of the organs. + +But the great triumph of the microscope as applied to anatomy has +been in the resolution of the organs and the tissues into their +simple constituent anatomical elements. It has taken up general +anatomy where Bichat left it. He had succeeded in reducing the +structural language of nature to syllables, if you will permit me to +use so bold an image. The microscopic observers who have come after +him have analyzed these into letters, as we may call them,--the +simple elements by the combination of which Nature spells out +successively tissues, which are her syllables, organs which are her +words, systems which are her chapters, and so goes on from the simple +to the complex, until she binds up in one living whole that wondrous +volume of power and wisdom which we call the human body. + +The alphabet of the organization is so short and simple, that I will +risk fatiguing your attention by repeating it, according to the plan +I have long adopted. + +A. Cells, either floating, as in the blood, or fixed, like those in +the cancellated structure of bone, already referred to. Very +commonly they have undergone a change of figure, most frequently a +flattening which reduces them to scales, as in the epidermis and the +epithelium. + +B. Simple, translucent, homogeneous solid, such as is found at the +back of the cornea, or forming the intercellular substance of +cartilage. + +C. The white fibrous element, consisting of very delicate, tenacious +threads. This is the long staple textile substance of the body. It +is to the organism what cotton is pretended to be to our Southern +States. It pervades the whole animal fabric as areolar tissue, which +is the universal packing and wrapping material. It forms the +ligaments which bind the whole frame-work together. It furnishes the +sinews, which are the channels of power. It enfolds every muscle. +It wraps the brain in its hard, insensible folds, and the heart +itself beats in a purse that is made of it. + +D. The yellow elastic, fibrous element, the caoutchouc of the animal +mechanism, which pulls things back into place, as the India-rubber +band shuts the door we have opened. + +E. The striped muscular fibre,--the red flesh, which shortens itself +in obedience to the will, and thus produces all voluntary active +motion. + +F. The unstriped muscular fibre, more properly the fusiform-cell +fibre, which carries on the involuntary internal movements. + +G. The nerve-cylinder, a glassy tube, with a pith of some firmness, +which conveys sensation to the brain and the principle which induces +motion from it. + +H. The nerve-corpuscle, the centre of nervous power. + +I. The mucous tissue, as Virchow calls it, common in embryonic +structures, seen in the vitreous humor of the adult. + +To these add X, granules, of indeterminate shape and size, Y, for +inorganic matters, such as the salts of bone and teeth, and Z, to +stand as a symbol of the fluids, and you have the letters of what I +have ventured to call the alphabet of the body. + +But just as in language certain diphthongs and syllables are +frequently recurring, so we have in the body certain secondary and +tertiary combinations, which we meet more frequently than the +solitary elements of which they are composed. + +Thus A B, or a collection of cells united by simple structureless +solid, is seen to be extensively employed in the body under the name +of cartilage. Out of this the surfaces of the articulations and the +springs of the breathing apparatus are formed. But when Nature came +to the buffers of the spinal column (intervertebral disks) and the +washers of the joints (semilunar fibrocartilages of the knee, etc.), +she required more tenacity than common cartilage possessed. What did +she do? What does man do in a similar case of need? I need hardly +tell you. The mason lays his bricks in simple mortar. But the +plasterer works some hair into the mortar which he is going to lay in +large sheets on the walls. The children of Israel complained that +they had no straw to make their bricks with, though portions of it +may still be seen in the crumbling pyramid of Darshour, which they +are said to have built. I visited the old house on Witch Hill in +Salem a year or two ago, and there I found the walls coated with clay +in which straw was abundantly mingled;--the old Judaizing witch- +hangers copied the Israelites in a good many things. The Chinese and +the Corsicans blend the fibres of amianthus in their pottery to give +it tenacity. Now to return to Nature. To make her buffers and +washers hold together in the shocks to which they would be subjected, +she took common cartilage and mingled the white fibrous tissue with +it, to serve the same purpose as the hair in the mortar, the straw in +the bricks and in the plaster of the old wall, and the amianthus in +the earthen vessels. Thus we have the combination A B C, or fibro- +cartilage. Again, the bones were once only gristle or cartilage, A +B. To give them solidity they were infiltrated with stone, in the +form of salts of lime, an inorganic element, so that bone would be +spelt out by the letters A, B, and Y. + +If from these organic syllables we proceed to form organic words, we +shall find that Nature employs three principal forms; namely, +Vessels, Membranes, and Parenchyma, or visceral tissue. The most +complex of them can be resolved into a combination of these few +simple anatomical constituents. + + +Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find +the same elements in morbid growths that we have met with in normal +structures. The pus-corpuscle and the white blood-corpuscle can only +be distinguished by tracing them to their origin. A frequent form of +so-called malignant disease proves to be only a collection of altered +epithelium-cells. Even cancer itself has no specific anatomical +element, and the diagnosis of a cancerous tumor by the microscope, +though tolerably sure under the eye of an expert, is based upon +accidental, and not essential points,--the crowding together of the +elements, the size of the cell-nuclei, and similar variable +characters. + +Let us turn to PHYSIOLOGY. The microscope, which has made a new +science of the intimate structure of the organs, has at the same time +cleared up many uncertainties concerning the mechanism of the special +functions. Up to the time of the living generation of observers, +Nature had kept over all her inner workshops the forbidding +inscription, No Admittance! If any prying observer ventured to spy +through his magnifying tubes into the mysteries of her glands and +canals and fluids, she covered up her work in blinding mists and +bewildering halos, as the deities of old concealed their favored +heroes in the moment of danger. + +Science has at length sifted the turbid light of her lenses, and +blanched their delusive rainbows. + +Anatomy studies the organism in space. Physiology studies it also in +time. After the study of form and composition follows close that of +action, and this leads us along back to the first moment of the germ, +and forward to the resolution of the living frame into its lifeless +elements. In this way Anatomy, or rather that branch of it which we +call Histology, has become inseparably blended with the study of +function. The connection between the science of life and that of +intimate structure on the one hand, and composition on the other, is +illustrated in the titles of two recent works of remarkable +excellence,--"the Physiological Anatomy" of Todd and Bowman, and the +"Physiological Chemistry" of Lehmann. + +Let me briefly recapitulate a few of our acquisitions in Physiology, +due in large measure to our new instruments and methods of research, +and at the same time indicate the limits which form the permanent or +the temporary boundaries of our knowledge. I will begin with the +largest fact and with the most absolute and universally encountered +limitation. + +The "largest truth in Physiology" Mr. Paget considers to be "the +development of ova through multiplication and division of their +cells." I would state it more broadly as the agency of the cell in +all living processes. It seems at present necessary to abandon the +original idea of Schwann, that we can observe the building up of a +cell from the simple granules of a blastema, or formative fluid. The +evidence points rather towards the axiom, Omnis cellula a cellula; +that is, the germ of a new cell is always derived from a preexisting +cell. The doctrine of Schwann, as I remarked long ago (1844), runs +parallel with the nebular theory in astronomy, and they may yet stand +or fall together. + +As we have seen Nature anticipating the plasterer in fibro-cartilage, +so we see her beforehand with the glassblower in her dealings with +the cell. The artisan blows his vitreous bubbles, large or small, to +be used afterwards as may be wanted. So Nature shapes her hyaline +vesicles and modifies them to serve the needs of the part where they +are found. The artisan whirls his rod, and his glass bubble becomes +a flattened disk, with its bull's-eye for a nucleus. These lips of +ours are all glazed with microscopic tiles formed of flattened cells, +each one of them with its nucleus still as plain and relatively as +prominent, to the eye of the microscopist, as the bull's-eye in the +old-fashioned windowpane. Everywhere we find cells, modified or +unchanged. They roll in inconceivable multitudes (five millions and +more to the cubic millimetre, according to Vierordt) as blood-disks +through our vessels. A close-fitting mail of flattened cells coats +our surface with a panoply of imbricated scales (more than twelve +thousand millions, as Harting has computed, as true a defence against +our enemies as the buckler of the armadillo or the carapace of the +tortoise against theirs. The same little protecting organs pave all +the great highways of the interior system. Cells, again, preside +over the chemical processes which elaborate the living fluids; they +change their form to become the agents of voluntary and involuntary +motion; the soul itself sits on a throne of nucleated cells, and +flashes its mandates through skeins of glassy filaments which once +were simple chains of vesicles. And, as if to reduce the problem of +living force to its simplest expression, we see the yolk of a +transparent egg dividing itself in whole or in part, and again +dividing and subdividing, until it becomes a mass of cells, out of +which the harmonious diversity of the organs arranges itself, worm or +man, as God has willed from the beginning. + +This differentiation having been effected, each several part assumes +its special office, having a life of its own adjusted to that of +other parts and the whole. "Just as a tree constitutes a mass +arranged in a definite manner, in which, in every single part, in the +leaves as in the root, in the trunk as in the blossom, cells are +discovered to be the ultimate elements, so is it also with the forms +of animal life. Every animal presents itself as a sum of vital +unities, every one of which manifests all the characteristics of +life." + +The mechanism is as clear, as unquestionable, as absolutely settled +and universally accepted, as the order of movement of the heavenly +bodies, which we compute backward to the days of the observatories on +the plains of Shinar, and on the faith of which we regulate the +movements of war and trade by the predictions of our ephemeris. + +The mechanism, and that is all. We see the workman and the tools, +but the skill that guides the work and the power that performs it are +as invisible as ever. I fear that not every listener took the +significance of those pregnant words in the passage I quoted from +John Bell,--"thinking to discover its properties in its form." We +have discovered the working bee in this great hive of organization. +We have detected the cell in the very act of forming itself from a +nucleus, of transforming itself into various tissues, of selecting +the elements of various secretions. But why one cell becomes nerve +and another muscle, why one selects bile and another fat, we can no +more pretend to tell, than why one grape sucks out of the soil the +generous juice which princes hoard in their cellars, and another the +wine which it takes three men to drink,--one to pour it down, another +to swallow it, and a third to hold him while it is going down. +Certain analogies between this selecting power and the phenomena of +endosmosis in the elective affinities of chemistry we can find, but +the problem of force remains here, as everywhere, unsolved and +insolvable. + +Do we gain anything by attempting to get rid of the idea of a special +vital force because we find certain mutually convertible relations +between forces in the body and out of it? I think not, any more than +we should gain by getting rid of the idea and expression Magnetism +because of its correlation with electricity. We may concede the +unity of all forms of force, but we cannot overlook the fixed +differences of its manifestations according to the conditions under +which it acts. It is a mistake, however, to think the mystery is +greater in an organized body than in any other. We see a stone fall +or a crystal form, and there is nothing stranger left to wonder at, +for we have seen the Infinite in action. + +Just so far as we can recognize the ordinary modes of operation of +the common forces of nature,--gravity, cohesion, elasticity, +transudation, chemical action, and the rest,--we see the so-called +vital acts in the light of a larger range of known facts and familiar +analogies. Matteuecci's well-remembered lectures contain many and +striking examples of the working of physical forces in physiological +processes. Wherever rigid experiment carries us, we are safe in +following this lead; but the moment we begin to theorize beyond our +strict observation, we are in danger of falling into those mechanical +follies which true science has long outgrown. + +Recognizing the fact, then, that we have learned nothing but the +machinery of life, and are no nearer to its essence, what is it that +we have gained by this great discovery of the cell formation and +function? + +It would have been reward enough to learn the method Nature pursues +for its own sake. If the sovereign Artificer lets us into his own +laboratories and workshops, we need not ask more than the privilege +of looking on at his work. We do not know where we now stand in the +hierarchy of created intelligences. We were made a little lower than +the angels. I speak it not irreverently; as the lower animals +surpass man in some of their attributes, so it may be that not every +angel's eye can see as broadly and as deeply into the material works +of God as man himself, looking at the firmament through an equatorial +of fifteen inches' aperture, and searching into the tissues with a +twelfth of an inch objective. + +But there are other positive gains of a more practical character. +Thus we are no longer permitted to place the seat of the living +actions in the extreme vessels, which are only the carriers from +which each part takes what it wants by the divine right of the +omnipotent nucleated cell. The organism has become, in the words +already borrowed from Virchow, "a sum of vital unities." The +strictum and laxum, the increased and diminished action of the +vessels, out of which medical theories and methods of treatment have +grown up, have yielded to the doctrine of local cell-communities, +belonging to this or that vascular district, from which they help +themselves, as contractors are wont to do from the national treasury. + +I cannot promise to do more than to select a few of the points of +contact between our ignorance and our knowledge which present +particular interest in the existing state of our physiological +acquisitions. Some of them involve the microscopic discoveries of +which I have been speaking, some belong to the domain of chemistry, +and some have relations with other departments of physical science. + +If we should begin with the digestive function, we should find that +the long-agitated question of the nature of the acid of the gastric +juice is becoming settled in favor of the lactic. But the whole +solvent agency of the digestive fluid enters into the category of +that exceptional mode of action already familiar to us in chemistry +as catalysis. It is therefore doubly difficult of explanation; +first, as being, like all reactions, a fact not to be accounted for +except by the imaginative appeal to "affinity," and secondly, as +being one of those peculiar reactions provoked by an element which +stands outside and looks on without compromising itself. + +The doctrine of Mulder, so widely diffused in popular and scientific +belief, of the existence of a common base of all albuminous +substances, the so-called protein, has not stood the test of rigorous +analysis. The division of food into azotized and non-azotized is no +doubt important, but the attempt to show that the first only is +plastic or nutritive, while the second is simply calorifacient, or +heat-producing, fails entirely in the face of the facts revealed by +the study of man in different climates, and of numerous experiments +in the feeding of animals. I must return to this subject in +connection with the respiratory function. + +The sugar-making faculty of the liver is another "catalytic" mystery, +as great as the rest of them, and no greater. Liver-tissue brings +sugar out of the blood, or out of its own substance;--why? + + Quia est in eo + Virtus saccharitiva. + +Just what becomes of the sugar beyond the fact of its disappearance +before it can get into the general circulation and sweeten our +tempers, it is hard to say. + +The pancreatic fluid makes an emulsion of the fat contained in our +food, but just how the fatty particles get into the villi we must +leave Brucke and Kolliker to settle if they can. + +No one has shown satisfactorily the process by which the blood- +corpuscles are formed out of the lymph-corpuscles, nor what becomes +of them. These two questions are like those famous household +puzzles,--Where do the flies come from? and, Where do the pins go +to? + +There is a series of organs in the body which has long puzzled +physiologists,--organs of glandular aspect, but having no ducts,--the +spleen, the thyroid and thymus bodies, and the suprarenal capsules. +We call them vascular glands, and we believe that they elaborate +colored and uncolored blood-cells; but just what changes they effect, +and just how they effect them, it has proved a very difficult matter +to determine. So of the noted glandules which form Peyer's patches, +their precise office, though seemingly like those of the lymphatic +glands, cannot be positively assigned, so far as I know, at the +present time. It is of obvious interest to learn it with reference +to the pathology of typhoid fever. It will be remarked that the +coincidence of their changes in this disease with enlargement of the +spleen suggests the idea of a similarity of function in these two +organs. + +The theories of the production of animal heat, from the times of +Black, Lavoisier, and Crawford to those of Liebig, are familiar to +all who have paid any attention to physiological studies. The +simplicity of Liebig's views, and the popular form in which they have +been presented, have given them wide currency, and incorporated them +in the common belief and language of our text-books. Direct +oxidation or combustion of the carbon and hydrogen contained in the +food, or in the tissues themselves; the division of alimentary +substances into respiratory, or non-azotized, and azotized,--these +doctrines are familiar even to the classes in our high-schools. But +this simple statement is boldly questioned. Nothing proves that +oxygen combines (in the system) with hydrogen and carbon in +particular, rather than with sulphur and azote. Such is the well- +grounded statement of Robin and Verdeil. "It is very probable that +animal heat is entirely produced by the chemical actions which take +place in the organism, but the phenomenon is too complex to admit of +our calculating it according to the quality of oxygen consumed." +These last are the words of Regnault, as cited by Mr. Lewes, whose +intelligent discussion of this and many of the most interesting +physiological problems I strongly recommend to your attention. + +This single illustration covers a wider ground than the special +function to which it belongs. We are learning that the chemistry of +the body must be studied, not simply by its ingesta and egesta, but +that there is a long intermediate series of changes which must be +investigated in their own light, under their own special conditions. +The expression "sum of vital unities" applies to the chemical +actions, as well as to other actions localized in special parts; and +when the distinguished chemists whom I have just cited entitle their +work a treatise on the immediate principles of the body, they only +indicate the nature of that profound and subtile analysis which must +take the place of all hasty generalizations founded on a comparison +of the food with residual products. + +I will only call your attention to the fact, that the exceptional +phenomenon of the laboratory is the prevailing law of the organism. +Nutrition itself is but one great catalytic process. As the blood +travels its rounds, each part selects its appropriate element and +transforms it to its own likeness. Whether the appropriating agent +be cell or nucleus, or a structureless solid like the intercellular +substance of cartilage, the fact of its presence determines the +separation of its proper constituents from the circulating fluid, so +that even when we are wounded bone is replaced by bone, skin by skin, +and nerve by nerve. + +It is hardly without a smile that we resuscitate the old question of +the vis insita of the muscular fibre, so famous in the discussions of +Haller and his contemporaries. Speaking generally, I think we may +say that Haller's doctrine is the one now commonly received; namely, +that the muscles contract in virtue of their own inherent endowments. +It is true that Kolliker says no perfectly decisive fact has been +brought forward to prove that the striated muscles contract with. +out having been acted on by nerves. Yet Mr. Bowman's observations on +the contraction of isolated fibres appear decisive enough (unless we +consider them invalidated by Dr. Lionel Beale's recent researches, +tending to show that each elementary fibre is supplied with nerves; +and as to the smooth muscular fibres, we have Virchow's statement +respecting the contractility of those of the umbilical cord, where +there is not a trace of any nerves. + +In the investigation of the nervous system, anatomy and physiology +have gone hand in hand. It is very singular that so important, and +seemingly simple, a fact as the connection of the nerve-tubes, at +their origin or in their course, with the nerve-cells, should have so +long remained open to doubt, as you may see that it did by referring +to the very complete work of Sharpey and Quain (edition of 1849), the +histological portion of which is cordially approved by Kolliker +himself. + +Several most interesting points of the minute anatomy of the nervous +centres have been laboriously and skilfully worked out by a recent +graduate of this Medical School, in a monograph worthy to stand in +line with those of Lockhart Clarke, Stilling, and Schroder van der +Kolk. I have had the privilege of examining and of showing some of +you a number of Dr. Dean's skilful preparations. I have no space to +give even an abstract of his conclusions. I can only refer to his +proof of the fact, that a single cell may send its processes into +several different bundles of nerve-roots, and to his demonstration of +the curved ascending and descending fibres from the posterior +nerveroots, to reach what he has called the longitudinal columns of +the cornea. I must also mention Dr. Dean's exquisite microscopic +photographs from sections of the medulla oblongata, which appear to +me to promise a new development, if not a new epoch, in anatomical +art. + +It having been settled that the nerve-tubes can very commonly be +traced directly to the nerve-cells, the object of all the observers +in this department of anatomy is to follow these tubes to their +origin. We have an infinite snarl of telegraph wires, and we may be +reasonably sure, that, if we can follow them up, we shall find each +of them ends in a battery somewhere. One of the most interesting +problems is to find the ganglionic origin of the great nerves of the +medulla oblongata, and this is the end to which, by the aid of the +most delicate sections, colored so as to bring out their details, +mounted so as to be imperishable, magnified by the best instruments, +and now self-recorded in the light of the truth-telling sunbeam, our +fellow-student is making a steady progress in a labor which I think +bids fair to rank with the most valuable contributions to histology +that we have had from this side of the Atlantic. + +It is interesting to see how old questions are incidentally settled +in the course of these new investigations. Thus, Mr. Clarke's +dissections, confirmed by preparations of Mr. Dean's which I have +myself examined, placed the fact of the decussation of the pyramids-- +denied by Haller, by Morgagni, and even by Stilling--beyond doubt. +So the spinal canal, the existence of which, at least in the adult, +has been so often disputed, appears as a coarse and unequivocal +anatomical fact in many of the preparations referred to. + +While these studies of the structure of the cord have been going on, +the ingenious and indefatigable Brown-Sequard has been investigating +the functions of its different parts with equal diligence. The +microscopic anatomists had shown that the ganglionic corpuscles of +the gray matter of the cord are connected with each other by their +processes, as well as with the nerve-roots. M. Brown-Sequard has +proved by numerous experiments that the gray substance transmits +sensitive impressions and muscular stimulation. The oblique +ascending and descending fibres from the posterior nerve-roots, +joining the "longitudinal columns of the cornua," account for the +results of Brown-Sequard's sections of the posterior columns. The +physiological experimenter has also made it evident that the +decussation of the conductors of sensitive impressions has its seat +in the spinal core, and not in the encephalon, as had been supposed. +Not less remarkable than these results are the facts, which I with +others of my audience have had the opportunity of observing, as shown +by M. Brown-S6quard, of the artificial production of epilepsy in +animals by injuring the spinal cord, and the induction of the +paroxysm by pinching a certain portion of the skin. I would also +call the student's attention to his account of the relations of the +nervous centres to nutrition and secretion, the last of which +relations has been made the subject of an extended essay by our +fellow countryman, Dr. H. F. Campbell of Georgia. + +The physiology of the spinal cord seems a simple matter as you study +it in Longet. The experiments of Brown-Sequard have shown the +problem to be a complex one, and raised almost as many doubts as they +have solved questions; at any rate, I believe all lecturers on +physiology agree that there is no part of their task they dread so +much as the analysis of the evidence relating to the special offices +of the different portions of the medulla spinalis. In the brain we +are sure that we do not know how to localize functions; in the spinal +cord, we think we do know something; but there are so many anomalies, +and seeming contradictions, and sources of fallacy, that beyond the +facts of crossed paralysis of sensation, and the conducting agency of +the gray substance, I am afraid we retain no cardinal principles +discovered since the development of the reflex function took its +place by Sir Charles Bell's great discovery. + +By the manner in which I spoke of the brain, you will see that I am +obliged to leave phrenology sub Jove,--out in the cold,--as not one +of the household of science. I am not one of its haters; on the +contrary, I am grateful for the incidental good it has done. I love +to amuse myself in its plaster Golgothas, and listen to the glib +professor, as he discovers by his manipulations + + "All that disgraced my betters met in me." + +I loved of old to see square-headed, heavy-jawed Spurzheim make a +brain flower out into a corolla of marrowy filaments, as Vieussens +had done before him, and to hear the dry-fibred but human-hearted +George Combe teach good sense under the disguise of his equivocal +system. But the pseudo-sciences, phrenology and the rest, seem to me +only appeals to weak minds and the weak points of strong ones. There +is a pica or false appetite in many intelligences; they take to odd +fancies in place of wholesome truth, as girls gnaw at chalk and +charcoal. Phrenology juggles with nature. It is so adjusted as to +soak up all evidence that helps it, and shed all that harms it. It +crawls forward in all weathers, like Richard Edgeworth's hygrometer. +It does not stand at the boundary of our ignorance, it seems to me, +but is one of the will-o'-the-wisps of its undisputed central domain +of bog and quicksand. Yet I should not have devoted so many words to +it, did I not recognize the light it has thrown on human actions by +its study of congenital organic tendencies. Its maps of the. +surface of the head are, I feel sure, founded on a delusion, but its +studies of individual character are always interesting and +instructive. + +The "snapping-turtle" strikes after its natural fashion when it first +comes out of the egg. Children betray their tendencies in their way +of dealing with the breasts that nourish them; nay, lean venture to +affirm, that long before they are born they teach their mothers +something of their turbulent or quiet tempers. + + "Castor gaudet equis, ovo proanatus eodem + Pugnis." + +Strike out the false pretensions of phrenology; call it anthropology; +let it study man the individual in distinction from man the +abstraction, the metaphysical or theological lay-figure; and it +becomes "the proper study of mankind," one of the noblest and most +interesting of pursuits. + +The whole physiology of the nervous system, from the simplest +manifestation of its power in an insect up to the supreme act of the +human intelligence working through the brain, is full of the most +difficult yet profoundly interesting questions. The singular +relations between electricity and nerve-force, relations which it has +been attempted to interpret as meaning identity, in the face of +palpable differences, require still more extended studies. You may +be interested by Professor Faraday's statement of his opinion on the +matter. "Though I am not satisfied that the nervous fluid is only +electricity, still I think that the agent in the nervous system maybe +an inorganic force; and if there be reason for supposing that +magnetism is a higher relation of force than electricity, so it may +well be imagined that the nervous power may be of a still more +exalted character, and yet within the reach of experiment." + +In connection with this statement, it is interesting to refer to the +experiments of Helmholtz on the rapidity of transmission of the +nervous actions. The rate is given differently in Valentin's report +of these experiments and in that found in the "Scientific Annual" for +1858. One hundred and eighty to three hundred feet per second is the +rate of movement assigned for sensation, but all such results must be +very vaguely approximative. Boxers, fencers, players at the Italian +game of morn, "prestidigitators," and all who depend for their +success on rapidity of motion, know what differences there are in the +personal equation of movement. + +Reflex action, the mechanical sympathy, if I may so call it, of +distant parts; Instinct, which is crystallized intelligence,--an +absolute law with its invariable planes and angles introduced into +the sphere of consciousness, as raphides are inclosed in the living +cells of plants; Intellect,--the operation of the thinking principle +through material organs, with an appreciable waste of tissue in every +act of thought, so that our clergymen's blood has more phosphates to +get rid of on Monday than on any other day of the week; Will,-- +theoretically the absolute determining power, practically limited in +different degrees by the varying organization of races and +individuals, annulled or perverted by different ill-understood +organic changes; on all these subjects our knowledge is in its +infancy, and from the study of some of them the interdict of the +Vatican is hardly yet removed. + +I must allude to one or two points in the histology and physiology of +the organs of sense. The anterior continuation of the retina beyond +the ora serrata has been a subject of much discussion. If H. Muller +and Kolliker can be relied upon, this question is settled by +recognizing that a layer of cells, continued from the retina, passes +over the surface of the zonula Zinnii, but that no proper nervous +element is so prolonged forward. + +I observe that Kolliker calls the true nervous elements of the retina +"the layer of gray cerebral substance." In fact, the ganglionic +corpuscles of each eye may be considered as constituting a little +brain, connected with the masses behind by the commissure, commonly +called the optic nerve. We are prepared, therefore, to find these +two little brains in the most intimate relations with each other, as +we find the cerebral hemispheres. We know that they are directly +connected by fibres that arch round through the chiasma. + +I mention these anatomical facts to introduce a physiological +observation of my own, first announced in one of the lectures before +the Medical Class, subsequently communicated to the American Academy +of Arts and Sciences, and printed in its "Transactions" for February +14, 1860. I refer to the apparent transfer of impressions from one +retina to the other, to which I have given the name reflex vision. +The idea was suggested to me in consequence of certain effects +noticed in employing the stereoscope. Professor William B. Rodgers +has since called the attention of the American Scientific Association +to some facts bearing on the subject, and to a very curious +experiment of Leonardo da Vinci's, which enables the observer to look +through the palm of his hand (or seem to), as if it had a hole bored +through it. As he and others hesitated to accept my explanation, I +was not sorry to find recently the following words in the +"Observations on Man" of that acute observer and thinker, David +Hartley. "An impression made on the right eye alone by a single +object may propagate itself into the left, and there raise up an +image almost equal in vividness to itself; and consequently when we +see with one eye only, we may, however, have pictures in both eyes." +Hartley, in 1784, had anticipated many of the doctrines which have +since been systematized into the theory of reflex actions, and with +which I have attempted to associate this act of reflex vision. My +sixth experiment, however, in the communication referred to, appears +to me to be a crucial one, proving the correctness of my explanation, +and I am not aware that it has been before instituted. + +Another point of great interest connected with the physiology of +vision, and involved for a long time in great obscurity, is that of +the adjustment of the eye to different distances. Dr. Clay Wallace +of New York, who published a very ingenious little book on the eye +about twenty years ago, with vignettes reminding one of Bewick, was +among the first, if not the first, to describe the ciliary muscle, to +which the power of adjustment is generally ascribed. It is +ascertained, by exact experiment with the phacueidoscope, that +accommodation depends on change of form of the crystalline lens. +Where the crystalline is wanting, as Mr. Ware long ago taught, no +power of accommodation remains. The ciliary muscle is generally +thought to effect the change of form of the crystalline. The power +of accommodation is lost after the application of atropine, in +consequence, as is supposed, of the paralysis of this muscle. This, +I believe, is the nearest approach to a demonstration we have on this +point. + +I have only time briefly to refer to Professor Draper's most +ingenious theory as to the photographic nature of vision, for an +account of which I must refer to his original and interesting +Treatise on Physiology. + +It were to be wished that the elaborate and very interesting +researches of the Marquis Corti, which have revealed such singular +complexity of structure in the cochlea of the ear, had done more to +clear up its doubtful physiology; but I am afraid we have nothing but +hypotheses for the special part it plays in the act of hearing, and +that we must say the same respecting the office of the semicircular +canals. + +The microscope has achieved some of its greatest triumphs in teaching +us the changes which occur in the development of the embryo. No more +interesting discovery stands recorded in the voluminous literature of +this subject than the one originally announced by Martin Barry, +afterwards discredited, and still later confirmed by Mr. Newport and +others; namely the fact that the fertilizing filament reaches the +interior of the ovum in various animals;--a striking parallel to the +action of the pollen-tube in the vegetable. But beyond the +mechanical facts all is mystery in the movements of organization, as +profound as in the fall of a stone or the formation of a crystal. + +To the chemist and the microscopist the living body presents the same +difficulties, arising from the fact that everything is in perpetual +change in the organism. The fibrine of the blood puzzles the one as +much as its globules puzzle the other. The difference between the +branches of science which deal with space only, and those which deal +with space and time, is this: we have no glasses that can magnify +time. The figure I here show you a was photographed from an object +(pleurosigma angulatum) magnified a thousand diameters, or presenting +a million times its natural surface. This other figure of the same +object, enlarged from the one just shown, is magnified seven thousand +diameters, or forty-nine million times in surface. When we can make +the forty-nine millionth of a second as long as its integer, +physiology and chemistry will approach nearer the completeness of +anatomy. + +Our reverence becomes more worthy, or, if you will, less unworthy of +its Infinite Object in proportion as our intelligence is lifted and +expanded to a higher and broader understanding of the Divine methods +of action. If Galen called his heathen readers to admire, the power, +the wisdom, the providence, the goodness of the Framer of the animal +body,"--if Mr. Boyle, the student of nature, as Addison and that +friend of his who had known him for forty years tell us, never +uttered the name of the Supreme Being without making a distinct pause +in his speech, in token of his devout recognition of its awful +meaning,--surely we, who inherit the accumulated wisdom of nearly two +hundred years since the time of the British philosopher, and of +almost two thousand since the Greek physician, may well lift our +thoughts from the works we study to their great Artificer. These +wonderful discoveries which we owe to that mighty little instrument, +the telescope of the inner firmament with all its included worlds; +these simple formulae by which we condense the observations of a +generation in a single axiom; these logical analyses by which we +fence out the ignorance we cannot reclaim, and fix the limits of our +knowledge,--all lead us up to the inspiration of the Almighty, which +gives understanding to the world's great teachers. To fear science +or knowledge, lest it disturb our old beliefs, is to fear the influx +of the Divine wisdom into the souls of our fellow-men; for what is +science but the piecemeal revelation,--uncovering,--of the plan of +creation, by the agency of those chosen prophets of nature whom God +has illuminated from the central light of truth for that single +purpose? + +The studies which we have glanced at are preliminary in your +education to the practical arts which make use of them,--the arts of +healing,--surgery and medicine. The more you examine the structure +of the organs and the laws of life, the more you will find how +resolutely each of the cell-republics which make up the E pluribus +unum of the body maintains its independence. Guard it, feed it, air +it, warm it, exercise or rest it properly, and the working elements +will do their best to keep well or to get well. What do we do with +ailing vegetables? Dr. Warren, my honored predecessor in this chair, +bought a country-place, including half of an old orchard. A few +years afterwards I saw the trees on his side of the fence looking in +good health, while those on the other side were scraggy and +miserable. How do you suppose this change was brought about? By +watering them with Fowler's solution? By digging in calomel freely +about their roots? Not at all; but by loosening the soil round them, +and supplying them with the right kind of food in fitting quantities. + +Now a man is not a plant, or, at least, he is a very curious one, for +he carries his soil in his stomach, which is a kind--of portable +flower-pot, and he grows round it, instead of out of it. He has, +besides, a singularly complex nutritive apparatus and a nervous +system. But recollect the doctrine already enunciated in the +language of Virchow, that an animal, like a tree, is a sum of vital +unities, of which the cell is the ultimate element. Every healthy +cell, whether in a vegetable or an animal, necessarily performs its +function properly so long as it is supplied with its proper materials +and stimuli. A cell may, it is true, be congenitally defective, in +which case disease is, so to speak, its normal state. But if +originally sound and subsequently diseased, there has certainly been +some excess, deficiency, or wrong quality in the materials or stimuli +applied to it. You remove this injurious influence and substitute a +normal one; remove the baked coal-ashes, for instance, from the roots +of a tree, and replace them with loam; take away the salt meat from +the patient's table, and replace it with fresh meat and vegetables, +and the cells of the tree or the man return to their duty. + +I do not know that we ever apply to a plant any element which is not +a natural constituent of the vegetable structure, except perhaps +externally, for the accidental purpose of killing parasites. The +whole art of cultivation consists in learning the proper food and +conditions of plants, and supplying them. We give them water, +earths, salts of various kinds such as they are made of, with a +chance to help themselves to air and light. The farmer would be +laughed at who undertook to manure his fields or his trees with a +salt of lead or of arsenic. These elements are not constituents of +healthy plants. The gardener uses the waste of the arsenic furnaces +to kill the weeds in his walks. + +If the law of the animal cell, and of the animal organism, which is +built up of such cells, is like that of the vegetable, we might +expect that we should treat all morbid conditions of any of the vital +unities belonging to an animal in the same way, by increasing, +diminishing, or changing its natural food or stimuli. + +"That is an aliment which nourishes; whatever we find in the +organism, as a constant and integral element, either forming part of +its structure, or one of the conditions of vital processes, that and +that only deserves the name of aliment." " I see no reason, +therefore, why iron, phosphate of lime, sulphur, should not be +considered food for man, as much as guano or poudrette for +vegetables. Whether one or another of them is best in any given +case,--whether they shall be taken alone or in combination, in large +or small quantities, are separate questions. But they are elements +belonging to the body, and even in moderate excess will produce +little disturbance. There is no presumption against any of this +class of substances, any more than against water or salt, provided +they are used in fitting combinations, proportions, and forms. + +But when it comes to substances alien to the healthy system, which +never belong to it as normal constituents, the case is very +different. There is a presumption against putting lead or arsenic +into the human body, as against putting them into plants, because +they do not belong there, any more than pounded glass, which, it is +said, used to be given as a poison. The same thing is true of +mercury and silver. What becomes of these alien substances after +they get into the system we cannot always tell. But in the case of +silver, from the accident of its changing color under the influence +of light, we do know what happens. It is thrown out, in part at +least, under the epidermis, and there it remains to the patient's +dying day. This is a striking illustration of the difficulty which +the system finds in dealing with non-assimilable elements, and +justifies in some measure the vulgar prejudice against mineral +poisons." + +I trust the youngest student on these benches will not commit the +childish error of confounding a presumption against a particular +class of agents with a condemnation of them. Mercury, for instance, +is alien to the system, and eminently disturbing in its influence. +Yet its efficacy in certain forms of specific disease is acknowledged +by all but the most sceptical theorists. Even the esprit moqueur of +Ricord, the Voltaire of pelvic literature, submits to the time- +honored constitutional authority of this great panacea in the class +of cases to which he has devoted his brilliant intelligence. Still, +there is no telling what evils have arisen from the abuse of this +mineral. Dr. Armstrong long ago pointed out some of them, and they +have become matters of common notoriety. I am pleased, therefore, +when I find so able and experienced a practitioner as Dr. Williams of +this city proving that iritis is best treated without mercury, and +Dr. Vanderpoel showing the same thing to be true for pericarditis. + +Whatever elements nature does not introduce into vegetables, the +natural food of all animal life,--directly of herbivorous, indirectly +of carnivorous animals,--are to be regarded with suspicion. Arsenic- +eating may seem to improve the condition of horses for a time,--and +even of human beings, if Tschudi's stories can be trusted,--but it +soon appears that its alien qualities are at war with the animal +organization. So of copper, antimony, and other non-alimentary +simple substances; everyone of them is an intruder in the living +system, as much as a constable would be, quartered in our household. +This does not mean that they may not, any of them, be called in for a +special need, as we send for the constable when we have good reason +to think we have a thief under our roof; but a man's body is his +castle, as well as his house, and the presumption is that we are to +keep our alimentary doors bolted against these perturbing agents. + +Now the feeling is very apt to be just contrary to this. The habit +has been very general with well-taught practitioners, to have +recourse to the introduction of these alien elements into the system +on the occasion of any slight disturbance. The tongue was a little +coated, and mercury must be given; the skin was a little dry, and the +patient must take antimony. It was like sending for the constable +and the posse comitatus when there is only a carpet to shake or a +refuse-barrel to empty. [Dr. James Johnson advises persons not ailing +to take ,five grains of blue pill with one or two of aloes twice a +week for three or four months in the year, with half a pint of +compound decoction of sarsaparilla every day for the same period, to +preserve health and prolong life. Pract. Treatise on Dis. of +Liver, etc. p. 272.] The constitution bears slow poisoning a great +deal better than might be expected; yet the most intelligent men in +the profession have gradually got out of the habit of prescribing +these powerful alien substances in the old routine way. Mr. Metcalf +will tell you how much more sparingly they are given by our +practitioners at the present time, than when he first inaugurated the +new era of pharmacy among us. Still, the presumption in favor of +poisoning out every spontaneous reaction of outraged nature is not +extinct in those who are trusted with the lives of their fellow- +citizens. "On examining the file of prescriptions at the hospital, I +discovered that they were rudely written, and indicated a treatment, +as they consisted chiefly of tartar emetic, ipecacuanha, and epsom +salts, hardly favorable to the cure of the prevailing diarrhoea and +dysenteries." In a report of a poisoning case now on trial, where +we are told that arsenic enough was found in the stomach to produce +death in twenty-four hours, the patient is said to have been treated +by arsenic, phosphorus, bryonia, aconite, nux vomica, and muriatic +acid,--by a practitioner of what school it may be imagined. + +The traditional idea of always poisoning out disease, as we smoke out +vermin, is now seeking its last refuge behind the wooden cannon and +painted port-holes of that unblushing system of false scientific +pretences which I do not care to name in a discourse addressed to an +audience devoted to the study of the laws of nature in the light of +the laws of evidence. It is extraordinary to observe that the system +which, by its reducing medicine to a name and a farce, has accustomed +all who have sense enough to see through its thin artifices to the +idea that diseases get well without being "cured," should now be the +main support of the tottering poison-cure doctrine. It has +unquestionably helped to teach wise people that nature heals most +diseases without help from pharmaceutic art, but it continues to +persuade fools that art can arrest them all with its specifics. + +It is worse than useless to attempt in any way to check the freest +expression of opinion as to the efficacy of any or all of the +"heroic" means of treatment employed by practitioners of different +schools and periods. Medical experience is a great thing, but we +must not forget that there is a higher experience, which tries its +results in a court of a still larger jurisdiction; that, namely, in +which the laws of human belief are summoned to the witness-box, and +obliged to testify to the sources of error which beset the medical +practitioner. The verdict is as old as the father of medicine, who +announces it in the words, "judgment is difficult." Physicians +differed so in his time, that some denied that there was any such +thing as an art of medicine. + +One man's best remedies were held as mischievous by another. The art +of healing was like soothsaying, so the common people said; the same +bird was lucky or unlucky, according as he flew to the right or +left." + +The practice of medicine has undergone great changes within the +period of my own observation. Venesection, for instance, has so far +gone out of fashion, that, as I am told by residents of the New York +Bellevue and the Massachusetts General Hospitals, it is almost +obsolete in these institutions, at least in medical practice. The +old Brunonian stimulating treatment has come into vogue again in the +practice of Dr. Todd and his followers. The compounds of mercury +have yielded their place as drugs of all work, and specifics for that +very frequent subjective complaint, nescio quid faciam,--to compounds +of iodine. [Sir Astley Cooper has the boldness,--or honesty,--to +speak of medicines which "are given as much to assist the medical man +as his patient." Lectures (London, 1832), p. 14.] Opium is believed +in, and quinine, and "rum," using that expressive monosyllable to +mean all alcoholic cordials. If Moliere were writing now, instead of +saignare, purgare, and the other, he would be more like to say, +Stimulare, opium dare et potassio-iodizare. + +I have been in relation successively with the English and American +evacuant and alterative practice, in which calomel and antimony +figured so largely that, as you may see in Dr. Jackson's last +"Letter," Dr. Holyoke, a good representative of sterling old- +fashioned medical art, counted them with opium and Peruvian bark as +his chief remedies; with the moderately expectant practice of Louis; +the blood-letting "coup sur coup" of Bouillaud; the contra-stimulant +method of Rasori and his followers; the anti-irritant system of +Broussais, with its leeching and gum-water; I have heard from our own +students of the simple opium practice of the renowned German teacher, +Oppolzer; and now I find the medical community brought round by the +revolving cycle of opinion to that same old plan of treatment which +John Brown taught in Edinburgh in the last quarter of the last +century, and Miner and Tully fiercely advocated among ourselves in +the early years of the present. The worthy physicians last +mentioned, and their antagonist Dr. Gallup, used stronger language +than we of these degenerate days permit ourselves. "The lancet is a +weapon which annually slays more than the sword," says Dr. Tully. +"It is probable that, for forty years past, opium and its +preparations have done seven times the injury they have rendered +benefit, on the great scale of the world," says Dr. Gallup. + +What is the meaning of these perpetual changes and conflicts of +medical opinion and practice, from an early antiquity to our own +time? Simply this: all "methods" of treatment end in disappointment +of those extravagant expectations which men are wont to entertain of +medical art. The bills of mortality are more obviously affected by +drainage, than by this or that method of practice. The insurance +companies do not commonly charge a different percentage on the lives +of the patients of this or that physician. In the course of a +generation, more or less, physicians themselves are liable to get +tired of a practice which has so little effect upon the average +movement of vital decomposition. Then they are ready for a change, +even if it were back again to a method which has already been tried, +and found wanting. + +Our practitioners, or many of them, have got back to the ways of old +Dr. Samuel Danforth, who, as it is well known, had strong objections +to the use of the lancet. By and by a new reputation will be made by +some discontented practitioner, who, tired of seeing patients die +with their skins full of whiskey and their brains muddy with opium, +returns to a bold antiphlogistic treatment, and has the luck to see a +few patients of note get well under it. So of the remedies which +have gone out of fashion and been superseded by others. It can +hardly be doubted that they will come into vogue again, more or less +extensively, under the influence of that irresistible demand for +change just referred to. + +Then will come the usual talk about a change in the character of +disease, which has about as much meaning as that concerning +"old-fashioned snow-storms." "Epidemic constitutions" of disease +mean something, no doubt; a great deal as applied to malarious +affections; but that the whole type of diseases undergoes such +changes that the practice must be reversed from depleting to +stimulating, and vice versa, is much less likely than that methods of +treatment go out of fashion and come in again. If there is any +disease which claims its percentage with reasonable uniformity, it is +phthisis. Yet I remember that the reverend and venerable Dr. Prince +of Salem told me one Commencement day, as I was jogging along towards +Cambridge with him, that he recollected the time when that disease +was hardly hardly known; and in confirmation of his statement +mentioned a case in which it was told as a great event, that somebody +down on "the Cape" had died of "a consumption." This story does not +sound probable to myself, as I repeat it, yet I assure you it is +true, and it shows how cautiously we must receive all popular stories +of great changes in the habits of disease. + +Is there no progress, then, but do we return to the same beliefs and +practices which our forefathers wore out and threw away? I trust and +believe that there is a real progress. We may, for instance, return +in a measure to the Brunonian stimulating system, but it must be in a +modified way, for we cannot go back to the simple Brunonian +pathology, since we have learned too much of diseased action to +accept its convenient dualism. So of other doctrines, each new +Avatar strips them of some of their old pretensions, until they take +their fitting place at last, if they have any truth in them, or +disappear, if they were mere phantasms of the imagination. + +In the mean time, while medical theories are coming in and going out, +there is a set of sensible men who are never run away with by them, +but practise their art sagaciously and faithfully in much the same +way from generation to generation. From the time of Hippocrates to +that of our own medical patriarch, there has been an apostolic +succession of wise and good practitioners. If you will look at the +first aphorism of the ancient Master you will see that before all +remedies he places the proper conduct of the patient and his +attendants, and the fit ordering of all the conditions surrounding +him. The class of practitioners I have referred to have always been +the most faithful in attending to these points. No doubt they have +sometimes prescribed unwisely, in compliance with the prejudices of +their time, but they have grown wiser as they have grown older, and +learned to trust more in nature and less in their plans of +interference. I believe common opinion confirms Sir James Clark's +observation to this effect. + +The experience of the profession must, I think, run parallel with +that of the wisest of its individual members. Each time a plan of +treatment or a particular remedy comes up for trial, it is submitted +to a sharper scrutiny. When Cullen wrote his Materia Medica, he had +seriously to assail the practice of giving burnt toad, which was +still countenanced by at least one medical authority of note. I have +read recently in some medical journal, that an American practitioner, +whose name is known to the country, is prescribing the hoof of a +horse for epilepsy. It was doubtless suggested by that old fancy of +wearing a portion of elk's hoof hung round the neck or in a ring, for +this disease. But it is hard to persuade reasonable people to +swallow the abominations of a former period. The evidence which +satisfied Fernelius will not serve one of our hospital physicians. + +In this way those articles of the Materia Medica which had nothing +but loathsomeness to recommend them have been gradually dropped, and +are not like to obtain any general favor again with civilized +communities. The next culprits to be tried are the poisons. I have +never been in the least sceptical as to the utility of some of them, +when properly employed. Though I believe that at present, taking the +world at large, and leaving out a few powerful agents of such immense +value that they rank next to food in importance, the poisons +prescribed for disease do more hurt than good, I have no doubt, and +never professed to have any, that they do much good in prudent and +instructed hands. But I am very willing to confess a great jealousy +of many agents, and I could almost wish to see the Materia Medica so +classed as to call suspicion upon certain ones among them. + +Thus the alien elements, those which do not properly enter into the +composition of any living tissue, are the most to be suspected,-- +mercury, lead, antimony, silver, and the rest, for the reasons I have +before mentioned. Even iodine, which, as it is found in certain +plants, seems less remote from the animal tissues, gives unequivocal +proofs from time to time that it is hostile to some portions of the +glandular system. + +There is, of course, less prima facie objection to those agents which +consist of assimilable elements, such as are found making a part of +healthy tissues. These are divisible into three classes,--foods, +poisons, and inert, mostly because insoluble, substances. The food +of one animal or of one human being is sometimes poison to another, +and vice versa; inert substances may act mechanically, so as to +produce the effect of poisons; but this division holds exactly enough +for our purpose. + +Strictly speaking, every poison consisting of assimilable elements +may be considered as unwholesome ,food. It is rejected by the +stomach, or it produces diarrhoea, or it causes vertigo or +disturbance of the heart's action, or some other symptom for which +the subject of it would consult the physician, if it came on from any +other cause than taking it under the name of medicine. Yet portions +of this unwholesome food which we call medicine, we have reason to +believe, are assimilated; thus, castor-oil appears to be partially +digested by infants, so that they require large doses to affect them +medicinally. Even that deadliest of poisons, hydrocyanic acid, is +probably assimilated, and helps to make living tissue, if it do not +kill the patient, for the assimilable elements which it contains, +given in the separate forms of amygdalin and emulsin, produce no +disturbance, unless, as in Bernard's experiments, they are suffered +to meet in the digestive organs. A medicine consisting of +assimilable substances being then simply unwholesome food, we +understand what is meant by those cumulative effects of such remedies +often observed, as in the case of digitalis and strychnia. They are +precisely similar to the cumulative effects of a salt diet in +producing scurvy, or of spurred rye in producing dry gangrene. As +the effects of such substances are a violence to the organs, we +should exercise the same caution with regard to their use that we +would exercise about any other kind of poisonous food,--partridges at +certain seasons, for instance. Even where these poisonous kinds of +food seem to be useful, we should still regard them with great +jealousy. Digitalis lowers the pulse in febrile conditions. +Veratrum viride does the same thing. How do we know that a rapid +pulse is not a normal adjustment of nature to the condition it +accompanies? Digitalis has gone out of favor; how sure are we that +Veratrum viride will not be found to do more harm than good in a case +of internal inflammation, taking the whole course of the disease into +consideration? Think of the change of opinion with regard to the use +of opium in delirium tremens (which you remember is sometimes called +delirium vigilans), where it seemed so obviously indicated, since the +publication of Dr. Ware's admirable essay. I respect the evidence of +my contemporaries, but I cannot forget the sayings of the Father of +medicine,--Ars longa, judicium diffcile. + +I am not presuming to express an opinion concerning Veratrum viride, +which was little heard of when I was still practising medicine. I am +only appealing to that higher court of experience which sits in +judgment on all decisions of the lower medical tribunals, and which +requires more than one generation for its final verdict. + +Once change the habit of mind so long prevalent among practitioners +of medicine; once let it be everywhere understood that the +presumption is in favor of food, and not of alien substances, of +innocuous, and not of unwholesome food, for the sick; that this +presumption requires very strong evidence in each particular case to +overcome it; but that, when such evidence is afforded, the alien +substance or the unwholesome food should be given boldly, in +sufficient quantities, in the same spirit as that with which the +surgeon lifts his knife against a patient,--that is, with the same +reluctance and the same determination,--and I think we shall have and +hear much less of charlatanism in and out of the profession. The +disgrace of medicine has been that colossal system of self-deception, +in obedience to which mines have been emptied of their cankering +minerals, the vegetable kingdom robbed of all its noxious growths, +the entrails of animals taxed for their impurities, the poison-bags +of reptiles drained of their venom, and all the inconceivable +abominations thus obtained thrust down the throats of human beings +suffering from some fault of organization, nourishment, or vital +stimulation. + +Much as we have gained, we have not yet thoroughly shaken off the +notion that poison is the natural food of disease, as wholesome +aliment is the support of health. Cowper's lines, in "The Task," +show the matter-of-course practice of his time: + + "He does not scorn it, who has long endured + A fever's agonies, and fed on drugs." + +Dr. Kimball of Lowell, who has been in the habit of seeing a great +deal more of typhoid fever than most practitioners, and whose +surgical exploits show him not to be wanting in boldness or +enterprise, can tell you whether he finds it necessary to feed his +patients on drugs or not. His experience is, I believe, that of the +most enlightened and advanced portion of the profession; yet I think +that even in typhoid fever, and certainly in many other complaints, +the effects of ancient habits and prejudices may still be seen in the +practice of some educated physicians. + +To you, young men, it belongs to judge all that has gone before you. +You come nearer to the great fathers of modern medicine than some of +you imagine. Three of my own instructors attended Dr. Rush's +Lectures. The illustrious Haller mentions Rush's inaugural thesis in +his "Bibliotheca Anatomica;" and this same Haller, brought so close +to us, tells us he remembers Ruysch, then an old man, and used to +carry letters between him and Boerhaave. Look through the history of +medicine from Boerhaave to this present day. You will see at once +that medical doctrine and practice have undergone a long series of +changes. You will see that the doctrine and practice of our own time +must probably change in their turn, and that, if we can trust at all +to the indications of their course, it will be in the direction of an +improved hygiene and a simplified treatment. Especially will the old +habit of violating the instincts of the sick give place to a +judicious study of these same instincts. It will be found that +bodily, like mental insanity, is best managed, for the most part, by +natural soothing agencies. Two centuries ago there was a +prescription for scurvy containing "stercoris taurini et anserini +par, quantitas trium magnarum nucum," of the hell-broth containing +which "guoties-cumque sitit oeger, large bibit." When I have +recalled the humane common-sense of Captain Cook in the matter of +preventing this disease; when I have heard my friend, Mr. Dana, +describing the avidity with which the scurvy-stricken sailors snuffed +up the earthy fragrance of fresh raw potatoes, the food which was to +supply the elements wanting to their spongy tissues, I have +recognized that the perfection of art is often a return to nature, +and seen in this single instance the germ of innumerable beneficent +future medical reforms. + +I cannot help believing that medical curative treatment will by and +by resolve itself in great measure into modifications of the food, +swallowed and breathed, and of the natural stimuli, and that less +will be expected from specifics and noxious disturbing agents, either +alien or assimilable. The noted mineral-waters containing iron, +sulphur, carbonic acid, supply nutritious or stimulating materials to +the body as much as phosphate of lime and ammoniacal compounds do to +the cereal plants. The effects of a milk and vegetable diet, of +gluten bread in diabetes, of cod-liver oil in phthisis, even of such +audacious innovations as the water-cure and the grape-cure, are only +hints of what will be accomplished when we have learned to discover +what organic elements are deficient or in excess in a case of chronic +disease, and the best way of correcting the abnormal condition, just +as an agriculturist ascertains the wants of his crops and modifies +the composition of his soil. In acute febrile diseases we have long +ago discovered that far above all drug-medication is the use of mild +liquid diet in the period of excitement, and of stimulant and +nutritious food in that of exhaustion. Hippocrates himself was as +particular about his barley-ptisan as any Florence Nightingale of our +time could be. + +The generation to which you, who are just entering the profession, +belong, will make a vast stride forward, as I believe, in the +direction of treatment by natural rather than violent agencies. What +is it that makes the reputation of Sydenham, as the chief of English +physicians? His prescriptions consisted principally of simples. An +aperient or an opiate, a "cardiac" or a tonic, may be commonly found +in the midst of a somewhat fantastic miscellany of garden herbs. It +was not by his pharmaceutic prescriptions that he gained his great +name. It was by daring to order fresh air for small-pox patients, +and riding on horseback for consumptives, in place of the smothering +system, and the noxious and often loathsome rubbish of the +established schools. Of course Sydenham was much abused by his +contemporaries, as he frequently takes occasion to remind his reader. +"I must needs conclude," he says, "either that I am void of merit, or +that the candid and ingenuous part of mankind, who are formed with so +excellent a temper of mind as to be no strangers to gratitude, make a +very small part of the whole." If in the fearless pursuit of truth +you should find the world as ungracious in the nineteenth century as +he found it in the seventeenth, you may learn a lesson of self- +reliance from another utterance of the same illustrious physician: +"'T is none of my business to inquire what other persons think, but +to establish my own observations; in order to which, I ask no favor +of the reader but to peruse my writings with temper." + +The physician has learned a great deal from the surgeon, who is +naturally in advance of him, because he has a better opportunity of +seeing the effects of his remedies. Let me shorten one of Ambroise +Pare's stories for you. There had been a great victory at the pass +of Susa, and they were riding into the city. The wounded cried out +as the horses trampled them under their hoofs, which caused good +Ambroise great pity, and made him wish himself back in Paris. Going +into a stable he saw four dead soldiers, and three desperately +wounded, placed with their backs against the wall. An old campaigner +came up. --"Can these fellows get well?" he said. "No!" answered the +surgeon. Thereupon, the old soldier walked up to them and cut all +their throats, sweetly, and without wrath (doulcement et sans +cholere). Ambroise told him he was a bad man to do such a thing. +"I hope to God;" he said, "somebody will do as much for me if I ever +get into such a scrape" (accoustre de telle facon). "I was not much +salted in those days" (bien doux de sel), says Ambroise, "and little +acquainted with the treatment of wounds." However, as he tells us, +he proceeded to apply boiling oil of Sambuc (elder) after the +approved fashion of the time,--with what torture to the patient may +be guessed. At last his precious oil gave out, and he used instead +an insignificant mixture of his own contrivance. He could not sleep +that night for fear his patients who had not been scalded with the +boiling oil would be poisoned by the gunpowder conveyed into their +wounds by the balls. To his surprise, he found them much better than +the others the next morning, and resolved never again to burn his +patients with hot oil for gun-shot wounds. + +This was the beginning, as nearly as we can fix it, of that reform +which has introduced plain water-dressings in the place of the +farrago of external applications which had been a source of profit to +apothecaries and disgrace to art from, and before, the time when +Pliny complained of them. A young surgeon who was at Sudley Church, +laboring among the wounded of Bull Run, tells me they had nothing but +water for dressing, and he (being also doux de sel) was astonished to +see how well the wounds did under that simple treatment. + +Let me here mention a fact or two which may be of use to some of you +who mean to enter the public service. You will, as it seems, have +gun-shot wounds almost exclusively to deal with. Three different +surgeons, the one just mentioned and two who saw the wounded of Big +Bethel, assured me that they found no sabre-cuts or bayonet wounds. +It is the rifle-bullet from a safe distance which pierces the breasts +of our soldiers, and not the gallant charge of broad platoons and +sweeping squadrons, such as we have been in the habit of considering +the chosen mode of warfare of ancient and modern chivalry. [Sir +Charles James Napier had the same experience in Virginia in 1813. +"Potomac. We have nasty sort of fighting here, amongst creeks and +bushes, and lose men without show." "Yankee never shows himself, he +keeps in the thickest wood, fires and runs off." --These five +thousand in the open field might be attacked, but behind works it +would be throwing away lives." He calls it "an inglorious warfare," +--says one of the leaders is "a little deficient in gumption,"--but +--still my opinion is, that if we tuck up our sleeves and lay our +ears back we might thrash them; that is, if we caught them out of +their trees, so as to slap at them with the bayonet." --Life, etc. +vol. i. p. 218 et seq.] + +Another fact parallels the story of the old campaigner, and may teach +some of you caution in selecting your assistants. A chaplain told it +to two of our officers personally known to myself. He overheard the +examination of a man who wished to drive one of the "avalanche" +wagons, as they call them. The man was asked if he knew how to deal +with wounded men. "Oh yes," he answered; "if they're hit here," +pointing to the abdomen, "knock 'em on the head,--they can't get +well." + +In art and outside of it you will meet the same barbarisms that +Ambroise Pare met with,--for men differ less from century to century +than we are apt to suppose; you will encounter the same opposition, +if you attack any prevailing opinion, that Sydenham complained of. +So far as possible, let not such experiences breed in you a contempt +for those who are the subjects of folly or prejudice, or foster any +love of dispute for its own sake. Should you become authors, express +your opinions freely; defend them rarely. It is not often that an +opinion is worth expressing, which cannot take care of itself. +Opposition is the best mordant to fix the color of your thought in +the general belief. + +It is time to bring these crowded remarks to a close. The day has +been when at the beginning of a course of Lectures I should have +thought it fitting to exhort you to diligence and entire devotion to +your tasks as students. It is not so now. The young man who has not +heard the clarion-voices of honor and of duty now sounding throughout +the land, will heed no word of mine. In the camp or the city, in the +field or the hospital, under sheltering roof, or half-protecting +canvas, or open sky, shedding our own blood or stanching that of our +wounded defenders, students or teachers, whatever our calling and our +ability, we belong, not to ourselves, but to our imperilled country, +whose danger is our calamity, whose ruin would be our enslavement, +whose rescue shall be our earthly salvation! + + + + + + +SCHOLASTIC AND BEDSIDE TEACHING. + +An Introductory Lecture delivered before the Medical Class of Harvard +University, November 6, 1867. + +The idea is entertained by some of our most sincere professional +brethren, that to lengthen and multiply our Winter Lectures will be +of necessity to advance the cause of medical education. It is a fair +subject for consideration whether they do not overrate the relative +importance of that particular mode of instruction which forms the +larger part of these courses. + +As this School could only lengthen its lecture term at the expense of +its "Summer Session," in which more direct, personal, and familiar +teaching takes the place of our academic discourses, and in which +more time can be given to hospitals, infirmaries, and practical +instruction in various important specialties, whatever might be +gained, a good deal would certainly be lost in our case by the +exchange. + +The most essential part of a student's instruction is obtained, as I +believe, not in the lecture-room, but at the bedside. Nothing seen +there is lost; the rhythms of disease are learned by frequent +repetition; its unforeseen occurrences stamp themselves indelibly in +the memory. Before the student is aware of what he has acquired, he +has learned the aspects and course and probable issue of the diseases +he has seen with his teacher, and the proper mode of dealing with +them, so far as his master knows it. On the other hand, our ex +cathedra prelections have a strong tendency to run into details +which, however interesting they may be to ourselves and a few of our +more curious listeners, have nothing in them which will ever be of +use to the student as a practitioner. It is a perfectly fair +question whether I and some other American Professors do not teach +quite enough that is useless already. Is it not well to remind the +student from time to time that a physician's business is to avert +disease, to heal the sick, to prolong life, and to diminish +suffering? Is it not true that the young man of average ability will +find it as much as he can do to fit himself for these simple duties? +Is it not best to begin, at any rate, by making sure of such +knowledge as he will require in his daily walk, by no means +discouraging him from any study for which his genius fits him when he +once feels that he has become master of his chosen art. + +I know that many branches of science are of the greatest value as +feeders of our medical reservoirs. But the practising physician's +office is to draw the healing waters, and while he gives his time to +this labor he can hardly be expected to explore all the sources that +spread themselves over the wide domain of science. The traveller who +would not drink of the Nile until he had tracked it to its parent +lakes, would be like to die of thirst; and the medical practitioner +who would not use the results of many laborers in other departments +without sharing their special toils, would find life far too short +and art immeasurably too long. + +We owe much to Chemistry, one of the most captivating as well as +important of studies; but the medical man must as a general rule +content himself with a clear view of its principles and a limited +acquaintance with its facts; such especially as are pertinent to his +pursuits. I am in little danger of underrating Anatomy or +Physiology; but as each of these branches splits up into specialties, +any one of which may take up a scientific life-time, I would have +them taught with a certain judgment and reserve, so that they shall +not crowd the more immediately practical branches. So of all the +other ancillary and auxiliary kinds of knowledge, I would have them +strictly subordinated to that particular kind of knowledge for which +the community looks to its medical advisers. + +A medical school is not a scientific school, except just so far as +medicine itself is a science. On the natural history side, medicine +is a science; on the curative side, chiefly an art. This is implied +in Hufeland's aphorism: "The physician must generalize the disease +and individualize the patient." + +The coordinated and classified results of empirical observation, in +distinction from scientific experiment, have furnished almost all we +know about food, the medicine of health, and medicine, the food of +sickness. We eat the root of the Solanum tuberosum and throw away +its fruit; we eat the fruit of the Solanum Lycopersicum and throw +away its root. Nothing but vulgar experience has taught us to reject +the potato ball and cook the tomato. So of most of our remedies. +The subchloride of mercury, calomel, is the great British specific; +the protochloride of mercury, corrosive sublimate, kills like +arsenic, but no chemist could have told us it would be so. + +>From observations like these we can obtain certain principles from +which we can argue deductively to facts of a like nature, but the +process is limited, and we are suspicious of all reasoning in that +direction applied to the processes of healthy and diseased life. We +are continually appealing to special facts. We are willing to give +Liebig's artificial milk when we cannot do better, but we watch the +child anxiously whose wet-nurse is a chemist's pipkin. A pair of +substantial mammary glands has the advantage over the two hemispheres +of the most learned Professor's brain, in the art of compounding a +nutritious fluid for infants. + +The bedside is always the true centre of medical teaching. Certain +branches must be taught in the lecture-room, and will necessarily +involve a good deal that is not directly useful to the future +practitioner. But the over ambitious and active student must not be +led away by the seduction of knowledge for its own sake from his +principal pursuit. The humble beginner, who is alarmed at the vast +fields of knowledge opened to him, may be encouraged by the assurance +that with a very slender provision of science, in distinction from +practical skill, he may be a useful and acceptable member of the +profession to which the health of the community is intrusted. + +To those who are not to engage in practice, the various pursuits of +science hardly require to be commended. Only they must not be +disappointed if they find many subjects treated in our courses as a +medical class requires, rather than as a scientific class would +expect, that is, with special limitations and constant reference to +practical ends. Fortunately they are within easy reach of the +highest scientific instruction. The business of a school like this +is to make useful working physicians, and to succeed in this it is +almost as important not to overcrowd the mind of the pupil with +merely curious knowledge as it is to store it with useful +information. + +In this direction I have written my lecture, not to undervalue any +form of scientific labor in its place, an unworthy thought from which +I hope I need not defend myself,--but to discourage any undue +inflation of the scholastic programme, which even now asks more of +the student than the teacher is able to obtain from the great +majority of those who present themselves for examination. I wish to +take a hint in education from the Secretary of the Massachusetts +Board of Agriculture, who regards the cultivation of too much land as +a great defect in our New England farming. I hope that our Medical +Institutions may never lay themselves open to the kind of accusation +Mr. Lowe brings against the English Universities, when he says that +their education is made up "of words that few understand and most +will shortly forget; of arts that can never be used, if indeed they +can even be learnt; of histories inapplicable to our times; of +languages dead and even mouldy; of grammatical rules that never had +living use and are only post mortem examinations; and of statements +fagoted with utter disregard of their comparative value." + +This general thought will be kept in view throughout my somewhat +discursive address, which will begin with an imaginary clinical +lesson from the lips of an historical personage, and close with the +portrait from real life of one who, both as teacher and practitioner, +was long loved and honored among us. If I somewhat overrun my hour, +you must pardon me, for I can say with Pascal that I have not had the +time to make my lecture shorter. + + +In the year 1647, that good man John Eliot, commonly called the +Apostle Eliot, writing to Mr. Thomas Shepherd, the pious minister of +Cambridge, referring to the great need of medical instruction for the +Indians, used these words: + +"I have thought in my heart that it were a singular good work, if the +Lord would stirre up the hearts of some or other of his people in +England to give some maintenance toward some Schoole or Collegiate +exercise this way, wherein there should be Anatomies and other +instructions that way, and where there might be some recompence given +to any that should bring in any vegetable or other thing that is +vertuous in the way of Physick. + +"There is another reason which moves my thought and desires this way, +namely that our young students in Physick may be trained up better +then they yet bee, who have onely theoreticall knowledge, and are +forced to fall to practise before ever they saw an Anatomy made, or +duely trained up in making experiments, for we never had but one +Anatomy in the countrey, which Mr. Giles Firman [Firmin] now in +England, did make and read upon very well, but no more of that now." + +Since the time of the Apostle Eliot the Lord has stirred up the +hearts of our people to the building of many Schools and Colleges +where medicine is taught in all its branches. Mr. Giles Firmin's +"Anatomy " may be considered the first ancestor of a long line of +skeletons which have been dangling and rattling in our lecture-rooms +for more than a century. + +Teaching in New England in 1647 was a grave but simple matter. A +single person, combining in many cases, as in that of Mr. Giles +Firmin, the offices of physician and preacher, taught what he knew to +a few disciples whom he gathered about him. Of the making of that +"Anatomy" on which my first predecessor in the branch I teach" did +read very well" we can know nothing. The body of some poor wretch +who had swung upon the gallows, was probably conveyed by night to +some lonely dwelling at the outskirts of the village, and there by +the light of flaring torches hastily dissected by hands that trembled +over the unwonted task. And ever and anon the master turned to his +book, as he laid bare the mysteries of the hidden organs; to his +precious Vesalius, it might be, or his figures repeated in the +multifarious volume of Ambroise Pare; to the Aldine octavo in which +Fallopius recorded his fresh observations; or that giant folio of +Spigelius just issued from the press of Amsterdam, in which lovely +ladies display their viscera with a coquettish grace implying that it +is rather a pleasure than otherwise to show the lace-like omentum, +and hold up their appendices epiploicae as if they were saying "these +are our jewels." + +His teaching of medicine was no doubt chiefly clinical, and received +with the same kind of faith as that which accepted his words from the +pulpit. His notions of disease were based on what he had observed, +seen always in the light of the traditional doctrines in which he was +bred. His discourse savored of the weighty doctrines of Hippocrates, +diluted by the subtle speculations of Galen, reinforced by the +curious comments of the Arabian schoolmen as they were conveyed in +the mellifluous language of Fernelius, blended, it may be, with +something of the lofty mysticism of Van Helmont, and perhaps stealing +a flavor of that earlier form of Homoeopathy which had lately come to +light in Sir Kenelm Digby's "Discourse concerning the Cure of Wounds +by the Sympathetic Powder." + +His Pathology was mythology. A malformed foetus, as the readers of +Winthrop's Journal may remember, was enough to scare the colonists +from their propriety, and suggest the gravest fears of portended +disaster. The student of the seventeenth century opened his Licetus +and saw figures of a lion with the head of a woman, and a man with +the head of an elephant. He had offered to his gaze, as born of a +human mother, the effigy of a winged cherub, a pterocephalous +specimen, which our Professor of Pathological Anatomy would hardly +know whether to treat with the reverence due to its celestial aspect, +or to imprison in one of his immortalizing jars of alcohol. + +His pharmacopoeia consisted mainly of simples, such as the venerable +"Herball" of Gerard describes and figures in abounding affluence. +St. John's wort and Clown's All-heal, with Spurge and Fennel, Saffron +and Parsley, Elder and Snake-root, with opium in some form, and +roasted rhubarb and the Four Great Cold Seeds, and the two Resins, of +which it used to be said that whatever the Tacamahaca has not cured, +the Caranna will, with the more familiar Scammony and Jalap and Black +Hellebore, made up a good part of his probable list of remedies. He +would have ordered Iron now and then, and possibly an occasional dose +of Antimony. He would perhaps have had a rheumatic patient wrapped +in the skin of a wolf or a wild cat, and in case of a malignant fever +with "purples" or petechiae, or of an obstinate king's evil, he might +have prescribed a certain black powder, which had been made by +calcining toads in an earthen pot; a choice remedy, taken internally, +or applied to any outward grief. + +Except for the toad-powder and the peremptory drastics, one might +have borne up against this herb doctoring as well as against some +more modern styles of medication. Barbeyrac and his scholar Sydenham +had not yet cleansed the Pharmacopoeia of its perilous stuff, but +there is no doubt that the more sensible physicians of that day knew +well enough that a good honest herb-tea which amused the patient and +his nurses was all that was required to carry him through all common +disorders. + +The student soon learned the physiognomy of disease by going about +with his master; fevers, pleurisies, asthmas, dropsies, fluxes, +small-pox, sore-throats, measles, consumptions. He saw what was done +for them. He put up the medicines, gathered the herbs, and so +learned something of materia medico and botany. He learned these few +things easily and well, for he could give his whole attention to +them. Chirurgery was a separate specialty. Women in child-birth +were cared for by midwives. There was no chemistry deserving the +name to require his study. He did not learn a great deal, perhaps, +but what he did learn was his business, namely, how to take care of +sick people. + +Let me give you a picture of the old=fashioned way of instruction, by +carrying you with me in imagination in the company of worthy Master +Giles Firmin as he makes his round of visits among the good folk of +Ipswich, followed by his one student, who shall answer to the +scriptural name of Luke. It will not be for entertainment chiefly, +but to illustrate the one mode of teaching which can never be +superseded, and which, I venture to say, is more important than all +the rest put together. The student is a green hand, as you will +perceive. + +In the first dwelling they come to, a stout fellow is bellowing with +colic. + +"He will die, Master, of a surety, methinks," says the timid youth in +a whisper. + +"Nay, Luke," the Master answers, "'t is but a dry belly-ache. Didst +thou not mark that he stayed his roaring when I did press hard over +the lesser bowels? Note that he hath not the pulse of them with +fevers, and by what Dorcas telleth me there hath been no long +shutting up of the vice naturales. We will steep certain comforting +herbs which I will shew thee, and put them in a bag and lay them on +his belly. Likewise he shall have my cordial julep with a portion of +this confection which we do call Theriaca Andromachi, which hath +juice of poppy in it, and is a great stayer of anguish. This fellow +is at his prayers to-day, but I warrant thee he shall be swearing +with the best of them to-morrow." + +They jog along the bridle-path on their horses until they come to +another lowly dwelling. They sit a while with a delicate looking +girl in whom the ingenuous youth naturally takes a special interest. +The good physician talks cheerfully with her, asks her a few +questions. Then to her mother: "Good-wife, Margaret hath somewhat +profited, as she telleth, by the goat's milk she hath taken night and +morning. Do thou pluck a maniple--that is an handful--of the plant +called Maidenhair, and make a syrup therewith as I have shewed thee. +Let her take a cup full of the same, fasting, before she sleepeth, +also before she riseth from her bed." And so they leave the house. + +"What thinkest thou, Luke, of the maid we have been visiting?" "She +seemeth not much ailing, Master, according to my poor judgment. For +she did say she was better. And she had a red cheek and a bright +eye, and she spake of being soon able to walk unto the meeting, and +did seem greatly hopeful, but spare of flesh, methought, and her +voice something hoarse, as of one that hath a defluxion, with some +small coughing from a cold, as she did say. Speak I not truly, +Master, that she will be well speedily?" + +"Yea, Luke, I do think she shall be well, and mayhap speedily. But +it is not here with us she shall be well. For that redness of the +cheek is but the sign of the fever which, after the Grecians, we do +call the hectical; and that shining of the eyes is but a sickly +glazing, and they which do every day get better and likewise thinner +and weaker shall find that way leadeth to the church-yard gate. This +is the malady which the ancients did call tubes, or the wasting +disease, and some do name the consumption. A disease whereof most +that fall ailing do perish. This Margaret is not long for earth--but +she knoweth it not, and still hopeth." + +"Why, then, Master, didst thou give her of thy medicine, seeing that +her ail is unto death?" + +"Thou shalt learn, boy, that they which are sick must have somewhat +wherewith to busy their thoughts. There be some who do give these +tabid or consumptives a certain posset made with lime-water and anise +and liquorice and raisins of the sun, and there be other some who do +give the juice of craw-fishes boiled in barley-water with chicken- +broth, but these be toys, as I do think, and ye shall find as good +virtue, nay better, in this syrup of the simple called Maidenhair." + +Something after this manner might Master Giles Firmin have delivered +his clinical instructions. Somewhat in this way, a century and a +half later, another New England physician, Dr. Edward Augustus +Holyoke, taught a young man who came to study with him, a very +diligent and intelligent youth, James Jackson by name, the same whose +portrait in his advanced years hangs upon this wall, long the honored +Professor of Theory and Practice in this Institution, of whom I shall +say something in this Lecture. Our venerated Teacher studied +assiduously afterwards in the great London Hospitals, but I think he +used to quote his "old Master" ten times where he quoted Mr. Cline or +Dr. Woodville once. + +When I compare this direct transfer of the practical experience of a +wise man into the mind of a student,--every fact one that he can use +in the battle of life and death,--with the far off, unserviceable +"scientific" truths that I and some others are in the habit of +teaching, I cannot help asking myself whether, if we concede that our +forefathers taught too little, there is not--a possibility that we +may sometimes attempt to teach too much. I almost blush when I think +of myself as describing the eight several facets on two slender +processes of the palate bone, or the seven little twigs that branch +off from the minute tympanic nerve, and I wonder whether my excellent +colleague feels in the same way when he pictures himself as giving +the constitution of neurin, which as he and I know very well is that +of the hydrate of trimethyle-oxethyle-ammonium, or the formula for +the production of alloxan, which, though none but the Professors and +older students can be expected to remember it, is C10 H4 N4 O6+ 2HO, +NO5}=C8 H4 N2 O10+2CO2+N2+NH4 O, NO5. + +I can bear the voice of some rough iconoclast addressing the +Anatomist and the Chemist in tones of contemptuous indignation: "What +is this stuff with which you are cramming the brains of young men who +are to hold the lives of the community in their hands? Here is a man +fallen in a fit; you can tell me all about the eight surfaces of the +two processes of the palate bone, but you have not had the sense to +loosen that man's neck-cloth, and the old women are all calling you a +fool? Here is a fellow that has just swallowed poison. I want +something to turn his stomach inside out at the shortest notice. Oh, +you have forgotten the dose of the sulphate of zinc, but you remember +the formula for the production of alloxan!" + +"Look you, Master Doctor,--if I go to a carpenter to come and stop a +leak in my roof that is flooding the house, do you suppose I care +whether he is a botanist or not? Cannot a man work in wood without +knowing all about endogens and exogens, or must he attend Professor +Gray's Lectures before he can be trusted to make a box-trap? If my +horse casts a shoe, do you think I will not trust a blacksmith to +shoe him until I have made sure that he is sound on the distinction +between the sesquioxide and the protosesquioxide of iron?" + +--But my scientific labor is to lead to useful results by and by, in +the next generation, or in some possible remote future.-- + +"Diavolo!" as your Dr. Rabelais has it,--answers the iconoclast,-- +"what is that to me and my colic, to me and my strangury? I pay the +Captain of the Cunard steamship to carry me quickly and safely to +Liverpool, not to make a chart of the Atlantic for after voyagers! +If Professor Peirce undertakes to pilot me into Boston Harbor and +runs me on Cohasset rocks, what answer is it to tell me that he is +Superintendent of the Coast Survey? No, Sir! I want a plain man in +a pea-jacket and a sou'wester, who knows the channel of Boston +Harbor, and the rocks of Boston Harbor, and the distinguished +Professor is quite of my mind as to the matter, for I took the pains +to ask him before I ventured to use his name in the way of +illustration." + + +I do not know how the remarks of the image-breaker may strike others, +but I feel that they put me on my defence with regard to much of my +teaching. Some years ago I ventured to show in an introductory +Lecture how very small a proportion of the anatomical facts taught in +a regular course, as delivered by myself and others, had any +practical bearing whatever on the treatment of disease. How can I, +how can any medical teacher justify himself in teaching anything that +is not like to be of practical use to a class of young men who are to +hold in their hands the balance in which life and death, ease and +anguish, happiness and wretchedness are to be daily weighed? + +I hope we are not all wrong. Oftentimes in finding how sadly +ignorant of really essential and vital facts and rules were some of +those whom we had been larding with the choicest scraps of science, I +have doubted whether the old one-man system of teaching, when the one +man was of the right sort, did not turn out better working physicians +than our more elaborate method. The best practitioner I ever knew +was mainly shaped to excellence in that way. I can understand +perfectly the regrets of my friend Dr. John Brown of Edinburgh, for +the good that was lost with the old apprenticeship system. I +understand as well Dr. Latham's fear "that many men of the best +abilities and good education will be deterred from prosecuting physic +as a profession, in consequence of the necessity indiscriminately +laid upon all for impossible attainments." + +I feel therefore impelled to say a very few words in defence of that +system of teaching adopted in our Colleges, by which we wish to +supplement and complete the instruction given by private individuals +or by what are often called Summer Schools. + +The reason why we teach so much that is not practical and in itself +useful, is because we find that the easiest way of teaching what is +practical and useful. If we could in any way eliminate all that +would help a man to deal successfully with disease, and teach it by +itself so that it should be as tenaciously rooted in the memory, as +easily summoned when wanted, as fertile in suggestion of related +facts, as satisfactory to the peremptory demands of the intelligence +as if taught in its scientific connections, I think it would be our +duty so to teach the momentous truths of medicine, and to regard all +useless additions as an intrusion on the time which should be +otherwise occupied. + +But we cannot successfully eliminate and teach by itself that which +is purely practical. The easiest and surest why of acquiring facts +is to learn them in groups, in systems, and systematized knowledge is +science. You can very often carry two facts fastened together more +easily than one by itself, as a housemaid can carry two pails of +water with a hoop more easily than one without it. You can remember +a man's face, made up of many features, better than you can his nose +or his mouth or his eye-brow. Scores of proverbs show you that you +can remember two lines that rhyme better than one without the jingle. +The ancients, who knew the laws of memory, grouped the seven cities +that contended for the honor of being Homer's birthplace in a line +thus given by Aulus Gellius : + +Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai. + +I remember, in the earlier political days of Martin Van Buren, that +Colonel Stone, of the "New York Commercial," or one of his +correspondents, said that six towns of New York would claim in the +same way to have been the birth-place of the "Little Magician," as he +was then called; and thus he gave their names, any one of which I +should long ago have forgotten, but which as a group have stuck tight +in my memory from that day to this; + +Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac. + +If the memory gains so much by mere rhythmical association, how much +more will it gain when isolated facts are brought together under laws +and principles, when organs are examined in their natural +connections, when structure is coupled with function, and healthy and +diseased action are studied as they pass one into the other! +Systematic, or scientific study is invaluable as supplying a natural +kind of mnemonics, if for nothing else. You cannot properly learn +the facts you want from Anatomy and Chemistry in any way so easily as +by taking them in their regular order, with other allied facts, only +there must be common sense exercised in leaving out a great deal +which belongs to each of the two branches as pure science. The +dullest of teachers is the one who does not know what to omit. + +The larger aim of scientific training is to furnish you with +principles to which you will be able to refer isolated facts, and so +bring these within the range of recorded experience. See what the +"London Times" said about the three Germans who cracked open John +Bull Chatwood's strong-box at the Fair the other day, while the three +Englishmen hammered away in vain at Brother Jonathan Herring's. The +Englishmen represented brute force. The Germans had been trained to +appreciate principle. The Englishman "knows his business by rote and +rule of thumb"--science, which would "teach him to do in an hour what +has hitherto occupied him two hours," "is in a manner forbidden to +him." To this cause the "Times" attributes the falling off of +English workmen in comparison with those of the Continent. + +Granting all this, we must not expect too much from "science" as +distinguished from common experience. There are ten thousand +experimenters without special apparatus for every one in the +laboratory. Accident is the great chemist and toxicologist. Battle +is the great vivisector. Hunger has instituted researches on food +such as no Liebig, no Academic Commission has ever recorded. + +Medicine, sometimes impertinently, often ignorantly, often carelessly +called "allopathy," appropriates everything from every source that +can be of the slightest use to anybody who is ailing in any way, or +like to be ailing from any cause. It learned from a monk how to use +antimony, from a Jesuit how to cure agues, from a friar how to cut +for stone, from a soldier how to treat gout, from a sailor how to +keep off scurvy, from a postmaster how to sound the Eustachian tube, +from a dairy-maid how to prevent small-pox, and from an old market- +woman how to catch the itch-insect. It borrowed acupuncture and the +moxa from the Japanese heathen, and was taught the use of lobelia by +the American savage. It stands ready to-day to accept anything from +any theorist, from any empiric who can make out a good case for his +discovery or his remedy. "Science" is one of its benefactors, but +only one, out of many. Ask the wisest practising physician you know, +what branches of science help him habitually, and what amount of +knowledge relating to each branch he requires for his professional +duties. He will tell you that scientific training has a value +independent of all the special knowledge acquired. He will tell you +that many facts are explained by studying them in the wider range of +related facts to which they belong. He will gratefully recognize +that the anatomist has furnished him with indispensable data, that +the physiologist has sometimes put him on the track of new modes of +treatment, that the chemist has isolated the active principles of his +medicines, has taught him how to combine them, has from time to time +offered him new remedial agencies, and so of others of his allies. +But he will also tell you, if I am not mistaken, that his own branch +of knowledge is so extensive and so perplexing that he must accept +most of his facts ready made at their hands. He will own to you that +in the struggle for life which goes on day and night in our thoughts +as in the outside world of nature, much that he learned under the +name of science has died out, and that simple homely experience has +largely taken the place of that scholastic knowledge to which he and +perhaps some of his instructors once attached a paremount importance. + +This, then, is my view of scientific training as conducted in courses +such as you are entering on. Up to a certain point I believe in set +Lectures as excellent adjuncts to what is far more important, +practical instruction at the bedside, in the operating room, and +under the eye of the Demonstrator. But I am so far from wishing +these courses extended, that I think some of them--suppose I say my +own--would almost bear curtailing. Do you want me to describe more +branches of the sciatic and crural nerves? I can take Fischer's +plates, and lecturing on that scale fill up my whole course and not +finish the nerves alone. We must stop somewhere, and for my own part +I think the scholastic exercises of our colleges have already claimed +their full share of the student's time without our seeking to extend +them. + +I trust I have vindicated the apparent inconsequence of teaching +young students a good deal that seems at first sight profitless, but +which helps them to learn and retain what is profitable. But this is +an inquisitive age, and if we insist on piling up beyond a certain +height knowledge which is in itself mere trash and lumber to a man +whose life is to be one long fight with death and disease, there will +be some sharp questions asked by and by, and our quick-witted people +will perhaps find they can get along as well without the professor's +cap as without the bishop's mitre and the monarch's crown. + +I myself have nothing to do with clinical teaching. Yet I do not +hesitate to say it is more essential than all the rest put together, +so far as the ordinary practice of medicine is concerned; and this is +by far the most important thing to be learned, because it deals with +so many more lives than any other branch of the profession. So of +personal instruction, such as we give and others give in the interval +of lectures, much of it at the bedside, some of it in the laboratory, +some in the microscope-room, some in the recitation-room, I think it +has many advantages of its own over the winter course, and I do not +wish to see it shortened for the sake of prolonging what seems to me +long enough already. + +If I am jealous of the tendency to expand the time given to the +acquisition of curious knowledge, at the expense of the plain old- +fashioned bedside teachings, I only share the feeling which Sydenham +expressed two hundred years ago, using an image I have already +borrowed. "He would be no honest and successful pilot who was to +apply himself with less industry to avoid rocks and sands and bring +his vessel safely home, than to search into the causes of the ebbing +and flowing of the sea, which, though very well for a philosopher, is +foreign to him whose business it is to secure the ship. So neither +will a physician, whose province it is to cure diseases, be able to +do so, though he be a person of great genius, who bestows less time +on the hidden and intricate method of nature, and adapting his means +thereto, than on curious and subtle speculation." + +"Medicine is my wife and Science is my mistress," said Dr. Rush. I +do not think that the breach of the seventh commandment can be shown +to have been of advantage to the legitimate owner of his affections. +Read what Dr. Elisha Bartlett says of him as a practitioner, or ask +one of our own honored ex-professors, who studied under him, whether +Dr. Rush had ever learned the meaning of that saying of Lord Bacon, +that man is the minister and interpreter of Nature, or whether he did +not speak habitually of Nature as an intruder in the sick room, from +which his art was to expel her as an incompetent and a meddler. + +All a man's powers are not too much for such a profession as +Medicine. "He is a learned man," said old Parson Emmons of Franklin, +"who understands one subject, and he is a very learned man who +understands two subjects." Schonbein says he has been studying +oxygen for thirty years. Mitscherlich said it took fourteen years to +establish a new fact in chemistry. Aubrey says of Harvey, the +discoverer of the circulation, that "though all his profession would +allow him to be an excellent anatomist, I have never heard of any who +admired his therapeutic way." My learned and excellent friend before +referred to, Dr. Brown of Edinburgh, from whose very lively and +sensible Essay, "Locke and Sydenham," I have borrowed several of my +citations, contrasts Sir Charles Bell, the discoverer, the man of +science, with Dr. Abercrombie, the master in the diagnosis and +treatment of disease. It is through one of the rarest of +combinations that we have in our Faculty a teacher on whom the +scientific mantle of Bell has fallen, and who yet stands preeminent +in the practical treatment of the class of diseases which his +inventive and ardent experimental genius has illustrated. M. Brown- +Sequard's example is as, eloquent as his teaching in proof of the +advantages of well directed scientific investigation. But those who +emulate his success at once as a discoverer and a practitioner must +be content like him to limit their field of practice. The highest +genius cannot afford in our time to forget the ancient precept, +Divide et impera. + +"I suppose I must go and earn this guinea," said a medical man who +was sent for while he was dissecting an animal. I should not have +cared to be his patient. His dissection would do me no good, and his +thoughts would be too much upon it. I want a whole man for my +doctor, not a half one. I would have sent for a humbler +practitioner, who would have given himself entirely to me, and told +the other--who was no less a man than John Hunter--to go on and +finish the dissection of his tiger. + +Sydenham's "Read Don Quixote" should be addressed not to the student, +but to the Professor of today. Aimed at him it means, "Do not be too +learned. + +Do not think you are going to lecture to picked young men who are +training themselves to be scientific discoverers. They are of fair +average capacity, and they are going to be working doctors. + +These young men are to have some very serious vital facts to deal +with. I will mention a few of them. + +Every other resident adult you meet in these streets is or will be +more or less tuberculous. This is not an extravagant estimate, as +very nearly one third of the deaths of adults in Boston last year +were from phthisis. If the relative number is less in our other +northern cities, it is probably in a great measure because they are +more unhealthy; that is, they have as much, or nearly as much, +consumption, but they have more fevers or other fatal diseases. + +These heavy-eyed men with the alcoholized brains, these pallid youths +with the nicotized optic ganglia and thinking-marrows brown as their +own meerschaums, of whom you meet too many,--will ask all your wisdom +to deal with their poisoned nerves and their enfeebled wills. + +Nearly seventeen hundred children under five years of age died last +year in this city. A poor human article, no doubt, in many cases, +still, worth an attempt to save them, especially when we remember the +effect of Dr. Clarke's suggestion at the Dublin Hospital, by which +some twenty-five or thirty thousand children's lives have probably +been saved in a single city. + +Again, the complaint is often heard that the native population is not +increasing so rapidly as in former generations. The breeding and +nursing period of American women is one of peculiar delicacy and +frequent infirmity. Many of them must require a considerable +interval between the reproductive efforts, to repair damages arid +regain strength. This matter is not to be decided by an appeal to +unschooled nature. It is the same question as that of the deformed +pelvis,--one of degree. The facts of mal-vitalization are as much to +be attended to as those of mal-formation. If the woman with a +twisted pelvis is to be considered an exempt, the woman with a +defective organization should be recognized as belonging to the +invalid corps. We shudder to hear what is alleged as to the +prevalence of criminal practices; if back of these there can be shown +organic incapacity or overtaxing of too limited powers, the facts +belong to the province of the practical physician, as well as of the +moralist and the legislator, and require his gravest consideration. + +Take the important question of bleeding. Is venesection done with +forever? Six years ago it was said here in an introductory Lecture +that it would doubtless come back again sooner or later. A fortnight +ago I found myself in the cars with one of the most sensible and +esteemed practitioners in New England. He took out his wallet and +showed me two lancets, which he carried with him; he had never given +up their use. This is a point you will have to consider. + +Or, to mention one out of many questionable remedies, shall you give +Veratrum Viride in fevers and inflammations? It makes the pulse +slower in these affections. Then the presumption would naturally be +that it does harm. The caution with reference to it on this ground +was long ago recorded in the Lecture above referred to. See what Dr. +John Hughes Bennett says of it in the recent edition of his work on +Medicine. Nothing but the most careful clinical experience can +settle this and such points of treatment. + +These are all practical questions--questions of life and death, and +every day will be full of just such questions. Take the problem of +climate. A patient comes to you with asthma and wants to know where +he can breathe; another comes to you with phthisis and wants to know +where he can live. What boy's play is nine tenths of all that is +taught in many a pretentious course of lectures, compared with what +an accurate and extensive knowledge of the advantages and +disadvantages of different residences in these and other complaints +would be to a practising physician + +I saw the other day a gentleman living in Canada, who had spent seven +successive winters in Egypt, with the entire relief of certain +obscure thoracic symptoms which troubled him while at home. I saw, +two months ago, another gentleman from Minnesota, an observer and a +man of sense, who considered that State as the great sanatorium for +all pulmonary complaints. If half our grown population are or will +be more or less tuberculous, the question of colonizing Florida +assumes a new aspect. Even within the borders of our own State, the +very interesting researches of Dr. Bowditch show that there is a +great variation in the amount of tuberculous disease in different +towns, apparently connected with local conditions. The hygienic map +of a State is quite as valuable as its geological map, and it is the +business of every practising physician to know it thoroughly. They +understand this in England, and send a patient with a dry irritating +cough to Torquay or Penzance, while they send another with relaxed +bronchial membranes to Clifton or Brighton. Here is another great +field for practical study. + +So as to the all-important question of diet. "Of all the means of +cure at our command," says Dr. Bennett, "a regulation of the quantity +and quality of the diet is by far the most powerful." Dr. MacCormac +would perhaps except the air we breathe, for he thinks that impure +air, especially in sleeping rooms, is the great cause of tubercle. +It is sufficiently proved that the American,--the New Englander,--the +Bostonian, can breed strong and sound children, generation after +generation,--nay, I have shown by the record of a particular family +that vital losses may be retrieved, and a feeble race grow to lusty +vigor in this very climate and locality. Is not the question why our +young men and women so often break down, and how they can be kept +from breaking down, far more important for physicians to settle than +whether there is one cranial vertebra, or whether there are four, or +none? + +--But I have a taste for the homologies, I want to go deeply into the +subject of embryology, I want to analyze the protonihilates +precipitated from pigeon's milk by the action of the lunar spectrum,- +shall I not follow my star,--shall I not obey my instinct,--shall I +not give myself to the lofty pursuits of science for its own sake? + +Certainly you may, if you like. But take down your sign, or never +put it up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and +Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the +difficulty. We all admire the achievements of this band of +distinguished doctors who do not practise. But we say of their work +and of all pure science, as the French officer said of the charge of +the six hundred at Balaclava, "C'est magnifique, mais ce n'est pas la +guerre,"--it is very splendid, but it is not a practising doctor's +business. His patient has a right to the cream of his life and not +merely to the thin milk that is left after "science " has skimmed it +off. The best a physician can give is never too good for the +patient. + +It is often a disadvantage to a young practitioner to be known for +any accomplishment outside of his profession. Haller lost his +election as Physician to the Hospital in his native city of Berne, +principally on the ground that he was a poet. In his later years the +physician may venture more boldly. Astruc was sixty-nine years old +when he published his "Conjectures," the first attempt, we are told, +to decide the authorship of the Pentateuch showing anything like a +discerning criticism. Sir Benjamin Brodie was seventy years old +before he left his physiological and surgical studies to indulge in +psychological speculations. The period of pupilage will be busy +enough in acquiring the knowledge needed, and the season of active +practice will leave little leisure for any but professional studies. + +Dr. Graves of Dublin, one of the first clinical teachers of our time, +always insisted on his students' beginning at once to visit the +hospital. At the bedside the student must learn to treat disease, +and just as certainly as we spin out and multiply our academic +prelections we shall work in more and more stuffing, more and more +rubbish, more and more irrelevant, useless detail which the student +will get rid of just as soon as he leaves us. Then the next thing +will be a new organization, with an examining board of first-rate +practical men, who will ask the candidate questions that mean +business,--who will make him operate if he is to be a surgeon, and +try him at the bedside if he is to be a physician,--and not puzzle +him with scientific conundrums which not more than one of the +questioners could answer himself or ever heard of since he graduated. + +Or these women who are hammering at the gates on which is written "No +admittance for the mothers of mankind," will by and by organize an +institution, which starting from that skilful kind of nursing which +Florence Nightingale taught so well, will work backwards through +anodynes, palliatives, curatives, preventives, until with little show +of science it imparts most of what is most valuable in those branches +of the healing art it professes to teach. When that time comes, the +fitness of women for certain medical duties, which Hecquet advocated +in 1708, which Douglas maintained in 1736, which Dr. John Ware, long +the honored Professor of Theory and Practice in this Institution, +upheld within our own recollection in the face of his own recorded +opinion to the contrary, will very possibly be recognized. + +My advice to every teacher less experienced than myself would be, +therefore: Do not fret over the details you have to omit; you +probably teach altogether too many as it is. Individuals may learn a +thing with once hearing it, but the only way of teaching a whole +class is by enormous repetition, representation, and illustration in +all possible forms. Now and then you will have a young man on your +benches like the late Waldo Burnett,--not very often, if you lecture +half a century. You cannot pretend to lecture chiefly for men like +that,--a Mississippi raft might as well take an ocean-steamer in tow. +To meet his wants you would have to leave the rest of your class +behind and that you must not do. President Allen of Jefferson +College says that his instruction has been successful in proportion +as it has been elementary. It may be a humiliating statement, but it +is one which I have found true in my own experience. + +To the student I would say, that however plain and simple may be our +teaching, he must expect to forget much which he follows +intelligently in the lecture-room. But it is not the same as if he +had never learned it. A man must get a thing before he can forget +it. There is a great world of ideas we cannot voluntarily recall,-- +they are outside the limits of the will. But they sway our conscious +thought as the unseen planets influence the movements of those within +the sphere of vision. No man knows how much he knows,--how many +ideas he has,--any more than he knows how many blood-globules roll in +his veins. Sometimes accident brings back here and there one, but +the mind is full of irrevocable remembrances and unthinkable +thoughts, which take a part in all its judgments as indestructible +forces. Some of you must feel your scientific deficiencies painfully +after your best efforts. But every one can acquire what is most +essential. A man of very moderate ability may be a good physician, +if he devotes himself faithfully to the work. More than this, a +positively dull man, in the ordinary acceptation of the term, +sometimes makes a safer practitioner than one who has, we will say, +five per cent. more brains than his average neighbor, but who thinks +it is fifty per cent. more. Skulls belonging to this last variety of +the human race are more common, I may remark, than specimens like the +Neanderthal cranium, a cast of which you will find on the table in +the Museum. + +Whether the average talent be high or low, the Colleges of the land +must make the best commodity they can out of such material as the +country and the cities furnish them. The community must have Doctors +as it must have bread. It uses up its Doctors just as it wears out +its shoes, and requires new ones. All the bread need not be French +rolls, all the shoes need not be patent leather ones; but the bread +must be something that can be eaten, and the shoes must be something +that can be worn. Life must somehow find food for the two forces +that rub everything to pieces, or burn it to ashes,--friction and +oxygen. Doctors are oxydable products, and the schools must keep +furnishing new ones as the old ones turn into oxyds; some of first- +rate quality that burn with a great light, some of a lower grade of +brilliancy, some honestly, unmistakably, by the grace of God, of +moderate gifts, or in simpler phrase, dull. + +The public will give every honest and reasonably competent worker in +the healing art a hearty welcome. It is on the whole very loyal to +the Medical Profession. Three successive years have borne witness to +the feeling with which this Institution, representing it in its +educational aspect, is regarded by those who are themselves most +honored and esteemed. The great Master of Natural Science bade the +last year's class farewell in our behalf, in those accents which +delight every audience. The Head of our ancient University honored +us in the same way in the preceding season. And how can we forget +that other occasion when the Chief Magistrate of the Commonwealth, +that noble citizen whom we have just lost, large-souled, sweet- +natured, always ready for every kind office, came among us at our +bidding, and talked to us of our duties in words as full of wisdom as +his heart was of goodness? + +You have not much to fear, I think, from the fancy practitioners. +The vulgar quackeries drop off, atrophied, one after another. +Homoeopathy has long been encysted, and is carried on the body +medical as quietly as an old wen. Every year gives you a more +reasoning and reasonable people to deal with. See how it is in +Literature. The dynasty of British dogmatists, after lasting a +hundred years and more, is on its last legs. Thomas Carlyle, third +in the line of descent, finds an audience very different from those +which listened to the silver speech of Samuel Taylor Coleridge and +the sonorous phrases of Samuel Johnson. We read him, we smile at his +clotted English, his "swarmery" and other picturesque expressions, +but we lay down his tirade as we do one of Dr. Cumming's +interpretations of prophecy, which tells us that the world is coming +to an end next week or next month, if the weather permits,--not +otherwise,--feeling very sure that the weather will be unfavorable. + +It is the same common-sense public you will appeal to. The less +pretension you make, the better they will like you in the long run. +I hope we shall make everything as plain and as simple to you as we +can. I would never use a long word, even, where a short one would +answer the purpose. I know there are professors in this country who +"ligate" arteries. Other surgeons only tie them, and it stops the +bleeding just as well. It is the familiarity and simplicity of +bedside instruction which makes it so pleasant as well as so +profitable. A good clinical teacher is himself a Medical School. We +need not wonder that our young men are beginning to announce +themselves not only as graduates of this or that College, but also as +pupils of some one distinguished master. + +I wish to close this Lecture, if you will allow me a few moments +longer, with a brief sketch of an instructor and practitioner whose +character was as nearly a model one in both capacities as I can find +anywhere recorded. + +Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine +in this University from 1812 to 1846, and whose name has been since +retained on our rolls as Professor Emeritus, died on the 27th of +August last, in the ninetieth year of his age. He studied his +profession, as I have already mentioned, with Dr. Holyoke of Salem, +one of the few physicians who have borne witness to their knowledge +of the laws of life by living to complete their hundredth year. I +think the student took his Old Master, as he always loved to call +him, as his model; each was worthy of the other, and both were bright +examples to all who come after them. + +I remember that in the sermon preached by Dr. Grazer after Dr. +Holyoke's death, one of the points most insisted upon as +characteristic of that wise and good old man was the perfect balance +of all his faculties. The same harmonious adjustment of powers, the +same symmetrical arrangement of life, the same complete fulfilment of +every day's duties, without haste and without needless delay, which +characterized the master, equally distinguished the scholar. A +glance at the life of our own Old Master, if I can do any justice at +all to his excellences, will give you something to carry away from +this hour's meeting not unworthy to be remembered. + +>From December, 1797, to October, 1799, he remained with Dr. Holyoke +as a student, a period which he has spoken of as a most interesting +and most gratifying part of his life. After this he passed eight +months in London, and on his return, in October, 1800, he began +business in Boston. + +He had followed Mr. Cline, as I have mentioned, and was competent to +practise Surgery. But he found Dr. John Collins Warren had already +occupied the ground which at that day hardly called for more than one +leading practitioner, and wisely chose the Medical branch of the +profession. He had only himself to rely upon, but he had confidence +in his prospects, conscious, doubtless, of his own powers, knowing +his own industry and determination, and being of an eminently +cheerful and hopeful disposition. No better proof of his spirit can +be given than that, just a year from the time when he began to +practise as a physician, he took that eventful step which in such a +man implies that he sees his way clear to a position; he married a +lady blessed with many gifts, but not bringing him a fortune to +paralyze his industry. + +He had not miscalculated his chances in life. He very soon rose into +a good practice, and began the founding of that reputation which grew +with his years, until he stood by general consent at the head of his +chosen branch of the profession, to say the least, in this city and +in all this region of country. His skill and wisdom were the last +tribunal to which the sick and suffering could appeal. The community +trusted and loved him, the profession recognized him as the noblest +type of the physician. The young men whom he had taught wandered +through foreign hospitals; where they learned many things that were +valuable, and many that were curious; but as they grew older and +began to think more of their ability to help the sick than their +power of talking about phenomena, they began to look back to the +teaching of Dr. Jackson, as he, after his London experience, looked +back to that of Dr. Holyoke. And so it came to be at last that the +bare mention of his name in any of our medical assemblies would call +forth such a tribute of affectionate regard as is only yielded to age +when it brings with it the record of a life spent in well doing. + +No accident ever carries a man to eminence such as his in the medical +profession. He who looks for it must want it earnestly and work for +it vigorously; Nature must have qualified him in many ways, and +education must have equipped him with various knowledge, or his +reputation will evaporate before it reaches the noon-day blaze of +fame. How did Dr. Jackson gain the position which all conceded to +him? In the answer to this question some among you may find a key +that shall unlock the gate opening on that fair field of the future +of which all dream but which not all will ever reach. + +First of all, he truly loved his profession. He had no intellectual +ambitions outside of it, literary, scientific or political. To him +it was occupation enough to apply at the bedside the best of all that +he knew for the good of his patient; to protect the community against +the inroads of pestilence; to teach the young all that he himself had +been taught, with all that his own experience had added; to leave on +record some of the most important results of his long observation. + +With his patients he was so perfect at all points that it is hard to +overpraise him. I have seen many noted British and French and +American practitioners, but I never saw the man so altogether +admirable at the bedside of the sick as Dr. James Jackson. His smile +was itself a remedy better than the potable gold and the dissolved +pearls that comforted the praecordia of mediaeval monarchs. Did a +patient, alarmed without cause, need encouragement, it carried the +sunshine of hope into his heart and put all his whims to flight, as +David's harp cleared the haunted chamber of the sullen king. Had the +hour come, not for encouragement, but for sympathy, his face, his +voice, his manner all showed it, because his heart felt it. So +gentle was he, so thoughtful, so calm, so absorbed in the case before +him, not to turn round and look for a tribute to his sagacity, not to +bolster himself in a favorite theory, but to find out all he could, +and to weigh gravely and cautiously all that he found, that to follow +him in his morning visit was not only to take a lesson in the healing +art, it was learning how to learn, how to move, how to look, how to +feel, if that can be learned. To visit with Dr. Jackson was a +medical education. + +He was very firm, with all his kindness. He would have the truth +about his patients. The nurses found it out; and the shrewder ones +never ventured to tell him anything but a straight story. A clinical +dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse +in the Massachusetts General Hospital, a mistress in her calling, was +as good questioning and answering as one would be like to hear +outside of the court-room. + +Of his practice you can form an opinion from his book called "Letters +to a Young Physician." Like all sensible men from the days of +Hippocrates to the present, he knew that diet and regimen were more +important than any drug or than all drugs put together. Witness his +treatment of phthisis and of epilepsy. He retained, however, more +confidence in some remedial agents than most of the younger +generation would concede to them. Yet his materia medica was a +simple one. + +"When I first went to live with Dr. Holyoke," he says, "in 1797, +showing me his shop, he said, 'There seems to you to be a great +variety of medicines here, and that it will take you long to get +acquainted with them, but most of them are unimportant. There are +four which are equal to all the rest, namely, Mercury, Antimony, Bark +and Opium.'" And Dr. Jackson adds, "I can only say of his practice, +the longer I have lived, I have thought better and better of it." +When he thought it necessary to give medicine, he gave it in earnest. +He hated half-practice--giving a little of this or that, so as to be +able to say that one had done something, in case a consultation was +held, or a still more ominous event occurred. He would give opium, +for instance, as boldly as the late Dr. Fisher of Beverly, but he +followed the aphorism of the Father of Medicine, and kept extreme +remedies for extreme cases. + +When it came to the "non-naturals," as he would sometimes call them, +after the old physicians,--namely, air, meat and drink, sleep and +watching, motion and rest, the retentions and excretions, and the +affections of the mind,--he was, as I have said, of the school of +sensible practitioners, in distinction from that vast community of +quacks, with or without the diploma, who think the chief end of man +is to support apothecaries, and are never easy until they can get +every patient upon a regular course of something nasty or noxious. +Nobody was so precise in his directions about diet, air, and +exercise, as Dr. Jackson. He had the same dislike to the a peu pres, +the about so much, about so often, about so long, which I afterwards +found among the punctilious adherents of the numerical system at La +Pitie. + +He used to insist on one small point with a certain philological +precision, namely, the true meaning of the word "cure." He would +have it that to cure a patient was simply to care for him. I refer +to it as showing what his idea was of the relation of the physician +to the patient. It was indeed to care for him, as if his life were +bound up in him, to watch his incomings and outgoings, to stand guard +at every avenue that disease might enter, to leave nothing to chance; +not merely to throw a few pills and powders into one pan of the +scales of Fate, while Death the skeleton was seated in the other, but +to lean with his whole weight on the side of life, and shift the +balance in its favor if it lay in human power to do it. Such +devotion as this is only to be looked for in the man who gives +himself wholly up to the business of healing, who considers Medicine +itself a Science, or if not a science, is willing to follow it as an +art,--the noblest of arts, which the gods and demigods of ancient +religions did not disdain to practise and to teach. + +The same zeal made him always ready to listen to any new suggestion +which promised to be useful, at a period of life when many men find +it hard to learn new methods and accept new doctrines. Few of his +generation became so accomplished as he in the arts of direct +exploration; coming straight from the Parisian experts, I have +examined many patients with him, and have had frequent opportunities +of observing his skill in percussion and auscultation. + +One element in his success, a trivial one compared with others, but +not to be despised, was his punctuality. He always carried two +watches,--I doubt if he told why, any more than Dr. Johnson told what +he did with the orange-peel,--but probably with reference to this +virtue. He was as much to be depended upon at the appointed time as +the solstice or the equinox. There was another point I have heard +him speak of as an important rule with him; to come at the hour when +he was expected; if he had made his visit for several days +successively at ten o'clock, for instance, not to put it off, if be +could possibly help it, until eleven, and so keep a nervous patient +and an anxious family waiting for him through a long, weary hour. + +If I should attempt to characterize his teaching, I should say that +while it conveyed the best results of his sagacious and extended +observation, it was singularly modest, cautious, simple, sincere. +Nothing was for show, for self-love; there was no rhetoric, no +declamation, no triumphant "I told you so," but the plain statement +of a clear-headed honest man, who knows that he is handling one of +the gravest subjects that interest humanity. His positive +instructions were full of value, but the spirit in which he taught +inspired that loyal love of truth which lies at the bottom of all +real excellence. + +I will not say that, during his long career, Dr. Jackson never made +an enemy. I have heard him tell how, in his very early days, old Dr. +Danforth got into a towering passion with him about some professional +consultation, and exploded a monosyllable or two of the more +energetic kind on the occasion. I remember that that somewhat +peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson +succeeded to his place as Professor of Theory and Practice. A young +man of Dr. Jackson's talent and energy could hardly take the position +that belonged to him without crowding somebody in a profession where +three in a bed is the common rule of the household. But he was a +peaceful man and a peace-maker all his days. No man ever did more, +if so much, to produce and maintain the spirit of harmony for which +we consider our medical community as somewhat exceptionally +distinguished. + +If this harmony should ever be threatened, I could wish that every +impatient and irritable member of the profession would read that +beautiful, that noble Preface to the "Letters," addressed to John +Collins Warren. I know nothing finer in the medical literature of +all time than this Prefatory Introduction. It is a golden prelude, +fit to go with the three great Prefaces which challenge the +admiration of scholars,--Calvin's to his Institutes, De Thou's to his +History, and Casaubon's to his Polybius,--not because of any learning +or rhetoric, though it is charmingly written, but for a spirit +flowing through it to which learning and rhetoric are but as the +breath that is wasted on the air to the Mood that warms the heart. + +Of a similar character is this short extract which I am permitted to +make from a private letter of his to a dear young friend. He was +eighty-three years old at the time of writing it. + +"I have not loved everybody whom I have known, but I have striven to +see the good points in the characters of all men and women. At first +I must have done this from something in my own nature, for I was not +aware of it, and yet was doing it without any plan, when one day, +sixty years ago, a friend whom I loved and respected said this to me, +'Ah, James, I see that you are destined to succeed in the world, and +to make friends, because you are so ready to see the good point in +the characters of those you meet.'" + +I close this imperfect notice of some features in the character of +this most honored and beloved of physicians by applying to him the +words which were written of William Heberden, whose career was not +unlike his own, and who lived to the same patriarchal age. + +"From his early youth he had always entertained a deep sense of +religion, a consummate love of virtue, an ardent thirst after +knowledge, and an earnest desire to promote the welfare and happiness +of all mankind. By these qualities, accompanied with great sweetness +of manners, he acquired the love and esteem of all good men, in a +degree which perhaps very few have experienced; and after passing an +active life with the uniform testimony of a good conscience, he +became an eminent example of its influence, in the cheerfulness and +serenity of his latest age." + +Such was the man whom I offer to you as a model, young gentlemen, at +the outset of your medical career. I hope that many of you will +recognize some traits of your own special teachers scattered through +various parts of the land in the picture I have drawn. Let me assure +you that whatever you may learn in this or any other course of public +lectures,--and I trust you will learn a great deal,--the daily +guidance, counsel, example, of your medical father, for such the Oath +of Hippocrates tells you to consider your preceptor, will, if he is +in any degree like him of whom I have spoken, be the foundation on +which all that we teach is reared, and perhaps outlive most of our +teachings, as in Dr. Jackson's memory the last lessons that remained +with him were those of his Old Master. + + + + + + +THE MEDICAL PROFESSION IN MASSACHUSETTS. + +A Lecture of a Course by members of the Massachusetts Historical +Society, delivered before the Lowell Institute, January 29, 1869. + +The medical history of eight generations, told in an hour, must be in +many parts a mere outline. The details I shall give will relate +chiefly to the first century. I shall only indicate the leading +occurrences, with the more prominent names of the two centuries which +follow, and add some considerations suggested by the facts which have +been passed in review. + +A geographer who was asked to describe the tides of Massachusetts +Bay, would have to recognize the circumstance that they are a limited +manifestation of a great oceanic movement. To consider them apart +from this, would be to localize a planetary phenomenon, and to +provincialize a law of the universe. The art of healing in +Massachusetts has shared more or less fully and readily the movement +which, with its periods of ebb and flow, has been raising its level +from age to age throughout the better part of Christendom. Its +practitioners brought with them much of the knowledge and many of the +errors of the Old World; they have always been in communication with +its wisdom and its folly; it is not without interest to see how far +the new conditions in which they found themselves have been favorable +or unfavorable to the growth of sound medical knowledge and practice. + +The state of medicine is an index of the civilization of an age and +country,--one of the best, perhaps, by which it can be judged. +Surgery invokes the aid of all the mechanical arts. From the rude +violences of the age of stone,--a relic of which we may find in the +practice of Zipporah, the wife of Moses,--to the delicate operations +of to-day upon patients lulled into temporary insensibility, is a +progress which presupposes a skill in metallurgy and in the labors of +the workshop and the laboratory it has taken uncounted generations to +accumulate. Before the morphia which deadens the pain of neuralgia, +or the quinine which arrests the fit of an ague, can find their place +in our pharmacies, commerce must have perfected its machinery, and +science must have refined its processes, through periods only to be +counted by the life of nations. Before the means which nature and +art have put in the hands of the medical practitioner can be fairly +brought into use, the prejudices of the vulgar must be overcome, the +intrusions of false philosophy must be fenced out, and the +partnership with the priesthood dissolved. All this implies that +freedom and activity of thought which belong only to the most +advanced conditions of society; and the progress towards this is by +gradations as significant of wide-spread changes, as are the varying +states of the barometer of far-extended conditions of the atmosphere. + +Apart, then, from its special and technical interest, my subject has +a meaning which gives a certain importance, and even dignity, to +details in themselves trivial and almost unworthy of record. A +medical entry in Governor Winthrop's journal may seem at first sight +a mere curiosity; but, rightly interpreted, it is a key to his whole +system of belief as to the order of the universe and the relations +between man and his Maker. Nothing sheds such light on the +superstitions of an age as the prevailing interpretation and +treatment of disease. When the touch of a profligate monarch was a +cure for one of the most inveterate of maladies, when the common +symptoms of hysteria were prayed over as marks of demoniacal +possession, we might well expect the spiritual realms of thought to +be peopled with still stranger delusions. + +Let us go before the Pilgrims of the Mayflower, and look at the +shores on which they were soon to land. A wasting pestilence had so +thinned the savage tribes that it was sometimes piously interpreted +as having providentially prepared the way for the feeble band of +exiles. Cotton Mather, who, next to the witches, hated the +"tawnies," " wild beasts," "blood-hounds," "rattlesnakes," +"infidels," as in different places he calls the unhappy Aborigines, +describes the condition of things in his lively way, thus: +"The Indians in these Parts had newly, even about a Year or Two +before, been visited with such a prodigious Pestilence; as carried +away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of +Twenty) among them so that the Woods were almost cleared of those +pernicious Creatures to make Room for a better Growth." + +What this pestilence was has been much discussed. It is variously +mentioned by different early writers as "the plague," "a great and +grievous plague," "a sore consumption," as attended with spots which +left unhealed places on those who recovered, as making the "whole +surface yellow as with a garment." Perhaps no disease answers all +these conditions so well as smallpox. We know from different sources +what frightful havoc it made among the Indians in after years,--in +1631, for instance, when it swept away the aboriginal inhabitants of +whole towns," and in 1633. We have seen a whole tribe, the Mandans, +extirpated by it in our own day. The word "plague" was used very +vaguely, as in the description of the "great sickness" found among +the Indians by the expedition of 1622. This same great sickness +could hardly have been yellow fever, as it occurred in the month of +November. I cannot think, therefore, that either the scourge of the +East or our Southern malarial pestilence was the disease that wasted +the Indians. As for the yellowness like a garment, that is too +familiar to the eyes of all who have ever looked on the hideous mask +of confluent variola. + +Without the presence or the fear of these exotic maladies, the +forlorn voyagers of the Mayflower had sickness enough to contend +with. At their first landing at Cape Cod, gaunt and hungry and +longing for fresh food, they found upon the sandy shore "great +mussel's, and very fat and full of sea-pearl." Sailors and +passengers indulged in the treacherous delicacy; which seems to have +been the sea-clam; and found that these mollusks, like the shell the +poet tells of, remembered their august abode, and treated the way- +worn adventurers to a gastric reminiscence of the heaving billows. +In the mean time it blew and snowed and froze. The water turned to +ice on their clothes, and made them many times like coats of iron. +Edward Tilley had like to have "sounded" with cold. The gunner, too, +was sick unto death, but "hope of trucking" kept him on his feet,--a +Yankee, it should seem, when he first touched the shore of New +England. Most, if not all, got colds and coughs, which afterwards +turned to scurvy, whereof many died. + +How can we wonder that the crowded and tempest-tossed voyagers, many +of them already suffering, should have fallen before the trials of +the first winter in Plymouth? Their imperfect shelter, their +insufficient supply of bread, their salted food, now in unwholesome +condition, account too well for the diseases and the mortality that +marked this first dreadful season; weakness, swelling of the limbs, +and other signs of scurvy, betrayed the want of proper nourishment +and protection from the elements. In December six of their number +died, in January eight, in February, seventeen, in March thirteen. +With the advance of spring the mortality diminished, the sick and +lame began to recover, and the colonists, saddened but not +disheartened, applied themselves to the labors of the opening year. + +One of the most pressing needs of the early colonists must have been +that of physicians and surgeons. In Mr. Savage's remarkable +Genealogical Dictionary of the first settlers who came over before +1692 and their descendants to the third generation, I find scattered +through the four crowded volumes the names of one hundred and thirty- +four medical practitioners. Of these, twelve, and probably many +more, practised surgery; three were barber-surgeons. A little +incident throws a glimmer from the dark lantern of memory upon +William Direly, one of these practitioners with the razor and the +lancet. He was lost between Boston and Roxbury in a violent tempest +of wind and snow; ten days afterwards a son was born to his widow, +and with a touch of homely sentiment, I had almost said poetry, they +called the little creature "Fathergone" Direly. Six or seven, +probably a larger number, were ministers as well as physicians, one +of whom, I am sorry to say, took to drink and tumbled into the +Connecticut River, and so ended. One was not only doctor, but also +schoolmaster and poet. One practised medicine and kept a tavern. +One was a butcher, but calls himself a surgeon in his will, a union +of callings which suggests an obvious pleasantry. One female +practitioner, employed by her own sex,--Ann Moore,--was the precursor +of that intrepid sisterhood whose cause it has long been my pleasure +and privilege to advocate on all fitting occasions. + +Outside of this list I must place the name of Thomas Wilkinson, who +was complained of, is 1676, for practising contrary to law. + +Many names in the catalogue of these early physicians have been +associated, in later periods, with the practice of the profession,-- +among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge, +Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams, +Woodward. Touton was a Huguenot, Burchsted a German from Silesia, +Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the +honor of the profession, was only Peacock disguised under this alias, +which would not, I fear, prove very attractive to patients. + +What doctrines and practice were these colonists likely to bring, +with them? + +Two principal schools of medical practice prevailed in the Old World +during the greater part of the seventeenth century. The first held +to the old methods of Galen: its theory was that the body, the +microcosm, like the macrocosm, was made up of the four elements-- +fire, air, water, earth; having respectively the qualities hot, dry, +moist, cold. The body was to be preserved in health by keeping each +of these qualities in its natural proportion; heat, by the proper +temperature; moisture, by the due amount of fluid; and so as to the +rest. Diseases which arose from excess of heat were to be attacked +by cooling remedies; those from excess of cold, by heating ones; and +so of the other derangements of balance. This was truly the +principle of contraries contrariis, which ill-informed persons have +attempted to make out to be the general doctrine of medicine, whereas +there is no general dogma other than this: disease is to be treated +by anything that is proved to cure it. The means the Galenist +employed were chiefly diet and vegetable remedies, with the use of +the lancet and other depleting agents. He attributed the four +fundamental qualities to different vegetables, in four different +degrees; thus chicory was cold in the fourth degree, pepper was hot +in the fourth, endive was cold and dry in the second, and bitter +almonds were hot in the first and dry in the second degree. When we +say "cool as a cucumber," we are talking Galenism. The seeds of that +vegetable ranked as one of "the four greater cold seeds" of this +system. + +Galenism prevailed mostly in the south of Europe and France. The +readers of Moliere will have no difficulty in recalling some of its +favorite modes of treatment, and the abundant mirth he extracted from +them. + +These Galenists were what we should call "herb-doctors" to-day. +Their insignificant infusions lost credit after a time; their +absurdly complicated mixtures excited contempt, and their nauseous +prescriptions provoked loathing and disgust. A simpler and bolder +practice found welcome in Germany, depending chiefly on mineral +remedies, mercury, antimony, sulphur, arsenic, and the use, sometimes +the secret use, of opium. Whatever we think of Paracelsus, the chief +agent in the introduction of these remedies, and whatever limits we +may assign to the use of these long-trusted mineral drugs, there can +be no doubt that the chemical school, as it was called, did a great +deal towards the expurgation of the old, overloaded, and repulsive +pharmacopoeia. We shall find evidence in the practice of our New- +England physicians of the first century, that they often employed +chemical remedies, and that, by the early part of the following +century, their chief trust was in the few simple, potent drugs of +Paracelsus. + +We have seen that many of the practitioners of medicine, during the +first century of New England, were clergymen. This relation between +medicine and theology has existed from a very early period; from the +Egyptian priest to the Indian medicine-man, the alliance has been +maintained in one form or another. The partnership was very common +among our British ancestors. Mr. Ward, the Vicar of Stratford-on- +Avon, himself a notable example of the union of the two characters, +writing about 1660, says, + +"The Saxons had their blood-letters, but under the Normans physicke, +begunne in England; 300 years agoe itt was not a distinct profession +by itself, but practised by men in orders, witness Nicholas de +Ternham, the chief English physician and Bishop of Durham; Hugh of +Evesham, a physician and cardinal; Grysant, physician and pope; John +Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul +Bush, a bachelor of divinitie in Oxford, was a man well read in +physick as well as divinitie, he was the first bishop of Bristol." + +"Again in King Richard the Second's time physicians and divines were +not distinct professions; for one Tydeman, Bishop of Landaph and +Worcester, was physician to King Richard the Second." + +This alliance may have had its share in creating and keeping up the +many superstitions which have figured so largely in the history of +medicine. It is curious to see that a medical work left in +manuscript by the Rev. Cotton Mather and hereafter to be referred to, +is running over with follies and superstitious fancies; while his +contemporary and fellow-townsman, William Douglass, relied on the +same few simple remedies which, through Dr. Edward Holyoke and Dr. +James Jackson, have come down to our own time, as the most important +articles of the materia medica. + +Let us now take a general glance at some of the conditions of the +early settlers; and first, as to the healthfulness of the climate. +The mortality of the season that followed the landing of the Pilgrims +at Plymouth has been sufficiently accounted for. After this, the +colonists seem to have found the new country agreeing very well with +their English constitutions. Its clear air is the subject of eulogy. +Its dainty springs of sweet water are praised not only by Higginson +and Wood, but even the mischievous Morton says, that for its delicate +waters Canaan came not near this country." There is a tendency to +dilate on these simple blessings, which reminds one a little of the +Marchioness in Dickens's story, with her orange-peel-and-water +beverage. Still more does one feel the warmth of coloring,--such as +we expect from converts to a new faith, and settlers who want to +entice others over to their clearings, when Winslow speaks, in 1621, +of "abundance of roses, white, red, and damask; single, but very +sweet indeed;" a most of all, however, when, in the same connection, +he says, "Here are grapes white and red, and very sweet and strong +also." This of our wild grape, a little vegetable Indian, which +scalps a civilized man's mouth, as his animal representative scalps +his cranium. But there is something quite charming in Winslow's +picture of the luxury in which they are living. Lobsters, oysters, +eels, mussels, fish and fowl, delicious fruit, including the grapes +aforesaid,--if they only had "kine, horses, and sheep," he makes no +question but men would live as contented here as in any part of the +world. We cannot help admiring the way in which they took their +trials, and made the most of their blessings. + +"And how Content they were," says Cotton Mather, "when an Honest Man, +as I have heard, inviting his Friends to a Dish of Clams, at the +Table gave Thanks to Heaven, who had given them to suck the abundance +of the Seas, and of the Treasures Aid in the Sands!" + +Strangely enough, as it would seem, except for this buoyant +determination to make the best of everything, they hardly appear to +recognize the difference of the climate from that which they had +left. After almost three years' experience, Winslow says, he can +scarce distinguish New England from Old England, in respect of heat +and cold, frost, snow, rain, winds, etc. The winter, he thinks (if +there is a difference), is sharper and longer; but yet he may be +deceived by the want of the comforts he enjoyed at home. He cannot +conceive any climate to agree better with the constitution of the +English, not being oppressed with extremity of heats, nor nipped by +biting cold : + +"By which means, blessed be God, we enjoy our health, notwithstanding +those difficulties we have undergone, in such a measure as would have +been admired, if we had lived in England with the like means." + +Edward Johnson, after mentioning the shifts to which they were put +for food, says,-- + +"And yet, methinks, our children are as cheerful, fat, and lusty, +with feeding upon those mussels, clams, and other fish, as they were +in England with their fill of bread." + +Higginson, himself a dyspeptic, "continually in physic," as he says, +and accustomed to dress in thick clothing, and to comfort his stomach +with drink that was "both strong and stale,"--the "jolly good ale and +old," I suppose, of free and easy Bishop Still's song,--found that he +both could and did oftentimes drink New England water very well, +--which he seems to look upon as a remarkable feat. He could go as +lightclad as any, too, with only a light stuff cassock upon his +shirt, and stuff breeches without linings. Two of his children were +sickly: one,--little misshapen Mary,--died on the passage, and, in +her father's words, "was the first in our ship that was buried in the +bowels of the great Atlantic sea;" the other, who had been "most +lamentably handled" by disease, recovered almost entirely "by the +very wholesomeness of the air, altering, digesting, and drying up the +cold and crude humors of the body." Wherefore, he thinks it a wise +course for all cold complexions to come to take physic in New +England, and ends with those often quoted words, that "a sup of New +England's air is better than a whole draught of Old England's ale." +Mr. Higginson died, however, "of a hectic fever," a little more than +a year after his arrival. + +The medical records which I shall cite show that the colonists were +not exempt from the complaints of the Old World. Besides the common +diseases to which their descendants are subject, there were two +others, to say nothing of the dreaded small-pox, which later medical +science has disarmed,--little known among us at the present day, but +frequent among the first settlers. The first of these was the +scurvy, already mentioned, of which Winthrop speaks in 1630, saying, +that it proved fatal to those who fell into discontent, and lingered +after their former conditions in England; the poor homesick creatures +in fact, whom we so forget in our florid pictures of the early times +of the little band in the wilderness. Many who were suffering from +scurvy got well when the Lyon arrived from England, bringing store of +juice of lemons. The Governor speaks of another case in 1644; and it +seems probable that the disease was not of rare occurrence. + +The other complaint from which they suffered, but which has nearly +disappeared from among us, was intermittent fever, or fever and ague. +I investigated the question as to the prevalence of this disease in +New England, in a dissertation, which was published in a volume with +other papers, in the year 1838. I can add little to the facts there +recorded. One which escaped me was, that Joshua Scottow, in "Old +Men's Tears," dated 1691, speaks of "shaking agues," as among the +trials to which they had been subjected. The outline map of New +England, accompanying the dissertation above referred to, indicates +all the places where I had evidence that the disease had originated. +It was plain enough that it used to be known in many localities where +it has long ceased to be feared. Still it was and is remarkable to +see what a clean bill of health in this particular respect our barren +soil inherited with its sterility. There are some malarious spots on +the edge of Lake Champlain, arid there have been some temporary +centres of malaria, within the memory of man, on one or more of our +Massachusetts rivers, but these are harmless enough, for the most +part, unless the millers dam them, when they are apt to retaliate +with a whiff from their meadows, that sets the whole neighborhood +shaking with fever and ague. + + +The Pilgrims of the Mayflower had with them a good physician, a man +of standing, a deacon of their church, one whom they loved and +trusted, Dr. Samuel Fuller. But no medical skill could keep cold and +hunger and bad food, and, probably enough, desperate homesickness in +some of the feebler sort, from doing their work. No detailed record +remains of what they suffered or what was attempted for their relief +during the first sad winter. The graves of those who died were +levelled and sowed with grain that the losses of the little band +might not be suspected by the savage tenants of the wilderness, and +their story remains untold. + +Of Dr. Fuller's practice, at a later period, we have an account in a +letter of his to Governor Bradford, dated June, 1630. "I have been +to Matapan" (now Dorchester), he says, "and let some twenty of those +people blood." Such wholesale depletion as this, except with avowed +homicidal intent, is quite unknown in these days; though I once saw +the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy, +order some ten or fifteen patients, taken almost indiscriminately, to +be bled in a single morning. + +Dr. Fuller's two visits to Salem, at the request of Governor +Endicott, seem to have been very satisfactory to that gentleman. +Morton, the wild fellow of Merry Mount, gives a rather questionable +reason for the Governor's being so well pleased with the physician's +doings. The names under which he mentions the two personages, it +will be seen, are not intended to be complimentary. "Dr. Noddy did a +great cure for Captain Littleworth. He cured him of a disease called +a wife." William Gager, who came out with Winthrop, is spoken of as +"a right godly man and skilful chyrurgeon," but died of a malignant +fever not very long after his arrival." + +Two practitioners of the ancient town of Newbury are entitled to +special notice, for different reasons. The first is Dr. John Clark, +who is said by tradition to have been the first regularly educated +physician who resided in New England. His portrait, in close-fitting +skull-cap, with long locks and venerable flowing beard, is familiar +to our eyes on the wall of our Society's antechamber. His left hand +rests upon a skull, his right hand holds an instrument which deserves +a passing comment. It is a trephine, a surgical implement for +cutting round pieces out of broken skulls, so as to get at the +fragments which have been driven in, and lift them up. It has a +handle like that of a gimlet, with a claw like a hammer, to lift +with, I suppose, which last contrivance I do not see figured in my +books. But the point I refer to is this: the old instrument, the +trepan, had a handle like a wimble, what we call a brace or bit- +stock. The trephine is not mentioned at all in Peter Lowe's book, +London, 1634; nor in Wiseman's great work on Surgery, London, 1676; +nor in the translation of Dionis, published by Jacob Tonson, in 1710. +In fact it was only brought into more general use by Cheselden and +Sharpe so late as the beginning of the last century. As John Clark +died in 1661, it is remarkable to see the last fashion in the way of +skull-sawing contrivances in his hands,--to say nothing of the claw +on the handle, and a Hey's saw, so called in England, lying on the +table by him, and painted there more than a hundred years before Hey +was born. This saw is an old invention, perhaps as old as +Hippocrates, and may be seen figured in the "Armamentarium +Chirurgicum" of Scultetus, or in the Works of Ambroise Pare. + +Dr. Clark is said to have received a diploma before be came, for +skill in lithotomy. He loved horses, as a good many doctors do, and +left a good property, as they all ought to do. His grave and noble +presence, with the few facts concerning him, told with more or less +traditional authority, give us the feeling that the people of +Newbury, and afterwards of Boston, had a wise and skilful medical +adviser and surgeon in Dr. John Clark. + +The venerable town of Newbury had another physician who was less +fortunate. The following is a court record of 1652: + +"This is to certify whom it may concern, that we the subscribers, +being called upon to testify against doctor William Snelling for +words by him uttered, affirm that being in way of merry discourse, a +health being drank to all friends, he answered, + + "I'll pledge my friends, + And for my foes + A plague for their heels + And,'--- + +[a similar malediction on the other extremity of their feet.] + +"Since when he hath affirmed that he only intended the proverb used +in the west country, nor do we believe he intended otherwise. + +[Signed] +WILLIAM THOMAS. +THOMAS MILWARD. + +"March 12th 1651, All which I acknowledge, and am sorry I did not +expresse my intent, or that I was so weak as to use so foolish a +proverb. + +[Signed] +GULIELMUS SNELLING." + + +Notwithstanding this confession and apology, the record tells us that +"William Snelling in his presentment for cursing is fined ten +shillings and the fees of court." + +I will mention one other name among those of the Fathers of the +medical profession in New England. The "apostle" Eliot says, writing +in 1647, "We never had but one anatomy in the country, which Mr. +Giles Firman, now in England, did make and read upon very well." + +Giles Firmin, as the name is commonly spelled, practised physic in +this country for a time. He seems to have found it a poor business; +for, in a letter to Governor Winthrop, he says, "I am strongly sett +upon to studye divinitie: my studyes else must be lost, for physick +is but a meene helpe." + +Giles Firmin's Lectures on Anatomy were the first scientific +teachings of the New World. While the Fathers were enlightened +enough to permit such instructions, they were severe in dealing with +quackery; for, in 1631, our court records show that one Nicholas +Knopp, or Knapp, was sentenced to be fined or whipped "for taking +upon him to cure the scurvey by a water of noe worth nor value, which +he solde att a very deare rate." Empty purses or sore backs would be +common with us to-day if such a rule were enforced. + +Besides the few worthies spoken of, and others whose names I have not +space to record, we must remember that there were many clergymen who +took charge of the bodies as well as the souls of their patients, +among them two Presidents of Harvard College, Charles Chauncy and +Leonard Hoar,--and Thomas Thacher, first minister of the "Old South," +author of the earliest medical treatises printed in the country,[A +Brief Rule to Guide the Common People in Small pox and +Measles. 1674.] whose epitaph in Latin and Greek, said to have been +written by Eleazer, an "Indian Youth" and a member of the Senior +Class of Harvard College, may be found in the "Magnalia." I miss +this noble savage's name in our triennial catalogue; and as there is +many a slip between the cup and lip, one is tempted to guess that he +may have lost his degree by some display of his native instinct,-- +possibly a flourish of the tomahawk or scalping-knife. However this +may have been, the good man he celebrated was a notable instance of +the Angelical Conjunction, as the author of the "Magnalia" calls it, +of the offices of clergyman and medical practitioner. + +Michael Wigglesworth, author of the "Day of Doom," attended the sick, +"not only as a Pastor, but as a Physician too, and this, not only in +his own town, but also in all those of the vicinity." Mather says of +the sons of Charles Chauncy, " All of these did, while they had +Opportunity, Preach the Gospel; and most, if not all of them, like +their excellent Father before them, had an eminent skill in physick +added unto their other accomplishments," etc. Roger Williams is said +to have saved many in a kind of pestilence which swept away many +Indians. + +To these names must be added, as sustaining a certain relation to the +healing art, that of the first Governor Winthrop, who is said by John +Cotton to have been "Help for our Bodies by Physick [and] for our +Estates by Law," and that of his son, the Governor of Connecticut, +who, as we shall see, was as much physician as magistrate. + +I had submitted to me for examination, in 1862, a manuscript found +among the Winthrop Papers, marked with the superscription, "For my +worthy friend Mr. Wintrop," dated in 1643, London, signed Edward +Stafford, and containing medical directions and prescriptions. It +may be remembered by some present that I wrote a report on this +paper, which was published in the "Proceedings" of this Society. +Whether the paper was written for Governor John Winthrop of +Massachusetts, or for his son, Governor John of Connecticut, there is +no positive evidence that I have been able to obtain. It is very +interesting, however, as giving short and simple practical +directions, such as would be most like to be wanted and most useful, +in the opinion of a physician in repute of that day. + +The diseases prescribed for are plague, small-pox, fevers, king's +evil, insanity, falling-sickness, and the like; with such injuries as +broken bones, dislocations, and burning with gunpowder. The remedies +are of three kinds: simples, such as St. John's wort, Clown's all- +heal, elder, parsley, maidenhair, mineral drugs, such as lime, +saltpetre, Armenian bole, crocus metallorum, or sulphuret of +antimony; and thaumaturgic or mystical, of which the chief is, "My +black powder against the plague, small-pox; purples, all sorts of +feavers; Poyson; either, by Way of Prevention or after Infection." +This marvellous remedy was made by putting live toads into an earthen +pot so as to half fill it, and baking and burning them "in the open +ayre, not in an house,"--concerning which latter possibility I +suspect Madam Winthrop would have had something to say,--until they +could be reduced by pounding, first into a brown, and then into a +black, powder. Blood-letting in some inflammations, fasting in the +early stage of fevers, and some of those peremptory drugs with which +most of us have been well acquainted in our time, the infragrant +memories of which I will not pursue beyond this slight allusion, are +among his remedies. + +The Winthrops, to one of whom Dr. Stafford's directions were +addressed, were the medical as well as the political advisers of +their fellow-citizens for three or four successive generations. One +of them, Governor John of Connecticut, practised so extensively, +that, but for his more distinguished title in the State, he would +have been remembered as the Doctor. The fact that he practised in +another colony, for the most part, makes little difference in the +value of the records we have of his medical experience, which have +fortunately been preserved, and give a very fair idea, in all +probability, of the way in which patients were treated in +Massachusetts, when they fell into intelligent and somewhat educated +hands, a little after the middle of the seventeenth century: + +I have before me, while writing, a manuscript collection of the +medical cases treated by him, and recorded at the time in his own +hand, which has been intrusted to me by our President, his +descendant. + +They are generally marked Hartford, and extend from the year 1657 to +1669. From these, manuscripts, and from the letters printed in the +Winthrop Papers published by our Society, I have endeavored to obtain +some idea of the practice of Governor John Winthrop, Junior. The +learned eye of Mr. Pulsifer would have helped me, no doubt, as it has +done in other cases; but I have ventured this time to attempt finding +my own way among the hieroglyphics of these old pages. By careful +comparison of many prescriptions, and by the aid of Schroder, Salmon, +Culpeper, and other old compilers, I have deciphered many of his +difficult paragraphs with their mysterious recipes. + +The Governor employed a number of the simples dear to ancient women, +--elecampane and elder and wormwood and anise and the rest; but he +also employed certain mineral remedies, which he almost always +indicates by their ancient symbols, or by a name which should leave +them a mystery to the vulgar. I am now prepared to reveal the mystic +secrets of the Governor's beneficent art, which rendered so many good +and great as well as so many poor and dependent people his debtors,- +at least, in their simple belief,--for their health and their lives. + +His great remedy, which he gave oftener than any other, was nitre; +which he ordered in doses of twenty or thirty grains to adults, and +of three grains to infants. Measles, colics, sciatica, headache, +giddiness, and many other ailments, all found themselves treated, and +I trust bettered, by nitre; a pretty safe medicine in moderate doses, +and one not likely to keep the good Governor awake at night, thinking +whether it might not kill, if it did not cure. We may say as much +for spermaceti, which he seems to have considered "the sovereign'st +thing on earth" for inward bruises, and often prescribes after falls +and similar injuries. + +One of the next remedies, in point of frequency, which he was in the +habit of giving, was (probably diaphoretic) antimony; a mild form of +that very active metal, and which, mild as it was, left his patients +very commonly with a pretty strong conviction that they had been +taking something that did not exactly agree with them. Now and then +he gave a little iron or sulphur or calomel, but very rarely; +occasionally, a good, honest dose of rhubarb or jalap; a taste of +stinging horseradish, oftener of warming guiacum; sometimes an +anodyne, in the shape of mithridate,--the famous old farrago, which +owed its virtue to poppy juice; [This is the remedy which a Boston +divine tried to simplify. See Electuarium Novum Alexipharmacum, by +Rev. Thomas Harward, lecturer at the Royal Chappell. Boston, 1732. +This tract is in our Society's library.] very often, a harmless +powder of coral; less frequently, an inert prescription of pleasing +amber; and (let me say it softly within possible hearing of his +honored descendant), twice or oftener,--let us hope as a last +resort,--an electuary of millipedes,--sowbugs, if we must give them +their homely English name. One or two other prescriptions, of the +many unmentionable ones which disgraced the pharmacopoeia of the +seventeenth century, are to be found, but only in very rare +instances, in the faded characters of the manuscript. + +The excellent Governor's accounts of diseases are so brief, that we +get only a very general notion of the complaints for which he +prescribed. Measles and their consequences are at first more +prominent than any other one affection, but the common infirmities of +both sexes and of all ages seem to have come under his healing hand. +Fever and ague appears to have been of frequent occurrence. + +His published correspondence shows that many noted people were in +communication with him as his patients. Roger Williams wants a +little of his medicine for Mrs. Weekes's daughter; worshipful John +Haynes is in receipt of his powders; troublesome Captain Underhill +wants "a little white vitterall" for his wife, and something to cure +his wife's friend's neuralgia, (I think his wife's friend's husband +had a little rather have had it sent by the hands of Mrs. Underhill, +than by those of the gallant and discursive captain); and pious John +Davenport says, his wife "tooke but one halfe of one of the papers" +(which probably contained the medicine he called rubila), "but could +not beare the taste of it, and is discouraged from taking any more;" +and honored William Leete asks for more powders for his "poore little +daughter Graciana, though he found it "hard to make her take it," +delicate, and of course sensitive, child as she was, languishing and +dying before her time, in spite of all the bitter things she +swallowed,--God help all little children in the hands of dosing +doctors and howling dervishes! Restless Samuel Gorton, now tamed by +the burden of fourscore and two years, writes so touching an account +of his infirmities, and expresses such overflowing gratitude for the +relief he has obtained from the Governor's prescriptions, wondering +how "a thing so little in quantity, so little in sent, so little in +taste, and so little to sence in operation, should beget and bring +forth such efects," that we repent our hasty exclamation, and bless +the memory of the good Governor, who gave relief to the worn-out +frame of our long-departed brother, the sturdy old heretic of Rhode +Island. + +What was that medicine which so frequently occurs in the printed +letters under the name of "rubila"? It is evidently a secret remedy, +and, so far as I know, has not yet been made out. I had almost given +it up in despair, when I found what appears to be a key to the +mystery. In the vast multitude of prescriptions contained in the +manuscripts, most of them written in symbols, I find one which I thus +interpret: + +"Four grains of (diaphoretic) antimony, with twenty grains of nitre, +with a little salt of tin, making rubila." Perhaps something was +added to redden the powder, as he constantly speaks of "rubifying " +or "viridating" his prescriptions; a very common practice of +prescribers, when their powders look a little too much like plain +salt or sugar. + + +Waitstill Winthrop, the Governor's son, "was a skilful physician," +says Mr. Sewall, in his funeral sermon; "and generously gave, not +only his advice, but also his Medicines, for the healing of the Sick, +which, by the Blessing of God, were made successful for the recovery +of many." "His son John, a member of the Royal Society, speaks of +himself as "Dr. Winthrop," and mentions one of his own prescriptions +in a letter to Cotton Mather. Our President tells me that there was +an heirloom of the ancient skill in his family, within his own +remembrance, in the form of a certain precious eye-water, to which +the late President John Quincy Adams ascribed rare virtue, and which +he used to obtain from the possessor of the ancient recipe. + +These inherited prescriptions are often treasured in families, I do +not doubt, for many generations. When I was yet of trivial age, and +suffering occasionally, as many children do, from what one of my +Cambridgeport schoolmates used to call the "ager,"--meaning thereby +toothache or face-ache,--I used to get relief from a certain plaster +which never went by any other name in the family than "Dr. Oliver." + +Dr. James Oliver was my great-great-grandfather, graduated in 1680, +and died in 1703. This was, no doubt, one of his nostrums; for +nostrum, as is well known, means nothing more than our own or my own +particular medicine, or other possession or secret, and physicians in +old times used to keep their choice recipes to themselves a good +deal, as we have had occasion to see. + +Some years ago I found among my old books a small manuscript marked +"James Oliver. This Book Begun Aug. 12, 1685." It is a rough sort +of account-book, containing among other things prescriptions for +patients, and charges for the same, with counter-charges for the +purchase of medicines and other matters. Dr. Oliver practised in +Cambridge, where may be seen his tomb with inscriptions, and with +sculptured figures that look more like Diana of the Ephesians, as +given in Calmet's Dictionary, than like any angels admitted into good +society here or elsewhere. + +I do not find any particular record of what his patients suffered +from, but I have carefully copied out the remedies he mentions, and +find that they form a very respectable catalogue. Besides the usual +simples, elder, parsley, fennel, saffron, snake-root, wormwood, I +find the Elixir Proprietatis, with other elixire and cordials, as if +he rather fancied warming medicines; but he called in the aid of some +of the more energetic remedies, including iron, and probably mercury, +as he bought two pounds of it at one time. + +The most interesting item is his bill against the estate of Samuel +Pason of Roxbury, for services during his last illness. He attended +this gentleman,--for such he must have been, by the amount of physic +which he took, and which his heirs paid for,--from June 4th, 1696, to +September 3d of the same year, three months. I observe he charges +for visits as well as for medicines, which is not the case in most of +his bills. He opens the attack with a carminative appeal to the +visceral conscience, and follows it up with good hard-hitting +remedies for dropsy,--as I suppose the disease would have been +called,--and finishes off with a rallying dose of hartshorn and iron. + +It is a source of honest pride to his descendant that his bill, which +was honestly paid, as it seems to have been honorably earned, +amounted to the handsome total of seven pounds and two shillings. +Let me add that he repeatedly prescribes plaster, one of which was +very probably the "Dr. Oliver" that soothed my infant griefs, and for +which I blush to say that my venerated ancestor received from Goodman +Hancock the painfully exiguous sum of no pounds, no shillings, and +sixpence. + +I have illustrated the practice of the first century, from the two +manuscripts I have examined, as giving an impartial idea of its +every-day methods. The Governor, Johannes Secundus, it is fair to +remember, was an amateur practitioner, while my ancestor was a +professed physician. Comparing their modes of treatment with the +many scientific follies still prevailing in the Old World, and still +more with the extraordinary theological superstitions of the +community in which they lived, we shall find reason, I think, to +consider the art of healing as in a comparatively creditable state +during the first century of New England. + +In addition to the evidence as to methods of treatment furnished by +the manuscripts I have cited, I subjoin the following document, to +which my attention was called by Dr. Shurtleff, our present Mayor. +This is a letter of which the original is to be found in vol. lxix. +page 10 of the "Archives" preserved at the State House in Boston. It +will be seen that what the surgeon wanted consisted chiefly of +opiates, stimulants, cathartics, plasters, and materials for +bandages. The complex and varied formulae have given place to +simpler and often more effective forms of the same remedies; but the +list and the manner in which it is made out are proofs of the good +sense and schooling of the surgeon, who, it may be noted, was in such +haste that he neglected all his stops. He might well be in a hurry, +as on the very day upon which he wrote, a great body of Indians-- +supposed to be six or seven hundred--appeared before Hatfield; and +twenty-five resolute young men of Hadley, from which town he wrote, +crossed the river and drove them away. + + +HADLY May 30: 76 + +Mr RAWSON Sr + +What we have recd by Tho: Houey the past month is not the cheifest of +our wants as you have love for poor wounded I pray let us not want +for these following medicines if you have not a speedy conveyance of +them I pray send on purpose they are those things mentioned in my +former letter but to prevent future mistakes I have wrote them att +large wee have great want with the greatest halt and speed let +us be supplyed. +Sr +Yr Sert +WILL LOCHS + + +(Endorsed + +Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye +Council with it but could not obtaine any thing to be sent in answer +thereto 13 June 1676 + + +I have given some idea of the chief remedies used by our earlier +physicians, which were both Galenic and chemical; that is, vegetable +and mineral. They, of course, employed the usual perturbing +medicines which Montaigne says are the chief reliance of their craft. +There were, doubtless, individual practitioners who employed special +remedies with exceptional boldness and perhaps success. Mr. Eliot is +spoken of, in a letter of William Leete to Winthrop, Junior, as being +under Mr. Greenland's mercurial administrations. The latter was +probably enough one of these specialists. + +There is another class of remedies which appears to have been +employed occasionally, but, on the whole, is so little prominent as +to imply a good deal of common sense among the medical practitioners, +as compared with the superstitions prevailing around them. I have +said that I have caught the good Governor, now and then, prescribing +the electuary of millipedes; but he is entirely excused by the almost +incredible fact that they were retained in the materia medica so late +as when Rees's Cyclopaedia was published, and we there find the +directions formerly given by the College of Edinburgh for their +preparation. Once or twice we have found him admitting still more +objectionable articles into his materia medica; in doing which, I am +sorry to say that he could plead grave and learned authority. But +these instances are very rare exceptions in a medical practice of +many years, which is, on the whole, very respectable, considering the +time and circumstances. + +Some remedies of questionable though not odious character appear +occasionally to have been employed by the early practitioners, but +they were such as still had the support of the medical profession. +Governor John Winthrop, the first, sends for East Indian bezoar, with +other commodities he is writing for. Governor Endicott sends him one +he had of Mr. Humfrey. I hope it was genuine, for they cheated +infamously in the matter of this concretion, which ought to come out +of an animal's stomach, but the real history of which resembles what +is sometimes told of modern sausages. + +There is a famous law-case of James the First's time, in which a +goldsmith sold a hundred pounds' worth of what he called bezoar, +which was proved to be false, and the purchaser got a verdict against +him. Governor Endicott also sends Winthrop a unicorn's horn, which +was the property of a certain Mrs. Beggarly, who, in spite of her +name, seems to have been rich in medical knowledge and possessions. +The famous Thomas Bartholinus wrote a treatise on the virtues of this +fabulous-sounding remedy, which was published in 1641, and +republished in 1678. + +The "antimonial cup," a drinking vessel made of that metal, which, +like our quassia-wood cups, might be filled and emptied in saecula +saeculorum without exhausting its virtues, is mentioned by Matthew +Cradock, in a letter to the elder Winthrop, but in a doubtful way, as +it was thought, he says, to have shortened the days of Sir Nathaniel +Riche; and Winthrop himself, as I think, refers to its use, calling +it simply "the cup." An antimonial cup is included in the inventory +of Samuel Seabury, who died 1680, and is valued at five shillings.° +There is a treatise entitled "The Universall Remedy, or the Vertues +of the Antimoniall Cup, By John Evans, Minister and Preacher of God's +Word, London, 1634," in our own Society's library. + +One other special remedy deserves notice, because of native growth. +I do not know when Culver's root, Leptandra Virginica of our National +Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to +John Winthrop of New London, speaks of it as famous for the cure of +consumptions, and wishes to get some of it, through his mediation, +for Katharine, his eldest daughter. He gets it, and gives it to the +"poor damsel," who is languishing, as he says, and who dies the next +month,--all the sooner, I have little doubt, for this uncertain and +violent drug, with which the meddlesome pedant tormented her in that +spirit of well-meant but restless quackery, which could touch nothing +without making mischief, not even a quotation, and yet proved at +length the means of bringing a great blessing to our community, as we +shall see by and by; so does Providence use our very vanities and +infirmities for its wise purposes. + +Externally, I find the practitioners on whom I have chiefly relied +used the plasters of Paracelsus, of melilot, diachylon, and probably +diaphoenicon, all well known to the old pharmacopoeias, and some of +them to the modern ones,--to say nothing of "my yellow salve," of +Governor John, the second, for the composition of which we must apply +to his respected descendant. + +The authors I find quoted are Barbette's Surgery, Camerarius on Gout, +and Wecherus, of all whom notices may be found in the pages of Haller +and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's +Practice of Physic and Anatomy, the last as belonging to Samuel +Seabury, chirurgeon, before mentioned. Nicholas Culpeper was a +shrewd charlatan, and as impudent a varlet as ever prescribed for a +colic; but knew very well what he was about, and badgers the College +with great vigor. A copy of Spigelius's famous Anatomy, in the +Boston Athenaeum, has the names of Increase and Samuel Mather written +in it, and was doubtless early overhauled by the youthful Cotton, who +refers to the great anatomist's singular death, among his curious +stories in the "Magnalia," and quotes him among nearly a hundred +authors whom he cites in his manuscript "The Angel of Bethesda." Dr. +John Clark's "books and instruments, with several chirurgery +materials in the closet," a were valued in his inventory at sixty +pounds; Dr. Matthew Fuller, who died in 1678, left a library valued +at ten pounds; and a surgeon's chest and drugs valued at sixteen +pounds.' + + +Here we leave the first century and all attempts at any further +detailed accounts of medicine and its practitioners. It is necessary +to show in a brief glance what had been going on in Europe during the +latter part of that century, the first quarter of which had been made +illustrious in the history of medical science by the discovery of the +circulation. + +Charles Barbeyrac, a Protestant in his religion, was a practitioner +and teacher of medicine at Montpellier. His creed was in the way of +his obtaining office; but the young men followed his instructions +with enthusiasm. Religious and scientific freedom breed in and in, +until it becomes hard to tell the family of one from that of the +other. Barbeyrac threw overboard the old complex medical farragos of +the pharmacopoeias, as his church had disburdened itself of the +popish ceremonies. + +Among the students who followed his instructions were two Englishmen: +one of them, John Locke, afterwards author of an "Essay on the Human +Understanding," three years younger than his teacher; the other, +Thomas Sydenham, five years older. Both returned to England. Locke, +whose medical knowledge is borne witness to by Sydenham, had the good +fortune to form a correct opinion on a disease from which the Earl of +Shaftesbury was suffering, which led to an operation that saved his +life. Less felicitous was his experience with a certain ancilla +culinaria virgo,--which I am afraid would in those days have been +translated kitchen-wench, instead of lady of the culinary +department,--who turned him off after she had got tired of him, and +called in another practitioner. [Locke and Sydenham, p. 124. By John +Brown, M. D. Edinburgh, 1866.] This helped, perhaps, to spoil a +promising doctor, and make an immortal metaphysician. At any rate, +Locke laid down the professional wig and cane, and took to other +studies. + +The name of Thomas Sydenham is as distinguished in the history of +medicine as that of John Locke in philosophy. As Barbeyrac was found +in opposition to the established religion, as Locke took the rational +side against orthodox Bishop Stillingfleet, so Sydenham went with +Parliament against Charles, and was never admitted a Fellow by the +College of Physicians, which, after he was dead, placed his bust in +their hall by the side of that of Harvey. + +What Sydenham did for medicine was briefly this he studied the course +of diseases carefully, and especially as affected by the particular +season; to patients with fever he gave air and cooling drinks, +instead of smothering and heating them, with the idea of sweating out +their disease; he ordered horseback exercise to consumptives; he, +like his teacher, used few and comparatively simple remedies; he did +not give any drug at all, if he thought none was needed, but let well +enough alone. He was a sensible man, in short, who applied his +common sense to diseases which he had studied with the best light of +science that he could obtain. + +The influence of the reform he introduced must have been more or less +felt in this country, but not much before the beginning of the +eighteenth century, as his great work was not published until 1675, +and then in Latin. I very strongly suspect that there was not so +much to reform in the simple practice of the physicians of the new +community, as there was in that of the learned big-wigs of the +"College," who valued their remedies too much in proportion to their +complexity, and the extravagant and fantastic ingredients which went +to their making. + +During the memorable century which bred and bore the Revolution, the +medical profession gave great names to our history. But John Brooks +belonged to the State, and Joseph Warren belongs to the country and +mankind, and to speak of them would lead me beyond my limited-- +subject. There would be little pleasure in dwelling on the name of +Benjamin Church; and as for the medical politicians, like Elisha +Cooke in the early part of the century, or Charles Jarvis, the bald +eagle of Boston, in its later years, whether their practice was +heroic or not, their patients were, for he is a bold man who trusts +one that is making speeches and coaxing voters, to meddle with the +internal politics of his corporeal republic. + +One great event stands out in the medical history of this eighteenth +century; namely, the introduction of the practice of inoculation for +small-pox. Six epidemics of this complaint had visited Boston in the +course of a hundred years." Prayers had been asked in the churches +for more than a hundred sick in a single day, and this many times. +About a thousand persons had died in a twelvemonth, we are told, and, +as we may infer, chiefly from this cause. + +In 1721, this disease, after a respite of nineteen years, again +appeared as an epidemic. In that year it was that Cotton Mather, +browsing, as was his wont, on all the printed fodder that came within +reach of his ever-grinding mandibles, came upon an account of +inoculation as practised in Turkey, contained in the "Philosophical +Transactions." He spoke of it to several physicians, who paid little +heed to his story; for they knew his medical whims, and had probably +been bored, as we say now-a-days, many of them, with listening to his +"Angel of Bethesda," and satiated with his speculations on the +Nishmath Chajim. + +The Reverend Mather,--I use a mode of expression he often employed +when speaking of his honored brethren,--the Reverend Mather was right +this time, and the irreverent doctors who laughed at him were wrong. +One only of their number disputes his claim to giving the first +impulse to the practice, in Boston. This is what that person says: +"The Small-Pox spread in Boston, New England, A.1721, and the +Reverend Dr. Cotton Mather, having had the use of these +Communications from Dr. William Douglass " (that is, the writer of +these words); surreptitiously, without the knowledge of his Informer, +that he might have the honour of a New fangled notion, sets an +Undaunted Operator to work, and in this Country about 290 were +inoculated." + +All this has not deprived Cotton Mather of the credit of suggesting, +and a bold and intelligent physician of the honor of carrying out, +the new practice. On the twenty-seventh day of June, 1721, Zabdiel +Boylston of Boston inoculated his only son for smallpox,--the first +person ever submitted to the operation in the New World. The story +of the fierce resistance to the introduction of the practice; of how +Boylston was mobbed, and Mather had a hand-grenade thrown in at his +window; of how William Douglass, the Scotchman, "always positive, and +sometimes accurate," as was neatly said of him, at once depreciated +the practice and tried to get the credit of suggesting it, and how +Lawrence Dalhonde, the Frenchman, testified to its destructive +consequences; of how Edmund Massey, lecturer at St. Albans, preached +against sinfully endeavoring to alter the course of nature by +presumptuous interposition, which he would leave to the atheist and +the scoffer, the heathen and unbeliever, while in the face of his +sermon, afterwards reprinted in Boston, many of our New England +clergy stood up boldly in defence of the practice,--all this has been +told so well and so often that I spare you its details. Set this +good hint of Cotton Mather against that letter of his to John +Richards, recommending the search after witch-marks, and the +application of the water-ordeal, which means throw your grandmother +into the water, if she has a mole on her arm;--if she swims, she is a +witch and must be hanged; if she sinks, the Lord have mercy on her +soul! + +Thus did America receive this great discovery, destined to save +thousands of lives, via Boston, from the hands of one of our own +Massachusetts physicians. + +The year 1735 was rendered sadly memorable by the epidemic of the +terrible disease known as "throat distemper," and regarded by many as +the same as our "diphtheria." Dr. Holyoke thinks the more general +use of mercurials in inflammatory complaints dates from the time of +their employment in this disease, in which they were thought to have +proved specially useful. + +At some time in the course of this century medical practice had +settled down on four remedies as its chief reliance. I must repeat +an incident which I have related in another of these Essays. When +Dr. Holyoke, nearly seventy years ago, received young Mr. James +Jackson as his student, he showed him the formidable array of +bottles, jars, and drawers around his office, and then named the four +remedies referred to as being of more importance than all the rest +put together. These were Mercury, Antimony, Opium, and Peruvian +Bark." I doubt if either of them remembered that, nearly seventy +years before, in 1730, Dr. William Douglass, the disputatious +Scotchman, mentioned those same four remedies, in the dedication of +his quarrelsome essay on inoculation, as the most important ones in +the hands of the physicians of his time. + +In the "Proceedings" of this Society for the year 1863 is a very +pleasant paper by the late Dr. Ephraim Eliot, giving an account of +the leading physicians of Boston during the last quarter of the last +century. The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch, +Danforth, John Warren, Jeffries, are all famous in local history, and +are commemorated in our medical biographies. One of them, at least, +appears to have been more widely known, not only as one of the first +aerial voyagers, but as an explorer in the almost equally hazardous +realm of medical theory. Dr. John Jeffries, the first of that name, +is considered by Broussais as a leader of medical opinion in America, +and so referred to in his famous "Examen des Doctrines Medicales." + +Two great movements took place in this eighteenth century, the effect +of which has been chiefly felt in our own time; namely, the +establishment of the Massachusetts Medical Society, and the founding +of the Medical School of Harvard University. + + +The third century of our medical history began with the introduction +of the second great medical discovery of modern times,--of all time +up to that date, I may say,--once more via Boston, if we count the +University village as its suburb, and once more by one of our +Massachusetts physicians. In the month of July, 1800, Dr. Benjamin +Waterhouse of Cambridge submitted four of his own children to the new +process of vaccination,--the first persons vaccinated, as Dr. Zabdiel +Boylston's son had been the first person inoculated in the New World. + +A little before the first half of this century was completed, in the +autumn of 1846, the great discovery went forth from the Massachusetts +General Hospital, which repaid the debt of America to the science of +the Old World, and gave immortality to the place of its origin in the +memory and the heart of mankind. The production of temporary +insensibility at will--tuto, cito, jucunde, safely, quickly, +pleasantly--is one of those triumphs over the infirmities of our +mortal condition which change the aspect of life ever afterwards. +Rhetoric can add nothing to its glory; gratitude, and the pride +permitted to human weakness, that our Bethlehem should have been +chosen as the birthplace of this new embodiment of the divine mercy, +are all we can yet find room for. + +The present century has seen the establishment of all those great +charitable institutions for the cure of diseases of the body and of +the mind, which our State and our city have a right to consider as +among the chief ornaments of their civilization. + +The last century had very little to show, in our State, in the way of +medical literature. The worthies who took care of our grandfathers +and great-grandfathers, like the Revolutionary heroes, fought (with +disease) and bled (their patients) and died (in spite of their own +remedies); but their names, once familiar, are heard only at rare +intervals. Honored in their day, not unremembered by a few solitary +students of the past, their memories are going sweetly to sleep in +the arms of the patient old dry-nurse, whose "blackdrop" is the +never-failing anodyne of the restless generations of men. Except the +lively controversy on inoculation, and floating papers in journals, +we have not much of value for that long period, in the shape of +medical records. + +But while the trouble with the last century is to find authors to +mention, the trouble of this would be to name all that we find. Of +these, a very few claim unquestioned preeminence. + +Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical +School of our University, did a great work for the advancement of +medicine and surgery in New England, by his labors as teacher and +author, greater, it is claimed by some, than was ever done by any +other man. The two Warrens, of our time, each left a large and +permanent record of a most extended surgical practice. James Jackson +not only educated a whole generation by his lessons of wisdom, but +bequeathed some of the most valuable results of his experience to +those who came after him, in a series of letters singularly pleasant +and kindly as well as instructive. John Ware, keen and cautious, +earnest and deliberate, wrote the two remarkable essays which have +identified his name, for all time, with two important diseases, on +which he has shed new light by his original observations. + +I must do violence to the modesty of the living by referring to the +many important contributions to medical science by Dr. Jacob Bigelow, +and especially to his discourse on "Self-limited Diseases," an +address which can be read in a single hour, but the influence of +which will be felt for a century. + +Nor would the profession forgive me if I forgot to mention the +admirable museum of pathological anatomy, created almost entirely by +the hands of Dr. John Barnard Swett Jackson, and illustrated by his +own printed descriptive catalogue, justly spoken of by a +distinguished professor in the University of Pennsylvania as the most +important contribution which had ever been made in this country to +the branch to which it relates. + +When we look at the literature of mental disease, as seen in hospital +reports and special treatises, we can mention the names of Wyman, +Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts +or placed at the head of her institutions for the treatment of the +insane. + +We have a right to claim also one who is known all over the civilized +world as a philanthropist, to us as a townsman and a graduate of our +own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor +of a great multitude who were born to a world of inward or of outward +darkness. + +I cannot pass over in silence the part taken by our own physicians in +those sanitary movements which are assuming every year greater +importance. Two diseases especially have attracted attention, above +all others, with reference to their causes and prevention; cholera, +the "black death" of the nineteenth century, and consumption, the +white plague of the North, both of which have been faithfully studied +and reported on by physicians of our own State and city. The +cultivation of medical and surgical specialties, which is fast +becoming prevalent, is beginning to show its effects in the +literature of the profession, which is every year growing richer in +original observations and investigations. + +To these benefactors who have labored for us in their peaceful +vocation, we must add the noble army of surgeons, who went with the +soldiers who fought the battles of their country, sharing many of +their dangers, not rarely falling victims to fatigue, disease, or the +deadly volleys to which they often exposed themselves in the +discharge of their duties. + +The pleasant biographies of the venerable Dr. Thacher, and the worthy +and kind-hearted gleaner, Dr. Stephen W. Williams, who came after +him, are filled with the names of men who served their generation +well, and rest from their labors, followed by the blessing of those +for whom they endured the toils and fatigues inseparable from their +calling. The hardworking, intelligent country physician more +especially deserves the gratitude of his own generation, for he +rarely leaves any permanent record in the literature of his +profession. Books are hard to obtain; hospitals, which are always +centres of intelligence, are remote; thoroughly educated and superior +men are separated by wide intervals; and long rides, though favorable +to reflection, take up much of the time which might otherwise be +given to the labors of the study. So it is that men of ability and +vast experience, like the late Dr. Twitchell, for instance, make a +great and deserved reputation, become the oracles of large districts, +and yet leave nothing, or next to nothing, by which their names shall +be preserved from blank oblivion. + +One or two other facts deserve mention, as showing the readiness of +our medical community to receive and adopt any important idea or +discovery. The new science of Histology, as it is now called, was +first brought fully before the profession of this country by the +translation of Bichat's great work, "Anatomie Generale," by the late +Dr. George Hayward. + +The first work printed in this country on Auscultation,--that +wonderful art of discovering disease, which, as it were, puts a +window in the breast, through which the vital organs can be seen, to +all intents and purposes, was the manual published anonymously by +"A Member of the Massachusetts Medical Society." + + +We are now in some slight measure prepared to weigh the record of the +medical profession in Massachusetts, and pass our judgment upon it. +But in-order to do justice to the first generation of practitioners, +we must compare what we know of their treatment of disease with the +state of the art in England, and the superstitions which they saw all +around them in other departments of knowledge or belief. + +English medical literature must have been at a pretty low ebb when +Sydenham recommended Don Quixote to Sir Richard Blackmore for +professional reading. The College Pharmacopoeia was loaded with the +most absurd compound mixtures, one of the most complex of which (the +same which the Reverend Mr. Harward, "Lecturer at the Royal Chappel +in Boston," tried to simplify, was not dropped until the year 1801. +Sir Kenelm Digby was playing his fantastic tricks with the +Sympathetic powder, and teaching Governor Winthrop, the second, how +to cure fever and ague, which some may like to know. "Pare the +patient's nails; put the parings in a little bag, and hang the bag +round the neck of a live eel, and put him in a tub of water. The eel +will die, and the patient will recover." + +Wiseman, the great surgeon, was discoursing eloquently on the +efficacy of the royal touch in scrofula. The founder of the +Ashmolean Museum at Oxford, consorting with alchemists and +astrologers, was treasuring the manuscripts of the late pious Dr. +Richard Napier, in which certain letters (Rx Ris) were understood to +mean Responsum Raphaelis,--the answer of the angel Raphael to the +good man's medical questions. The illustrious Robert Boyle was +making his collection of choice and safe remedies, including the sole +of an old shoe, the thigh bone of a hanged man, and things far worse +than these, as articles of his materia medica. Dr. Stafford, whose +paper of directions to his "friend, Mr. Wintrop," I cited, was +probably a man of standing in London; yet toad-powder was his +sovereign remedy. + +See what was the state of belief in other matters among the most +intelligent persons of the colonies, magistrates and clergymen. +Jonathan Brewster, son of the church-elder, writes the wildest +letters to John Winthrop about alchemy,--mad for making gold as the +Lynn rock-borers are for finding it." + +Remember the theology and the diabology of the time. Mr. Cotton's +Theocracy was a royal government, with the King of kings as its +nominal head, but with an upper chamber of saints, and a tremendous +opposition in the lower house; the leader of which may have been +equalled, but cannot have been surpassed by any of our earth-born +politicians. The demons were prowling round the houses every night, +as the foxes were sneaking about the hen-roosts. The men of +Gloucester fired whole flasks of gunpowder at devils disguised as +Indians and Frenchmen. + +How deeply the notion of miraculous interference with the course of +nature was rooted, is shown by the tenacity of the superstition about +earthquakes. We can hardly believe that our Professor Winthrop, +father of the old judge and the "squire," whom many of us Cambridge +people remember so well, had to defend himself against the learned +and excellent Dr. Prince, of the Old South Church, for discussing +their phenomena as if they belonged to the province of natural +science: + +Not for the sake of degrading the aspect of the noble men who founded +our State, do I refer to their idle beliefs and painful delusions, +but to show against what influences the common sense of the medical +profession had to assert itself. + +Think, then, of the blazing stars, that shook their horrid hair in +the sky; the phantom ship, that brought its message direct from the +other world; the story of the mouse and the snake at Watertown; of +the mice and the prayer-book; of the snake in church; of the calf +with two heads; and of the cabbage in the perfect form of a cutlash, +--all which innocent occurrences were accepted or feared as alarming +portents. + +We can smile at these: but we cannot smile at the account of unhappy +Mary Dyer's malformed offspring; or of Mrs. Hutchinson's domestic +misfortune of similar character, in the story of which the physician, +Dr. John Clark of Rhode Island, alone appears to advantage; or as we +read the Rev. Samuel Willard's fifteen alarming pages about an +unfortunate young woman suffering with hysteria. Or go a little +deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia, +first admonished, then whipped; at last, taking her own little +daughter's life; put on trial, and standing mute, threatened to be +pressed to death, confessing, sentenced, praying to be beheaded; and +none the less pitilessly swung from the fatal ladder. + +The cooper's crazy wife--crazy in the belief that she has committed +the unpardonable sin--tries to drown her child, to save it from +misery; and the poor lunatic, who would be tenderly cared for to-day +in a quiet asylum, is judged to be acting under the instigation of +Satan himself." Yet, after all, what can we say, who put Bunyan's +"Pilgrim's Progress," full of nightmare dreams of horror, into all +our children's hands; a story in which the awful image of the man in +the cage might well turn the nursery where it is read into a +madhouse? + +The miserable delusion of witchcraft illustrates, in a still more +impressive way, the false ideas which governed the supposed relation +of men with the spiritual world. I have no doubt many physicians +shared in these superstitions. Mr. Upham says they--that is, some of +them--were in the habit of attributing their want of success to the +fact, that an "evil hand" was on their patient. The temptation was +strong, no doubt, when magistrates and ministers and all that +followed their lead were contented with such an explanation. But how +was it in Salem, according to Mr. Upham's own statement? Dr. John +Swinnerton was, he says, for many years the principal physician of +Salem. And he says, also, "The Swinnerton family were all along +opposed to Mr. Parris, and kept remarkably clear from the witchcraft +delusion." Dr. John Swinnerton--the same, by the way, whose memory +is illuminated by a ray from the genius of Hawthorne--died the very +year before the great witchcraft explosion took place. But who can +doubt that it was from him that the family had learned to despise and +to resist the base superstition; or that Bridget Bishop, whose house +he rented, as Mr. Upham tells me, the first person hanged in the time +of the delusion, would have found an efficient protector in her +tenant, had he been living, to head the opposition of his family to +the misguided clergymen and magistrates? + +I cannot doubt that our early physicians brought with them many Old- +World medical superstitions, and I have no question that they were +more or less involved in the prevailing errors of the community in +which they lived. But, on the whole, their record is a clean one, so +far as we can get at it; and where it is questionable we must +remember that there must have been many little-educated persons among +them; and that all must have felt, to some extent, the influence of +those sincere and devoted but unsafe men, the physic-practising +clergymen, who often used spiritual means as a substitute for +temporal ones, who looked upon a hysteric patient as possessed by the +devil, and treated a fractured skull by prayers and plasters, +following the advice of a ruling elder in opposition to the unanimous +opinion of seven surgeons." + +To what results the union of the two professions was liable to lead, +may be seen by the example of a learned and famous person, who has +left on record the product of his labors in the double capacity of +clergyman and physician. + +I have had the privilege of examining a manuscript of Cotton Mather's +relating to medicine, by the kindness of the librarian of the +American Antiquarian Society, to which society it belongs. A brief +notice of this curious document may prove not uninteresting. + +It is entitled "The Angel of Bethesda: an Essay upon the Common +Maladies of Mankind, offering, first, the sentiments of Piety," etc., +etc., and "a collection of plain but potent and Approved REMEDIES for +the Maladies." There are sixty-six "Capsula's," as he calls them, or +chapters, in his table of contents; of which, five--from the +fifteenth to the nineteenth, inclusive--are missing. This is a most +unfortunate loss, as the eighteenth capsula treated of agues, and we +could have learned from it something of their degree of frequency in +this part of New England. There is no date to the manuscript; which, +however, refers to a case observed Nov. 14, 1724. + +The divine takes precedence of the physician in this extraordinary +production. He begins by preaching a sermon at his unfortunate +patient. Having thrown him into a cold sweat by his spiritual +sudorific, he attacks him with his material remedies, which are often +quite as unpalatable. The simple and cleanly practice of Sydenham, +with whose works he was acquainted, seems to have been thrown away +upon him. Everything he could find mentioned in the seventy or +eighty authors he cites, all that the old women of both sexes had +ever told him of, gets into his text, or squeezes itself into his +margin. + +Evolving disease out of sin, he hates it, one would say, as he hates +its cause, and would drive it out of the body with all noisome +appliances. "Sickness is in Fact Flagellum Dei pro peccatis mundi." +So saying, he encourages the young mother whose babe is wasting away +upon her breast with these reflections: + +"Think; oh the grievous Effects of Sin! This wretched Infant has not +arrived unto years of sense enough, to sin after the similitude of +the transgression committed by Adam. Nevertheless the Transgression +of Adam, who had all mankind Foederally, yea, Naturally, in him, has +involved this Infant in the guilt of it. And the poison of the old +serpent, which infected Adam when he fell into his Transgression, by +hearkening to the Tempter, has corrupted all mankind, and is a seed +unto such diseases as this Infant is now laboring under. Lord, what +are we, and what are our children, but a Generation of Vipers?" + +Many of his remedies are at least harmless, but his pedantry and +utter want of judgment betray themselves everywhere. He piles his +prescriptions one upon another, without the least discrimination. He +is run away with by all sorts of fancies and superstitions. He +prescribes euphrasia, eye-bright, for disease of the eyes; appealing +confidently to the strange old doctrine of signatures, which inferred +its use from the resemblance of its flower to the organ of vision. +For the scattering of wens, the efficacy of a Dead Hand has been out +of measure wonderful. But when he once comes to the odious class of +remedies, he revels in them like a scarabeus. This allusion will +bring us quite near enough to the inconceivable abominations with +which he proposed to outrage the sinful stomachs of the unhappy +confederates and accomplices of Adam. + +It is well that the treatise was never printed, yet there are +passages in it worth preserving. He speaks of some remedies which +have since become more universally known: + +"Among the plants of our soyl, Sir William Temple singles out Five +[Six] as being of the greatest virtue and most friendly to health: +and his favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and +Elder." + +"But these Five [Six] plants may admitt of some competitors. The +QUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!" + +Of Ipecacuanha, he says,-- +"This is now in its reign; the most fashionable vomit." + +"I am not sorry that antimonial emetics begin to be disused." + +He quotes "Mr. Lock" as recommending red poppy-water and abstinence +from flesh as often useful in children's diseases. + +One of his "Capsula's" is devoted to the animalcular origin of +diseases, at the end of which he says, speaking of remedies for this +supposed source of our distempers: + +"Mercury we know thee: But we are afraid thou wilt kill us too, if we +employ thee to kill them that kill us. + +"And yett, for the cleansing of the small Blood Vessels, and making +way for the free circulation of the Blood and Lymph--there is nothing +like Mercurial Deobstruents." + +>From this we learn that mercury was already in common use, and the +subject of the same popular prejudice as in our own time. + +His poetical turn shows itself here and there : + +"O Nightingale, with a Thorn at thy Breast; Under the trouble of a +Cough, what can be more proper than such thoughts as these?"... + +If there is pathos in this, there is bathos in his apostrophe to the +millipede, beginning "Poor sowbug!" and eulogizing the healing +virtues of that odious little beast; of which he tells us to take +"half a pound, putt 'em alive into a quart or two of wine," with +saffron and other drugs, and take two ounces twice a day. + +The "Capsula " entitled "Nishmath Chajim " was printed in 1722, at +New London, and is in the possession of our own Society. He means, +by these words, something like the Archxus of Van Helmont, of which +he discourses in a style wonderfully resembling that of Mr. Jenkinson +in the "Vicar of Wakefield." "Many of the Ancients thought there was +much of a Real History in the Parable, and their Opinion was that +there is, DIAPHORA KATA TAS MORPHAS, A Distinction (and so a +Resemblance) of men as to their Shapes after Death." And so on, with +Ireaeus, Tertullian, Thespesius, and "the TA TONE PSEUCONE CROMATA," +in the place of "Sanconiathon, Manetho, Berosus," and "Anarchon ara +kai ateleutaion to pan." + +One other passage deserves notice, as it relates to the single +medical suggestion which does honor to Cotton Mather's memory. It +does not appear that he availed himself of the information which he +says, he obtained from his slave, for such I suppose he was. + +In his appendix to " Variolae Triumphatae," he says,-- + +"There has been a wonderful practice lately used in several parts of +the world, which indeed is not yet become common in our nation. + +"I was first informed of it by a Garamantee servant of my own, long +before I knew that any Europeans or Asiaticks had the least +acquaintance with it, and some years before I was enriched with the +communications of the learned Foreigners, whose accounts I found +agreeing with what I received of my servant, when he shewed me the +Scar of the Wound made for the operation; and said, That no person +ever died of the smallpox, in their countrey, that had the courage to +use it. + +"I have since met with a considerable Number of these Africans, who +all agree in one story; That in their countrey grandy-many dy of the +small-pox: But now they learn this way: people take juice of smallpox +and cutty-skin and put in a Drop; then by'nd by a little sicky, +sicky: then very few little things like small-pox; and nobody dy of +it; and nobody have small-pox any more. Thus, in Africa, where the +poor creatures dy of the smallpox like Rotten Sheep, a merciful God +has taught them an Infallible preservative. 'T is a common practice, +and is attended with a constant success." + +What has come down to us of the first century of medical practice, in +the hands of Winthrop and Oliver, is comparatively simple and +reasonable. I suspect that the conditions of rude, stern life, in +which the colonists found themselves in the wilderness, took the +nonsense out of them, as the exigencies of a campaign did out of our +physicians and surgeons in the late war. Good food and enough of it, +pure air and water, cleanliness, good attendance, an anaesthetic, an +opiate, a stimulant, quinine, and two or three common drugs, proved +to be the marrow of medical treatment; and the fopperies of the +pharmacopoeia went the way of embroidered shirts and white kid gloves +and malacca joints, in their time of need. "Good wine is the best +cordiall for her," said Governor John Winthrop, Junior, to Samuel +Symonds, speaking of that gentleman's wife,--just as Sydenham, +instead of physic, once ordered a roast chicken and a pint of canary +for his patient in male hysterics. + +But the profession of medicine never could reach its full development +until it became entirely separated from that of divinity. The +spiritual guide, the consoler in afliction, the confessor who is +admitted into the secrets of our souls, has his own noble sphere of +duties; but the healer of men must confine himself solely to the +revelations of God in nature, as he sees their miracles with his own +eyes. No doctrine of prayer or special providence is to be his +excuse for not looking straight at secondary causes, and acting, +exactly so far as experience justifies him, as if he were himself the +divine agent which antiquity fabled him to be. While pious men were +praying--humbly, sincerely, rightly, according to their knowledge-- +over the endless succession of little children dying of spasms in the +great Dublin Hospital, a sagacious physician knocked some holes in +the walls of the ward, let God's blessed air in on the little +creatures, and so had already saved in that single hospital, as it +was soberly calculated thirty years ago, more than sixteen thousand +lives of these infant heirs of immortality. [Collins's Midwifery, p. +312. Published by order of the Massachusetts Medical Society. +Boston, 1841.] + +Let it be, if you will, that the wise inspiration of the physician +was granted in virtue of the clergyman's supplications. Still, the +habit of dealing with things seen generates another kind of +knowledge, and another way of thought, from that of dealing with +things unseen; which knowledge and way of thought are special means +granted by Providence, and to be thankfully accepted. + +The mediaeval ecclesiastics expressed a great truth in that saying, +so often quoted, as carrying a reproach with it: "Ubi tres medici, +duo athei,"--"Where there are three physicians, there are two +atheists." + +It was true then, it is true to-day, that the physician very +commonly, if not very generally, denies and repudiates the deity of +ecclesiastical commerce. The Being whom Ambroise Pare meant when he +spoke those memorable words, which you may read over the professor's +chair in the French School of Medicine, "Te le pensay, et Dieu le +guarit," "I dressed his wound, and God healed it,"--is a different +being from the God that scholastic theologians have projected from +their consciousness, or shaped even from the sacred pages which have +proved so plastic in their hands. He is a God who never leaves +himself without witness, who repenteth him of the evil, who never +allows a disease or an injury, compatible with the enjoyment of life, +to take its course without establishing an effort, limited by certain +fixed conditions, it is true, but an effort, always, to restore the +broken body or the shattered mind. In the perpetual presence of this +great Healing Agent, who stays the bleeding of wounds, who knits the +fractured bone, who expels the splinter by a gentle natural process, +who walls in the inflammation that might involve the vital organs, +who draws a cordon to separate the dead part from the living, who +sends his three natural anaesthetics to the over-tasked frame in due +order, according to its need,--sleep, fainting, death; in this +perpetual presence, it is doubtless hard for the physician to realize +the theological fact of a vast and permanent sphere of the universe, +where no organ finds itself in its natural medium, where no wound +heals kindly, where the executive has abrogated the pardoning power, +and mercy forgets its errand; where the omnipotent is unfelt save in +malignant agencies, and the omnipresent is unseen and unrepresented; +hard to accept the God of Dante's "Inferno," and of Bunyan's caged +lunatic. If this is atheism, call three, instead of two of the trio, +atheists, and it will probably come nearer the truth. + +I am not disposed to deny the occasional injurious effect of the +materializing influences to which the physician is subjected. +A spiritual guild is absolutely necessary to keep him, to keep us +all, from becoming the "fingering slaves" that Wordsworth treats with +such shrivelling scorn. But it is well that the two callings have +been separated, and it is fitting that they remain apart. In +settling the affairs of the late concern, I am afraid our good +friends remain a little in our debt. We lent them our physician +Michael Servetus in fair condition, and they returned him so damaged +by fire as to be quite useless for our purposes. Their Reverend +Samuel Willard wrote us a not over-wise report of a case of hysteria; +and our Jean Astruc gave them (if we may trust Dr. Smith's Dictionary +of the Bible) the first discerning criticism on the authorship of the +Pentateuch. Our John Locke enlightened them with his letters +concerning toleration; and their Cotton Mather obscured our twilight +with his "Nishmath Chajim." + +Yet we must remember that the name of Basil Valentine, the monk, is +associated with whatever good and harm we can ascribe to antimony; +and that the most remarkable of our specifics long bore the name of +"Jesuit's Bark," from an old legend connected with its introduction. +"Frere Jacques," who taught the lithotomists of Paris, owes his +ecclesiastical title to courtesy, as he did not belong to a religious +order. + +Medical science, and especially the study of mental disease, is +destined, I believe, to react to much greater advantage on the +theology of the future than theology has acted on medicine in the +past. The liberal spirit very generally prevailing in both +professions, and the good understanding between their most +enlightened members, promise well for the future of both in a +community which holds every point of human belief, every institution +in human hands, and every word written in a human dialect, open to +free discussion today, to-morrow, and to the end of time. Whether +the world at large will ever be cured of trusting to specifics as a +substitute for observing the laws of health, and to mechanical or +intellectual formula as a substitute for character, may admit of +question. Quackery and idolatry are all but immortal. + +We can find most of the old beliefs alive amongst us to-day, only +having changed their dresses and the social spheres in which they +thrive. We think the quarrels of Galenists and chemists belong to +the past, forgetting that Thomsonism has its numerous apostles in our +community; that it is common to see remedies vaunted as purely +vegetable, and that the prejudice against "mineral poisons," +especially mercury, is as strong in many quarters now as it was at +the beginning of the seventeenth century. Names are only air, and +blow away with a change of wind; but beliefs are rooted in human +wants and weakness, and die hard. The oaks of Dodona are prostrate, +and the shrine of Delphi is desolate; but the Pythoness and the Sibyl +may be consulted in Lowell Street for a very moderate compensation. +Nostradamus and Lilly seem impossible in our time; but we have seen +the advertisements of an astrologer in our Boston papers year after +year, which seems to imply that he found believers and patrons. You +smiled when I related Sir Kenelm Digby's prescription with the live +eel in it; but if each of you were to empty his or her pockets, would +there not roll out, from more than one of them, a horse-chestnut, +carried about as a cure for rheumatism? The brazen head of Roger +Bacon is mute; but is not "Planchette" uttering her responses in a +hundred houses of this city? We think of palmistry or chiromancy as +belonging to the days of Albertus Magnus, or, if existing in our +time, as given over to the gypsies; but a very distinguished person +has recently shown me the line of life, and the line of fortune, on +the palm of his hand, with a seeming confidence in the sanguine +predictions of his career which had been drawn from them. What shall +we say of the plausible and well-dressed charlatans of our own time, +who trade in false pretences, like Nicholas Knapp of old, but without +any fear of being fined or whipped; or of the many follies and +inanities, imposing on the credulous part of the community, each of +them gaping with eager, open mouth for a gratuitous advertisement by +the mention of its foolish name in any respectable connection? + +I turn from this less pleasing aspect of the common intelligence +which renders such follies possible, to close the honorable record of +the medical profession in this, our ancient Commonwealth. + +We have seen it in the first century divided among clergymen, +magistrates, and regular practitioners; yet, on the whole, for the +time, and under the circumstances, respectable, except where it +invoked supernatural agencies to account for natural phenomena. + +In the second century it simplified its practice, educated many +intelligent practitioners, and began the work of organizing for +concerted action, and for medical teaching. + +In this, our own century, it has built hospitals, perfected and +multiplied its associations and educational institutions, enlarged +and created museums, and challenged a place in the world of science +by its literature. + +In reviewing the whole course of its history we read a long list of +honored names, and a precious record written in private memories, in +public charities, in permanent contributions to medical science, in +generous sacrifices for the country. We can point to our capital as +the port of entry for the New World of the great medical discoveries +of two successive centuries, and we can claim for it the triumph over +the most dreaded foe that assails the human body,--a triumph which +the annals of the race can hardly match in three thousand years of +medical history. + + + + + + +THE YOUNG PRACTITIONER + +[A Valedictory Address delivered to the Graduating Class of the +Bellevue Hospital College, March 2, 1871.] + + +The occasion which calls us together reminds us not a little of that +other ceremony which unites a man and woman for life. The banns have +already been pronounced which have wedded our young friends to the +profession of their choice. It remains only to address to them some +friendly words of cheering counsel, and to bestow upon them the +parting benediction. + +This is not the time for rhetorical display or ambitious eloquence. +We must forget ourselves, and think only of them. To us it is an +occasion; to them it is an epoch. The spectators at the wedding look +curiously at the bride and bridegroom; at the bridal veil, the +orange-flower garland, the giving and receiving of the ring; they +listen for the tremulous "I will," and wonder what are the mysterious +syllables the clergyman whispers in the ear of the married maiden. +But to the newly-wedded pair what meaning in those words, "for +better, for worse," "in sickness and in health," "till death us do +part!" To the father, to the mother, who know too well how often the +deadly nightshade is interwoven with the wreath of orange-blossoms, +how empty the pageant, how momentous the reality! + +You will not wonder that I address myself chiefly to those who are +just leaving academic life for the sterner struggle and the larger +tasks of matured and instructed manhood. The hour belongs to them; +if others find patience to listen, they will kindly remember that, +after all, they are but as the spectators at the wedding, and that +the priest is thinking less of them than of their friends who are +kneeling at the altar. + +I speak more directly to you, then, gentlemen of the graduating +class. The days of your education, as pupils of trained instructors, +are over. Your first harvest is all garnered. Henceforth you are to +be sowers as well as reapers, and your field is the world. How does +your knowledge stand to-day? What have you gained as a permanent +possession? What must you expect to forget? What remains for you +yet to learn? These are questions which it may interest you to +consider. + +There is another question which must force itself on the thoughts of +many among you: "How am I to obtain patients and to keep their +confidence? "You have chosen a laborious calling, and made many +sacrifices to fit yourselves for its successful pursuit. You wish to +be employed that you may be useful, and that you may receive the +reward of your industry. I would take advantage of these most +receptive moments to give you some hints which may help you to +realize your hopes and expectations. Such is the outline of the +familiar talk I shall offer you. + +Your acquaintance with some of the accessory branches is probably +greater now than it will be in a year from now,--much greater than it +will by ten years from now. The progress of knowledge, it may be +feared, or hoped, will have outrun the text-books in which you +studied these branches. Chemistry, for instance, is very apt to +spoil on one's hands. "Nous avons change tout cela" might serve as +the standing motto of many of our manuals. Science is a great +traveller, and wears her shoes out pretty fast, as might be expected. + +You are now fresh from the lecture-room and the laboratory. You can +pass an examination in anatomy, physiology, chemistry, materia +medica, which the men in large practice all around you would find a +more potent sudorific than any in the Pharmacopceia. These masters +of the art of healing were once as ready with their answers as you +are now, but they have got rid of a great deal of the less +immediately practical part of their acquisitions, and you must +undergo the same depleting process. Hard work will train it off, as +sharp exercise trains off the fat of a prize-fighter. + +Yet, pause a moment before you infer that your teachers must have +been in fault when they furnished you with mental stores not directly +convertible to practical purposes, and likely in a few years to lose +their place in your memory. All systematic knowledge involves much +that is not practical, yet it is the only kind of knowledge which +satisfies the mind, and systematic study proves, in the long-run, the +easiest way of acquiring and retaining facts which are practical. +There are many things which we can afford to forget, which yet it was +well to learn. Your mental condition is not the same as if you had +never known what you now try in vain to recall. There is a perpetual +metempsychosis of thought, and the knowledge of to-day finds a soil +in the forgotten facts of yesterday. You cannot see anything in the +new season of the guano you placed last year about the roots of your +climbing plants, but it is blushing and breathing fragrance in your +trellised roses; it has scaled your porch in the bee-haunted honey- +suckle; it has found its way where the ivy is green; it is gone where +the woodbine expands its luxuriant foliage. + +Your diploma seems very broad to-day with your list of +accomplishments, but it begins to shrink from this hour like the Peau +de Chagrin of Balzac's story. Do not worry about it, for all the +while there will be making out for you an ampler and fairer +parchment, signed by old Father Time himself as President of that +great University in which experience is the one perpetual and all- +sufficient professor. + +Your present plethora of acquirements will soon cure itself. +Knowledge that is not wanted dies out like the eyes of the fishes of +the Mammoth Cave. When you come to handle life and death as your +daily business, your memory will of itself bid good-by to such +inmates as the well-known foramina of the sphenoid bone and the +familiar oxides of methyl-ethylamyl-phenyl-ammonium. Be thankful +that you have once known them, and remember that even the learned +ignorance of a nomenclature is something to have mastered, and may +furnish pegs to hang facts upon which would otherwise have strewed +the floor of memory in loose disorder. + +But your education has, after all, been very largely practical. You +have studied medicine and surgery, not chiefly in books, but at the +bedside and in the operating amphitheatre. It is the special +advantage of large cities that they afford the opportunity of seeing +a great deal of disease in a short space of time, and of seeing many +cases of the same kind of disease brought together. Let us not be +unjust to the claims of the schools remote from the larger centres of +population. Who among us has taught better than Nathan Smith, better +than Elisha Bartlett? who teaches better than some of our living +contemporaries who divide their time between city and country +schools? I am afraid we do not always do justice to our country +brethren, whose merits are less conspicuously exhibited than those of +the great city physicians and surgeons, such especially as have +charge of large hospitals. There are modest practitioners living in +remote rural districts who are gifted by nature with such sagacity +and wisdom, trained so well in what is most essential to the practice +of their art, taught so thoroughly by varied experience, forced to +such manly self-reliance by their comparative isolation, that, from +converse with them alone, from riding with them on their long rounds +as they pass from village to village, from talking over cases with +them, putting up their prescriptions, watching their expedients, +listening to their cautions, marking the event of their predictions, +hearing them tell of their mistakes, and now and then glory a little +in the detection of another's blunder, a young man would find himself +better fitted for his real work than many who have followed long +courses of lectures and passed a showy examination. But the young +man is exceptionally fortunate who enjoys the intimacy of such a +teacher. And it must be confessed that the great hospitals, +infirmaries, and dispensaries of large cities, where men of well- +sifted reputations are in constant attendance, are the true centres +of medical education. No students, I believe, are more thoroughly +aware of this than those who have graduated at this institution. +Here, as in all our larger city schools, the greatest pains are taken +to teach things as well as names. You have entered into the +inheritance of a vast amount of transmitted skill and wisdom, which +you have taken, warm, as it were, with the life of your well-schooled +instructors. You have not learned all that art has to teach you, but +you are safer practitioners to-day than were many of those whose +names we hardly mention without a genuflection. I had rather be +cared for in a fever by the best-taught among you than by the +renowned Fernelius or the illustrious Boerhaave, could they come back +to us from that better world where there are no physicians needed, +and, if the old adage can be trusted, not many within call. I had +rather have one of you exercise his surgical skill upon me than find +myself in the hands of a resuscitated Fabricius Hildanus, or even of +a wise Ambroise Pare, revisiting earth in the light of the nineteenth +century. + +You will not accuse me of underrating your accomplishments. You know +what to do for a child in a fit, for an alderman in an apoplexy, for +a girl that has fainted, for a woman in hysterics, for a leg that is +broken, for an arm that is out of joint, for fevers of every color, +for the sailor's rheumatism, and the tailor's cachexy. In fact you +do really know so much at this very hour, that nothing but the +searching test of time can fully teach you the limitations of your +knowledge. + +Of some of these you will permit me to remind you. You will never +have outgrown the possibility of new acquisitions, for Nature is +endless in her variety. But even the knowledge which you may be said +to possess will be a different thing after long habit has made it a +part of your existence. The tactus eruditus extends to the mind as +well as to the finger-ends. Experience means the knowledge gained by +habitual trial, and an expert is one who has been in the habit of +trying. This is the kind of knowledge that made Ulysses wise in the +ways of men. Many cities had he seen, and known the minds of those +who dwelt in them. This knowledge it was that Chaucer's Shipman +brought home with him from the sea a + + "In many a tempest had his berd be shake." + +This is the knowledge we place most confidence in, in the practical +affairs of life. + +Our training has two stages. The first stage deals with our +intelligence, which takes the idea of what is to be done with the +most charming ease and readiness. Let it be a game of billiards, for +instance, which the marker is going to teach us. We have nothing to +do but to make this ball glance from that ball and hit that other +ball, and to knock that ball with this ball into a certain caecal +sacculus or diverticulum which our professional friend calls a +pocket. Nothing can be clearer; it is as easy as "playing upon this +pipe," for which Hamlet gives Guildenstern such lucid directions. +But this intelligent Me, who steps forward as the senior partner in +our dual personality, turns out to be a terrible bungler. He misses +those glancing hits which the hard-featured young professional person +calls "carroms," and insists on pocketing his own ball instead of the +other one. + +It is the unintelligent Me, stupid as an idiot, that has to try a +thing a thousand times before he can do it, and then never knows how +he does it, that at last does it well. We have to educate ourselves +through the pretentious claims of intellect, into the humble accuracy +of instinct, and we end at last by acquiring the dexterity, the +perfection, the certainty, which those masters of arts, the bee and +the spider, inherit from Nature. + +Book-knowledge, lecture-knowledge, examination-knowledge, are all in +the brain. But work-knowledge is not only in the brain, it is in the +senses, in the muscles, in the ganglia of the sympathetic nerves,-- +all over the man, as one may say, as instinct seems diffused through +every part of those lower animals that have no such distinct organ as +a brain. See a skilful surgeon handle a broken limb; see a wise old +physician smile away a case that looks to a novice as if the sexton +would soon be sent for; mark what a large experience has done for +those who were fitted to profit by it, and you will feel convinced +that, much as you know, something is still left for you to learn. + +May I venture to contrast youth and experience in medical practice, +something in the way the man painted the lion, that is, the lion +under? + +The young man knows the rules, but the old man knows-the exceptions. +The young man knows his patient, but the old man knows also his +patient's family, dead and alive, up and down for generations. He +can tell beforehand what diseases their unborn children will be +subject to, what they will die of if they live long enough, and +whether they had better live at all, or remain unrealized +possibilities, as belonging to a stock not worth being perpetuated. +The young man feels uneasy if he is not continually doing something +to stir up his patient's internal arrangements. The old man takes +things more quietly, and is much more willing to let well enough +alone: All these superiorities, if such they are,'you must wait for +time to bring you. In the meanwhile (if we will let the lion be +uppermost for a moment), the young man's senses are quicker than +those of his older rival. His education in all the accessory +branches is more recent, and therefore nearer the existing condition +of knowledge. He finds it easier than his seniors to accept the +improvements which every year is bringing forward. New ideas build +their nests in young men's brains. "Revolutions are not made by men +in spectacles," as I once heard it remarked, and the first whispers +of a new truth are not caught by those who begin to feel the need of +an ear-trumpet. Granting all these advantages to the young man, he +ought, nevertheless, to go on improving, on the whole, as a medical +practitioner, with every year, until he has ripened into a well- +mellowed maturity. But, to improve, he must be good for something at +the start. If you ship a poor cask of wine to India and back, if you +keep it a half a century, it only grows thinner and sharper. + +You are soon to enter into relations with the public, to expend your +skill and knowledge for its benefit, and find your support in the +rewards of your labor. What kind of a constituency is this which is +to look to you as its authorized champions in the struggle of life +against its numerous enemies? + +In the first place, the persons who seek the aid of the physician are +very honest and sincere in their wish to get rid of their complaints, +and, generally speaking, to live as long as they can. However +attractively the future is painted to them, they are attached to the +planet with which they are already acquainted. They are addicted to +the daily use of this empirical and unchemical mixture which we call +air; and would hold on to it as a tippler does to his alcoholic +drinks. There is nothing men will not do, there is nothing they have +not done, to recover their health and save their lives. They have +submitted to be half-drowned in water, and half-choked with gases, to +be buried up to their chins in earth, to be seared with hot irons +like galley-slaves, to be crimped with knives, like cod-fish, to have +needles thrust into their flesh, and bonfires kindled on their skin, +to swallow all sorts of abominations, and to pay for all this, as if +to be singed and scalded were a costly privilege, as if blisters were +a blessing, and leeches were a luxury. What more can be asked to +prove their honesty and sincerity? + +This same community is very intelligent with respect to a great many +subjects-commerce, mechanics, manufactures, politics. But with +regard to medicine it is hopelessly ignorant and never finds it out. +I do not know that it is any worse in this country than in Great +Britain, where Mr. Huxley speaks very freely of "the utter ignorance +of the simplest laws of their own animal life, which prevails among +even the most highly educated persons." And Cullen said before him +"Neither the acutest genius nor the soundest judgment will avail in +judging of a particular science, in regard to which they have not +been exercised. I have been obliged to please my patients sometimes +with reasons, and I have found that any will pass, even with able +divines and acute lawyers; the same will pass with the husbands as +with the wives." If the community could only be made aware of its +own utter ignorance, and incompetence to form opinions on medical +subjects, difficult enough to those who give their lives to the study +of them, the practitioner would have an easier task. But it will +form opinions of its own, it cannot help it, and we cannot blame it, +even though we know how slight and deceptive are their foundations. + +This is the way it happens: Every grown-up person has either been ill +himself or had a friend suffer from illness, from which he has +recovered. Every sick person has done something or other by +somebody's advice, or of his own accord, a little before getting +better. There is an irresistible tendency to associate the thing +done, and the improvement which followed it, as cause and effect. +This is the great source of fallacy in medical practice. But the +physician has some chance of correcting his hasty inference. He +thinks his prescription cured a single case of a particular +complaint; he tries it in twenty similar cases without effect, and +sets down the first as probably nothing more than a coincidence. The +unprofessional experimenter or observer has no large experience to +correct his hasty generalization. He wants to believe that the means +he employed effected his cure. He feels grateful to the person who +advised it, he loves to praise the pill or potion which helped him, +and he has a kind of monumental pride in himself as a living +testimony to its efficacy. So it is that you will find the community +in which you live, be it in town or country, full of brands plucked +from the burning, as they believe, by some agency which, with your +better training, you feel reasonably confident had nothing to do with +it. Their disease went out of itself, and the stream from the +medical fire-annihilator had never even touched it. + +You cannot and need not expect to disturb the public in the +possession of its medical superstitions. A man's ignorance is as +much his private property, and as precious in his own eyes, as his +family Bible. You have only to open your own Bible at the ninth +chapter of St. John's Gospel, and you will find that the logic of a +restored patient was very simple then, as it is now, and very hard to +deal with. My clerical friends will forgive me for poaching on their +sacred territory, in return for an occasional raid upon the medical +domain of which they have now and then been accused. + +A blind man was said to have been restored to sight by a young person +whom the learned doctors of the Jewish law considered a sinner, and, +as such, very unlikely to have been endowed with a divine gift of +healing. They visited the patient repeatedly, and evidently teased +him with their questions about the treatment, and their insinuations +about the young man, until he lost his temper. At last he turned +sharply upon them: "Whether he be a sinner or no, I know not: one +thing I know, that, whereas I was blind, now I see." + +This is the answer that always has been and always will be given by +most persons when they find themselves getting well after doing +anything, no matter what,--recommended by anybody, no matter whom. +Lord Bacon, Robert Boyle, Bishop Berkeley, all put their faith in +panaceas which we should laugh to scorn. They had seen people get +well after using them. Are we any wiser than those great men? Two +years ago, in a lecture before the Massachusetts Historical Society, +I mentioned this recipe of Sir Kenelm Digby for fever and ague: Pare +the patient's nails; put the parings in a little bag, and hang the +bag round the neck of a live eel, and place him in a tub of water. +The eel will die, and the patient will recover. + +Referring to this prescription in the course of the same lecture, I +said: "You smiled when I related Sir Kenehn Digby's prescription, +with the live eel in it; but if each of you were to empty his or her +pockets, would there not roll out, from more than one of them, a +horse-chestnut, carried about as a cure for rheumatism? Nobody saw +fit to empty his or her pockets, and my question brought no response. +But two months ago I was in a company of educated persons, college +graduates every one of them, when a gentleman, well known in our +community, a man of superior ability and strong common-sense, on the +occasion of some talk arising about rheumatism, took a couple of very +shiny horse-chestnuts from his breeches-pocket, and laid them on the +table, telling us how, having suffered from the complaint in +question, he had, by the advice of a friend, procured these two +horse-chestnuts on a certain time a year or more ago, and carried +them about him ever since; from which very day he had been entirely +free from rheumatism. + +This argument, from what looks like cause and effect, whether it be +so or not, is what you will have to meet wherever you go, and you +need not think you can answer it. In the natural course of things +some thousands of persons must be getting well or better of slight +attacks of colds, of rheumatic pains, every week, in this city alone. +Hundreds of them do something or other in the way of remedy, by +medical or other advice, or of their own motion, and the last thing +they do gets the credit of the recovery. Think what a crop of +remedies this must furnish, if it were all harvested! + +Experience has taught, or will teach you, that most of the wonderful +stories patients and others tell of sudden and signal cures are like +Owen Glendower's story of the portents that announced his birth. The +earth shook at your nativity, did it? Very likely, and + + "So it would have done, + At the same season, if your mother's cat + Had kittened, though yourself had ne'er been born." + +You must listen more meekly than Hotspur did to the babbling +Welshman, for ignorance is a solemn and sacred fact, and, like +infancy, which it resembles, should be respected. Once in a while +you will have a patient of sense, born with the gift of observation, +from whom you may learn something. When you find yourself in the +presence of one who is fertile of medical opinions, and affluent in +stories of marvellous cures,--of a member of Congress whose name +figures in certificates to the value of patent medicines, of a +voluble dame who discourses on the miracles she has wrought or seen +wrought with the little jokers of the sugar-of-milk globule-box, take +out your watch and count the pulse; also note the time of day, and +charge the price of a visit for every extra fifteen, or, if you are +not very busy, every twenty minutes. In this way you will turn what +seems a serious dispensation into a double blessing, for this class +of patients loves dearly to talk, and it does them a deal of good, +and you feel as if you had earned your money by the dose you have +taken, quite as honestly as by any dose you may have ordered. + +You must take the community just as it is, and make the best of it. +You wish to obtain its confidence; there is a short rule for doing +this which you will find useful,--deserve it. But, to deserve it in +full measure, you must unite many excellences, natural and acquired. + +As the basis of all the rest, you must have all those traits of +character which fit you to enter into the most intimate and +confidential relations with the families of which you are the +privileged friend and counsellor. Medical Christianity, if I may use +such a term, is of very early date. By the oath of Hippocrates, the +practitioner of ancient times bound himself to enter his patient's +house with the sole purpose of doing him good, and so to conduct +himself as to avoid the very appearance of evil. Let the physician +of to-day begin by coming up to this standard, and add to it all the +more recently discovered virtues and graces. + +A certain amount of natural ability is requisite to make you a good +physician, but by no means that disproportionate development of some +special faculty which goes by the name of genius. A just balance of +the mental powers is a great deal more likely to be useful than any +single talent, even were it the power of observation; in excess. For +a mere observer is liable to be too fond of facts for their own sake, +so that, if he told the real truth, he would confess that he takes +more pleasure in a post-mortem examination which shows him what was +the matter with a patient, than in a case which insists on getting +well and leaving him in the dark as to its nature. Far more likely +to interfere with the sound practical balance of the mind is that +speculative, theoretical tendency which has made so many men noted in +their day, whose fame has passed away with their dissolving theories. +Read Dr. Bartlett's comparison of the famous Benjamin Rush with his +modest fellow-townsman Dr. William Currie, and see the dangers into +which a passion for grandiose generalizations betrayed a man of many +admirable qualities. + +I warn you against all ambitious aspirations outside of your +profession. Medicine is the most difficult of sciences and the most +laborious of arts. It will task all your powers of body and mind if +you are faithful to it. Do not dabble in the muddy sewer of +politics, nor linger by the enchanted streams of literature, nor dig +in far-off fields for the hidden waters of alien sciences. The great +practitioners are generally those who concentrate all their powers on +their business. If there are here and there brilliant exceptions, it +is only in virtue of extraordinary gifts, and industry to which very +few are equal. + +To get business a man mast really want it; and do you suppose that +when you are in the middle of a heated caucus, or half-way through a +delicate analysis, or in the spasm of an unfinished ode, your eyes +rolling in the fine frenzy of poetical composition, you want to be +called to a teething infant, or an ancient person groaning under the +griefs of a lumbago? I think I have known more than one young man +whose doctor's sign proclaimed his readiness to serve mankind in that +capacity, but who hated the sound of a patient's knock, and as he sat +with his book or his microscope, felt exactly as the old party +expressed himself in my friend Mr. Brownell's poem + + "All I axes is, let me alone:' + +The community soon finds out whether you are in earnest, and really +mean business, or whether you are one of those diplomaed dilettanti +who like the amusement of quasi medical studies, but have no idea of +wasting their precious time in putting their knowledge in practice +for the benefit of their suffering fellow-creatures. + +The public is a very incompetent judge of your skill and knowledge, +but it gives its confidence most readily to those who stand well with +their professional brethren, whom they call upon when they themselves +or their families are sick, whom they choose to honorable offices, +whose writings and teachings they hold in esteem. A man may be much +valued by the profession and yet have defects which prevent his +becoming a favorite practitioner, but no popularity can be depended +upon as permanent which is not sanctioned by the judgment of +professional experts, and with these you will always stand on your +substantial merits. + +What shall I say of the personal habits you must form if you wish for +success? Temperance is first upon the list. Intemperance in a +physician partakes of the guilt of homicide, for the muddled brain +may easily make a fatal blunder in a prescription and the unsteady +hand transfix an artery in an operation. Tippling doctors have been +too common in the history of medicine. Paracelsus was a sot, +Radcliffe was much too fond of his glass, and Dr. James Hurlbut of +Wethersfield, Connecticut, a famous man in his time, used to drink a +square bottle of rum a day, with a corresponding allowance of opium +to help steady his nerves. We commonly speak of a man as being the +worse for liquor, but I was asking an Irish laborer one day about his +doctor, who, as he said, was somewhat given to drink. "I like him +best when he's a little that way," he said; "then I can spake to +him." I pitied the poor patient who could not venture to allude to +his colic or his pleurisy until his physician was tipsy. + +There are personal habits of less gravity than the one I have +mentioned which it is well to guard against, or, if they are formed, +to relinquish. A man who may be called at a moment's warning into +the fragrant boudoir of suffering loveliness should not unsweeten its +atmosphere with reminiscences of extinguished meerschaums. He should +remember that the sick are sensitive and fastidious, that they love +the sweet odors and the pure tints of flowers, and if his presence is +not like the breath of the rose, if his hands are not like the leaf +of the lily, his visit may be unwelcome, and if he looks behind him +he may see a window thrown open after he has left the sick-chamber. +I remember too well the old doctor who sometimes came to help me +through those inward griefs to which childhood is liable. "Far off +his coming "--shall I say "shone," and finish the Miltonic phrase, or +leave the verb to the happy conjectures of my audience? Before him +came a soul-subduing whiff of ipecacuanha, and after him lingered a +shuddering consciousness of rhubarb. He had lived so much among his +medicaments that he had at last become himself a drug, and to have +him pass through a sick-chamber was a stronger dose than a +conscientious disciple of Hahnemann would think it safe to +administer. + +Need I remind yon of the importance of punctuality in your +engagements, and of the worry and distress to patients and their +friends which the want of it occasions? One of my old teachers +always carried two watches, to make quite sure of being exact, and +not only kept his appointments with the regularity of a chronometer, +but took great pains to be at his patient's house at the time when he +had reason to believe he was expected, even if no express appointment +was made. It is a good rule; if you call too early, my lady's hair +may not be so smooth as could be wished, and, if you keep her waiting +too long, her hair may be smooth, but her temper otherwise. + +You will remember, of course, always to get the weather-gage of your +patient. I mean, to place him so that the light falls on his face +and not on yours. It is a kind of, ocular duel that is about to take +place between you; you are going to look through his features into +his pulmonary and hepatic and other internal machinery, and he is +going to look into yours quite as sharply to see what you think about +his probabilities for time or eternity. + +No matter how hard he stares at your countenance, he should never be +able to read his fate in it. It should be cheerful as long as there +is hope, and serene in its gravity when nothing is left but +resignation. The face of a physician, like that of a diplomatist, +should be impenetrable. Nature is a benevolent old hypocrite; she +cheats the sick and the dying with illusions better than any +anodynes. If there are cogent reasons why a patient should be +undeceived, do it deliberately and advisedly, but do not betray your +apprehensions through your tell-tale features. + +We had a physician in our city whose smile was commonly reckoned as +being worth five thousand dollars a year to him, in the days, too, of +moderate incomes. You cannot put on such a smile as that any more +than you can get sunshine without sun; there was a tranquil and +kindly nature under it that irradiated the pleasant face it made one +happier to meet on his daily rounds. But you can cultivate the +disposition, and it will work its way through to the surface, nay, +more,--you can try to wear a quiet and encouraging look, and it will +react on your disposition and make you like what you seem to be, or +at least bring you nearer to its own likeness. + +Your patient has no more right to all the truth you know than he has +to all the medicine in your saddlebags, if you carry that kind of +cartridge-box for the ammunition that slays disease. He should get +only just so much as is good for him. I have seen a physician +examining a patient's chest stop all at once, as he brought out a +particular sound with a tap on the collarbone, in the attitude of a +pointer who has just come on the scent or sight of a woodcock. You +remember the Spartan boy, who, with unmoved countenance, hid the fox +that was tearing his vitals beneath his mantle. What he could do in +his own suffering you must learn to do for others on whose vital +organs disease has fastened its devouring teeth. It is a terrible +thing to take away hope, even earthly hope, from a fellow-creature. +Be very careful what names you let fall before your patient. He +knows what it means when you tell him he has tubercles or Bright's +disease, and, if he hears the word carcinoma, he will certainly look +it out in a medical dictionary, if he does not interpret its dread +significance on the instant. Tell him he has asthmatic symptoms, or +a tendency to the gouty diathesis, and he will at once think of all +the asthmatic and gouty old patriarchs he has ever heard of, and be +comforted. You need not be so cautious in speaking of the health of +rich and remote relatives, if he is in the line of succession. + +Some shrewd old doctors have a few phrases always on hand for +patients that will insist on knowing the pathology of their +complaints without the slightest capacity of understanding the +scientific explanation. I have known the term "spinal irritation " +serve well on such occasions, but I think nothing on the whole has +covered so much ground, and meant so little, and given such profound +satisfaction to all parties, as the magnificent phrase "congestion of +the portal system." + +Once more, let me recommend you, as far as possible, to keep your +doubts to yourself, and give the patient the benefit of your +decision. Firmness, gentle firmness, is absolutely necessary in this +and certain other relations. Mr. Rarey with Cruiser, Richard with +Lady Ann, Pinel with his crazy people, show what steady nerves can do +with the most intractable of animals, the most irresistible of +despots, and the most unmanageable of invalids. + +If you cannot acquire and keep the confidence of your patient, it is +time for you to give place to some other practitioner who can. If +you are wise and diligent, you can establish relations with the best +of them which they will find it very hard to break. But, if they +wish to employ another person, who, as they think, knows more than +you do, do not take it as a personal wrong. A patient believes +another man can save his life, can restore him to health, which, as +he thinks, you have not the skill to do. No matter whether the +patient is right or wrong, it is a great impertinence to think you +have any property in him. Your estimate of your own ability is not +the question, it is what the patient thinks of it. All your wisdom +is to him like the lady's virtue in Raleigh's song: + + "If she seem not chaste to me, + What care I how chaste she be?" + +What I call a good patient is one who, having found a good physician, +sticks to him till he dies. But there are many very good people who +are not what I call good patients. I was once requested to call on a +lady suffering from nervous and other symptoms. It came out in the +preliminary conversational skirmish, half medical, half social, that +I was the twenty-sixth member of the faculty into whose arms, +professionally speaking, she had successively thrown herself. Not +being a believer in such a rapid rotation of scientific crops, I +gently deposited the burden, commending it to the care of number +twenty-seven, and, him, whoever he might be, to the care of Heaven. + +If there happened to be among my audience any person who wished to +know on what principles the patient should choose his physician, I +should give him these few precepts to think over: + +Choose a man who is personally agreeable, for a daily visit from an +intelligent, amiable, pleasant, sympathetic person will cost you no +more than one from a sloven or a boor, and his presence will do more +for you than any prescription the other will order. + +Let him be a man of recognized good sense in other matters, and the +chance is that he will be sensible as a practitioner. + +Let him be a man who stands well with his professional brethren, whom +they approve as honest, able, courteous. + +Let him be one whose patients are willing to die in his hands, not +one whom they go to for trifles, and leave as soon as they are in +danger, and who can say, therefore, that he never loses a patient. + +Do not leave the ranks of what is called the regular profession, +unless you wish to go farther and fare worse, for you may be assured +that its members recognize no principle which hinders their accepting +any remedial agent proved to be useful, no matter from what quarter +it comes. The difficulty is that the stragglers, organized under +fantastic names in pretentious associations, or lurking in solitary +dens behind doors left ajar, make no real contributions to the art of +healing. When they bring forward a remedial agent like chloral, like +the bromide of potassium, like ether, used as an anesthetic, they +will find no difficulty in procuring its recognition. + +Some of you will probably be more or less troubled by the pretensions +of that parody of mediaeval theology which finds its dogma of +hereditary depravity in the doctrine of psora, its miracle of +transubstantiation in the mystery of its triturations and dilutions, +its church in the people who have mistaken their century, and its +priests in those who have mistaken their calling. You can do little +with persons who are disposed to accept these curious medical +superstitions. The saturation-point of individual minds with +reference to evidence, and especially medical evidence, differs, and +must always continue to differ, very widely. There are those whose +minds are satisfied with the decillionth dilution of a scientific +proof. No wonder they believe in the efficacy of a similar +attenuation of bryony or pulsatilla. You have no fulcrum you can +rest upon to lift an error out of such minds as these, often highly +endowed with knowledge and talent, sometimes with genius, but +commonly richer in the imaginative than the observing and reasoning +faculties. + +Let me return once more to the young graduate. Your relations to +your professional brethren may be a source of lifelong happiness and +growth in knowledge and character, or they may make you wretched and +end by leaving you isolated from those who should be your friends and +counsellors. The life of a physician becomes ignoble when he suffers +himself to feed on petty jealousies and sours his temper in perpetual +quarrels. You will be liable to meet an uncomfortable man here and +there in the profession,--one who is so fond of being in hot water +that it is a wonder all the albumen in his body is not coagulated. +There are common barrators among doctors as there are among lawyers, +--stirrers up of strife under one pretext and another, but in reality +because they like it. They are their own worst enemies, and do +themselves a mischief each time they assail their neighbors. In my +student days I remember a good deal of this Donnybrook-Fair style of +quarrelling, more especially in Paris, where some of the noted +surgeons were always at loggerheads, and in one of our lively Western +cities. Soon after I had set up an office, I had a trifling +experience which may serve to point a moral in this direction. I had +placed a lamp behind the glass in the entry to indicate to the +passer-by where relief from all curable infirmities was to be sought +and found. Its brilliancy attracted the attention of a devious +youth, who dashed his fist through the glass and upset my modest +luminary. All he got by his vivacious assault was that he left +portions of integument from his knuckles upon the glass, had a lame +hand, was very easily identified, and had to pay the glazier's bill. +The moral is that, if the brilliancy of another's reputation excites +your belligerent instincts, it is not worth your while to strike at +it, without calculating which of you is likely to suffer most, if you +do. + +You may be assured that when an ill-conditioned neighbor is always +complaining of a bad taste in his mouth and an evil atmosphere about +him, there is something wrong about his own secretions. In such +cases there is an alterative regimen of remarkable efficacy: it is a +starvation-diet of letting alone. The great majority of the +profession are peacefully inclined. Their pursuits are eminently +humanizing, and they look with disgust on the personalities which +intrude themselves into the placid domain of an art whose province it +is to heal and not to wound. + +The intercourse of teacher and student in a large school is +necessarily limited, but it should be, and, so far as my experience +goes, it is, eminently cordial and kindly. You will leave with +regret, and hold in tender remembrance, those who have taken you by +the hand at your entrance on your chosen path, and led you patiently +and faithfully, until the great gates at its end have swung upon +their hinges, and the world lies open before you. That venerable +oath to which I have before referred bound the student to regard his +instructor in the light of a parent, to treat his children like +brothers, to succor him in his day of need. I trust the spirit of +the oath of Hippocrates is not dead in the hearts of the students of +to-day. They will remember with gratitude every earnest effort, +every encouraging word, which has helped them in their difficult and +laborious career of study. The names they read on their diplomas +will recall faces that are like family-portraits in their memory, and +the echo of voices they have listened to so long will linger in their +memories far into the still evening of their lives. + +One voice will be heard no more which has been familiar to many among +you. It is not for me, a stranger to these scenes, to speak his +eulogy. I have no right to sadden this hour by dwelling on the deep +regrets of friendship, or to bid the bitter tears of sorrow flow +afresh. Yet I cannot help remembering what a void the death of such +a practitioner as your late instructor must leave in the wide circle +of those who leaned upon his counsel and assistance in their hour of +need, in a community where he was so widely known and esteemed, in a +school where he bore so important a part. There is no exemption from +the common doom for him who holds the shield to protect others. The +student is called from his bench, the professor from his chair, the +practitioner in his busiest period hears a knock more peremptory than +any patient's midnight summons, and goes on that unreturning visit +which admits of no excuse, and suffers no delay. The call of such a +man away from us is the bereavement of a great family. Nor can we +help regretting the loss for him of a bright and cheerful earthly +future; for the old age of a physician is one of the happiest periods +of his life. He is loved and cherished for what he has been, and +even in the decline of his faculties there are occasions when his +experience is still appealed to, and his trembling hands are looked +to with renewing hope and trust, as being yet able to stay the arm of +the destroyer. + +But if there is so much left for age, how beautiful, how inspiring is +the hope of youth! I see among those whom I count as listeners one +by whose side I have sat as a fellow-teacher, and by whose +instructions I have felt myself not too old to profit. As we +borrowed him from your city, I must take this opportunity of telling +you that his zeal, intelligence, and admirable faculty as an +instructor were heartily and universally recognized among us. We +return him, as we trust, uninjured, to the fellow-citizens who have +the privilege of claiming him as their own. + +And now, gentlemen of the graduating class, nothing remains but for +me to bid you, in the name of those for whom I am commissioned and +privileged to speak, farewell as students, and welcome as +practitioners. I pronounce the two benedictions in the same breath, +as the late king's demise and the new king's accession are proclaimed +by the same voice at the same moment. You would hardly excuse me if +I stooped to any meaner dialect than the classical and familiar +language of your prescriptions, the same in which your title to the +name of physician is, if, like our own institution, you follow the +ancient usage, engraved upon your diplomas. + +Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete, +filii! + +Salvete, VIRI, artis medicae magister; Salvete amici; salvete +fratres! + + + + + + +MEDICAL LIBRARIES. + +[Dedicatory Address at the opening of the Medical Library in Boston, +December 3, 1878.] + +It is my appointed task, my honorable privilege, this evening, to +speak of what has been done by others. No one can bring his tribute +of words into the presence of great deeds, or try with them to +embellish the memory of any inspiring achievement, without feeling +and leaving with others a sense of their insufficiency. So felt +Alexander when he compared even his adored Homer with the hero the +poet had sung. So felt Webster when he contrasted the phrases of +rhetoric with the eloquence of patriotism and of self-devotion. So +felt Lincoln when on the field of Gettysburg he spoke those immortal +words which Pericles could not nave bettered, which Aristotle could +not have criticised. So felt he who wrote the epitaph of the builder +of the dome which looks down on the crosses and weathercocks that +glitter over London. + +We are not met upon a battle-field, except so far as every laborious +achievement means a victory over opposition, indifference, +selfishness, faintheartedness, and that great property of mind as +well as matter,--inertia. We are not met in a cathedral, except so +far as every building whose walls are lined with the products of +useful and ennobling thought is a temple of the Almighty, whose +inspiration has given us understanding. But we have gathered within +walls which bear testimony to the self-sacrificing, persevering +efforts of a few young men, to whom we owe the origin and development +of all that excites our admiration in this completed enterprise; and +I might consider my task as finished if I contented myself with +borrowing the last word of the architect's epitaph and only saying, +Look around you! + +The reports of the librarian have told or will tell you, in some +detail, what has been accomplished since the 21st of December, 1874, +when six gentlemen met at the house of Dr. Henry Ingersoll Bowditch +to discuss different projects for a medical library. In less than +four years from that time, by the liberality of associations and of +individuals, this collection of nearly ten thousand volumes, of five +thousand pamphlets, and of one hundred and twenty-five journals, +regularly received,--all worthily sheltered beneath this lofty roof, +--has come into being under our eyes. It has sprung up, as it were; +in the night like a mushroom; it stands before us in full daylight as +lusty as an oak, and promising to grow and flourish in the perennial +freshness of an evergreen. + +To whom does our profession owe this already large collection of +books, exceeded in numbers only by four or five of the most extensive +medical libraries in the country, and lodged in a building so well +adapted to its present needs? We will not point out individually all +those younger members of the profession who have accomplished what +their fathers and elder brethren had attempted and partially +achieved. We need not write their names on these walls, after the +fashion of those civic dignitaries who immortalize themselves on +tablets of marble and gates of iron. But their contemporaries know +them well, and their descendants will not forget them,--the men who +first met together, the men who have given their time and their +money, the faithful workers, worthy associates of the strenuous +agitator who gave no sleep to his eyes, no slumber to his eyelids, +until he had gained his ends; the untiring, imperturbable, tenacious, +irrepressible, all-subduing agitator who neither rested nor let +others rest until the success of the project was assured. If, +against his injunctions, I name Dr. James Read Chadwick, it is only +my revenge for his having kept me awake so often and so long while he +was urging on the undertaking in which he has been preeminently +active and triumphantly successful. + +We must not forget the various medical libraries which preceded this: +that of an earlier period, when Boston contained about seventy +regular practitioners, the collection afterwards transferred to the +Boston Athenaeum; the two collections belonging to the University; +the Treadwell Library at the Massachusetts General Hospital; the +collections of the two societies, that for Medical Improvement and +that for Medical Observation; and more especially the ten thousand +volumes relating to medicine belonging to our noble public city +library,--too many blossoms on the tree of knowledge, perhaps, for +the best fruit to ripen. But the Massachusetts Medical Society now +numbers nearly four hundred members in the city of Boston. The time +had arrived for a new and larger movement. There was needed a place +to which every respectable member of the medical profession could +obtain easy access; where, under one roof, all might find the special +information they were seeking; where the latest medical intelligence +should be spread out daily as the shipping news is posted on the +bulletins of the exchange; where men engaged in a common pursuit +could meet, surrounded by the mute oracles of science and art; where +the whole atmosphere should be as full of professional knowledge as +the apothecary's shop is of the odor of his medicaments. This was +what the old men longed for,--the prophets and kings of the +profession, who + + "Desired it long, + But died without the sight." + +This is what the young men and those who worked under their guidance +undertook to give us. And now such a library, such a reading-room, +such an exchange, such an intellectual and social meeting place, we +be hold a fact, plain before us. The medical profession of our city, +and, let us add, of all those neighboring places which it can reach +with its iron arms, is united as never before by the commune +vinculum, the common bond of a large, enduring, ennobling, unselfish +interest. It breathes a new air of awakened intelligence. It +marches abreast of the other learned professions, which have long had +their extensive and valuable centralized libraries; abreast of them, +but not promising to be content with that position. What glorifies a +town like a cathedral? What dignifies a province like a university? +What illuminates a country like its scholarship, and what is the nest +that hatches scholars but a library? + +The physician, some may say, is a practical man and has little use +for all this book-learning. Every student has heard Sydenham's reply +to Sir Richard Blackmore's question as to what books he should read, +--meaning medical books. "Read Don Quixote," was his famous answer. +But Sydenham himself made medical books and may be presumed to have +thought those at least worth reading. Descartes was asked where was +his library, and in reply held up the dissected body of an animal. +But Descartes made books, great books, and a great many of them. A +physician of common sense without erudition is better than a learned +one without common sense, but the thorough master of his profession +must have learning added to his natural gifts. + +It is not necessary to maintain the direct practical utility of all +kinds of learning. Our shelves contain many books which only a +certain class of medical scholars will be likely to consult. There +is a dead medical literature, and there is a live one. The dead is +not all ancient, the live is not all modern. There is none, modern +or ancient, which, if it has no living value for the student, will +not teach him something by its autopsy. But it is with the live +literature of his profession that the medical practitioner is first +of all concerned. + +Now there has come a great change in our time over the form in which +living thought presents itself. The first printed books,--the +incunabula,--were inclosed in boards of solid oak, with brazen clasps +and corners; the boards by and by were replaced by pasteboard covered +with calf or sheepskin; then cloth came in and took the place of +leather; then the pasteboard was covered with paper instead of cloth; +and at this day the quarterly, the monthly, the weekly periodical in +its flimsy unsupported dress of paper, and the daily journal, naked +as it came from the womb of the press, hold the larger part of the +fresh reading we live upon. We must have the latest thought in its +latest expression; the page must be newly turned like the morning +bannock; the pamphlet must be newly opened like the ante-prandial +oyster. + +Thus a library, to meet the need of our time, must take, and must +spread out in a convenient form, a great array of periodicals. Our +active practitioners read these by preference over almost everything +else. Our specialists, more particularly, depend on the month's +product, on the yearly crop of new facts, new suggestions, new +contrivances, as much as the farmer on the annual yield of his acres. +One of the first wants, then, of the profession is supplied by our +library in its great array of periodicals from many lands, in many +languages. Such a number of medical periodicals no private library +would have room for, no private person would pay for, or flood his +tables with if they were sent him for nothing. These, I think, with +the reports of medical societies and the papers contributed to them, +will form the most attractive part of our accumulated medical +treasures. They will be also one of our chief expenses, for these +journals must be bound in volumes and they require a great amount of +shelf-room; all this, in addition to the cost of subscription for +those which are not furnished us gratuitously. + +It is true that the value of old scientific periodicals is, other +things being equal, in the inverse ratio of their age, for the +obvious reason that what is most valuable in the earlier volumes of a +series is drained off into the standard works with which the +intelligent practitioner is supposed to be familiar. But no extended +record of facts grows too old to be useful, provided only that we +have a ready and sure way of getting at the particular fact or facts +we are in search of. + +And this leads me to speak of what I conceive to be one of the +principal tasks to be performed by the present and the coming +generation of scholars, not only in the medical, but in every +department of knowledge. I mean the formation of indexes, and more +especially of indexes to periodical literature. + +This idea has long been working in the minds of scholars, and all who +have had occasion to follow out any special subject. I have a right +to speak of it, for I long ago attempted to supply the want of +indexes in some small measure for my own need. I had a very complete +set of the "American Journal of the Medical Sciences;" an entire set +of the "North American Review," and many volumes of the reprints of +the three leading British quarterlies. Of what use were they to me +without general indexes? I looked them all through carefully and +made classified lists of all the articles I thought I should most +care to read. But they soon outgrew my lists. The "North American +Review " kept filling up shelf after shelf, rich in articles which I +often wanted to consult, but what a labor to find them, until the +index of Mr. Gushing, published a few months since, made the contents +of these hundred and twenty volumes as easily accessible as the words +in a dictionary! I had a, copy of good Dr. Abraham Rees's +Cyclopaedia, a treasure-house to my boyhood which has not lost its +value for me in later years. But where to look for what I wanted? I +wished to know, for instance, what Dr. Burney had to say about +singing. Who would have looked for it under the Italian word +cantare? I was curious to learn something of the etchings of +Rembrandt, and where should I find it but under the head "Low +Countries, Engravers of the,"--an elaborate and most valuable article +of a hundred double-columned close-printed quarto pages, to which no +reference, even, is made under the title Rembrandt. + +There was nothing to be done, if I wanted to know where that which I +specially cared for was to be found in my Rees's Cyclopaedia, but to +look over every page of its forty-one quarto volumes and make out a +brief list of matters of interest which I could not find by their +titles, and this I did, at no small expense of time and trouble. + +Nothing, therefore, could be more pleasing to me than to see the +attention which has been given of late years to the great work of +indexing. It is a quarter of a century since Mr. Poole published his +"Index to Periodical Literature," which it is much to be hoped is +soon to appear in a new edition, grown as it must be to formidable +dimensions by the additions of so long a period. The "British and +Foreign Medical Review," edited by the late Sir John Forties, +contributed to by Huxley, Carpenter, Laycock, and others of the most +distinguished scientific men of Great Britain, has an index to its +twenty-four volumes, and by its aid I find this valuable series as +manageable as a lexicon. The last edition of the "Encyclopaedia +Britannica" had a complete index in a separate volume, and the +publishers of Appletons' "American Cyclopaedia" have recently issued +an index to their useful work, which must greatly add to its value. +I have already referred to the index to the "North American Review," +which to an American, and especially to a New Englander, is the most +interesting and most valuable addition of its kind to our literary +apparatus since the publication of Mr. Allibone's "Dictionary of +Authors." I might almost dare to parody Mr. Webster's words in +speaking of Hamilton, to describe what Mr. Gushing did for the solemn +rows of back volumes of our honored old Review which had been long +fossilizing on our shelves: "He touched the dead corpse of the 'North +American,'" and it sprang to its feet." A library of the best +thought of the best American scholars during the greater portion of +the century was brought to light by the work of the indexmaker as +truly as were the Assyrian tablets by the labors of Layard. + +A great portion of the best writing and reading literary, scientific, +professional, miscellaneous--comes to us now, at stated intervals, in +paper covers. The writer appears, as it were, in his shirt-sleeves. +As soon as he has delivered his message the book-binder puts a coat +on his back, and he joins the forlorn brotherhood of "back volumes," +than which, so long as they are unindexed, nothing can be more +exasperating. Who wants a lock without a key, a ship without a +rudder, a binnacle without a compass, a check without a signature, a +greenback without a goldback behind it? + +I have referred chiefly to the medical journals, but I would include +with these the reports of medical associations, and those separate +publications which, coming in the form of pamphlets, heap themselves +into chaotic piles and bundles which are worse than useless, taking +up a great deal of room, and frightening everything away but mice and +mousing antiquarians, or possibly at long intervals some terebrating +specialist. + +Arranged, bound, indexed, all these at once become accessible and +valuable. I will take the first instance which happens to suggest +itself. How many who know all about osteoblasts and the experiments +of Ollier, and all that has grown out of them, know where to go for a +paper by the late Dr. A. L. Peirson of Salem, published in the year +1840, under the modest title, Remarks on Fractures? And if any +practitioner who has to deal with broken bones does not know that +most excellent and practical essay, it is a great pity, for it +answers very numerous questions which will be sure to suggest +themselves to the surgeon and the patient as no one of the recent +treatises, on my own shelves, at least, can do. + +But if indexing is the special need of our time in medical +literature, as in every department of knowledge, it must be +remembered that it is not only an immense labor, but one that never +ends. It requires, therefore, the cooperation of a large number of +individuals to do the work, and a large amount of money to pay for +making its results public through the press. When it is remembered +that the catalogue of the library of the British Museum is contained +in nearly three thousand large folios of manuscript, and not all its +books are yet included, the task of indexing any considerable branch +of science or literature looks as if it were well nigh impossible. +But many hands make light work. An "Index Society" has been formed +in England, already numbering about one hundred and seventy members. +It aims at "supplying thorough indexes to valuable works and +collections which have hitherto lacked them; at issuing indexes to +the literature of special subjects; and at gathering materials for a +general reference index." This society has published a little +treatise setting forth the history and the art of indexing, which I +trust is in the hands of some of our members, if not upon our +shelves. + +Something has been done in the same direction by individuals in our +own country, as we have already seen. The need of it in the +department of medicine is beginning to be clearly felt. Our library +has already an admirable catalogue with cross references, the work of +a number of its younger members cooperating in the task. A very +intelligent medical student, Mr. William D. Chapin, whose excellent +project is indorsed by well-known New York physicians and professors, +proposes to publish a yearly index to original communications in the +medical journals of the United States, classified by authors and +subjects. But it is from the National Medical Library at Washington +that we have the best promise and the largest expectations. That +great and growing collection of fifty thousand volumes is under the +eye and hand of a librarian who knows books and how to manage them. +For libraries are the standing armies of civilization, and an army is +but a mob without a general who can organize and marshal it so as to +make it effective. The "Specimen Fasciculus of a Catalogue of the +National Medical Library," prepared under the direction of Dr. +Billings, the librarian, would have excited the admiration of Haller, +the master scholar in medical science of the last century, or rather +of the profession in all centuries, and if carried out as it is begun +will be to the nineteenth all and more than all that the three +Bibliothecae--Anatomica, Chirurgica, and Medicinae-Practicae--were to +the eighteenth century. I cannot forget the story that Agassiz was +so fond of telling of the king of Prussia and Fichte. It was after +the humiliation and spoliation of the kingdom by Napoleon that the +monarch asked the philosopher what could be done to regain the lost +position of the nation. "Found a great university, Sire," was the +answer, and so it was that in the year 1810 the world-renowned +University of Berlin came into being. I believe that we in this +country can do better than found a national university, whose +professors shall be nominated in caucuses, go in and out, perhaps, +like postmasters, with every change of administration, and deal with +science in the face of their constituency as the courtier did with +time when his sovereign asked him what o'clock it was: "Whatever hour +your majesty pleases." But when we have a noble library like that at +Washington, and a librarian of exceptional qualifications like the +gentleman who now holds that office, I believe that a liberal +appropriation by Congress to carry out a conscientious work for the +advancement of sound knowledge and the bettering of human conditions, +like this which Dr. Billings has so well begun, would redound greatly +to the honor of the nation. It ought to be willing to be at some +charge to make its treasures useful to its citizens, and, for its own +sake, especially to that class which has charge of health, public and +private. This country abounds in what are called "self-made men," +and is justly proud of many whom it thus designates. In one sense no +man is self-made who breathes the air of a civilized community. In +another sense every man who is anything other than a phonograph on +legs is self-made. But if we award his just praise to the man who +has attained any kind of excellence without having had the same +advantages as others whom, nevertheless, he has equalled or +surpassed, let us not be betrayed into undervaluing the mechanic's +careful training to his business, the thorough and laborious +education of the scholar and the professional man. + +Our American atmosphere is vocal with the flippant loquacity of half +knowledge. We must accept whatever good can be got out of it, and +keep it under as we do sorrel and mullein and witchgrass, by +enriching the soil, and sowing good seed in plenty; by good teaching +and good books, rather than by wasting our time in talking against +it. Half knowledge dreads nothing but whole knowledge. + +I have spoken of the importance and the predominance of periodical +literature, and have attempted to do justice to its value. But the +almost exclusive reading of it is not without its dangers. The +journals contain much that is crude and unsound; the presumption; it +might be maintained, is against their novelties, unless they come +from observers of established credit. Yet I have known a +practitioner,--perhaps more than one,--who was as much under the +dominant influence of the last article he had read in his favorite +medical journal as a milliner under the sway of the last fashion- +plate. The difference between green and seasoned knowledge is very +great, and such practitioners never hold long enough to any of their +knowledge to have it get seasoned. + +It is needless to say, then, that all the substantial and permanent +literature of the profession should be represented upon our shelves. +Much of it is there already, and as one private library after another +falls into this by the natural law of gravitation, it will gradually +acquire all that is most valuable almost without effort. A scholar +should not be in a hurry to part with his books. They are probably +more valuable to him than they can be to any other individual. What +Swedenborg called "correspondence" has established itself between his +intelligence and the volumes which wall him within their sacred +inclosure. Napoleon said that his mind was as if furnished with +drawers,--he drew out each as he wanted its contents, and closed it +at will when done with them. The scholar's mind, to use a similar +comparison, is furnished with shelves, like his library. Each book +knows its place in the brain as well as against the wall or in the +alcove. His consciousness is doubled by the books which encircle +him, as the trees that surround a lake repeat themselves in its +unruffled waters. Men talk of the nerve that runs to the pocket, but +one who loves his books, and has lived long with them, has a nervous +filament which runs from his sensorium to every one of them. Or, if +I may still let my fancy draw its pictures, a scholar's library is to +him what a temple is to the worshipper who frequents it. There is +the altar sacred to his holiest experiences. There is the font where +his new-born thought was baptized and first had a name in his +consciousness. There is the monumental tablet of a dead belief, +sacred still in the memory of what it was while yet alive. No +visitor can read all this on the lettered backs of the books that +have gathered around the scholar, but for him, from the Aldus on the +lowest shelf to the Elzevir on the highest, every volume has a +language which none but be can interpret. Be patient with the book- +collector who loves his companions too well to let them go. Books +are not buried with their owners, and the veriest book-miser that +ever lived was probably doing far more for his successors than his +more liberal neighbor who despised his learned or unlearned avarice. +Let the fruit fall with the leaves still clinging round it. Who +would have stripped Southey's walls of the books that filled them, +when, his mind no longer capable of taking in their meaning, he would +still pat and fondle them with the vague loving sense of what they +had once been to him,--to him, the great scholar, now like a little +child among his playthings? + +We need in this country not only the scholar, but the virtuoso, who +hoards the treasures which he loves, it may be chiefly for their +rarity and because others who know more than he does of their value +set a high price upon them. As the wine of old vintages is gently +decanted out of its cobwebbed bottles with their rotten corks into +clean new receptacles, so the wealth of the New World is quietly +emptying many of the libraries and galleries of the Old World into +its newly formed collections and newly raised edifices. And this +process must go on in an accelerating ratio. No Englishman will be +offended if I say that before the New Zealander takes his stand on a +broken arch of London Bridge to sketch the ruins of St. Paul's in the +midst of a vast solitude, the treasures of the British Museum will +have found a new shelter in the halls of New York or Boston. No +Catholic will think hardly of my saying that before the Coliseum +falls, and with it the imperial city, whose doom prophecy has linked +with that of the almost eternal amphitheatre, the marbles, the +bronzes, the paintings, the manuscripts of the Vatican will have left +the shores of the Tiber for those of the Potomac, the Hudson, the +Mississippi, or the Sacramento. And what a delight in the pursuit of +the rarities which the eager book-hunter follows with the scent of a +beagle! + +Shall I ever forget that rainy day in Lyons, that dingy bookshop, +where I found the Aetius, long missing from my Artis bledicae +Principes, and where I bought for a small pecuniary consideration, +though it was marked rare, and was really tres rare, the Aphorisms of +Hippocrates, edited by and with a preface from the hand of Francis +Rabelais? And the vellum-bound Tulpius, which I came upon in Venice, +afterwards my only reading when imprisoned in quarantine at +Marseilles, so that the two hundred and twenty-eight cases he has +recorded are, many of them, to this day still fresh in my memory. +And the Schenckius,--the folio filled with casus rariores, which had +strayed in among the rubbish of the bookstall on the boulevard,--and +the noble old Vesalius with its grand frontispiece not unworthy of +Titian, and the fine old Ambroise Pare, long waited for even in Paris +and long ago, and the colossal Spigelius with his eviscerated +beauties, and Dutch Bidloo with its miracles of fine engraving and +bad dissection, and Italian Mascagni, the despair of all would-be +imitators, and pre-Adamite John de Ketam, and antediluvian +Berengarius Carpensis,--but why multiply names, every one of which +brings back the accession of a book which was an event almost like +the birth of an infant? + +A library like ours must exercise the largest hospitality. A great +many books may be found in every large collection which remind us of +those apostolic looking old men who figure on the platform at our +political and other assemblages. Some of them have spoken words of +wisdom in their day, but they have ceased to be oracles; some of them +never had any particularly important message for humanity, but they +add dignity to the meeting by their presence; they look wise, whether +they are so or not, and no one grudges them their places of honor. +Venerable figure-heads, what would our platforms be without you? + +Just so with our libraries. Without their rows of folios in creamy +vellum, or showing their black backs with antique lettering of +tarnished gold, our shelves would look as insufficient and unbalanced +as a column without its base, as a statue without its pedestal. And +do not think they are kept only to be spanked and dusted during that +dreadful period when their owner is but too thankful to become an +exile and a wanderer from the scene of single combats between dead +authors and living housemaids. Men were not all cowards before +Agamemnon or all fools before the days of Virchow and Billroth. And +apart from any practical use to be derived from the older medical +authors, is there not a true pleasure in reading the accounts of +great discoverers in their own words? I do not pretend to hoist up +the Bibliotheca Anatomica of Mangetus and spread it on my table every +day. I do not get out my great Albinus before every lecture on the +muscles, nor disturb the majestic repose of Vesalius every time I +speak of the bones he has so admirably described and figured. But it +does please me to read the first descriptions of parts to which the +names of their discoverers or those who have first described them +have become so joined that not even modern science can part them; to +listen to the talk of my old volume as Willis describes his circle +and Fallopius his aqueduct and Varolius his bridge and Eustachius his +tube and Monro his foramen,--all so well known to us in the human +body; it does please me to know the very words in which Winslow +described the opening which bears his name, and Glisson his capsule +and De Graaf his vesicle; I am not content until I know in what +language Harvey announced his discovery of the circulation, and how +Spigelius made the liver his perpetual memorial, and Malpighi found a +monument more enduring than brass in the corpuscles of the spleen and +the kidney. + +But after all, the readers who care most for the early records of +medical science and art are the specialists who are dividing up the +practice of medicine and surgery as they were parcelled out, +according to Herodotus, by the Egyptians. For them nothing is too +old, nothing is too new, for to their books of ail others is +applicable the saying of D'Alembert that the author kills himself in +lengthening out what the reader kills himself in trying to shorten. + +There are practical books among these ancient volumes which can never +grow old. Would you know how to recognize "male hysteria" and to +treat it, take down your Sydenham; would you read the experience of a +physician who was himself the subject of asthma, and who, +notwithstanding that, in the words of Dr. Johnson, "panted on till +ninety," you will find it in the venerable treatise of Sir John +Floyer; would you listen to the story of the King's Evil cured by the +royal touch, as told by a famous chirurgeon who fully believed in it, +go to Wiseman; would you get at first hand the description of the +spinal disease which long bore his name, do not be startled if I tell +you to go to Pott,--to Percival Pott, the great surgeon of the last +century. + +There comes a time for every book in a library when it is wanted by +somebody. It is but a few weeks since one of the most celebrated +physicians in the country wrote to me from a great centre of medical +education to know if I had the works of Sanctorius, which he had +tried in vain to find. I could have lent him the "Medicina Statica," +with its frontispiece showing Sanctorius with his dinner on the table +before him, in his balanced chair which sunk with him below the level +of his banquet-board when he had swallowed a certain number of +ounces,--an early foreshadowing of Pettenkofer's chamber and +quantitative physiology,--but the "Opera Omnia" of Sanctorius I had +never met with, and I fear he had to do without it. + +I would extend the hospitality of these shelves to a class of works +which we are in the habit of considering as being outside of the pale +of medical science, properly so called, and sometimes of coupling +with a disrespectful name. Such has always been my own practice. I +have welcomed Culpeper and Salmon to my bookcase as willingly as +Dioscorides or Quincy, or Paris or Wood and Bache. I have found a +place for St. John Long, and read the story of his trial for +manslaughter with as much interest as the laurel-water case in which +John Hunter figured as a witness. I would give Samuel Hahnemann a +place by the side of Samuel Thomson. Am I not afraid that some +student of imaginative turn and not provided with the needful +cerebral strainers without which all the refuse of gimcrack +intelligences gets into the mental drains and chokes them up,--am I +not afraid that some such student will get hold of the "Organon" or +the "Maladies Chroniques" and be won over by their delusions, and so +be lost to those that love him as a man of common sense and a brother +in their high calling? Not in the least. If he showed any symptoms +of infection I would for once have recourse to the principle of +similia similibus. To cure him of Hahnemann I would prescribe my +favorite homoeopathic antidote, Okie's Bonninghausen. If that +failed, I would order Grauvogl as a heroic remedy, and if he survived +that uncured, I would give him my blessing, if I thought him honest, +and bid him depart in peace. For me he is no longer an individual. +He belongs to a class of minds which we are bound to be patient with +if their Maker sees fit to indulge them with existence. We must +accept the conjuring ultra-ritualist, the dreamy second adventist, +the erratic spiritualist, the fantastic homoeopathist, as not +unworthy of philosophic study; not more unworthy of it than the +squarers of the circle and the inventors of perpetual motion, and the +other whimsical visionaries to whom De Morgan has devoted his most +instructive and entertaining "Budget of Paradoxes." I hope, +therefore, that our library will admit the works of the so-called +Eclectics, of the Thomsonians, if any are in existence, of the +Clairvoyants, if they have a literature, and especially of the +Homoeopathists. This country seems to be the place for such a +collection, which will by and by be curious and of more value than at +present, for Homoeopathy seems to be following the pathological law +of erysipelas, fading out where it originated as it spreads to new +regions. At least I judge so by the following translated extract +from a criticism of an American work in the "Homoeopatische +Rundschau" of Leipzig for October, 1878, which I find in the +"Homoeopathic Bulletin" for the month of November just passed: +"While we feel proud of the spread and rise of Homoeopathy across the +ocean, and while the Homoeopathic works reaching us from there, and +published in a style such as is unknown in Germany, bear eloquent +testimony to the eminent activity of our transatlantic colleagues, we +are overcome by sorrowful regrets at the position Homoeopathy +occupies in Germany. Such a work [as the American one referred to] +with us would be impossible; it would lack the necessary support." + +By all means let our library secure a good representation of the +literature of Homoeopathy before it leaves us its "sorrowful regrets" +and migrates with its sugar of milk pellets, which have taken the +place of the old pilulae micae panis, to Alaska, to "Nova Zembla, or +the Lord knows where." + +What shall I say in this presence of the duties of a Librarian? +Where have they ever been better performed than in our own public +city library, where the late Mr. Jewett and the living Mr. Winsor +have shown us what a librarian ought to be,--the organizing head, the +vigilant guardian, the seeker's index, the scholar's counsellor? His +work is not merely that of administration, manifold and laborious as +its duties are. He must have a quick intelligence and a retentive +memory. He is a public carrier of knowledge in its germs. His +office is like that which naturalists attribute to the bumble-bee,-- +he lays up little honey for himself, but he conveys the fertilizing +pollen from flower to flower. + +Our undertaking, just completed,--and just begun--has come at the +right time, not a day too soon. Our practitioners need a library +like this, for with all their skill and devotion there is too little +genuine erudition, such as a liberal profession ought to be able to +claim for many of its members. In reading the recent obituary +notices of the late Dr. Geddings of South Carolina, I recalled what +our lamented friend Dr. Coale used to tell me of his learning and +accomplishments, and I could not help reflecting how few such medical +scholars we had to show in Boston or New England. We must clear up +this unilluminated atmosphere, and here,--here is the true electric +light which will irradiate its darkness. + +The public will catch the rays reflected from the same source of +light, and it needs instruction on the great subjects of health and +disease,--needs it sadly. It is preyed upon by every kind of +imposition almost without hindrance. Its ignorance and prejudices +react upon the profession to the great injury of both. The jealous +feeling, for instance, with regard to such provisions for the study +of anatomy as are sanctioned by the laws in this State and carried +out with strict regard to those laws, threatens the welfare, if not +the existence of institutions for medical instruction wherever it is +not held in check by enlightened intelligence. And on the other hand +the profession has just been startled by a verdict against a +physician, ruinous in its amount,--enough to drive many a hard- +working young practitioner out of house and home,--a verdict which +leads to the fear that suits for malpractice may take the place of +the panel game and child-stealing as a means of extorting money. If +the profession in this State, which claims a high standard of +civilization, is to be crushed and ground beneath the upper millstone +of the dearth of educational advantages and the lower millstone of +ruinous penalties for what the ignorant ignorantly shall decide to be +ignorance, all I can say is + +God save the Commonhealth of Massachusetts! + +Once more, we cannot fail to see that just as astrology has given +place to astronomy, so theology, the science of Him whom by searching +no man can find out, is fast being replaced by what we may not +improperly call theonomy, or the science of the laws according to +which the Creator acts. And since these laws find their fullest +manifestations for us, at least, in rational human natures, the study +of anthropology is largely replacing that of scholastic divinity. We +must contemplate our Maker indirectly in human attributes as we talk +of Him in human parts of speech. And this gives a sacredness to the +study of man in his physical, mental, moral, social, and religious +nature which elevates the faithful students of anthropology to the +dignity of a priesthood, and sheds a holy light on the recorded +results of their labors, brought together as they are in such a +collection as this which is now spread out before us. + +Thus, then, our library is a temple as truly as the dome-crowned +cathedral hallowed by the breath of prayer and praise, where the dead +repose and the living worship. May it, with all its treasures, be +consecrated like that to the glory of God, through the contributions +it shall make to the advancement of sound knowledge, to the relief of +human suffering, to the promotion of harmonious relations between the +members of the two noble professions which deal with the diseases of +the soul and with those of the body, and to the common cause in which +all good men are working, the furtherance of the well-being of their +fellow-creatures! + +NOTE.--As an illustration of the statement in the last paragraph but +one, I take the following notice from the "Boston Daily Advertiser," +of December 4th, the day after the delivery of the address: +"Prince Lucien Bonaparte is now living in London, and is devoting +himself to the work of collecting the creeds of all religions and +sects, with a view to their classification,--his object being simply +scientific or anthropological." + +Since delivering the address, also, I find a leading article in the +"Cincinnati Lancet and Clinic" of November 30th, headed "The +Decadence of Homoeopathy," abundantly illustrated by extracts from +the "Homoeopathic Times," the leading American organ of that sect. + +In the New York "Medical Record" of the same date, which I had not +seen before the delivery of my address, is an account of the action +of the Homoeopathic Medical Society of Northern New York, in which +Hahnemann's theory of "dynamization" is characterized in a formal +resolve as "unworthy the confidence of the Homoeopathic profession." + +It will be a disappointment to the German Homoeopathists to read in +the "Homoeopathic Times" such a statement as the following: +"Whatever the influences have been which have checked the outward +development of Homoeopathy, it is plainly evident that the +Homoeopathic school, as regards the number of its openly avowed +representatives, has attained its majority, and has begun to decline +both in this country and in England." + +All which is an additional reason for making a collection of the +incredibly curious literature of Homoeopathy before that +pseudological inanity has faded out like so many other delusions. + + + + + + +SOME OF MY EARLY TEACHERS + +[A Farewell Address to the Medical School of Harvard University, +November 28, 1882.] + +I had intended that the recitation of Friday last should be followed +by a few parting words to my class and any friends who might happen +to be in the lecture-room. But I learned on the preceding evening +that there was an expectation, a desire, that my farewell should take +a somewhat different form; and not to disappoint the wishes of those +whom I was anxious to gratify, I made up my mind to appear before you +with such hasty preparation as the scanty time admitted. + +There are three occasions upon which a human being has a right to +consider himself as a centre of interest to those about him: when he +is christened, when he is married, and when he is buried. Every one +is the chief personage, the hero, of his own baptism, his own +wedding, and his own funeral. + +There are other occasions, less momentous, in which one may make more +of himself than under ordinary circumstances he would think it proper +to do; when he may talk about himself, and tell his own experiences, +in fact, indulge in a more or less egotistic monologue without fear +or reproach. + +I think I may claim that this is one of those occasions. I have +delivered my last anatomical lecture and heard my class recite for +the last time. They wish to hear from me again in a less scholastic +mood than that in which they have known me. Will you not indulge me +in telling you something of my own story? + +This is the thirty-sixth Course of Lectures in which I have taken my +place and performed my duties as Professor of Anatomy. For more than +half of my term of office I gave instruction in Physiology, after the +fashion of my predecessors and in the manner then generally prevalent +in our schools, where the physiological laboratory was not a +necessary part of the apparatus of instruction. It was with my +hearty approval that the teaching of Physiology was constituted a +separate department and made an independent Professorship. Before my +time, Dr. Warren had taught Anatomy, Physiology, and Surgery in the +same course of Lectures, lasting only three or four months. As the +boundaries of science are enlarged, new divisions and subdivisions of +its territories become necessary. In the place of six Professors in +1847, when I first became a member of the Faculty, I count twelve +upon the Catalogue before me, and I find the whole number engaged in +the work of instruction in the Medical School amounts to no less than +fifty. + +Since I began teaching in this school, the aspect of many branches of +science has undergone a very remarkable transformation. Chemistry +and Physiology are no longer what they were, as taught by the +instructors of that time. We are looking forward to the synthesis of +new organic compounds; our artificial madder is already in the +market, and the indigo-raisers are now fearing that their crop will +be supplanted by the manufactured article. In the living body we +talk of fuel supplied and work done, in movement, in heat, just as if +we were dealing with a machine of our own contrivance. + +A physiological laboratory of to-day is equipped with instruments of +research of such ingenious contrivance, such elaborate construction, +that one might suppose himself in a workshop where some exquisite +fabric was to be wrought, such as Queens love to wear, and Kings do +not always love to pay for. They are, indeed, weaving a charmed web, +for these are the looms from which comes the knowledge that clothes +the nakedness of the intellect. Here are the mills that grind food +for its hunger, and "is not the life more than meat, and the body +than raiment?" + +But while many of the sciences have so changed that the teachers of +the past would hardly know them, it has not been so with the branch I +teach, or, rather, with that division of it which is chiefly taught +in this amphitheatre. General anatomy, or histology, on the other +hand, is almost all new; it has grown up, mainly, since I began my +medical studies. I never saw a compound microscope during my years +of study in Paris. Individuals had begun to use the instrument, but +I never heard it alluded to by either Professors or students. In +descriptive anatomy I have found little to unlearn, and not a great +deal that was both new and important to learn. Trifling additions +are made from year to year, not to be despised and not to be +overvalued. Some of the older anatomical works are still admirable, +some of the newer ones very much the contrary. I have had recent +anatomical plates brought me for inspection, and I have actually +button-holed the book-agent, a being commonly as hard to get rid of +as the tar-baby in the negro legend, that I might put him to shame +with the imperial illustrations of the bones and muscles in the great +folio of Albinus, published in 1747, and the unapproached figures of +the lymphatic system of Mascagni, now within a very few years of a +century old, and still copied, or, rather, pretended to be copied, in +the most recent works on anatomy. + +I am afraid that it is a good plan to get rid of old Professors, and +I am thankful to hear that there is a movement for making provision +for those who are left in need when they lose their offices and their +salaries. I remember one of our ancient Cambridge Doctors once asked +me to get into his rickety chaise, and said to me, half humorously, +half sadly, that he was like an old horse,--they had taken off his +saddle and turned him out to pasture. I fear the grass was pretty +short where that old servant of the public found himself grazing. If +I myself needed an apology for holding my office so long, I should +find it in the fact that human anatomy is much the same study that it +was in the days of Vesalius and Fallopius, and that the greater part +of my teaching was of such a nature that it could never become +antiquated. + +Let me begin with my first experience as a medical student. I had +come from the lessons of Judge Story and Mr. Ashmun in the Law School +at Cambridge. I had been busy, more or less, with the pages of +Blackstone and Chitty, and other text-books of the first year of +legal study. More or less, I say, but I am afraid it was less rather +than more. For during that year I first tasted the intoxicating +pleasure of authorship. A college periodical, conducted by friends +of mine, still undergraduates, tempted me into print, and there is no +form of lead-poisoning which more rapidly and thoroughly pervades the +blood and bones and marrow than that which reaches the young author +through mental contact with type-metal. Qui a bu, boira,--he who has +once been a drinker will drink again, says the French proverb. So +the man or woman who has tasted type is sure to return to his old +indulgence sooner or later. In that fatal year I had my first attack +of authors' lead-poisoning, and I have never got quite rid of it from +that day to this. But for that I might have applied myself more +diligently to my legal studies, and carried a green bag in place of a +stethoscope and a thermometer up to the present day. + +What determined me to give up Law and apply myself to Medicine I can +hardly say, but I had from the first looked upon that year's study as +an experiment. At any rate, I made the change, and soon found myself +introduced to new scenes and new companionships. + +I can scarcely credit my memory when I recall the first impressions +produced upon me by sights afterwards become so familiar that they +could no more disturb a pulse-beat than the commonest of every-day +experiences. The skeleton, hung aloft like a gibbeted criminal, +looked grimly at me as I entered the room devoted to the students of +the school I had joined, just as the fleshless figure of Time, with +the hour-glass and scythe, used to glare upon me in my childhood from +the "New England Primer." The white faces in the beds at the +Hospital found their reflection in my own cheeks, which lost their +color as I looked upon them. All this had to pass away in a little +time; I had chosen my profession, and must meet its painful and +repulsive aspects until they lost their power over my sensibilities. + +The private medical school which I had joined was one established by +Dr. James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow +Lewis, and Dr. George W. Otis. Of the first three gentlemen I have +either spoken elsewhere or may find occasion to speak hereafter. The +two younger members of this association of teachers were both +graduates of our University, one of the year 1819, the other of 1818. + +Dr. Lewis was a great favorite with students. He was a man of very +lively temperament, fond of old books and young people, open-hearted, +free-spoken, an enthusiast in teaching, and especially at home in +that apartment of the temple of science where nature is seen in +undress, the anthropotomic laboratory, known to common speech as the +dissecting-room. He had that quality which is the special gift of +the man born for a teacher,--the power of exciting an interest in +that which he taught. While he was present the apartment I speak of +was the sunniest of studios in spite of its mortuary spectacles. Of +the students I met there I best remember James Jackson, Junior, full +of zeal and playful as a boy, a young man whose early death was a +calamity to the profession of which he promised to be a chief +ornament; the late Reverend J. S. C. Greene, who, as the prefix to +his name signifies, afterwards changed his profession, but one of +whose dissections I remember looking upon with admiration; and my +friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is +entitled to be called, then, as now and always, a favorite with all +about him. He had come to us from the schools of Germany, and +brought with him recollections of the teachings of Blumenbach and the +elder Langenbeck, father of him whose portrait hangs in our Museum. +Dr. Lewis was our companion as well as our teacher. A good +demonstrator is,--I will not say as important as a good Professor in +the teaching of Anatomy, because I am not sure that he is not more +important. He comes into direct personal relations with the +students,--he is one of them, in fact, as the Professor cannot be +from the nature of his duties. The Professor's chair is an +insulating stool, so to speak; his age, his knowledge, real or +supposed, his official station, are like the glass legs which support +the electrician's piece of furniture, and cut it off from the common +currents of the floor upon which it stands. Dr. Lewis enjoyed +teaching and made his students enjoy being taught. He delighted in +those anatomical conundrums to answer which keeps the student's eyes +open and his wits awake. He was happy as he dexterously performed +the tour de maitre of the old barber-surgeons, or applied the spica +bandage and taught his scholars to do it, so neatly and symmetrically +that the aesthetic missionary from the older centre of civilization +would bend over it in blissful contemplation, as if it were a +sunflower. Dr. Lewis had many other tastes, and was a favorite, not +only with students, but in a wide circle, professional, antiquarian, +masonic, and social. + +Dr. Otis was less widely known, but was a fluent and agreeable +lecturer, and esteemed as a good surgeon. + +I must content myself with this glimpse at myself and a few of my +fellow-students in Boston. After attending two courses of Lectures +in the school of the University, I went to Europe to continue my +studies. + +You may like to hear something of the famous Professors of Paris in +the days when I was a student in the Ecole de Medicine, and following +the great Hospital teachers. + +I can hardly believe my own memory when I recall the old +practitioners and Professors who were still going round the hospitals +when I mingled with the train of students that attended the morning +visits. See that bent old man who is groping his way through the +wards of La Charity. That is the famous Baron Boyer, author of the +great work on surgery in nine volumes, a writer whose clearness of +style commends his treatise to general admiration, and makes it a +kind of classic. He slashes away at a terrible rate, they say, when +he gets hold of the subject of fistula in its most frequent habitat, +--but I never saw him do more than look as if he wanted to cut a good +dollop out of a patient he was examining. The short, square, +substantial man with iron-gray hair, ruddy face, and white apron is +Baron Larrey, Napoleon's favorite surgeon, the most honest man he +ever saw,--it is reputed that he called him. To go round the Hotel +des Invalides with Larrey was to live over the campaigns of Napoleon, +to look on the sun of Austerlitz, to hear the cannons of Marengo, to +struggle through the icy waters of the Beresina, to shiver in the +snows of the Russian retreat, and to gaze through the battle smoke +upon the last charge of the red lancers on the redder field of +Waterloo. Larrey was still strong and sturdy as I saw him, and few +portraits remain printed in livelier colors on the tablet of my +memory. + +Leave the little group of students which gathers about Larrey beneath +the gilded dome of the Invalides and follow me to the Hotel Dieu, +where rules and reigns the master-surgeon of his day, at least so far +as Paris and France are concerned,--the illustrious Baron Dupuytren. +No man disputed his reign, some envied his supremacy. Lisfranc +shrugged his shoulders as he spoke of "ce grand homme de 1'autre cots +de la riviere," that great man on the other side of the river, but +the great man he remained, until he bowed before the mandate which +none may disobey. "Three times," said Bouillaud, "did the apoplectic +thunderbolt fall on that robust brain,"--it yielded at last as the +old bald cliff that is riven and crashes down into the valley. I saw +him before the first thunderbolt had descended: a square, solid man, +with a high and full-domed head, oracular in his utterances, +indifferent to those around him, sometimes, it was said, very rough +with them. He spoke in low, even tones, with quiet fluency, and was +listened to with that hush of rapt attention which I have hardly seen +in any circle of listeners unless when such men as ex-President John +Quincy Adams or Daniel Webster were the speakers. I do not think +that Dupuytren has left a record which explains his influence, but in +point of fact he dominated those around him in a remarkable manner. +You must have all witnessed something of the same kind. The personal +presence of some men carries command with it, and their accents +silence the crowd around them, when the same words from other lips +might fall comparatively unheeded. + +As for Lisfranc, I can say little more of him than that he was a +great drawer of blood and hewer of members. I remember his ordering +a wholesale bleeding of his patients, right and left, whatever might +be the matter with them, one morning when a phlebotomizing fit was on +him. I recollect his regretting the splendid guardsmen of the old +Empire,--for what? because they had such magnificent thighs to +amputate. I got along about as far as that with him, when I ceased +to be a follower of M. Lisfranc. + +The name of Velpeau must have reached many of you, for he died in +1867, and his many works made his name widely known. Coming to Paris +in wooden shoes, starving, almost, at first, he raised himself to +great eminence as a surgeon and as an author, and at last obtained +the Professorship to which his talents and learning entitled him. +His example may be an encouragement to some of my younger hearers who +are born, not with the silver spoon in their mouths, but with the +two-tined iron fork in their hands. It is a poor thing to take up +their milk porridge with in their young days, but in after years it +will often transfix the solid dumplings that roll out of the silver +spoon. So Velpeau found it. He had not what is called genius, he +was far from prepossessing in aspect, looking as if he might have +wielded the sledge-hammer (as I think he had done in early life) +rather than the lancet, but he had industry, determination, +intelligence, character, and he made his way to distinction and +prosperity, as some of you sitting on these benches and wondering +anxiously what is to become of you in the struggle for life will have +done before the twentieth century has got halfway through its first +quarter. A good sound head over a pair of wooden shoes is a great +deal better than a wooden head belonging to an owner who cases his +feet in calf-skin, but a good brain is not enough without a stout +heart to fill the four great conduits which carry at once fuel and +fire to that mightiest of engines. + +How many of you who are before me are familiarly acquainted with the +name of Broussais, or even with that of Andral? Both were lecturing +at the Ecole de Medicine, and I often heard them. Broussais was in +those days like an old volcano, which has pretty nearly used up its +fire and brimstone, but is still boiling and bubbling in its +interior, and now and then sends up a spirt of lava and a volley of +pebbles. His theories of gastro-enteritis, of irritation and +inflammation as the cause of disease, and the practice which sprang +from them, ran over the fields of medicine for a time like flame over +the grass of the prairies. The way in which that knotty-featured, +savage old man would bring out the word irritation--with rattling and +rolling reduplication of the resonant letter r--might have taught a +lesson in articulation to Salvini. But Broussais's theory was +languishing and well-nigh become obsolete, and this, no doubt, added +vehemence to his defence of his cherished dogmas. + +Old theories, and old men who cling to them, must take themselves out +of the way as the new generation with its fresh thoughts and altered +habits of mind comes forward to take the place of that which is dying +out. This was a truth which the fiery old theorist found it very hard +to learn, and harder to bear, as it was forced upon him. For the +hour of his lecture was succeeded by that of a younger and far more +popular professor. As his lecture drew towards its close, the +benches, thinly sprinkled with students, began to fill up; the doors +creaked open and banged back oftener and oftener, until at last the +sound grew almost continuous, and the voice of the lecturer became a +leonine growl as he strove in vain to be heard over the noise of +doors and footsteps. + +Broussais was now sixty-two years old. The new generation had +outgrown his doctrines, and the Professor for whose hour the benches +had filled themselves belonged to that new generation. Gabriel +Andral was little more than half the age of Broussais, in the full +prime and vigor of manhood at thirty-seven years. He was a rapid, +fluent, fervid, and imaginative speaker, pleasing in aspect and +manner,--a strong contrast to the harsh, vituperative old man who had +just preceded him. His Clinique Medicale is still valuable as a +collection of cases, and his researches on the blood, conducted in +association with Gavarret, contributed new and valuable facts to +science. But I remember him chiefly as one of those instructors +whose natural eloquence made it delightful to listen to him. I doubt +if I or my fellow-students did full justice either to him or to the +famous physician of Hotel Dieu, Chomel. We had addicted ourselves +almost too closely to the words of another master, by whom we were +ready to swear as against all teachers that ever were or ever would +be. + +This object of our reverence, I might almost say idolatry, was one +whose name is well known to most of the young men before me, even to +those who may know comparatively little of his works and teachings. +Pierre Charles Alexandre Louis, at the age of forty-seven, as I +recall him, was a tall, rather spare, dignified personage, of serene +and grave aspect, but with a pleasant smile and kindly voice for the +student with whom he came into personal relations. If I summed up +the lessons of Louis in two expressions, they would be these; I do +not hold him answerable for the words, but I will condense them after +my own fashion in French, and then give them to you, expanded +somewhat, in English: + + Formez toujours des idees nettes. + Fuyez toujours les a peu pres. + +Always make sure that you form a distinct and clear idea of the +matter you are considering. + +Always avoid vague approximations where exact estimates are possible; +about so many,--about so much, instead of the precise number and +quantity. + +Now, if there is anything on which the biological sciences have +prided themselves in these latter years it is the substitution of +quantitative for qualitative formulae. The "numerical system," of +which Louis was the great advocate, if not the absolute originator, +was an attempt to substitute series of carefully recorded facts, +rigidly counted and closely compared, for those never-ending records +of vague, unverifiable conclusions with which the classics of the +healing art were overloaded. The history of practical medicine had +been like the story of the Danaides. "Experience " had been, from +time immemorial, pouring its flowing treasures into buckets full of +holes. At the existing rate of supply and leakage they would never +be filled; nothing would ever be settled in medicine. But cases +thoroughly recorded and mathematically analyzed would always be +available for future use, and when accumulated in sufficient number +would lead to results which would be trustworthy, and belong to +science. + +You young men who are following the hospitals hardly know how much +you are indebted to Louis. I say nothing of his Researches on +Phthisis or his great work on Typhoid Fever. But I consider his +modest and brief Essay on Bleeding in some Inflammatory Diseases, +based on cases carefully observed and numerically analyzed, one of +the most important written contributions to practical medicine, to +the treatment of internal disease, of this century, if not since the +days of Sydenham. The lancet was the magician's wand of the dark +ages of medicine. The old physicians not only believed in its +general efficacy as a wonder-worker in disease, but they believed +that each malady could be successfully attacked from some special +part of the body,--the strategic point which commanded the seat of +the morbid affection. On a figure given in the curious old work of +John de Ketam, no less than thirty-eight separate places are marked +as the proper ones to bleed from, in different diseases. Even Louis, +who had not wholly given up venesection, used now and then to order +that a patient suffering from headache should be bled in the foot, in +preference to any other part. + +But what Louis did was this: he showed by a strict analysis of +numerous cases that bleeding did not strangle,--jugulate was the word +then used,--acute diseases, more especially pneumonia. This was not +a reform,--it was a revolution. It was followed up in this country +by the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited +Diseases, which has, I believe, done more than any other work or +essay in our own language to rescue the practice of medicine from the +slavery to the drugging system which was a part of the inheritance of +the profession. + +Yes, I say, as I look back on the long hours of the many days I spent +in the wards and in the autopsy room of La Pitie, where Louis was one +of the attending physicians,--yes, Louis did a great work for +practical medicine. Modest in the presence of nature, fearless in +the face of authority, unwearying in the pursuit of truth, he was a +man whom any student might be happy and proud to claim as his teacher +and his friend, and yet, as I look back on the days when I followed +his teachings, I feel that I gave myself up too exclusively to his +methods of thought and study. + +There is one part of their business which certain medical +practitioners are too apt to forget; namely, that what they should +most of all try to do is to ward off disease, to alleviate suffering, +to preserve life, or at least to prolong it if possible. It is not +of the slightest interest to the patient to know whether three or +three and a quarter cubic inches of his lung are hepatized. His mind +is not occupied with thinking of the curious problems which are to be +solved by his own autopsy,--whether this or that strand of the spinal +marrow is the seat of this or that form of degeneration. He wants +something to relieve his pain, to mitigate the anguish of dyspnea, to +bring back motion and sensibility to the dead limb, to still the +tortures of neuralgia. What is it to him that you can localize and +name by some uncouth term the disease which you could not prevent and +which you cannot cure? An old woman who knows how to make a poultice +and how to put it on, and does it tuto, eito, jucunde, just when and +where it is wanted, is better,--a thousand times better in many +cases,--than a staring pathologist, who explores and thumps and +doubts and guesses, and tells his patient be will be better tomorrow, +and so goes home to tumble his books over and make out a diagnosis. + +But in those days, I, like most of my fellow students, was thinking +much more of "science" than of practical medicine, and I believe if +we had not clung so closely to the skirts of Louis and had followed +some of the courses of men like Trousseau,--therapeutists, who gave +special attention to curative methods, and not chiefly to diagnosis, +--it would have been better for me and others. One thing, at any +rate, we did learn in the wards of Louis. We learned that a very +large proportion of diseases get well of themselves, without any +special medication,--the great fact formulated, enforced, and +popularized by Dr. Jacob Bigelow in the Discourse referred to. We +unlearned the habit of drugging for its own sake. This detestable +practice, which I was almost proscribed for condemning somewhat too +epigrammatically a little more than twenty years ago, came to us, I +suspect, in a considerable measure from the English "general +practitioners," a sort of prescribing apothecaries. You remember +how, when the city was besieged, each artisan who was called upon in +council to suggest the best means of defence recommended the articles +he dealt in: the carpenter, wood; the blacksmith, iron; the mason, +brick; until it came to be a puzzle to know which to adopt. Then the +shoemaker said, "Hang your walls with new boots," and gave good +reasons why these should be the best of all possible defences. Now +the "general practitioner" charged, as I understand, for his +medicine, and in that way got paid for his visit. Wherever this is +the practice, medicine is sure to become a trade, and the people +learn to expect drugging, and to consider it necessary, because drugs +are so universally given to the patients of the man who gets his +living by them. + +It was something to have unlearned the pernicious habit of constantly +giving poisons to a patient, as if they were good in themselves, of +drawing off the blood which he would want in his struggle with +disease, of making him sore and wretched with needless blisters, of +turning his stomach with unnecessary nauseous draught and mixtures, +--only because he was sick and something must be done. But there +were positive as well as negative facts to be learned, and some of +us, I fear, came home rich in the negatives of the expectant +practice, poor in the resources which many a plain country +practitioner had ready in abundance for the relief and the cure of +disease. No one instructor can be expected to do all for a student +which he requires. Louis taught us who followed him the love of +truth, the habit of passionless listening to the teachings of nature, +the most careful and searching methods of observation, and the sure +means of getting at the results to be obtained from them in the +constant employment of accurate tabulation. He was not a showy, or +eloquent, or, I should say, a very generally popular man, though the +favorite, almost the idol, of many students, especially Genevese and +Bostonians. But he was a man of lofty and admirable scientific +character, and his work will endure in its influences long after his +name is lost sight of save to the faded eyes of the student of +medical literature. + +Many other names of men more or less famous in their day, and who +were teaching while I was in Paris, come up before me. They are but +empty sounds for the most part in the ears of persons of not more +than middle age. Who of you knows anything of Richerand, author of a +very popular work on Physiology, commonly put into the student's +hands when I first began to ask for medical text-books? I heard him +lecture once, and have had his image with me ever since as that of an +old, worn-out man,--a venerable but dilapidated relic of an effete +antiquity. To verify this impression I have just looked out the +dates of his birth and death, and find that he was eighteen years +younger than the speaker who is now addressing you. There is a +terrible parallax between the period before thirty and that after +threescore and ten, as two men of those ages look, one with naked +eyes, one through his spectacles, at the man of fifty and thereabout. +Magendie, I doubt not you have all heard of. I attended but one of +his lectures. I question if one here, unless some contemporary of my +own has strayed into the amphitheatre,--knows anything about +Marjolin. I remember two things about his lectures on surgery, the +deep tones of his voice as he referred to his oracle,--the earlier +writer, Jean Louis Petit,--and his formidable snuffbox. What he +taught me lies far down, I doubt not, among the roots of my +knowledge, but it does not flower out in any noticeable blossoms, or +offer me any very obvious fruits. Where now is the fame of +Bouillaud, Professor and Deputy, the Sangrado of his time? Where is +the renown of Piorry, percussionist and poet, expert alike in the +resonances of the thoracic cavity and those of the rhyming +vocabulary? --I think life has not yet done with the vivacious +Ricord, whom I remember calling the Voltaire of pelvic literature,--a +sceptic as to the morality of the race in general, who would have +submitted Diana to treatment with his mineral specifics, and ordered +a course of blue pills for the vestal virgins. + +Ricord was born at the beginning of the century, and Piorry some +years earlier. Cruveilhier, who died in 1874, is still remembered by +his great work on pathological anatomy; his work on descriptive +anatomy has some things which I look in vain for elsewhere. But +where is Civiale,--where are Orfila, Gendrin, Rostan, Biett, Alibert, +--jolly old Baron Alibert, whom I remember so well in his broad- +brimmed hat, worn a little jauntily on one side, calling out to the +students in the court-yard of the Hospital St. Louis, "Enfans de la +methode naturelle, etes-vous tous ici?" "Children of the natural +method [his own method of classification of skin diseases,] are you +all here? "All here, then, perhaps; all where, now? + +My show of ghosts is over. It is always the same story that old men +tell to younger ones, some few of whom will in their turn repeat the +tale, only with altered names, to their children's children. + + Like phantoms painted on the magic slide, + Forth from the darkness of the past we glide, + As living shadows for a moment seen + In airy pageant on the eternal screen, + Traced by a ray from one unchanging flame, + Then seek the dust and stillness whence we came. + +Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden, +where he had written his Latin graduating thesis, talking of the +learned Gaubius and the late illustrious Boerhaave and other dead +Dutchmen, of whom you know as much, most of you, as you do of Noah's +apothecary and the family physician of Methuselah, whose +prescriptions seem to have been lost to posterity. Dr. Lloyd came +back to Boston full of the teachings of Cheselden and Sharpe, William +Hunter, Smellie, and Warner; Dr. James Jackson loved to tell of Mr. +Cline and to talk of Mr. John Hunter; Dr. Reynolds would give you his +recollections of Sir Astley Cooper and Mr. Abernethy; I have named +the famous Frenchmen of my student days; Leyden, Edinburgh, London, +Paris, were each in turn the Mecca of medical students, just as at +the present day Vienna and Berlin are the centres where our young men +crowd for instruction. These also must sooner or later yield their +precedence and pass the torch they hold to other hands. Where shall +it next flame at the head of the long procession? Shall it find its +old place on the shores of the Gulf of Salerno, or shall it mingle +its rays with the northern aurora up among the fiords of Norway,--or +shall it be borne across the Atlantic and reach the banks of the +Charles, where Agassiz and Wyman have taught, where Hagen still +teaches, glowing like his own Lampyris splendidula, with enthusiasm, +where the first of American botanists and the ablest of American +surgeons are still counted in the roll of honor of our great +University? + +Let me add a few words which shall not be other than cheerful, as I +bid farewell to this edifice which I have known so long. I am +grateful to the roof which has sheltered me, to the floors which have +sustained me, though I have thought it safest always to abstain from +anything like eloquence, lest a burst of too emphatic applause might +land my class and myself in the cellar of the collapsing structure, +and bury us in the fate of Korah, Dathan, and Abiram. I have helped +to wear these stairs into hollows,--stairs which I trod when they +were smooth and level, fresh from the plane. There are just thirty- +two of them, as there were five and thirty years ago, but they are +steeper and harder to climb, it seems to me, than they were then. I +remember that in the early youth of this building, the late Dr. John +K. Mitchell, father of our famous Dr. Weir Mitchell, said to me as +we came out of the Demonstrator's room, that some day or other a +whole class would go heels over head down this graded precipice, like +the herd told of in Scripture story. This has never happened as yet; +I trust it never will. I have never been proud of the apartment +beneath the seats, in which my preparations for lecture were made. +But I chose it because I could have it to myself, and I resign it, +with a wish that it were more worthy of regret, into the hands of my +successor, with my parting benediction. Within its twilight +precincts I have often prayed for light, like Ajax, for the daylight +found scanty entrance, and the gaslight never illuminated its dark +recesses. May it prove to him who comes after me like the cave of +the Sibyl, out of the gloomy depths of which came the oracles which +shone with the rays of truth and wisdom! + +This temple of learning is not surrounded by the mansions of the +great and the wealthy. No stately avenues lead up to its facades and +porticoes. I have sometimes felt, when convoying a distinguished +stranger through its precincts to its door, that he might question +whether star-eyed Science had not missed her way when she found +herself in this not too attractive locality. I cannot regret that +we--you, I should say--are soon to migrate to a more favored region, +and carry on your work as teachers and as learners in ampler halls +and under far more favorable conditions. + +I hope that I may have the privilege of meeting you there, possibly +may be allowed to add my words of welcome to those of my former +colleagues, and in that pleasing anticipation I bid good-by to this +scene of my long labors, and, for the present at least, to the +friends with whom I have been associated. + + + + + + +APPENDUM + +NOTES TO THE ADDRESS ON CURRENTS AND COUNTER +CURRENTS IN MEDICAL SCIENCE. + +Some passages contained in the original manuscript of the Address, +and omitted in the delivery on account of its length, are restored in +the text or incorporated with these Notes. + +NOTE A. -- + +There is good reason to doubt whether the nitrate of silver has any +real efficacy in epilepsy. It has seemed to cure many cases, but +epilepsy is a very uncertain disease, and there is hardly anything +which has not been supposed to cure it. Dr. Copland cites many +authorities in its favor, most especially Lombard's cases. But De la +Berge and Monneret (Comp. de Med. Paris), 1839, analyze these same +cases, eleven in number, and can only draw the inference of a very +questionable value in the supposed remedy. Dr. James Jackson says +that relief of epilepsy is not to be attained by any medicine with +which he is acquainted, but by diet. (Letters to a Young Physician, +p. 67.) Guy Patin, Dean of the Faculty of Paris, Professor at the +Royal College, Author of the Antimonial Martyrology, a wit and a man +of sense and learning, who died almost two hundred years ago, had +come to the same conclusion, though the chemists of his time boasted +of their remedies. "Did, you ever see a case of epilepsy cured by +nitrate of silver?" I said to one of the oldest and most experienced +surgeons in this country. "Never," was his instant reply. Dr. +Twitchell's experience was very similar. How, then, did nitrate of +silver come to be given for epilepsy? Because, as Dr. Martin has so +well reminded us, lunatics were considered formerly to be under the +special influence of Luna, the moon (which Esquirol, be it observed, +utterly denies), and lunar caustic, or nitrate of silver, is a salt +of that metal which was called luna from its whiteness, and of course +must be in the closest relations with the moon. It follows beyond +all reasonable question that the moon's metal, silver, and its +preparations, must be the specific remedy for moonblasted maniacs and +epileptics! + +Yet the practitioner who prescribes the nitrate of silver supposes he +is guided by the solemn experience of the past, instead of by its +idle fancies. He laughs at those old physicians who placed such +confidence in the right hind hoof of an elk as a remedy for the same +disease, and leaves the record of his own belief in a treatment quite +as fanciful and far more objectionable, written in indelible ink upon +a living tablet where he who runs may read it for a whole generation, +if nature spares his walking advertisement so long. + + + +NOTE B. -- + +The presumption that a man is innocent until he is proved guilty, +does not mean that there are no rogues, but lays the onus probandi on +the party to which it properly belongs. So with this proposition. +A noxious agent should never be employed in sickness unless there is +ample evidence in the particular case to overcome the general +presumption against all such agents, and the evidence is very apt to +be defective. + +The miserable delusion of Homoeopathy builds itself upon an axiom +directly the opposite of this; namely, that the sick are to be cured +by poisons. Similia similibus curantur means exactly this. It is +simply a theory of universal poisoning, nullified in practice by the +infinitesimal contrivance. The only way to kill it and all similar +fancies, and to throw every quack nostrum into discredit, is to root +out completely the suckers of the old rotten superstition that +whatever is odious or noxious is likely to be good for disease. The +current of sound practice with ourselves is, I believe, setting fast +in the direction I have indicated in the above proposition. To +uphold the exhibition of noxious agents in disease, as the rule, +instead of admitting them cautiously and reluctantly as the +exception, is, as I think, an eddy of opinion in the direction of the +barbarism out of which we believe our art is escaping. It is only +through the enlightened sentiment and action of the Medical +Profession that the community can be brought to acknowledge that +drugs should always be regarded as evils. + +It is true that some suppose, and our scientific and thoughtful +associate, Dr. Gould, has half countenanced the opinion, that there +may yet be discovered a specific for every disease. Let us not +despair of the future, but let us be moderate in our expectations. +When an oil is discovered that will make a bad watch keep good time; +when a recipe is given which will turn an acephalous foetus into a +promising child; when a man can enter the second time into his +mother's womb and give her back the infirmities which twenty +generations have stirred into her blood, and infused into his own +through hers, we may be prepared to enlarge the National +Pharmacopoeia with a list of specifies for everything but old age, +--and possibly for that also. + + + +NOTE C. -- + +The term specific is used here in its ordinary sense, without raising +the question of the propriety of its application to these or other +remedies. + +The credit of introducing Cinchona rests between the Jesuits, the +Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor, +who employed it as a secret remedy. (Pereira.) Mercury as an +internal specific remedy was brought into use by that impudent and +presumptuous quack, as he was considered, Paracelsus. (Encyc. Brit. +art. "Paracelsus.") Arsenic was introduced into England as a remedy +for intermittents by Dr. Fowler, in consequence of the success of a +patent medicine, the Tasteless Ague Drops, which were supposed, +"probably with reason," to be a preparation of that mineral. (Rees's +Cyc. art. "Arsenic.") Colchicum came into notice in a similar way, +from the success of the Eau Medicinale of M. Husson, a French +military officer. (Pereira.) Iodine was discovered by a saltpetre +manufacturer, but applied by a physician in place of the old remedy, +burnt sponge, which seems to owe its efficacy to it. (Dunglison, New +Remedies.) As for Sulphur, "the common people have long used it as an +ointment" for scabies. (Rees's Cyc. art. "Scabies.") The modern +cantiscorbutic regimen is credited to Captain Cook. "To his sagacity +we are indebted for the first impulse to those regulations by which +scorbutus is so successfully prevented in our navy." (Lond. Cyc. +Prac. Med. art. "Scorbutus.") Iron and various salts which enter +into the normal composition of the human body do not belong to the +materia medica by our definition, but to the materia alimentaria. + +For the first introduction of iron as a remedy, see Pereira, who +gives a very curious old story. + +The statement in the text concerning a portion of the materia medica +stands exactly as delivered, and is meant exactly as it stands. No +denunciation of drugs, as sparingly employed by a wise physician, was +or is intended. If, however, as Dr. Gould stated in his "valuable +and practical discourse" to which the Massachusetts Medical Society +"listened with profit as well as interest," "Drugs, in themselves +considered, may always be regarded as evils,"--any one who chooses +may question whether the evils from their abuse are, on the whole, +greater or less than the undoubted benefits obtained from their +proper use. The large exception of opium, wine, specifics, and +anaesthetics, made in the text, takes off enough from the useful +side, as I fully believe, to turn the balance; so that a vessel +containing none of these, but loaded with antimony, strychnine, +acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus +diaboli, tormentilla, and other approved, and, in skilful hands, +really useful remedies, brings, on the whole, more harm than good to +the port it enters. + +It is a very narrow and unjust view of the practice of medicine, to +suppose it to consist altogether in the use of powerful drugs, or of +drugs of any kind. Far from it. "The physician may do very much for +the welfare of the sick, more than others can do, although he does +not, even in the major part of cases, undertake to control and +overcome the disease by art. It was with these views that I never +reported any patient cured at our hospital. Those who recovered +their health were reported as well; not implying that they were made +so by the active treatment they had received there. But it was to be +understood that all patients received in that house were to be cured, +that is, taken care of." (Letters to a Young Physician, by James +Jackson, M. D., Boston, 1855.) + +"Hygienic rules, properly enforced, fresh air, change of air, travel, +attention to diet, good and appropriate food judiciously regulated, +together with the administration of our tonics, porter, ale, wine, +iron, etc., supply the diseased or impoverished system with what Mr. +Gull, of St. Bartholomew's Hospital, aptly calls the 'raw material of +the blood;' and we believe that if any real improvement has taken +place in medical practice, independently of those truly valuable +contributions we have before described, it is in the substitution of +tonics, stimulants, and general management, for drastic cathartics, +for bleeding, depressing agents, including mercury, tartar emetics, +etc., so much in vogue during the early part even of this century." +(F. P. Porcher, in Charleston Med. Journal and Review for January, +1860.) + + + + + +End of Project Gutenberg Etext Medical Essays, by Oliver Wendell Holmes + diff --git a/old/medic10.zip b/old/medic10.zip Binary files differnew file mode 100644 index 0000000..a1bf6d2 --- /dev/null +++ b/old/medic10.zip diff --git a/old/medic11.txt b/old/medic11.txt new file mode 100644 index 0000000..0cc535b --- /dev/null +++ b/old/medic11.txt @@ -0,0 +1,13749 @@ +The Project Gutenberg Etext of Medical Essays, by O. W. Holmes, Sr. +#9 in our series by Oliver Wendell Holmes, Sr. (The Physician and Poet) + +Copyright laws are changing all over the world. Be sure to check the +copyright laws for your country before distributing this or any other +Project Gutenberg file. + +We encourage you to keep this file, exactly as it is, on your +own disk, thereby keeping an electronic path open for future +readers. Please do not remove this. + +This header should be the first thing seen when anyone starts to +view the etext. 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SOME OF MY EARLY TEACHERS + + + + + + +PREFACE. + +The character of the opposition which some of these papers have met +with suggests the inference that they contain really important, but +unwelcome truths. Negatives multiplied into each other change their +sign and become positives. Hostile criticisms meeting together are +often equivalent to praise, and the square of fault-finding turns out +to be the same thing as eulogy. + +But a writer has rarely so many enemies as it pleases him to believe. +Self-love leads us to overrate the numbers of our negative +constituency. The larger portion of my limited circle of readers +must be quite indifferent to, if not ignorant of, the adverse +opinions which have been expressed or recorded concerning any of +these Addresses or Essays now submitted to their own judgment. It is +proper, however, to inform them, that some of the positions +maintained in these pages have been unsparingly attacked, with +various degrees of ability, scholarship, and good-breeding. The tone +of criticism naturally changes with local conditions in different +parts of a country extended like our own, so that it is one of the +most convenient gauges of the partial movements in the direction of +civilization. It is satisfactory to add, that the views assailed +have also been unflinchingly defended by unsought champions, among +the ablest of whom it is pleasant to mention, at this moment of +political alienation, the Editor of the Charleston Medical Journal. + +"Currents and Counter-Currents" was written and delivered as an +Oration, a florid rhetorical composition, expressly intended to +secure the attention of an audience not easy to hold as listeners. +It succeeded in doing this, and also in being as curiously +misunderstood and misrepresented as if it had been a political +harangue. This gave it more local notoriety than it might otherwise +have attained, so that, as I learn, one ingenious person made use of +its title as an advertisement to a production of his own. + +The commonest mode of misrepresentation was this: qualified +propositions, the whole meaning of which depended on the +qualifications, were stripped of these and taken as absolute. Thus, +the attempt to establish a presumption against giving poisons to sick +persons was considered as equivalent to condemning the use of these +substances. The only important inference the writer has been able to +draw from the greater number of the refutations of his opinions which +have been kindly sent him, is that the preliminary education of the +Medical Profession is not always what it ought to be. + +One concession he is willing to make, whatever sacrifice of pride it +may involve. The story of Massasoit, which has furnished a coral, as +it were, for some teething critics, when subjected to a powerful +logical analysis, though correct in its essentials, proves to have +been told with exceptionable breadth of statement, and therefore (to +resume the metaphor) has been slightly rounded off at its edges, so +as to be smoother for any who may wish to bite upon it hereafter. In +other respects the Discourse has hardly been touched. It is only an +individual's expression, in his own way, of opinions entertained by +hundreds of the Medical Profession in every civilized country, and +has nothing in it which on revision the writer sees cause to retract +or modify. The superstitions it attacks lie at the very foundation +of Homoeopathy, and of almost every form of medical charlatanism. +Still the mere routinists and unthinking artisans in most callings +dislike whatever shakes the dust out of their traditions, and it may +be unreasonable to expect that Medicine will always prove an +exception to the rule. One half the opposition which the numerical +system of Louis has met with, as applied to the results of treatment, +has been owing to the fact that it showed the movements of disease to +be far more independent of the kind of practice pursued than was +agreeable to the pride of those whose self-confidence it abated. + +The statement, that medicines are more sparingly used in physicians' +families than in most others, admits of a very natural explanation, +without putting a harsh construction upon it, which it was not +intended to admit. Outside pressure is less felt in the physician's +own household; that is all. If this does not sometimes influence him +to give medicine, or what seems to be medicine, when among those who +have more confidence in drugging than his own family commonly has, +the learned Professor Dunglison is hereby requested to apologize for +his definition of the word Placebo, or to expunge it from his Medical +Dictionary. + +One thing is certain. A loud outcry on a slight touch reveals the +weak spot in a profession, as well as in a patient. It is a doubtful +policy to oppose the freest speech in those of our own number who are +trying to show us where they honestly believe our weakness lies. +Vast as are the advances of our Science and Art, may it not possibly +prove on examination that we retain other old barbarisms beside the +use of the astrological sign of Jupiter, with which we endeavor to +insure good luck to our prescriptions? Is it the act of a friend or +a foe to try to point them out to our brethren when asked to address +them, and is the speaker to subdue the constitutional habit of his +style to a given standard, under penalty of giving offence to a grave +assembly? + +"Homoeopathy and its Kindred Delusions" was published nearly twenty +years ago, and has been long out of print, so that the author tried +in vain to procure a copy until the kindness of a friend supplied him +with the only one he has had for years. A foolish story reached his +ears that he was attempting to buy up stray copies for the sake of +suppressing it. This edition was in the press at that very time. + +Many of the arguments contained in the Lectures have lost whatever +novelty they may have possessed. All its predictions have been +submitted to the formidable test of time. They appear to have stood +it, so far, about as well as most uninspired prophecies; indeed, some +of them require much less accommodation than certain grave +commentators employ in their readings of the ancient Prophets. + +If some statistics recently published are correct, Homoeopathy has +made very slow progress in Europe. + +In all England, as it appears, there are hardly a fifth more +Homoeopathic practitioners than there are students attending Lectures +at the Massachusetts Medical College at the present time. In America +it has undoubtedly proved more popular and lucrative, yet how loose a +hold it has on the public confidence is shown by the fact that, when +a specially valued life, which has been played with by one of its +agents, is seriously threatened, the first thing we expect to hear is +that a regular practitioner is by the patient's bed, and the +Homoeopathic counsellor overruled or discarded. Again, how many of +the ardent and capricious persons who embraced Homoeopathy have run +the whole round of pretentious novelties;--have been boarded at +water-cure establishments, closeted with uterine and other +specialists, and finally wandered over seas to put themselves in +charge of foreign celebrities, who dosed them as lustily as they were +ever dosed before they took to globules! It will surprise many to +learn to what a shadow of a shade Homoeopathy has dwindled in the +hands of many of its noted practitioners. The itch-doctrine is +treated with contempt. Infinitesimal doses are replaced by full ones +whenever the fancy-practitioner chooses. Good Homoeopathic reasons +can be found for employing anything that anybody wants to employ. +Homoeopathy is now merely a name, an unproved theory, and a box of +pellets pretending to be specifics, which, as all of us know, fail +ignominiously in those cases where we would thankfully sacrifice all +our prejudices and give the world to have them true to their +promises. + +Homoeopathy has not died out so rapidly as Tractoration. Perhaps it +was well that it should not, for it has taught us a lesson of the +healing faculty of Nature which was needed, and for which many of us +have made proper acknowledgments. But it probably does more harm +than good to medical science at the present time, by keeping up the +delusion of treating everything by specifics,--the old barbarous +notion that sick people should feed on poisons [Lachesis, arrow- +poison, obtained from a serpent (Pulte). Crotalus horridus, +rattlesnake's venom (Neidhard). The less dangerous Pediculus capitis +is the favorite remedy of Dr. Mure, the English "Apostle of +Homoeopathy." These are examples of the retrograde current setting +towards barbarism] against which a part of the Discourse at the +beginning of this volume is directed. + +The infinitesimal globules have not become a curiosity as yet, like +Perkins's Tractors. But time is a very elastic element in Geology +and Prophecy. If Daniel's seventy weeks mean four hundred and ninety +years, as the learned Prideaux and others have settled it that they +do, the "not many years" of my prediction may be stretched out a +generation or two beyond our time, if necessary, when the prophecy +will no doubt prove true. + +It might be fitting to add a few words with regard to the Essay on +the Contagiousness of Puerperal Fever. But the whole question I +consider to be now transferred from the domain of medical inquiry to +the consideration of Life Insurance agencies and Grand Juries. For +the justification of this somewhat sharply accented language I must +refer the reader to the paper itself for details which I regret to +have been forced to place on permanent record. + +BOSTON, January, 1861. + + + + +A SECOND PREFACE. + +These Lectures and Essays are arranged in the order corresponding to +the date of their delivery or publication. They must, of course, be +read with a constant reference to these dates, by such as care to +read them. I have not attempted to modernize their aspect or +character in presenting them, in this somewhat altered connection, to +the public. Several of them were contained in a former volume which +received its name from the Address called "Currents and Counter- +Currents." Some of those contained in the former volume have been +replaced by others. The Essay called "Mechanism of Vital Actions" +has been transferred to a distinct collection of Miscellaneous +essays, forming a separate volume. + +I had some intention of including with these papers an Essay on +Intermittent Fever in New England, which received one of the Boylston +prizes in 1837, and was published in the following year. But as this +was upon a subject of local interest, chiefly, and would have taken +up a good deal of room, I thought it best to leave it out, trusting +that the stray copies to be met with in musty book-shops would +sufficiently supply the not very extensive or urgent demand for a +paper almost half a century old. + +Some of these papers created a little stir when they first fell from +the press into the pool of public consciousness. They will slide in +very quietly now in this new edition, and find out for themselves +whether the waters are those of Lethe, or whether they are to live +for a time as not wholly unvalued reminiscences. + +March 21, 1883. + + + + +PREFACE TO THE NEW EDITION. + +These Essays are old enough now to go alone without staff or crutch +in the shape of Prefaces. A very few words may be a convenience to +the reader who takes up the book and wishes to know what he is likely +to find in it. + + + HOMOEOPATHY AND ITS KINDRED DELUSIONS. + +Homoeopathy has proved lucrative, and so long as it continues to be +so will surely exist,--as surely as astrology, palmistry, and other +methods of getting a living out of the weakness and credulity of +mankind and womankind. Though it has no pretensions to be considered +as belonging among the sciences, it may be looked upon by a +scientific man as a curious object of study among the vagaries of the +human mind. Its influence for good or the contrary may be made a +matter of calm investigation. I have studied it in the Essay before +the reader, under the aspect of an extravagant and purely imaginative +creation of its founder. Since that first essay was written, nearly +half a century ago, we have all had a chance to witness its practical +working. Two opposite inferences may be drawn from its doctrines and +practice. The first is that which is accepted by its disciples. +This is that all diseases are "cured" by drugs. The opposite +conclusion is drawn by a much larger number of persons. As they see +that patients are very commonly getting well under treatment by +infinitesimal drugging, which they consider equivalent to no +medication at all, they come to disbelieve in every form of drugging +and put their whole trust in "nature." Thus experience, + + "From seeming evil still educing good," + +has shown that the dealers in this preposterous system of pseudo- +therapeutics have cooperated with the wiser class of practitioners in +breaking up the system of over-dosing and over-drugging which has +been one of the standing reproaches of medical practice. While. +keeping up the miserable delusion that diseases were all to be +"cured" by drugging, Homoeopathy has been unintentionally showing +that they would very generally get well without any drugging at all. +In the mean time the newer doctrines of the "mind cure," the "faith +cure," and the rest are encroaching on the territory so long +monopolized by that most ingenious of the pseudo-sciences. It would +not be surprising if its whole ground should be taken possession of +by these new claimants with their flattering appeals to the +imaginative class of persons open to such attacks. Similia similabus +may prove fatally true for once, if Homoeopathy is killed out by its +new-born rivals. + +It takes a very moderate amount of erudition to unearth a charlatan +like the supposed father of the infinitesimal dosing system. The +real inventor of that specious trickery was an Irishman by the name +of Butler. The whole story is to be found in the "Ortus Medicinm" of +Van Helmont. I have given some account of his chapter "Butler" in +different articles, but I would refer the students of our +Homoeopathic educational institutions to the original, which they +will find very interesting and curious. + + + CURRENTS AND COUNTER-CURRENTS + +My attack on over-drugging brought out some hostile comments and +treatment. Thirty years ago I expressed myself with more vivacity +than I should show if I were writing on the same subjects today. +Some of my more lively remarks called out very sharp animadversion. +Thus my illustration of prevention as often better than treatment in +the mother's words to her child which had got a poisonous berry in +its mouth,--"Spit it out!" gave mortal offence to a well-known New +York practitioner and writer, who advised the Massachusetts Medical +Society to spit out the offending speaker. Worse than this was my +statement of my belief that if a ship-load of miscellaneous drugs, +with certain very important exceptions,--drugs, many of which were +then often given needlessly and in excess, as then used "could be +sunk to the bottom of the sea, it would be all the better for mankind +and all the worse for the fishes." This was too bad. The sentence +was misquoted, quoted without its qualifying conditions, and +frightened some of my worthy professional brethren as much as if I +had told them to throw all physic to the dogs. But for the +epigrammatic sting the sentiment would have been unnoticed as a +harmless overstatement at the very worst. + +Since this lecture was delivered a great and, as I think, beneficial +change has taken place in the practice of medicine. The habit of the +English "general practitioner" of making his profit out of the pills +and potions he administered was ruinous to professional advancement +and the dignity of the physician. When a half-starving medical man +felt that he must give his patient draught and boluses for which he +could charge him, he was in a pitiable position and too likely to +persuade himself that his drugs were useful to his patient because +they were profitable to him. This practice has prevailed a good deal +in America, and was doubtless the source in some measure of the +errors I combated. + + + THE CONTAGIOUSNESS OF PUERPERAL FEVER. + +This Essay was read before a small Association called "The Society +for Medical Improvement," and published in a Medical Journal which +lasted but a single year. It naturally attracted less attention than +it would have done if published in such a periodical as the "American +Journal of Medical Sciences." Still it had its effect, as I have +every reason to believe. I cannot doubt that it has saved the lives +of many young mothers by calling attention to the existence and +propagation of "Puerperal Fever as a Private Pestilence," and laying +down rules for taking the necessary precautions against it. The case +has long been decided in favor of the views I advocated, but, at the +time when I wrote two of the most celebrated professors of Obstetrics +in this country opposed my conclusions with all the weight of their +experience and position. + +This paper was written in a great heat and with passionate +indignation. If I touched it at all I might trim its rhetorical +exuberance, but I prefer to leave it all its original strength of +expression. I could not, if I had tried, have disguised the feelings +with which I regarded the attempt to put out of sight the frightful +facts which I brought forward and the necessary conclusions to which +they led. Of course the whole matter has been looked at in a new +point of view since the microbe as a vehicle of contagion has been +brought into light, and explained the mechanism of that which was +plain enough as a fact to all who were not blind or who did not shut +their eyes. + +O. W. H. + +BEVERLY Farms, Mass., August 3, 1891 + + + + + + +HOMOEOPATHY AND ITS KINDRED DELUSIONS +[Two lectures delivered before the Boston Society for the Diffusion +of Useful Knowledge. 1842.] + + +[When a physician attempts to convince a person, who has fallen into +the Homoeopathic delusion, of the emptiness of its pretensions, he is +often answered by a statement of cases in which its practitioners are +thought to have effected wonderful cures. The main object of the +first of these Lectures is to show, by abundant facts, that such +statements, made by persons unacquainted with the fluctuations of +disease and the fallacies of observation, are to be considered in +general as of little or no value in establishing the truth of a +medical doctrine or the utility of a method of practice. + +Those kind friends who suggest to a person suffering from a tedious +complaint, that he "Had better try Homoeopathy," are apt to enforce +their suggestion by adding, that "at any rate it can do no harm." +This may or may not be true as regards the individual. But it always +does very great harm to the community to encourage ignorance, error, +or deception in a profession which deals with the life and health of +our fellow-creatures. Whether or not those who countenance +Homoeopathy are guilty of this injustice towards others, the second +of these Lectures may afford them some means of determining. + +To deny that good effects may happen from the observance of diet and +regimen when prescribed by Homoeopathists as well as by others, would +be very unfair to them. But to suppose that men with minds so +constituted as to accept such statements and embrace such doctrines +as make up the so-called science of Homoeopathy are more competent +than others to regulate the circumstances which influence the human +body in health and disease, would be judging very harshly the average +capacity of ordinary practitioners. + +To deny that some patients may have been actually benefited through +the influence exerted upon their imaginations, would be to refuse to +Homoeopathy what all are willing to concede to every one of those +numerous modes of practice known to all intelligent persons by an +opprobrious title. + +So long as the body is affected through the mind, no audacious +device, even of the most manifestly dishonest character, can fail of +producing occasional good to those who yield it an implicit or even a +partial faith. The argument founded on this occasional good would be +as applicable in justifying the counterfeiter and giving circulation +to his base coin, on the ground that a spurious dollar had often +relieved a poor man's necessities. + +Homoeopathy has come before our public at a period when the growing +spirit of eclecticism has prepared many ingenious and honest minds to +listen to all new doctrines with a candor liable to degenerate into +weakness. It is not impossible that the pretended evolution of great +and mysterious virtues from infinitely attenuated atoms may have +enticed a few over-refining philosophers, who have slid into a vague +belief that matter subdivided grows less material, and approaches +nearer to a spiritual nature as it requires a more powerful +microscope for its detection. + +However this may be, some persons seem disposed to take the ground of +Menzel that the Laity must pass formal judgment between the Physician +and the Homoeopathist, as it once did between Luther and the +Romanists. The practitioner and the scholar must not, therefore, +smile at the amount of time and labor expended in these Lectures upon +this shadowy system; which, in the calm and serious judgment of many +of the wisest members of the medical profession, is not entitled by +anything it has ever said or done to the notoriety of a public +rebuke, still less to the honors of critical martyrdom.] + + +I + +I have selected four topics for this lecture, the first three of +which I shall touch but slightly, the last more fully. They are + +1. The Royal cure of the King's Evil, or Scrofula. + +2. The Weapon Ointment, and its twin absurdity, the Sympathetic +Powder. + +3. The Tar-water mania of Bishop Berkeley. + +4. The History of the Metallic Tractors, or Perkinism. + +The first two illustrate the ease with which numerous facts are +accumulated to prove the most fanciful and senseless extravagances. + +The third exhibits the entire insufficiency of exalted wisdom, +immaculate honesty, and vast general acquirements to make a good +physician of a great bishop. + +The fourth shows us the intimate machinery of an extinct delusion, +which flourished only forty years ago; drawn in all its details, as +being a rich and comparatively recent illustration of the +pretensions, the arguments, the patronage, by means of which windy +errors have long been, and will long continue to be, swollen into +transient consequence. All display in superfluous abundance the +boundless credulity and excitability of mankind upon subjects +connected with medicine. + +From the time of Edward the Confessor to Queen Anne, the monarchs of +England were in the habit of touching those who were brought to them +suffering with the scrofula, for the cure of that distemper. William +the Third had good sense enough to discontinue the practice, but Anne +resumed it, and, among her other patients, performed the royal +operation upon a child, who, in spite of his, disease, grew up at +last into Samuel Johnson. After laying his hand upon the sufferers, +it was customary for the monarch to hang a gold piece around the neck +of each patient. Very strict precautions were adopted to prevent +those who thought more of the golden angel hung round the neck by a +white ribbon, than of relief of their bodily infirmities, from making +too many calls, as they sometimes attempted to do. According to the +statement of the advocates and contemporaries of this remedy, none +ever failed of receiving benefit unless their little faith and +credulity starved their merits. Some are said to have been cured +immediately on the very touch, others did not so easily get rid of +their swellings, until they were touched a second time. Several +cases are related, of persons who had been blind for several weeks, +and months, and obliged even to be led to Whitehall, yet recovered +their sight immediately upon being touched, so as to walk away +without any guide." So widely, at one period, was the belief +diffused, that, in the course of twelve years, nearly a hundred +thousand persons were touched by Charles the Second. Catholic +divines; in disputes upon the orthodoxy of their church, did not deny +that the power had descended to protestant princes;--Dr. Harpsfield, +in his "Ecclesiastical History of England," admitted it, and in +Wiseman's words, "when Bishop Tooker would make use of this Argument +to prove the Truth of our Church, Smitheus doth not thereupon go +about to deny the Matter of fact; nay, both he and Cope acknowledge +it." "I myself," says Wiseman, the best English surgical writer of +his day,[Edinburgh Medical and Surgical Journal, vol. iii. p. 103.] +--"I my self have been a frequent Eye-witness of many hundred of +Cures performed by his Majesties Touch alone, without any assistance +of Chirurgery; and those, many of them such as had tired out the +endeavours of able Chirurgeons before they came hither. It were +endless to recite what I myself have seen, and what I have received +acknowledgments of by Letter, not only from the severall parts of +this Nation, but also from Ireland, Scotland, Jersey, Garnsey. It is +needless also to remember what Miracles of this nature were performed +by the very Bloud of his late Majesty of Blessed memory, after whose +decollation by the inhuman Barbarity of the Regicides, the reliques +of that were gathered on Chips and in Handkerchieffs by the pious +Devotes, who could not but think so great a suffering in so +honourable and pious a Cause, would be attended by an extraordinary +assistance of God, and some more then ordinary a miracle: nor did +their Faith deceive them in this there point, being so many hundred +that found the benefit of it." [Severall Chirurgicall Treatises. +London.1676. p. 246.] + +Obstinate and incredulous men, as he tells us, accounted for these +cures in three ways: by the journey and change of air the patients +obtained in coming to London; by the influence of imagination; and +the wearing of gold. + +To these objections he answers, 1st. That many of those cured were +inhabitants of the city. 2d. That the subjects of treatment were +frequently infants. 3d. That sometimes silver was given, and +sometimes nothing, yet the patients were cured. + +A superstition resembling this probably exists at the present time in +some ignorant districts of England and this country. A writer in a +Medical Journal in the year 1807, speaks of a farmer in Devonshire, +who, being a ninth son of a ninth son, is thought endowed with +healing powers like those of ancient royalty, and who is accustomed +one day in every week to strike for the evil. + +I remember that one of my schoolmates told me, when a boy, of a +seventh son of a seventh son, somewhere in Essex County, who touched +for the scrofula, and who used to hang a silver fourpence halfpenny +about the neck of those who came to him, which fourpence halfpenny it +was solemnly affirmed became of a remarkably black color after having +been some time worn, and that his own brother had been subjected to +this extraordinary treatment; but I must add that my schoolmate drew +a bow of remarkable length, strength, and toughness for his tender +years. + +One of the most curious examples of the fallacy of popular belief and +the uncertainty of asserted facts in medical experience is to be +found in the history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT. + +Fabricius Hildanus, whose name is familiar to every surgical +scholar, and Lord Bacon, who frequently dipped a little into +medicine, are my principal authorities for the few circumstances I +shall mention regarding it. The Weapon Ointment was a preparation +used for the healing of wounds, but instead of its being applied to +them, the injured part was washed and bandaged, and the weapon with +which the wound was inflicted was carefully anointed with the +unguent. Empirics, ignorant barbers, and men of that sort, are said +to have especially employed it. Still there were not wanting some +among the more respectable members of the medical profession who +supported its claims. The composition of this ointment was +complicated, in the different formulae given by different +authorities; but some substances addressed to the imagination, rather +than the wound or weapon, entered into all. Such were portions of +mummy, of human blood, and of moss from the skull of a thief hung in +chains. + +Hildanus was a wise and learned man, one of the best surgeons of his +time. He was fully aware that a part of the real secret of the +Unguentum Armarium consisted in the washing and bandaging the wound +and then letting it alone. But he could not resist the solemn +assertions respecting its efficacy; he gave way before the outcry of +facts, and therefore, instead of denying all their pretensions, he +admitted and tried to account for them upon supernatural grounds. As +the virtue of those applications, he says, which are made to the +weapon cannot reach the wound, and as they can produce no effect +without contact, it follows, of necessity, that the Devil must have a +hand in the business; and as he is by far the most long headed and +experienced of practitioners, he cannot find this a matter of any +great difficulty. Hildanus himself reports, in detail, the case of a +lady who had received a moderate wound, for which the Unguentum +Armarium was employed without the slightest use. Yet instead of +receiving this flat case of failure as any evidence against the +remedy, he accounts for its not succeeding by the devout character of +the lady, and her freedom from that superstitious and over- +imaginative tendency which the Devil requires in those who are to be +benefited by his devices. + +Lord Bacon speaks of the Weapon Ointment, in his Natural History, as +having in its favor the testimony of men of credit, though, in his +own language, he himself "as yet is not fully inclined to believe +it." His remarks upon the asserted facts respecting it show a +mixture of wise suspicion and partial belief. He does not like the +precise directions given as to the circumstances under which the +animals from which some of the materials were obtained were to be +killed; for he thought it looked like a provision for an excuse in +case of failure, by laying the fault to the omission of some of these +circumstances. But he likes well that "they do not observe the +confecting of the Ointment under any certain constellation; which is +commonly the excuse of magical medicines, when they fail, that they +were not made under a fit figure of heaven." [This was a mistake, +however, since the two recipes given by Hildanus are both very +explicit as to the aspect of the heavens required for different +stages of the process.] "It was pretended that if the offending +weapon could not be had, it would serve the purpose to anoint a +wooden one made like it." "This," says Bacon, "I should doubt to be a +device to keep this strange form of cure in request and use; because +many times you cannot come by the weapon itself." And in closing his +remarks on the statements of the advocates of the ointment, he says, +"Lastly, it will cure a beast as well as a man, which I like best of +all the rest, because it subjecteth the matter to an easy trial." It +is worth remembering, that more than two hundred years ago, when an +absurd and fantastic remedy was asserted to possess wonderful power, +and when sensible persons ascribed its pretended influence to +imagination, it was boldly answered that the cure took place when the +wounded party did not know of the application made to the weapon, and +even when a brute animal was the subject of the experiment, and that +this assertion, as we all know it was, came in such a shape as to +shake the incredulity of the keenest thinker of his time. The very +same assertion has been since repeated in favor of Perkinism, and, +since that, of Homoeopathy. + +The same essential idea as that of the Weapon Ointment reproduced +itself in the still more famous SYMPATHETIC POWDER. This Powder was +said to have the faculty, if applied to the blood-stained garments of +a wounded person, to cure his injuries, even though he were at a +great distance at the time. A friar, returning from the East, +brought the recipe to Europe somewhat before the middle of the +seventeenth century. The Grand Duke of Florence, in which city the +friar was residing, heard of his cures, and tried, but without +success, to obtain his secret. Sir Kenehn Digby, an Englishman well +known to fame, was fortunate enough to do him a favor, which wrought +upon his feelings and induced him to impart to his benefactor the +composition of his extraordinary Powder. This English knight was at +different periods of his life an admiral, a theologian, a critic, a +metaphysician, a politician, and a disciple of Alchemy. As is not +unfrequent with versatile and inflammable people, he caught fire at +the first spark of a new medical discovery, and no sooner got home to +England than he began to spread the conflagration. + +An opportunity soon offered itself to try the powers of the famous +powder. Mr. J. Howell, having been wounded in endeavoring to part +two of his friends who were fighting a duel, submitted himself to a +trial of the Sympathetic Powder. Four days after he received his +wounds, Sir Kenehn dipped one of Mr. Howell's gaiters in a solution +of the Powder, and immediately, it is said, the wounds, which were +very painful, grew easy, although the patient, who was conversing in +a corner of the chamber, had not, the least idea of what was doing +with his garter. He then returned home, leaving his garter in the +hands of Sir Kenelm, who had hung it up to dry, when Mr. Howell sent +his servant in a great hurry to tell him that his wounds were paining +him horribly; the garter was therefore replaced in the solution of +the Powder, "and the patient got well after five or six days of its +continued immersion." + +King James First, his son Charles the First, the Duke of Buckingham, +then prime minister, and all the principal personages of the time, +were cognizant of this fact; and James himself, being curious to know +the secret of this remedy, asked it of Sir Kenelm, who revealed it to +him, and his Majesty had the opportunity of making several trials of +its efficacy, "which all succeeded in a surprising manner." [Dict. +des Sciences Medieales.] + +The king's physician, Dr. Mayerne, was made master of the secret, +which he carried to France and communicated to the Duke of Mayenne, +who performed many cures by means of it, and taught it to his +surgeon, who, after the Duke's death, sold it to many distinguished +persons, by whose agency it soon ceased to be a secret. What was +this wonderful substance which so astonished kings, princes, dukes, +knights, and doctors? Nothing but powdered blue vitriol. But it was +made to undergo several processes that conferred on it extraordinary +virtues. Twice or thrice it was to be dissolved, filtered, and +crystallized. The crystals were to be laid in the sun during the +months of June, July, and August, taking care to turn them carefully +that all should be exposed. Then they were to be powdered, +triturated, and again exposed to the sun, again reduced to a very +fine powder, and secured in a vessel, while hot, from the sunshine. +If there seem anything remarkable in the fact of such astonishing +properties being developed by this process, it must be from our +short-sightedness, for common salt and charcoal develop powers quite +as marvellous after a certain number of thumps, stirs, and shakes, +from the hands of modern workers of miracles. In fact the Unguentum +Armarium and Sympathetic Powder resemble some more recent +prescriptions; the latter consisting in an infinite dilution of the +common dose in which remedies are given, and the two former in an +infinite dilution of the common distance at which they are applied. + +Whether philosophers, and more especially metaphysicians, have any +peculiar tendency to dabble in drugs and dose themselves with physic, +is a question which might suggest itself to the reader of their +biographies. + +When Bishop Berkeley visited the illustrious Malebranche at Paris, he +found him in his cell, cooking in a small pipkin a medicine for an +inflammation of the lungs, from which he was suffering; and the +disease, being unfortunately aggravated by the vehemence of their +discussion, or the contents of the pipkin, carried him off in the +course of a few days. Berkeley himself afforded a remarkable +illustration of a truth which has long been known to the members of +one of the learned professions, namely, that no amount of talent, or +of acquirements in other departments, can rescue from lamentable +folly those who, without something of the requisite preparation, +undertake to experiment with nostrums upon themselves and their +neighbors. The exalted character of Berkeley is thus drawn by Sir +James Mackintosh: Ancient learning, exact science, polished society, +modern literature, and the fine arts, contributed to adorn and enrich +the mind of this accomplished man. All his contemporaries agreed +with the satirist in ascribing + + "'To Berkeley every virtue under heaven.' + +"Even the discerning, fastidious, and turbulent Atterbury said, after +an interview with him, 'So much understanding, so much knowledge, so +much innocence, and such humility, I did not think had been the +portion of any but angels, till I saw this gentleman.'" + +But among the writings of this great and good man is an Essay of the +most curious character, illustrating his weakness upon the point in +question, and entitled, "Siris, a Chain of Philosophical Reflections +and Inquiries concerning the Virtues of TAR WATER, and divers other +Subjects,"--an essay which begins with a recipe for his favorite +fluid, and slides by gentle gradations into an examination of the +sublimest doctrines of Plato. To show how far a man of honesty and +benevolence, and with a mind of singular acuteness and depth, may be +run away with by a favorite notion on a subject which his habits and +education do not fit him to investigate, I shall give a short account +of this Essay, merely stating that as all the supposed virtues of Tar +Water, made public in successive editions of his treatise by so +illustrious an author, have not saved it from neglect and disgrace, +it may be fairly assumed that they were mainly imaginary. + +The bishop, as is usual in such cases, speaks of himself as +indispensably obliged, by the duty he owes to mankind, to make his +experience public. Now this was by no means evident, nor does it +follow in general, that because a man has formed a favorable opinion +of a person or a thing he has not the proper means of thoroughly +understanding, he shall be bound to print it, and thus give currency +to his impressions, which may be erroneous, and therefore injurious. +He would have done much better to have laid his impressions before +some experienced physicians and surgeons, such as Dr. Mead and Mr. +Cheselden, to have asked them to try his experiment over again, and +have been guided by their answers. But the good bishop got excited; +he pleased himself with the thought that he had discovered a great +panacea; and having once tasted the bewitching cup of self-quackery, +like many before and since his time, he was so infatuated with the +draught that he would insist on pouring it down the throats of his +neighbors and all mankind. + +The precious fluid was made by stirring a gallon of water with a +quart of tar, leaving it forty-eight hours, and pouring off the clear +water. Such was the specific which the great metaphysician +recommended for averting and curing all manner of diseases. It was, +if he might be believed, a preventive of the small-pox, and of great +use in the course of the disease. It was a cure for impurities of +the blood, coughs, pleurisy, peripneumony, erysipelas, asthma, +indigestion, carchexia, hysterics, dropsy, mortification, scurvy, and +hypochondria. It was of great use in gout and fevers, and was an +excellent preservative of the teeth and gums; answered all the +purpose of Elixir Proprietatis, Stoughton's drops, diet drinks, and +mineral waters; was particularly to be recommended to sea-faring +persons, ladies, and men of studious and sedentary lives; could never +be taken too long, but, on the contrary, produced advantages which +sometimes did not begin to show themselves for two or three months. + +"From my representing Tar Water as good for so many things," says +Berkeley, "some perhaps may conclude it is good for nothing. But +charity obligeth me to say what I know, and what I think, however it +may be taken. Men may censure and object as they please, but I +appeal to time and experiment. Effects misimputed, cases wrong told, +circumstances overlooked, perhaps, too, prejudices and partialities +against truth, may for a time prevail and keep her at the bottom of +her well, from whence nevertheless she emergeth sooner or later, and +strikes the eyes of all who do not keep them shut." I cannot resist +the temptation of illustrating the bishop's belief in the wonderful +powers of his remedy, by a few sentences from different parts of his +essay. "The hardness of stubbed vulgar constitutions renders them +insensible of a thousand things that fret and gall those delicate +people, who, as if their skin was peeled off, feel to the quick +everything that touches them. The tender nerves and low spirits of +such poor creatures would be much relieved by the use of Tar Water, +which might prolong and cheer their lives." "It [the Tar Water] may +be made stronger for brute beasts, as horses, in whose disorders I +have found it very useful." "This same water will also give +charitable relief to the ladies, who often want it more than the +parish poor; being many of them never able to make a good meal, and +sitting pale, puny, and forbidden, like ghosts, at their own table, +victims of vapors and indigestion." It does not appear among the +virtues of Tar Water that "children cried for it," as for some of our +modern remedies, but the bishop says, "I have known children take it +for above six months together with great benefit, and without any +inconvenience; and after long and repeated experience I do esteem it +a most excellent diet drink, fitted to all seasons and ages." After +mentioning its usefulness in febrile complaints, he says: "I have had +all this confirmed by my own experience in the late sickly season of +the year one thousand seven hundred and forty-one, having had twenty- +five fevers in my own family cured by this medicinal water, drunk +copiously." And to finish these extracts with a most important +suggestion for the improvement of the British nation: "It is much to +be lamented that our Insulars who act and think so much for +themselves, should yet, from grossness of air and diet, grow stupid +or doat sooner than other people, who, by virtue of elastic air, +water-drinking, and light food, preserve their faculties to extreme +old age; an advantage which may perhaps be approached, if not +equaled, even in these regions, by Tar Water, temperance, and early +hours." + +Berkeley died at the age of about seventy; he might have lived +longer, but his fatal illness was so sudden that there was not time +enough to stir up a quart of the panacea. He was an illustrious man, +but he held two very odd opinions; that tar water was everything, and +that the whole material universe was nothing. + + --------------------------- + +Most of those present have at some time in their lives heard mention +made of the METALLIC TRACTORS, invented by one Dr. Perkins, an +American, and formerly enjoying great repute for the cure of various +diseases. Many have seen or heard of a satirical poem, written by +one of our own countrymen also, about forty years since, and called +"Terrible Tractoration." The Metallic Tractors are now so utterly +abandoned that I have only by good fortune fallen upon a single one +of a pair, to show for the sake of illustration. For more than +thirty years this great discovery, which was to banish at least half +the evils which afflict humanity, has been sleeping undisturbed in +the grave of oblivion. Not a voice has, for this long period, been +raised in its favor; its noble and learned patrons, its public +institutions, its eloquent advocates, its brilliant promises are all +covered with the dust of silent neglect; and of the generation which +has sprung up since the period when it flourished, very few know +anything of its history, and hardly even the title which in its palmy +days it bore of PERKINISM. Taking it as settled, then, as no one +appears to answer for it, that Perkinism is entirely dead and gone, +that both in public and private, officially and individually, its +former adherents even allow it to be absolutely defunct, I select it +for anatomical examination. If this pretended discovery was made +public; if it was long kept before the public; if it was addressed to +the people of different countries; if it was formally investigated by +scientific men, and systematically adopted by benevolent persons, who +did everything in their power to diffuse the knowledge and practice +of it; if various collateral motives, such as interest and vanity, +were embarked in its cause; if, notwithstanding all these things, it +gradually sickened and died, then the conclusion seems a fair one, +that it did not deserve to live. Contrasting its failure with its +high pretensions, it is fair to call it an imposition; whether an +expressly fraudulent contrivance or not, some might be ready to +question. Everything historically shown to have happened concerning +the mode of promulgation, the wide diffusion, the apparent success of +this delusion, the respectability and enthusiasm of its advocates, is +of great interest in showing to what extent and by what means a +considerable part of the community may be led into the belief of that +which is to be eventually considered' as an idle folly. If there is +any existing folly, fraudulent or innocent in its origin, which +appeals to certain arguments for its support; provided that the very +same arguments can be shown to have been used for Perkinism with as +good reason, they will at once fall to the ground. Still more, if it +shall appear that the general course of any existing delusion bears a +strong resemblance to that of Perkinism, that the former is most +frequently advocated by the same class of persons who were +conspicuous in behalf of the latter, and treated with contempt or +opposed by the same kind of persons who thus treated Perkinism; if +the facts in favor of both have a similar aspect; if the motives of +their originators and propagators may be presumed to have been +similar; then there is every reason to suppose that the existing +folly will follow in the footsteps of the past, and after displaying +a given amount of cunning and credulity in those deceiving and +deceived, will drop from the public view like a fruit which has +ripened into spontaneous rottenness, and be succeeded by the fresh +bloom of some other delusion required by the same excitable portion +of the community. + +Dr. Elisha Perkins was born at Norwich, Connecticut, in the year +1740. He had practised his profession with a good local reputation +for many years, when he fell upon a course of experiments, as it is +related, which led to his great discovery. He conceived the idea +that metallic substances might have the effect of removing diseases, +if applied in a certain manner; a notion probably suggested by the +then recent experiments of Galvani, in which muscular contractions +were found to be produced by the contact of two metals with the +living fibre. It was in 1796 that his discovery was promulgated in +the shape of the Metallic Tractors, two pieces of metal, one +apparently iron and the other brass, about three inches long, blunt +at one end and pointed at the other. These instruments were applied +for the cure of different complaints, such as rheumatism, local +pains, inflammations, and even tumors, by drawing them over the +affected part very lightly for about twenty minutes. Dr. Perkins +took out a patent for his discovery, and travelled about the country +to diffuse the new practice. He soon found numerous advocates of his +discovery, many of them of high standing and influence. In the year +1798 the tractors had crossed the Atlantic, and were publicly +employed in the Royal Hospital at Copenhagen. About the same time +the son of the inventor, Mr. Benjamin Douglass Perkins, carried them +to London, where they soon attracted attention. The Danish +physicians published an account of their cases, containing numerous +instances of alleged success, in a respectable octavo volume. In the +year 1804 an establishment, honored with the name of the Perkinean +Institution, was founded in London. The transactions of this +institution were published in pamphlets, the Perkinean Society had +public dinners at the Crown and Anchor, and a poet celebrated their +medical triumph in strains like these: + + "See, pointed metals, blest with power t' appease + The ruthless rage of merciless disease, + O'er the frail part a subtle fluid pour, + Drenched with invisible Galvanic shower, + Till the arthritic staff and crutch forego, + And leap exulting like the bounding roe!" + +While all these things were going on, Mr. Benjamin Douglass Perkins +was calmly pocketing money, so that after some half a dozen years he +left the country with more than ten thousand pounds, which had been +paid him by the believers in Great Britain. But in spite of all this +success, and the number of those interested and committed in its +behalf, Perkinism soon began to decline, and in 1811 the Tractors are +spoken of by an intelligent writer as being almost forgotten. Such +was the origin and duration of this doctrine and practice, into the +history of which we will now look a little more narrowly. + +Let us see, then, by whose agency this delusion was established and +kept up; whether it was principally by those who were accustomed to +medical pursuits, or those whose habits and modes of reasoning were +different; whether it was with the approbation of those learned +bodies usually supposed to take an interest in scientific +discoveries, or only of individuals whose claims to distinction were +founded upon their position in society, or political station, or +literary eminence; whether the judicious or excitable classes entered +most deeply into it; whether, in short, the scientific men of that +time were deceived, or only intruded upon, and shouted down for the +moment by persons who had no particular call to invade their +precincts. + +Not much, perhaps, was to be expected of the Medical Profession in +the way of encouragement. One Dr. Fuller, who wrote in England, +himself a Perkinist, thus expressed his opinion: "It must be an +extraordinary exertion of virtue and humanity for a medical man, +whose livelihood depends either on the sale of drugs, or on receiving +a guinea for writing a prescription, which must relate to those +drugs, to say to his patient, 'You had better purchase a set of +Tractors to keep in your family; they will cure you without the +expense of my attendance, or the danger of the common medical +practice.' For very obvious reasons medical men must never be +expected to recommend the use of Perkinism. The Tractors must trust +for their patronage to the enlightened and philanthropic out of the +profession, or to medical men retired from practice, and who know of +no other interest than the luxury of relieving the distressed. And I +do not despair of seeing the day when but very few of this +description as well as private families will be without them." + +Whether the motives assigned by this medical man to his professional +brethren existed or not, it is true that Dr. Perkins did not gain a +great deal at their hands. The Connecticut Medical Society expelled +him in 1797 for violating their law against the use of nostrums, or +secret remedies. The leading English physicians appear to have +looked on with singular apathy or contempt at the miracles which it +was pretended were enacting in the hands of the apostles of the new +practice. In looking over the reviews of the time, I have found +little beyond brief occasional notices of their pretensions; the +columns of these journals being occupied with subjects of more +permanent interest. The state of things in London is best learned, +however, from the satirical poem to which I have already alluded as +having been written at the period referred to. This was entitled, +"Terrible Tractoration!! A Poetical Petition against Galvanizing +Trumpery and the Perkinistic Institution. Most respectfully +addressed to the Royal College of Physicians, by Christopher Caustic, +M. D., LL. D., A. S. S., Fellow of the Royal College of Physicians, +Aberdeen, and Honorary Member of no less than nineteen very learned +Societies." Two editions of this work were published in London in +the years 1803 and 1804, and one or two have been published in this +country. + +"Terrible Tractoration" is supposed, by those who never read it, to +be a satire upon the follies of Perkins and his followers. It is, on +the contrary, a most zealous defence of Perkinism, and a fierce +attack upon its opponents, most especially upon such of the medical +profession as treated the subject with neglect or ridicule. The +Royal College of Physicians was the more peculiar object of the +attack, but with this body, the editors of some of the leading +periodicals, and several physicians distinguished at that time, and +even now remembered for their services to science and humanity, were +involved in unsparing denunciations. The work is by no means of the +simply humorous character it might be supposed, but is overloaded +with notes of the most seriously polemical nature. Much of the +history of the subject, indeed, is to be looked for in this volume. + +It appears from this work that the principal members of the medical +profession, so far from hailing Mr. Benjamin Douglass Perkins as +another Harvey or Jenner, looked very coldly upon him and his +Tractors; and it is now evident that, though they were much abused +for so doing, they knew very well what they had to deal with, and +were altogether in the right. The delusion at last attracted such an +amount of attention as to induce Dr. Haygarth and some others of +respectable standing to institute some experiments which I shall +mention in their proper place, the result of which might have seemed +sufficient to show the emptiness of the whole contrivance. + +The Royal Society, that learned body which for ages has constituted +the best tribunal to which Britain can appeal in questions of +science, accepted Mr. Perkins's Tractors and the book written about +them, passed the customary vote of thanks, and never thought of +troubling itself further in the investigation of pretensions of such +an aspect. It is not to be denied that a considerable number of +physicians did avow themselves advocates of the new practice; but out +of the whole catalogue of those who were publicly proclaimed as such, +no one has ever been known, so far as I am aware, to the scientific +world, except in connection with the short-lived notoriety of +Perkinism. Who were the people, then, to whose activity, influence, +or standing with the community was owing all the temporary excitement +produced by the Metallic Tractors? + +First, those persons who had been induced to purchase a pair of +Tractors. These little bits of brass and iron, the intrinsic value +of which might, perhaps, amount to ninepence, were sold at five +guineas a pair! A man who has paid twenty-five dollars for his +whistle is apt to blow it louder and longer than other people. So it +appeared that when the "Perkinean Society" applied to the possessors +of Tractors in the metropolis to concur in the establishment of a +public institution for the use of these instruments upon the poor, +"it was found that only five out of above a hundred objected to +subscribe, on account of their want of confidence in the efficacy of +the practice; and these," the committee observes, "there is reason to +believe, never gave them a fair trial, probably never used them in +more than one case, and that perhaps a case in which the Tractors had +never been recommended as serviceable." "Purchasers of the +Tractors," said one of their ardent advocates, "would be among the +last to approve of them if they had reason to suppose themselves +defrauded of five guineas." He forgot poor Moses, with his "gross of +green spectacles, with silver rims and shagreen cases." "Dear +mother," cried the boy, "why won't you listen to reason? I had them +a dead bargain, or I should not have bought them. The silver rims +alone will sell for double the money." + +But it is an undeniable fact, that many persons of considerable +standing, and in some instances holding the most elevated positions +in society, openly patronized the new practice. In a translation of +a work entitled "Experiments with the Metallic Tractors," originally +published in Danish, thence rendered successively into German and +English, Mr. Benjamin Perkins, who edited the English edition, has +given a copious enumeration of the distinguished individuals, both in +America and Europe, whose patronage he enjoyed. He goes so far as to +signify that ROYALTY itself was to be included among the number. +When the Perkinean Institution was founded, no less a person than +Lord Rivers was elected President, and eleven other individuals of +distinction, among them Governor Franklin, son of Dr. Franklin, +figured as Vice-Presidents. Lord Henniker, a member of the Royal +Society, who is spoken of as a man of judgment and talents, +condescended to patronize the astonishing discovery, and at different +times bought three pairs of Tractors. When the Tractors were +introduced into Europe, a large number of testimonials accompanied +them from various distinguished characters in America, the list of +whom is given in the translation of the Danish work referred to as +follows: + +"Those who have individually stated cases, or who have presented +their names to the public as men who approved of this remedy, and +acknowledged themselves instrumental in circulating the Tractors, are +fifty-six in number; thirty-four of whom are physicians and surgeons, +and many of them of the first eminence, thirteen clergymen, most of +whom are doctors of divinity, and connected with the literary +institutions of America; among the remainder are two members of +Congress, one professor of natural philosophy in a college, etc., +etc." It seemed to be taken rather hardly by Mr. Perkins that the +translators of the work which he edited, in citing the names of the +advocates of the Metallic Practice, frequently omitted the honorary +titles which should have been annexed. The testimonials were +obtained by the Danish writer, from a pamphlet published in America, +in which these titles were given in full. Thus one of these +testimonials is from "John Tyler, Esq., a magistrate in the county +of New London, and late Brigadier-General of the militia in that +State." The "omission of the General's title" is the subject of +complaint, as if this title were sufficient evidence of the +commanding powers of one of the patrons of tractoration. A similar +complaint is made when "Calvin Goddard, Esq., of Plainfield, Attorney +at Law, and a member of the Legislature of the State of Connecticut," +is mentioned without his titular honors, and even on account of the +omission of the proper official titles belonging to "Nathan Pierce, +Esq., Governor and Manager of the Almshouse of Newburyport." These +instances show the great importance to be attached to civil and +military dignities, in qualifying their holders to judge of +scientific subjects, a truth which has not been overlooked by the +legitimate successors of the Perkinists. In Great Britain, the +Tractors were not less honored than in America, by the learned and +the illustrious. The "Perkinistic Committee" made this statement in +their report: "Mr. Perkins has annually laid before the public a +large collection of new cases communicated to him for that purpose by +disinterested and intelligent characters, from almost every quarter +of Great Britain. In regard to the competency of these vouchers, it +will be sufficient simply to state that, amongst others whose names +have been attached to their communications, are eight professors, in +four different universities, twenty-one regular Physicians, nineteen +Surgeons, thirty Clergymen, twelve of whom are Doctors of Divinity, +and numerous other characters of equal respectability." + +It cannot but excite our notice and surprise that the number of +clergymen both in America and Great Britain who thrust forward their +evidence on this medical topic was singularly large in proportion to +that of the members of the medical profession. Whole pages are +contributed by such worthies as the Rev. Dr. Trotter of Hans Place, +the Rear. Waring Willett, Chaplain to the Earl of Dunmore, the Rev. +Dr. Clarke, Chaplain to the Prince of Wales. The style of these +theologico-medical communications may be seen in the following from a +divine who was also professor in one of the colleges of New England. +"I have used the Tractors with success in several other cases in my +own family, and although, like Naaman the Syrian, I cannot tell why +the waters of Jordan should be better than Abana and Pharpar, rivers +of Damascus; yet since experience has proved them so, no reasoning +can change the opinion. Indeed, the causes of all common facts are, +we think, perfectly well known to us; and it is very probable, fifty +or a hundred years hence, we shall as well know why the Metallic +Tractors should in a few minutes remove violent pains, as we now know +why cantharides and opium will produce opposite effects, namely, we +shall know very little about either excepting facts." Fifty or a +hundred years hence! if he could have looked forward forty years, he +would have seen the descendants of the "Perkinistic" philosophers +swallowing infinitesimal globules, and knowing and caring as much +about the Tractors as the people at Saratoga Springs do about the +waters of Abana and Pharpar. + +I trust it will not be thought in any degree disrespectful to a +profession which we all honor, that I have mentioned the great zeal +of many clergymen in the cause of Perkinism. I hope, too, that I may +without offence suggest the causes which have often led them out of +their own province into one to which their education has no special +reference. The members of that profession ought to be, and commonly +are, persons of benevolent character. Their duties carry them into +the midst of families, and particularly at times when the members of +them are suffering from bodily illness. It is natural enough that a +strong desire should be excited to alleviate sufferings which may +have defied the efforts of professional skill; as natural that any +remedy which recommends itself to the belief or the fancy of the +spiritual physician should be applied with the hope of benefit; and +perfectly certain that the weakness of human nature, from which no +profession is exempt, will lead him to take the most flattering view +of its effects upon the patient; his own sagacity and judgment being +staked upon the success of the trial. The inventor of the Tractors +was aware of these truths. He therefore sent the Tractors +gratuitously to many clergymen, accompanied with a formal certificate +that the holder had become entitled to their possession by the +payment of five guineas. This was practised in our own neighborhood, +and I remember finding one of these certificates, so presented, which +proved that amongst the risks of infancy I had to encounter Perkins's +Tractors. Two clergymen of Boston and the vicinity, both well known +to local fame, gave in their testimony to the value of the +instruments thus presented to them; an unusually moderate proportion, +when it is remembered that to the common motives of which I have +spoken was added the seduction of a gift for which the profane public +was expected to pay so largely. + +It was remarkable, also, that Perkinism, which had so little success +with the medical and scientific part of the community, found great +favor in the eyes of its more lovely and less obstinate portion. +"The lady of Major Oxholin,"--I quote from Mr. Perkins's volume,-- +"having been lately in America, had seen and heard much of the great +effects of Perkinism. Influenced by a most benevolent disposition, +she brought these Tractors and the pamphlet with her to Europe, with +a laudable desire of extending their utility to her suffering +countrymen." Such was the channel by which the Tractors were +conveyed to Denmark, where they soon became the ruling passion. +The workmen, says a French writer, could not manufacture them fast +enough. Women carried them about their persons, and delighted in +bringing them into general use. To what extent the Tractors were +favored with the patronage of English and American ladies, it is of +course not easy to say, except on general principles, as their names +were not brought before the public. But one of Dr. Haygarth's +stories may lead us to conjecture that there was a class of female +practitioners who went about doing good with the Tractors in England +as well as in Denmark. A certain lady had the misfortune to have a +spot as big as a silver penny at the corner of her eye, caused by a +bruise, or some such injury. Another lady, who was a friend of hers, +and a strong believer in Perkinism, was very anxious to try the +effects of tractoration upon this unfortunate blemish. The patient +consented; the lady "produced the instruments, and, after drawing +them four or five times over the spot, declared that it changed to a +paler color, and on repeating the use of them a few minutes longer, +that it had almost vanished, and was scarcely visible, and departed +in high triumph at her success." The lady who underwent the +operation assured the narrator "that she looked in the glass +immediately after, and that not the least visible alteration had +taken place." + +It would be a very interesting question, what was the intellectual +character of those persons most conspicuous in behalf of the +Perkinistic delusion? Such an inquiry might bring to light some +principles which we could hereafter apply to the study of other +popular errors. But the obscurity into which nearly all these +enthusiasts have subsided renders the question easier to ask than to +answer. I believe it would have been found that most of these +persons were of ardent temperament and of considerable imagination, +and that their history would show that Perkinism was not the first +nor the last hobby-horse they rode furiously. Many of them may very +probably have been persons of more than common talent, of active and +ingenious minds, of versatile powers and various acquirements. Such, +for instance, was the estimable man to whom I have repeatedly +referred as a warm defender of tractoration, and a bitter assailant +of its enemies. The story tells itself in the biographical preface +to his poem. He went to London with the view of introducing a +hydraulic machine, which he and his Vermont friends regarded as a +very important invention. He found, however, that the machine was +already in common use in that metropolis. A brother Yankee, then in +London, had started the project of a mill, which was to be carried by +the water of the Thames. He was sanguine enough to purchase one +fifth of this concern, which also proved a failure. At about the +same period he wrote the work which proved the great excitement of +his mind upon the subject of the transient folly then before the +public. Originally a lawyer, he was in succession a mechanician, a +poet, and an editor, meeting with far less success in each of these +departments than usually attends men of less varied gifts, but of +more tranquil and phlegmatic composition. But who is ignorant that +there is a class of minds characterized by qualities like those I +have mentioned; minds with many bright and even beautiful traits; but +aimless and fickle as the butterfly; that settle upon every gayly- +colored illusion as it opens into flower, and flutter away to another +when the first has dropped its leaves, and stands naked in the icy +air of truth! + +Let us now look at the general tenor of the arguments addressed by +believers to sceptics and opponents. Foremost of all, emblazoned at +the head of every column, loudest shouted by every triumphant +disputant, held up as paramount to all other considerations, +stretched like an impenetrable shield to protect the weakest advocate +of the great cause against the weapons of the adversary, was that +omnipotent monosyllable which has been the patrimony of cheats and +the currency of dupes from time immemorial,--Facts! Facts! Facts! +First came the published cases of the American clergymen, brigadier- +generals, almshouse governors, representatives, attorneys, and +esquires. Then came the published cases of the surgeons of +Copenhagen. Then followed reports of about one hundred and fifty +cases published in England, "demonstrating the efficacy of the +metallic practice in a variety of complaints both upon the human body +and on horses, etc." But the progress of facts in Great Britain did +not stop here. Let those who rely upon the numbers of their +testimonials, as being alone sufficient to prove the soundness and +stability of a medical novelty, digest the following from the report +of the Perkinistic Committee. "The cases published [in Great +Britain] amounted, in March last, the date of Mr. Perkins's last +publication, to about five thousand. Supposing that not more than +one cure in three hundred which the Tractors have performed has been +published, and the proportion is probably much greater, it will be +seen that the number, to March last, will have exceeded one million +five hundred thousand!" + +Next in order after the appeal to what were called facts, came a +series of arguments, which have been so long bruised and battered +round in the cause of every doctrine or pretension, new, monstrous, +or deliriously impossible, that each of them is as odiously familiar +to the scientific scholar as the faces of so many old acquaintances, +among the less reputable classes, to the officers of police. + +No doubt many of my hearers will recognize, in the following +passages, arguments they may have heard brought forward with +triumphant confidence in behalf of some doctrine not yet extinct. No +doubt some may have honestly thought they proved something; may have +used them with the purpose of convincing their friends, or of +silencing the opponents of their favorite doctrine, whatever that +might be. But any train of arguments which was contrived for +Perkinism, which was just as applicable to it as to any other new +doctrine in the same branch of science, and which was fully employed +against its adversaries forty years since, might, in common charity, +be suffered to slumber in the grave of Perkinism. Whether or not the +following sentences, taken literally from the work of Mr. Perkins, +were the originals of some of the idle propositions we hear bandied +about from time to time, let those who listen judge. + +The following is the test assumed for the new practice: "If diseases +are really removed, as those persons who have practised extensively +with the Tractors declare, it should seem there would be but little +doubt of their being generally adopted; but if the numerous reports +of their efficacy which have been published are forgeries, or are +unfounded, the practice ought to be crushed." To this I merely add, +it has been crushed. + +The following sentence applies to that a priori judging and uncandid +class of individuals who buy their dinners without tasting all the +food there is in the market. "On all discoveries there are persons +who, without descending to any inquiry into the truth, pretend to +know, as it were by intuition, that newly asserted facts are founded +in the grossest errors. These were those who knew that Harvey's +report of the circulation of the blood was a preposterous and +ridiculous suggestion, and in latter later days there were others who +knew that Franklin deserved reproach for declaring that points were +preferable to balls for protecting buildings from lightning." + +Again: "This unwarrantable mode of offering assertion for proof, so +unauthorized and even unprecedented except in the condemnation of a +Galileo, the persecution of a Copernicus, and a few other acts of +inquisitorial authority, in the times of ignorance and superstition, +affords but a lamentable instance of one of his remarks, that this is +far from being the Age of Reason." + +"The most valuable medicines in the Materia Medica act on principles +of which we are totally ignorant. None have ever yet been able to +explain how opium produces sleep, or how bark cures intermittent +fevers; and yet few, it is hoped, will be so absurd as to desist from +the use of these important articles because they know nothing of the +principle of their operations." Or if the argument is preferred, in +the eloquent language of the Perkinistic poet: + + "What though the CAUSES may not be explained, + Since these EFFECTS are duly ascertained, + Let not self-interest, prejudice, or pride, + Induce mankind to set the means aside; + Means which, though simple, are by + Heaven designed to alleviate the woes of human kind." + +This course of argument is so often employed, that it deserves to be +expanded a little, so that its length and breadth may be fairly seen. +A series of what are called facts is brought forward to prove some +very improbable doctrine. It is objected by judicious people, or +such as have devoted themselves to analogous subjects, that these +assumed facts are in direct opposition to all that is known of the +course of nature, that the universal experience of the past affords a +powerful presumption against their truth, and that in proportion to +the gravity of these objections, should be the number and competence +of the witnesses. The answer is a ready one. What do we know of the +mysteries of Nature? Do we understand the intricate machinery of the +Universe? When to this is added the never-failing quotation, + + "There are more things in heaven and earth, Horatio, + Than are dreamt of in your philosophy,"-- + +the question is thought to be finally disposed of. + +Take the case of astrology as an example. It is in itself strange +and incredible that the relations of the heavenly bodies to each +other at a given moment of time, perhaps half a century ago, should +have anything to do with my success or misfortune in any undertaking +of to-day. But what right have I to say it cannot be so? Can I bind +the sweet influences of Pleiades, or loose the bands of Orion? I do +not know by what mighty magic the planets roll in their fluid paths, +confined to circles as unchanging as if they were rings of steel, nor +why the great wave of ocean follows in a sleepless round upon the +skirts of moonlight; nor cam I say from any certain knowledge that +the phases of the heavenly bodies, or even the falling of the leaves +of the forest, or the manner in which the sands lie upon the sea- +shore, may not be knit up by invisible threads with the web of human +destiny. There is a class of minds much more ready to believe that +which is at first sight incredible, and because it is incredible, +than what is generally thought reasonable. Credo quia impossibile +est,--"I believe, because it is impossible,"--is an old paradoxical +expression which might be literally applied to this tribe of persons. +And they always succeed in finding something marvellous, to call out +the exercise of their robust faith. The old Cabalistic teachers +maintained that there was not a verse, line, word, or even letter in +the Bible which had not a special efficacy either to defend the +person who rightly employed it, or to injure his enemies; always +provided the original Hebrew was made use of. In the hands of modern +Cabalists every substance, no matter how inert, acquires wonderful +medicinal virtues, provided it be used in a proper state of purity +and subdivision. + +I have already mentioned the motives attributed by the Perkinists to +the Medical Profession, as preventing its members from receiving the +new but unwelcome truths. This accusation is repeated in different +forms and places, as, for instance, in the following passage: +"Will the medical man who has spent much money and labor in the +pursuit of the arcana of Physic, and on the exercise of which depends +his support in life, proclaim the inefficacy of his art, and +recommend a remedy to his patient which the most unlettered in +society can employ as advantageously as himself? and a remedy, too, +which, unlike the drops, the pills, the powders, etc., of the Materia +Medica, is inconsumable, and ever in readiness to be employed in +successive diseases?" + +As usual with these people, much indignation was expressed at any +parallel between their particular doctrine and practice and those of +their exploded predecessors. "The motives," says the disinterested +Mr. Perkins, "which must have impelled to this attempt at classing +the METALLIC PRACTICE with the most paltry of empyrical projects, are +but too thinly veiled to escape detection." + +To all these arguments was added, as a matter of course, an appeal to +the feelings of the benevolent in behalf of suffering humanity, in +the shape of a notice that the poor would be treated gratis. It is +pretty well understood that this gratuitous treatment of the poor +does not necessarily imply an excess of benevolence, any more than +the gratuitous distribution of a trader's shop-bills is an evidence +of remarkable generosity; in short, that it is one of those things +which honest men often do from the best motives, but which rogues and +impostors never fail to announce as one of their special +recommendations. It is astonishing to see how these things brighten +up at the touch of Mr. Perkins's poet: + + "Ye worthy, honored, philanthropic few, + The muse shall weave her brightest wreaths for you, + Who in Humanity's bland cause unite, + Nor heed the shaft by interest aimed or spite; + Like the great Pattern of Benevolence, + Hygeia's blessings to the poor dispense; + And though opposed by folly's servile brood, + ENJOY THE LUXURY OF DOING GOOD." + +Having thus sketched the history of Perkinism in its days of +prosperity; having seen how it sprung into being, and by what means +it maintained its influence, it only remains to tell the brief story +of its discomfiture and final downfall. The vast majority of the +sensible part of the medical profession were contented, so far as we +can judge, to let it die out of itself. It was in vain that the +advocates of this invaluable discovery exclaimed over their perverse +and interested obstinacy,--in vain that they called up the injured +ghosts of Harvey, Galileo, and Copernicus to shame that unbelieving +generation; the Baillies and the Heberdens,--men whose names have +come down to us as synonymous with honor and wisdom,--bore their +reproaches in meek silence, and left them unanswered to their fate. +There were some others, however, who, believing the public to labor +under a delusion, thought it worth while to see whether the charm +would be broken by an open trial of its virtue, as compared with that +of some less hallowed formula. It must be remembered that a peculiar +value was attached to the Metallic Tractors, as made and patented by +Mr. Perkins. Dr. Haygarth, of Bath, performed various experiments +upon patients afflicted with different complaints,--the patients +supposing that the real five-guinea Tractors were employed. Strange +to relate, he obtained equally wonderful effects with Tractors of +lead and of wood; with nails, pieces of bone, slate pencil, and +tobacco-pipe. Dr. Alderson employed sham Tractors made of wood, and +produced such effects upon five patients that they returned solemn +thanks in church for their cures. A single specimen of these cases +may stand for all of them. Ann Hill had suffered for some months +from pain in the right arm and shoulder. The Tractors (wooden ones) +were applied, and in the space of five minutes she expressed herself +relieved in the following apostrophe: "Bless me! why, who could have +thought it, that them little things could pull the pain from one. +Well, to be sure, the longer one lives, the more one sees; ah, dear!" + +These experiments did not result in the immediate extinction of +Perkinism. Doubtless they were a great comfort to many obstinate +unbelievers, and helped to settle some sceptical minds; but for the +real Perkinistic enthusiasts, it may be questioned whether they would +at that time have changed their opinion though one had risen from the +dead to assure them that it was an error. It perished without +violence, by an easy and natural process. Like the famous toy of +Mongolfier, it rose by means of heated air,--the fevered breath of +enthusiastic ignorance,--and when this grew cool, as it always does +in a little while, it collapsed and fell. + +And now, on reviewing the whole subject, how shall we account for the +extraordinary prevalence of the belief in Perkinism among a portion +of what is supposed to be the thinking part of the community? + +Could the cures have been real ones, produced by the principle of +ANIMAL MAGNETISM? To this it may be answered that the Perkinists +ridiculed the idea of approximating Mesmer and the founder of their +own doctrine, that nothing like the somnambulic condition seems to +have followed the use of the Tractors, and that neither the exertion +of the will nor the powers of the individual who operated seem to +have been considered of any consequence. Besides, the absolute +neglect into which the Tractors soon declined is good evidence that +they were incapable of affording any considerable and permanent +relief in the complaints for the cure of which they were applied. + +Of course a large number of apparent cures were due solely to nature; +which is true under every form of treatment, orthodox or empirical. +Of course many persons experienced at least temporary relief from the +strong impression made upon their minds by this novel and marvellous +method of treatment. + +Many, again, influenced by the sanguine hopes of those about them, +like dying people, who often say sincerely, from day to day, that +they are getting better, cheated themselves into a false and short- +lived belief that they were cured; and as happens in such cases, the +public never knew more than the first half of the story. + +When it was said to the Perkinists, that whatever effects they +produced were merely through the imagination, they declared (like the +advocates of the ROYAL TOUCH and the UNGUENTUM ARMARIUM) that this +explanation was sufficiently disproved by the fact of numerous and +successful cures which had been witnessed in infants and brute +animals. Dr. Haygarth replied to this, that "in these cases it is +not the Patient, but the Observer, who is deceived by his own +imagination," and that such may be the fact, we have seen in the case +of the good lady who thought she had conjured away the spot from her +friend's countenance, when it remained just as before. + +As to the motives of the inventor and vender of the Tractors, the +facts must be allowed to speak for themselves. But when two little +bits of brass and iron are patented, as an invention, as the result +of numerous experiments, when people are led, or even allowed, to +infer that they are a peculiar compound, when they are artfully +associated with a new and brilliant discovery (which then happened to +be Galvanism), when they are sold at many hundred times their value, +and the seller prints his opinion that a Hospital will suffer +inconvenience, "unless it possesses many sets of the Tractors, and +these placed in the hands of the patients to practise on each other," +one cannot but suspect that they were contrived in the neighborhood +of a wooden nutmeg factory; that legs of ham in that region are not +made of the best mahogany; and that such as buy their cucumber seed +in that vicinity have to wait for the fruit as long as the Indians +for their crop of gunpowder. + + + --------------------------- + +The succeeding lecture will be devoted to an examination of the +doctrines of Samuel Hahnemann and his disciples; doctrines which some +consider new and others old; the common title of which is variously +known as Ho-moeopathy, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy, +and the claims of which are considered by some as infinitely +important, and by many as immeasurably ridiculous. + +I wish to state, for the sake of any who may be interested in the +subject, that I shall treat it, not by ridicule, but by argument; +perhaps with great freedom, but with good temper and in peaceable +language; with very little hope of reclaiming converts, with no +desire of making enemies, but with a firm belief that its pretensions +and assertions cannot stand before a single hour of calm +investigation. + + + + +II. + +It may be thought that a direct attack upon the pretensions of +HOMOEOPATHY is an uncalled-for aggression upon an unoffending +doctrine and its peaceful advocates. + +But a little inquiry will show that it has long assumed so hostile a +position with respect to the Medical Profession, that any trouble I, +or any other member of that profession, may choose to bestow upon it +may be considered merely as a matter of self-defence. It began with +an attempt to show the insignificance of all existing medical +knowledge. It not only laid claim to wonderful powers of its own, +but it declared the common practice to be attended with the most +positively injurious effects, that by it acute diseases are +aggravated, and chronic diseases rendered incurable. It has at +various times brought forward collections of figures having the air +of statistical documents, pretending to show a great proportional +mortality among the patients of the Medical Profession, as compared +with those treated according to its own rules. Not contented with +choosing a name of classical origin for itself, it invented one for +the whole community of innocent physicians, assuring them, to their +great surprise, that they were all ALLOPATHISTS, whether they knew it +or not, and including all the illustrious masters of the past, from +Hippocrates down to Hunter, under the same gratuitous title. The +line, then, has been drawn by the champions of the new doctrine; they +have lifted the lance, they have sounded the charge, and are +responsible for any little skirmishing which may happen. + +But, independently of any such grounds of active resistance, the +subject involves interests so disproportioned to its intrinsic +claims, that it is no more than an act of humanity to give it a +public examination. If the new doctrine is not truth, it is a +dangerous, a deadly error. If it is a mere illusion, and acquires +the same degree of influence that we have often seen obtained by +other illusions, there is not one of my audience who may not have +occasion to deplore the fatal credulity which listened to its +promises. + +I shall therefore undertake a sober examination of its principles, +its facts, and some points of its history. The limited time at my +disposal requires me to condense as much as possible what I have to +say, but I shall endeavor to be plain and direct in expressing it. +Not one statement shall be made which cannot be supported by +unimpeachable reference: not one word shall be uttered which I am not +as willing to print as to speak. I have no quibbles to utter, and I +shall stoop to answer none; but, with full faith in the sufficiency +of a plain statement of facts and reasons, I submit the subject to +the discernment of my audience. + + +The question may be asked in the outset,--Have you submitted the +doctrines you are professing to examine to the test of long-repeated +and careful experiment; have you tried to see whether they were true +or not? To this I answer, that it is abundantly evident, from what +has often happened, that it would be of no manner of use for me to +allege the results of any experiments I might have instituted. Again +and again have the most explicit statements been made by the most +competent persons of the utter failure of all their trials, and there +were the same abundant explanations offered as used to be for the +Unguentum Armarium arid the Metallic Tractors. I could by no +possibility perform any experiments the result of which could not be +easily explained away so as to be of no conclusive significance. +Besides, as arguments in favor of Homoeopathy are constantly +addressed to the public in journals, pamphlets, and even lectures, by +inexperienced dilettanti, the same channel must be open to all its +opponents. + +It is necessary, for the sake of those to whom the whole subject may +be new, to give in the smallest possible compass the substance of the +Homoeopathic Doctrine. Samuel Hahnemann, its founder, is a German +physician, now living in Paris, [Hahnemann died in 1843.] at the age +of eighty-seven years. In 1796 he published the first paper +containing his peculiar notions; in 1805 his first work on the +subject; in 1810 his somewhat famous "Organon of the Healing Art;" +the next year what he called the "Pure Materia Medica;" and in 1828 +his last work, the "Treatise on Chronic Diseases." He has therefore +been writing at intervals on his favorite subject for nearly half a +century. + +The one great doctrine which constitutes the basis of Homoeopathy as +a system is expressed by the Latin aphorism, + + "SIMILIA SIBILIBUS CURANTUR," + +or like cures like, that is, diseases are cured by agents capable of +producing symptoms resembling those found in the disease under +treatment. A disease for Hahnemann consists essentially in a group +of symptoms. The proper medicine for any disease is the one which is +capable of producing a similar group of symptoms when given to a +healthy person. + +It is of course necessary to know what are the trains of symptoms +excited by different substances, when administered to persons in +health, if any such can be shown to exist. Hahnemann and his +disciples give catalogues of the symptoms which they affirm were +produced upon themselves or others by a large number of drugs which +they submitted to experiment. + +The second great fact which Hahnemann professes to have established +is the efficacy of medicinal substances reduced to a wonderful degree +of minuteness or dilution. The following account of his mode of +preparing his medicines is from his work on Chronic Diseases, which +has not, I believe, yet been translated into English. A grain of the +substance, if it is solid, a drop if it is liquid, is to be added to +about a third part of one hundred grains of sugar of milk in an +unglazed porcelain capsule which has had the polish removed from the +lower part of its cavity by rubbing it with wet sand; they are to be +mingled for an instant with a bone or horn spatula, and then rubbed +together for six minutes; then the mass is to be scraped together +from the mortar and pestle, which is to take four minutes; then to be +again rubbed for six minutes. Four minutes are then to be devoted to +scraping the powder into a heap, and the second third of the hundred +grains of sugar of milk to be added. Then they are to be stirred an +instant and rubbed six minutes,--again to be scraped together four +minutes and forcibly rubbed six; once more scraped together for four +minutes, when the last third of the hundred grains of sugar of milk +is to be added and mingled by stirring with the spatula; six minutes +of forcible rubbing, four of scraping together, and six more +(positively the last six) of rubbing, finish this part of the +process. + +Every grain of this powder contains the hundredth of a grain of the +medicinal substance mingled with the sugar of milk. If, therefore, a +grain of the powder just prepared is mingled with another hundred +grains of sugar of milk, and the process just described repeated, we +shall have a powder of which every grain contains the hundredth of +the hundredth, or the ten thousandth part of a grain of the medicinal +substance. Repeat the same process with the same quantity of fresh +sugar of milk, and every grain of your powder will contain the +millionth of a grain of the medicinal substance. When the powder is +of this strength, it is ready to employ in the further solutions and +dilutions to be made use of in practice. + +A grain of the powder is to be taken, a hundred drops of alcohol are +to be poured on it, the vial is to be slowly turned for a few +minutes, until the powder is dissolved, and two shakes are to be +given to it. On this point I will quote Hahnemann's own words. +"A long experience and multiplied observations upon the sick lead me +within the last few years to prefer giving only two shakes to +medicinal liquids, whereas I formerly used to give ten." The process +of dilution is carried on in the same way as the attenuation of the +powder was done; each successive dilution with alcohol reducing the +medicine to a hundredth part of the quantity of that which preceded +it. In this way the dilution of the original millionth of a grain of +medicine contained in the grain of powder operated on is carried +successively to the billionth, trillionth, quadrillionth, +quintillionth, and very often much higher fractional divisions. A +dose of any of these medicines is a minute fraction of a drop, +obtained by moistening with them one or more little globules of +sugar, of which Hahnemann says it takes about two hundred to weigh a +grain. + +As an instance of the strength of the medicines prescribed by +Hahnemann, I will mention carbonate of lime. He does not employ +common chalk, but prefers a little portion of the friable part of an +oystershell. Of this substance, carried to the sextillionth degree, +so much as one or two globules of the size mentioned can convey is a +common dose. But for persons of very delicate nerves it is proper +that the dilution should be carried to the decillionth degree. That +is, an important medicinal effect is to be expected from the two +hundredth or hundredth part of the millionth of the millionth of the +millionth of the millionth of the millionth of the millionth of the +millionth of the millionth of the millionth of the millionth of a +grain of oyster-shell. This is only the tenth degree of potency, but +some of his disciples profess to have obtained palpable effects from +"much higher dilutions." + +The third great doctrine of Hahnemann is the following. Seven +eighths at least of all chronic diseases are produced by the +existence in the system of that infectious disorder known in the +language of science by the appellation of PSORA, but to the less +refined portion of the community by the name of ITCH. In the words +of Hahnemann's "Organon," "This Psora is the sole true and +fundamental cause that produces all the other countless forms of +disease, which, under the names of nervous debility, hysteria, +hypochondriasis, insanity, melancholy, idiocy, madness, epilepsy, and +spasms of all kinds, softening of the bones, or rickets, scoliosis +and cyphosis, caries, cancer, fungua haematodes, gout,--yellow +jaundice and cyanosis, dropsy,--" + +["The degrees of DILUTION must not be confounded with those of +POTENCY. Their relations may be seen by this table: + +lst dilution,--One hundredth of a drop or grain. + +2d " One ten thousandth. + +3d " One millionth, marked I. + +4th " One hundred millionth. + +5th " One ten thousand millionth. + +6th " One million millionth, or one billionth, marked II. + +7th " One hundred billionth. + +8th " One ten thousand billionth. + +9th " One million billionth, or one trillionth, marked III. + +10th " One hundred trillionth. + +11th " One ten thousand trillionth. + +12th " One million trillionth, or one quadrillionth, marked + IV.,--and so on indefinitely. + + +The large figures denote the degrees of POTENCY.] + + +"gastralgia, epistaxis, haemoptysis,--asthma and suppuration of the +lungs,--megrim, deafness, cataract and amaurosis,--paralysis, loss of +sense, pains of every kind, etc., appear in our pathology as so many +peculiar, distinct, and independent diseases." + +For the last three centuries, if the same authority may be trusted, +under the influence of the more refined personal habits which have +prevailed, and the application of various external remedies which +repel the affection from the skin; Psora has revealed itself in these +numerous forms of internal disease, instead of appearing, as in +former periods, under the aspect of an external malady. + +These are the three cardinal doctrines of Hahnemann, as laid down in +those standard works of Homoeopathy, the "Organon" and the "Treatise +on Chronic Diseases." + +Several other principles may be added, upon all of which he insists +with great force, and which are very generally received by his +disciples. + +1. Very little power is allowed to the curative efforts of nature. +Hahnemann goes so far as to say that no one has ever seen the simple +efforts of nature effect the durable recovery of a patient from a +chronic disease. In general, the Homoeopathist calls every recovery +which happens under his treatment a cure. + +2. Every medicinal substance must be administered in a state of the +most perfect purity, and uncombined with any other. The union of +several remedies in a single prescription destroys its utility, and, +according to the "Organon," frequently adds a new disease. + +3. A large number of substances commonly thought to be inert develop +great medicinal powers when prepared in the manner already described; +and a great proportion of them are ascertained to have specific +antidotes in case their excessive effects require to be neutralized. + +4. Diseases should be recognized, as far as possible, not by any of +the common names imposed upon them, as fever or epilepsy, but as +individual collections of symptoms, each of which differs from every +other collection. + +5. The symptoms of any complaint must be described with the most +minute exactness, and so far as possible in the patient's own words. +To illustrate the kind of circumstances the patient is expected to +record, I will mention one or two from the 313th page of the +"Treatise on Chronic Diseases,"--being the first one at which I +opened accidentally. + +"After dinner, disposition to sleep; the patient winks." + +"After dinner, prostration and feeling of weakness (nine days after +taking the remedy)." + +This remedy was that same oyster-shell which is to be prescribed +"fractions of the sextillionth or decillionth degree." According to +Hahnemann, the action of a single dose of the size mentioned does not +fully display itself in some cases until twenty-four or even thirty +days after it is taken, and in such instances has not exhausted its +good effects until towards the fortieth or fiftieth day,--before +which time it would be absurd and injurious to administer a new +remedy. + +So much for the doctrines of Hahnemann, which have been stated +without comment, or exaggeration of any of their features, very much +as any adherent of his opinions might have stated them, if obliged to +compress them into so narrow a space. + +Does Hahnemann himself represent Homoeopathy as it now exists? He +certainly ought to be its best representative, after having created +it, and devoted his life to it for half a century. He is spoken of +as the great physician of the time, in most, if not all Homoeopathic +works. If he is not authority on the subject of his own doctrines, +who is? So far as I am aware, not one tangible discovery in the +so-called science has ever been ascribed to any other observer; at +least, no general principle or law, of consequence enough to claim +any prominence in Homoeopathic works, has ever been pretended to have +originated with any of his illustrious disciples. He is one of the +only two Homoeopathic writers with whom, as I shall mention, the +Paris publisher will have anything to do upon his own account. The +other is Jahr, whose Manual is little more than a catalogue of +symptoms and remedies. If any persons choose to reject Hahnemann as +not in the main representing Homoeopathy, if they strike at his +authority, if they wink out of sight his deliberate and formally +announced results, it is an act of suicidal rashness; for upon his +sagacity and powers of observation, and experience, as embodied in +his works, and especially in his Materia Medica, repose the +foundations of Homoeopathy as a practical system. + +So far as I can learn from the conflicting statements made upon the +subject, the following is the present condition of belief. + +1. All of any note agree that the law Similia similibus is the only +fundamental principle in medicine. Of course if any man does not +agree to this the name Homoeopathist can no longer be applied to him +with propriety. + +2. The belief in and employment of the infinitesimal doses is +general, and in some places universal, among the advocates of +Homoeopathy; but a distinct movement has been made in Germany to get +rid of any restriction to the use of these doses, and to employ +medicines with the same license as other practitioners. + +3. The doctrine of the origin of most chronic diseases in Psora, +notwithstanding Hahnemann says it cost him twelve years of study and +research to establish the fact and its practical consequences, has +met with great neglect and even opposition from very many of his own +disciples. + +It is true, notwithstanding, that, throughout most of their writings +which I have seen, there runs a prevailing tone of great deference to +Hahnemann's opinions, a constant reference to his authority, a +general agreement with the minor points of his belief, and a pretence +of harmonious union in a common faith. [Those who will take the +trouble to look over Hull's Translation of Jahr's Manual may observe +how little comparative space is given to remedies resting upon any +other authority than that of Hahnemann.] + +Many persons, and most physicians and scientific men, would be +satisfied with the statement of these doctrines, and examine them no +further. They would consider it vastly more probable that any +observer in so fallacious and difficult a field of inquiry as +medicine had been led into error, or walked into it of his own +accord, than that such numerous and extraordinary facts had really +just come to light. They would feel a right to exercise the same +obduracy towards them as the French Institute is in the habit of +displaying when memoirs or models are offered to it relating to the +squaring of the circle or perpetual motion; which it is the rule to +pass over without notice. They would feel as astronomers and natural +philosophers must have felt when, some half a dozen years ago, an +unknown man came forward, and asked for an opportunity to demonstrate +to Arago and his colleagues that the moon and planets were at a +distance of a little more than a hundred miles from the earth. And +so they would not even look into Homoeopathy, though all its +advocates should exclaim in the words of Mr. Benjamin Douglass +Perkins, vender of the Metallic Tractors, that "On all discoveries +there are persons who, without descending to any inquiry into the +truth, pretend to know, as it were by intuition, that newly asserted +facts are founded in the grossest errors." And they would lay their +heads upon their pillows with a perfectly clear conscience, although +they were assured that they were behaving in the same way that people +of old did towards Harvey, Galileo, and Copernicus, the identical +great names which were invoked by Mr. Benjamin Douglass Perkins. + +But experience has shown that the character of these assertions is +not sufficient to deter many, from examining their claims to belief. +I therefore lean but very slightly on the extravagance and extreme +apparent singularity of their pretensions. I might have omitted +them, but on the whole it seemed more just to the claims of my +argument to suggest the vast complication of improbabilities involved +in the statements enumerated. Every one must of course judge for +himself as to the weight of these objections, which are by no means +brought forward as a proof of the extravagance of Homoeopathy, but +simply as entitled to a brief consideration before the facts of the +case are submitted to our scrutiny. + +The three great asserted discoveries of Hahnemann are entirely +unconnected with and independent of each other. Were there any +natural relation between them it would seem probable enough that the +discovery of the first would have led to that of the others. But +assuming it to be a fact that diseases are cured by remedies capable +of producing symptoms like their own, no manifest relation exists +between this fact and the next assertion, namely, the power of the +infinitesimal doses. And allowing both these to be true, neither has +the remotest affinity to the third new doctrine, that which declares +seven eighths of all chronic diseases to be owing to Psora. + +This want of any obvious relation between Hahnemann's three cardinal +doctrines appears to be self-evident upon inspection. But if, as is +often true with his disciples, they prefer the authority of one of +their own number, I will refer them to Dr. Trinks's paper on the +present state of Homoeopathy in Europe, with which, of course, they +are familiar, as his name is mentioned as one of the most prominent +champions of their faith, in their American official organ. It would +be a fact without a parallel in the history, not merely of medicine, +but of science, that three such unconnected and astonishing +discoveries, each of them a complete revolution of all that ages of +the most varied experience had been taught to believe, should spring +full formed from the brain of a single individual. + +Let us look a moment at the first of his doctrines. Improbable +though it may seem to some, there is no essential absurdity involved +in the proposition that diseases yield to remedies capable of +producing like symptoms. There are, on the other hand, some +analogies which lend a degree of plausibility to the statement. +There are well-ascertained facts, known from the earliest periods of +medicine, showing that, under certain circumstances, the very +medicine which, from its known effects, one would expect to aggravate +the disease, may contribute to its relief. I may be permitted to +allude, in the most general way, to the case in which the spontaneous +efforts of an overtasked stomach are quieted by the agency of a drug +which that organ refuses to entertain upon any terms. But that every +cure ever performed by medicine should have been founded upon this +principle, although without the knowledge of a physician; that the +Homoeopathic axiom is, as Hahnemann asserts, "the sole law of nature +in therapeutics," a law of which nothing more than a transient +glimpse ever presented itself to the innumerable host of medical +observers, is a dogma of such sweeping extent, and pregnant novelty, +that it demands a corresponding breadth and depth of unquestionable +facts to cover its vast pretensions. + +So much ridicule has been thrown upon the pretended powers of the +minute doses that I shall only touch upon this point for the purpose +of conveying, by illustrations, some shadow of ideas far transcending +the powers of the imagination to realize. It must be remembered that +these comparisons are not matters susceptible of dispute, being +founded on simple arithmetical computations, level to the capacity of +any intelligent schoolboy. A person who once wrote a very small +pamphlet made some show of objecting to calculations of thus kind, on +the ground that the highest dilutions could easily be made with a few +ounces of alcohol. But he should have remembered that at every +successive dilution he lays aside or throws away ninety-nine +hundredths of the fluid on which he is operating, and that, although +he begins with a drop, he only prepares a millionth, billionth, +trillionth, and similar fractions of it, all of which, added +together, would constitute but a vastly minute portion of the drop +with which he began. But now let us suppose we take one single drop +of the Tincture of Camomile, and that the whole of this were to be +carried through the common series of dilutions. + +A calculation nearly like the following was made by Dr. Panvini, and +may be readily followed in its essential particulars by any one who +chooses. + +For the first dilution it would take 100 drops of alcohol. + +For the second dilution it would take 10;000 drops, or about a pint. + +For the third dilution it would take 100 pints. + +For the fourth dilution it would take 10,000 pints, or more than +1,000 gallons, and so on to the ninth dilution, which would take ten +billion gallons, which he computed would fill the basin of Lake +Agnano, a body of water two miles in circumference. The twelfth +dilution would of course fill a million such lakes. By the time the +seventeenth degree of dilution should be reached, the alcohol +required would equal in quantity the waters of ten thousand Adriatic +seas. Trifling errors must be expected, but they are as likely to be +on one side as the other, and any little matter like Lake Superior or +the Caspian would be but a drop in the bucket. + +Swallowers of globules, one of your little pellets, moistened in the +mingled waves of one million lakes of alcohol, each two miles in +circumference, with which had been blended that one drop of Tincture +of Camomile, would be of precisely the strength recommended for that +medicine in your favorite Jahr's Manual, "against the most sudden, +frightful, and fatal diseases!" [In the French edition of 1834, the +proper doses of the medicines are mentioned, and Camomile is marked +IV. Why are the doses omitted in Hull's Translation, except in three +instances out of the whole two hundred remedies, notwithstanding the +promise in the preface that "some remarks upon the doses used may be +found at the head of each medicine"? Possibly because it makes no +difference whether they are employed in one Homoeopathic dose or +another; but then it is very singular that such precise directions +were formerly given in the same work, and that Hahnemann's +"experience" should have led him to draw the nice distinctions we +have seen in a former part of this Lecture (p. 44).] + +And proceeding on the common data, I have just made a calculation +which shows that this single drop of Tincture of Camomile, given in +the quantity ordered by Jahr's Manual, would have supplied every +individual of the whole human family, past and present, with more +than five billion doses each, the action of each dose lasting about +four days. + +Yet this is given only at the quadrillionth, or fourth degree of +potency, and various substances are frequently administered at the +decillionth or tenth degree, and occasionally at still higher +attenuations with professed medicinal results. Is there not in this +as great an exception to all the hitherto received laws of nature as +in the miracle of the loaves and fishes? Ask this question of a +Homoeopathist, and he will answer by referring to the effects +produced by a very minute portion of vaccine matter, or the +extraordinary diffusion of odors. But the vaccine matter is one of +those substances called morbid poisons, of which it is a peculiar +character to multiply themselves, when introduced into the system, as +a seed does in the soil. Therefore the hundredth part of a grain of +the vaccine matter, if no more than this is employed, soon increases +in quantity, until, in the course of about a week, it is a grain or +more, and can be removed in considerable drops. And what is a very +curious illustration of Homoeopathy, it does not produce its most. +characteristic effects until it is already in sufficient quantity not +merely to be visible, but to be collected for further use. The +thoughtlessness which can allow an inference to be extended from a +product of disease possessing this susceptibility of multiplication +when conveyed into the living body, to substances of inorganic +origin, such as silex or sulphur, would be capable of arguing that a +pebble may produce a mountain, because an acorn can become a forest. + +As to the analogy to be found between the alleged action of the +infinitely attenuated doses, and the effects of some odorous +substances which possess the extraordinary power of diffusing their +imponderable emanations through a very wide space, however it may be +abused in argument, and rapidly as it evaporates on examination, it +is not like that just mentioned, wholly without meaning. The fact of +the vast diffusion of some odors, as that of musk or the rose, for +instance, has long been cited as the most remarkable illustration of +the divisibility of matter, and the nicety of the senses. And if +this were compared with the effects of a very minute dose of morphia +on the whole system, or the sudden and fatal impression of a single +drop of prussic acid, or, with what comes still nearer, the poisonous +influence of an atmosphere impregnated with invisible malaria, we +should find in each of these examples an evidence of the degree to +which nature, in some few instances, concentrates powerful qualities +in minute or subtile forms of matter. But if a man comes to me with +a pestle and mortar in his hand, and tells me that he will take a +little speck of some substance which nobody ever thought to have any +smell at all, as, for instance, a grain of chalk or of charcoal, and +that he will, after an hour or two of rubbing and scraping, develop +in a portion of it an odor which, if the whole grain were used, would +be capable of pervading an apartment, a house, a village, a province, +an empire, nay, the entire atmosphere of this broad planet upon which +we tread; and that from each of fifty or sixty substances he can in +this way develop a distinct and hitherto unknown odor: and if he +tries to show that all this is rendered quite reasonable by the +analogy of musk and roses, I shall certainly be justified in +considering him incapable of reasoning, and beyond the reach of my +argument. What if, instead of this, he professes to develop new and +wonderful medicinal powers from the same speck of chalk or charcoal, +in such proportions as would impregnate every pond, lake, river, sea, +and ocean of our globe, and appeals to the same analogy in favor of +the probability of his assertion. + +All this may be true, notwithstanding these considerations. But so +extraordinary would be the fact, that a single atom of substances +which a child might swallow without harm by the teaspoonful could, by +an easy mechanical process, be made to develop such inconceivable +powers, that nothing but the strictest agreement of the most cautious +experimenters, secured by every guaranty that they were honest and +faithful, appealing to repeated experiments in public, with every +precaution to guard against error, and with the most plain and +peremptory results, should induce us to lend any credence to such +pretensions. + +The third doctrine, that Psora, the other name of which you remember, +is the cause of the great majority of chronic diseases, is a +startling one, to say the least. That an affection always recognized +as a very unpleasant personal companion, but generally regarded as a +mere temporary incommodity, readily yielding to treatment in those +unfortunate enough to suffer from it, and hardly known among the +better classes of society, should be all at once found out by a +German physician to be the great scourge of mankind, the cause of +their severest bodily and mental calamities, cancer and consumption, +idiocy and madness, must excite our unqualified surprise. And when +the originator of this singular truth ascribes, as in the page now +open before me, the declining health of a disgraced courtier, the +chronic malady of a bereaved mother, even the melancholy of the love- +sick and slighted maiden, to nothing more nor less than the +insignificant, unseemly, and almost unmentionable ITCH, does it not +seem as if the very soil upon which we stand were dissolving into +chaos, over the earthquake-heaving of discovery? + +And when one man claims to have established these three independent +truths, which are about as remote from each other as the discovery of +the law of gravitation, the invention of printing, and that of the +mariner's compass, unless the facts in their favor are overwhelming +and unanimous, the question naturally arises, Is not this man +deceiving himself, or trying to deceive others? + +I proceed to examine the proofs of the leading ideas of Hahnemann and +his school. + + +In order to show the axiom, similia similibus curantur (or like is +cured by like), to be the basis of the healing art,--"the sole law of +nature in therapeutics,"--it is necessary, + +1. That the symptoms produced by drugs in healthy persons should be +faithfully studied and recorded. + +2. That drugs should be shown to be always capable of curing those +diseases most like their own symptoms. + +3. That remedies should be shown not to cure diseases when they do +not produce symptoms resembling those presented in these diseases. + + +1. The effects of drugs upon healthy persons have been studied by +Hahnemann and his associates. Their results were made known in his +Materia Medica, a work in three large volumes in the French +translation, published about eight years ago. The mode of +experimentation appears to have been, to take the substance on trial, +either in common or minute doses, and then to set down every little +sensation, every little movement of mind or body, which occurred +within many succeeding hours or days, as being produced solely by the +substance employed. When I have enumerated some of the symptoms +attributed to the power of the drugs taken, you will be able to judge +how much value is to be ascribed to the assertions of such observers. + +The following list was taken literally from the Materia Medica of +Hahnemann, by my friend M. Vernois, for whose accuracy I am willing +to be responsible. He has given seven pages of these symptoms, not +selected, but taken at hazard from the French translation of the +work. I shall be very brief in my citations. + +"After stooping some time, sense of painful weight about the head +upon resuming the erect posture." + +"An itching, tickling sensation at the outer edge of the palm of the +left hand, which obliges the person to scratch." The medicine was +acetate of lime, and as the action of the globule taken is said to +last twenty-eight days, you may judge how many such symptoms as the +last might be supposed to happen. + +Among the symptoms attributed to muriatic acid are these: a catarrh, +sighing, pimples; "after having written a long time with the back a +little bent over, violent pain in the back and shoulder-blades, as if +from a strain,"--"dreams which are not remembered,--disposition to +mental dejection,--wakefulness before and after midnight." + +I might extend this catalogue almost indefinitely. I have not cited +these specimens with any view to exciting a sense of the ridiculous, +which many others of those mentioned would not fail to do, but to +show that the common accidents of sensation, the little bodily +inconveniences to which all of us are subject, are seriously and +systematically ascribed to whatever medicine may have been exhibited, +even in the minute doses I have mentioned, whole days or weeks +previously. + +To these are added all the symptoms ever said by anybody, whether +deserving confidence or not, as I shall hereafter illustrate, to be +produced by the substance in question. + +The effects of sixty-four medicinal substances, ascertained by one or +both of these methods, are enumerated in the Materia Medica of +Hahnemann, which may be considered as the basis of practical +Homoeopathy. In the Manual of Jahr, which is the common guide, so +far as I know, of those who practise Homoeopathy in these regions, +two hundred remedies are enumerated, many of which, however, have +never been employed in practice. In at least one edition there were +no means of distinguishing those which had been tried upon the sick +from the others. It is true that marks have been added in the +edition employed here, which serve to distinguish them; but what are +we to think of a standard practical author on Materia Medica, who at +one time omits to designate the proper doses of his remedies, and at +another to let us have any means of knowing whether a remedy has ever +been tried or not, while he is recommending its employment in the +most critical and threatening diseases? + +I think that, from what I have shown of the character of Hahnemann's +experiments, it would be a satisfaction to any candid inquirer to +know whether other persons, to whose assertions he could look with +confidence, confirm these pretended facts. Now there are many +individuals, long and well known to the scientific world, who have +tried these experiments upon healthy subjects, and utterly deny that +their effects have at all corresponded to Hahnemann's assertions. + +I will take, for instance, the statements of Andral (and I am not +referring to his well-known public experiments in his hospital) as +to the result of his own trials. This distinguished physician is +Professor of Medicine in the School of Paris, and one of the most +widely known and valued authors upon practical and theoretical +subjects the profession can claim in any country. He is a man of +great kindness of character, a most liberal eclectic by nature and +habit, of unquestioned integrity, and is called, in the leading +article of the first number of the "Homoepathic Examiner," "an +eminent and very enlightened allopathist." Assisted by a number of +other persons in good health, he experimented on the effects of +cinchona, aconite, sulphur, arnica, and the other most highly +extolled remedies. His experiments lasted a year, and he stated +publicly to the Academy of Medicine that they never produced the +slightest appearance of the symptoms attributed to them. The results +of a man like this, so extensively known as one of the most +philosophical and candid, as well as brilliant of instructors, and +whose admirable abilities and signal liberality are generally +conceded, ought to be of great weight in deciding the question. + +M. Double, a well-known medical writer and a physician of high +standing in Paris, had occasion so long ago as 1801, before he had +heard of Homoeopathy, to make experiments upon Cinchona, or Peruvian +bark. He and several others took the drug in every kind of dose for +four months, and the fever it is pretended by Hahnemann to excite +never was produced. + +M. Bonnet, President of the Royal Society of Medicine of Bordeaux, +had occasion to observe many soldiers during the Peninsular War, who +made use of Cinchona as a preservative against different diseases, +but he never found it to produce the pretended paroxysms. + +If any objection were made to evidence of this kind, I would refer to +the express experiments on many of the Homoeopathic substances, which +were given to healthy persons with every precaution as to diet and +regimen, by M. Louis Fleury, without being followed by the slightest +of the pretended consequences. And let me mention as a curious fact, +that the same quantity of arsenic given to one animal in the common +form of the unprepared powder, and to another after having been +rubbed up into six hundred globules, offered no particular difference +of activity in the two cases. + +This is a strange contradiction to the doctrine of the development of +what they call dynamic power, by means of friction and subdivision. + +In 1835 a public challenge was offered to the best known Homoeopathic +physician in Paris to select any ten substances asserted to produce +the most striking effects; to prepare them himself; to choose one by +lot without knowing which of them he had taken, and try it upon +himself or any intelligent and devoted Homoeopatbist, and, waiting +his own time, to come forward and tell what substance had been +employed. The challenge was at first accepted, but the acceptance +retracted before the time of trial arrived. + +From all this I think it fair to conclude that the catalogues of +symptoms attributed in Homoeopathic works to the influence of various +drugs upon healthy persons are not entitled to any confidence. + + +2. It is necessary to show, in the next place, that medicinal +substances are always capable of curing diseases most like their own +symptoms. For facts relating to this question we must look to two +sources; the recorded experience of the medical profession in +general, and the results of trials made according to Homoeopathic +principles, and capable of testing the truth of the doctrine. + +No person, that I am aware of, has ever denied that in some cases +there exists a resemblance between the effects of a remedy and the +symptoms of diseases in which it is beneficial. This has been +recognized, as Hahnemann himself has shown, from the time of +Hippocrates. But according to the records of the medical profession, +as they have been hitherto interpreted, this is true of only a very +small proportion of useful remedies. Nor has it ever been considered +as an established truth that the efficacy of even these few remedies +was in any definite ratio to their power of producing symptoms more +or less like those they cured. + +Such was the state of opinion when Hahnemann came forward with the +proposition that all the cases of successful treatment found in the +works of all preceding medical writers were to be ascribed solely to +the operation of the Homoeopathic principle, which had effected the +cure, although without the physician's knowledge that this was the +real secret. And strange as it may seem, he was enabled to give such +a degree of plausibility to this assertion, that any person not +acquainted somewhat with medical literature, not quite familiar, I +should rather say, with the relative value of medical evidence, +according to the sources whence it is derived, would be almost +frightened into the belief, at seeing the pages upon pages of Latin +names he has summoned as his witnesses. + +It has hitherto been customary, when examining the writings of +authors of preceding ages, upon subjects as to which they were less +enlightened than ourselves, and which they were very liable to +misrepresent, to exercise some little discretion; to discriminate, in +some measure, between writers deserving confidence and those not +entitled to it. But there is not the least appearance of any such +delicacy on the part of Hahnemann. A large majority of the names of +old authors he cites are wholly unknown to science. With some of +them I have been long acquainted, and I know that their accounts of +diseases are no more to be trusted than their contemporary Ambroise +Pare's stories of mermen, and similar absurdities. But if my +judgment is rejected, as being a prejudiced one, I can refer to +Cullen, who mentioned three of Hahnemann's authors in one sentence, +as being "not necessarily bad authorities; but certainly such when +they delivered very improbable events;" and as this was said more +than half a century ago, it could not have had any reference to +Hahnemann. But although not the slightest sign of discrimination is +visible in his quotations,--although for him a handful of chaff from +Schenck is all the same thing as a measure of wheat from Morgagni,-- +there is a formidable display of authorities, and an abundant proof +of ingenious researches to be found in each of the great works of +Hahnemann with which I am familiar. [Some painful surmises might +arise as to the erudition of Hahnemann's English Translator, who +makes two individuals of "Zacutus, Lucitanus," as well as respecting +that of the conductors of an American Homoeopathic periodical, who +suffer the name of the world-renowned Cardanus to be spelt Cardamus +in at least three places, were not this gross ignorance of course +attributable only to the printer.] + +It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has +proved many of Hahnemann's quotations from old authors to be +adulterate and false. What particular instances he has pointed out I +have no means of learning. And it is probably wholly impossible on +this side of the Atlantic, and even in most of the public libraries +of Europe, to find anything more than a small fraction of the +innumerable obscure publications which the neglect of grocers and +trunkmakers has spared to be ransacked by the all-devouring genius of +Homoeopathy. I have endeavored to verify such passages as my own +library afforded me the means of doing. For some I have looked in +vain, for want, as I am willing to believe, of more exact references. +But this I am able to affirm, that, out of the very small number +which I have been able, to trace back to their original authors, I +have found two to be wrongly quoted, one of them being a gross +misrepresentation. + +The first is from the ancient Roman author, Caelius Aurelianus; the +second from the venerable folio of Forestus. Hahnemann uses the +following expressions,--if he is not misrepresented in the English +Translation of the 'Organon': "Asclepiades on one occasion cured an +inflammation of the brain by administering a small quantity of wine." +After correcting the erroneous reference of the Translator, I can +find no such case alluded to in the chapter. But Caelius Aurelianus +mentions two modes of treatment employed by Asclepiades, into both of +which the use of wine entered, as being "in the highest degree +irrational and dangerous." [Caelius Aurel. De Morb. Acut. et +Chron. lib. I. cap. xv. not xvi. Amsterdam. Wetstein, 1755.] + +In speaking of the oil of anise-seed, Hahnemann says that Forestus +observed violent colic caused by its administration. But, as the +author tells the story, a young man took, by the counsel of a +surgeon, an acrid and virulent medicine, the name of which is not +given, which brought on a most cruel fit of the gripes and colic. +After this another surgeon was called, who gave him oil of anise-seed +and wine, "which increased his suffering." [Observ. et Curat. Med. +lib. XXI obs. xiii. Frankfort, 1614.] Now if this was the +Homoeopathic remedy, as Hahnemann pretends, it might be a fair +question why the young man was not cured by it. But it is a much +graver question why a man who has shrewdness and learning enough to +go so far after his facts, should think it right to treat them with +such astonishing negligence or such artful unfairness. + +Even if every word he had pretended to take from his old authorities +were to be found in them, even if the authority of every one of these +authors were beyond question, the looseness with which they are used +to prove whatever Hahnemann chooses is beyond the bounds of +credibility. Let me give one instance to illustrate the character of +this man's mind. Hahnemann asserts, in a note annexed to the 110th +paragraph of the "Organon," that the smell of the rose will cause +certain persons to faint. And he says in the text that substances +which produce peculiar effects of this nature on particular +constitutions cure the same symptoms in people in general. Then in +another note to the same paragraph he quotes the following fact from +one of the last sources one would have looked to for medical +information, the Byzantine Historians. + +"It was by these means (i.e. Homoeopathically) that the Princess +Eudosia with rose-water restored a person who had fainted!" + +Is it possible that a man who is guilty of such pedantic folly as +this,--a man who can see a confirmation of his doctrine in such a +recovery as this,--a recovery which is happening every day, from a +breath of air, a drop or two of water, untying a bonnet-string, +loosening a stay-lace, and which can hardly help happening, whatever +is done,--is it possible that a man, of whose pages, not here and +there one, but hundreds upon hundreds are loaded with such +trivialities, is the Newton, the Columbus, the Harvey of the +nineteenth century! + +The whole process of demonstration he employs is this. An experiment +is instituted with some drug upon one or more healthy persons. +Everything that happens for a number of days or weeks is, as we have +seen, set down as an effect of the medicine. Old volumes are then +ransacked promiscuously, and every morbid sensation or change that +anybody ever said was produced by the drug in question is added to +the list of symptoms. By one or both of these methods, each of the +sixty-four substances enumerated by Hahnemann is shown to produce a +very large number of symptoms, the lowest in his scale being ninety- +seven, and the highest fourteen hundred and ninety-one. And having +made out this list respecting any drug, a catalogue which, as you may +observe in any Homoeopathic manual, contains various symptoms +belonging to every organ of the body, what can be easier than to find +alleged cures in every medical author which can at once be attributed +to the Homoeopathic principle; still more if the grave of +extinguished credulity is called upon to give up its dead bones as +living witnesses; and worst of all, if the monuments of the past are +to be mutilated in favor of "the sole law of Nature in therapeutics"? + +There are a few familiar facts of which great use has been made as an +entering wedge for the Homoeopathic doctrine. They have been +suffered to pass current so long that it is time they should be +nailed to the counter, a little operation which I undertake, with +perfect cheerfulness, to perform for them. + +The first is a supposed illustration of the Homoeopathic law found in +the precept given for the treatment of parts which have been frozen, +by friction with snow or similar means. But we deceive ourselves by +names, if we suppose the frozen part to be treated by cold, and not +by heat. The snow may even be actually warmer than the part to which +it is applied. But even if it were at the same temperature when +applied, it never did and never could do the least good to a frozen +part, except as a mode of regulating the application of what? of +heat. But the heat must be applied gradually, just as food must be +given a little at a time to those perishing with hunger. If the +patient were brought into a warm room, heat would be applied very +rapidly, were not something interposed to prevent this, and allow its +gradual admission. Snow or iced water is exactly what is wanted; it +is not cold to the part; it is very possibly warm, on the contrary, +for these terms are relative, and if it does not melt and let the +heat in, or is not taken away, the part will remain frozen up until +doomsday. Now the treatment of a frozen limb by heat, in large or +small quantities, is not Homoeopathy. + +The next supposed illustration of the Homoeopathic law is the alleged +successful management of burns, by holding them to the fire. This is +a popular mode of treating those burns which are of too little +consequence to require any more efficacious remedy, and would +inevitably get well of themselves, without any trouble being bestowed +upon them. It produces a most acute pain in the part, which is +followed by some loss of sensibility, as happens with the eye after +exposure to strong light, and the ear after being subjected to very +intense sounds. This is all it is capable of doing, and all further +notions of its efficacy must be attributed merely to the vulgar love +of paradox. If this example affords any comfort to the +Homoeopathist, it seems as cruel to deprive him of it as it would be +to convince the mistress of the smoke-jack or the flatiron that the +fire does not literally "draw the fire out," which is her hypothesis. + +But if it were true that frost-bites were cured by cold and burns by +heat, it would be subversive, so far as it went, of the great +principle of Homoeopathy. + +For you will remember that this principle is that Like cures Like, +and not that Same cures Same; that there is resemblance and not +identity between the symptoms of the disease and those produced by +the drug which cures it, and none have been readier to insist upon +this distinction than the Homoeopathists themselves. For if Same +cures Same, then every poison must be its own antidote,--which is +neither a part of their theory nor their so-called experience. They +have been asked often enough, why it was that arsenic could not cure +the mischief which arsenic had caused, and why the infectious cause +of small-pox did not remedy the disease it had produced, and then +the; were ready enough to see the distinction I have pointed out. O +no! it was not the hair of the same dog, but only of one very much +like him! + +A third instance in proof of the Homoeopathic law is sought for in +the acknowledged efficacy of vaccination. And how does the law apply +to this? It is granted by the advocates of Homoeopathy that there is +a resemblance between the effects of the vaccine virus on a person in +health and the symptoms of small-pox. Therefore, according to the +rule, the vaccine virus will cure the small-pox, which, as everybody +knows, is entirely untrue. But it prevents small-pox, say the +Homoeopathists. Yes, and so does small-pox prevent itself from ever +happening again, and we know just as much of the principle involved +in the one case as in the other. For this is only one of a series of +facts which we are wholly unable to explain. Small-pox, measles, +scarlet-fever, hooping-cough, protect those who have them once from +future attacks; but nettle-rash and catarrh and lung fever, each of +which is just as Homoeopathic to itself as any one of the others, +have no such preservative power. We are obliged to accept the fact, +unexplained, and we can do no more for vaccination than for the rest. + + +I come now to the most directly practical point connected with the +subject, namely,-- + +What is the state of the evidence as to the efficacy of the proper +Homoeopathic treatment in the cure of diseases. + +As the treatment adopted by the Homoeopathists has been almost +universally by means of the infinitesimal doses, the question of +their efficacy is thrown open, in common with that of the truth of +their fundamental axiom, as both are tested in practice. + +We must look for facts as to the actual working of Homoeopathy to +three sources. + +1. The statements of the unprofessional public. + +2. The assertions of Homoeopathic practitioners. + +3. The results of trials by competent and honest physicians, not +pledged to the system. + +I think, after what we have seen of medical facts, as they are +represented by incompetent persons, we are disposed to attribute +little value to all statements of wonderful cures, coming from those +who have never been accustomed to watch the caprices of disease, and +have not cooled down their young enthusiasm by the habit of tranquil +observation. Those who know nothing of the natural progress of a +malady, of its ordinary duration, of its various modes of +terminating, of its liability to accidental complications, of the +signs which mark its insignificance or severity, of what is to be +expected of it when left to itself, of how much or how little is to +be anticipated from remedies, those who know nothing or next to +nothing of all these things, and who are in a great state of +excitement from benevolence, sympathy, or zeal for a new medical +discovery, can hardly be expected to be sound judges of facts which +have misled so many sagacious men, who have spent their lives in the +daily study and observation of them. I believe that, after having +drawn the portrait of defunct Perkinism, with its five thousand +printed cures, and its million and a half computed ones, its miracles +blazoned about through America, Denmark, and England; after relating +that forty years ago women carried the Tractors about in their +pockets, and workmen could not make them fast enough for the public +demand; and then showing you, as a curiosity, a single one of these +instruments, an odd one of a pair, which I obtained only by a lucky +accident, so utterly lost is the memory of all their wonderful +achievements; I believe, after all this, I need not waste time in +showing that medical accuracy is not to be looked for in the florid +reports of benevolent associations, the assertions of illustrious +patrons, the lax effusions of daily journals, or the effervescent +gossip of the tea-table. + +Dr. Hering, whose name is somewhat familiar to the champions of +Homoeopathy, has said that "the new healing art is not to be judged +by its success in isolated cases only, but according to its success +in general, its innate truth, and the incontrovertible nature of its +innate principles." + +We have seen something of "the incontrovertible nature of its innate +principles," and it seems probable, on the whole, that its success in +general must be made up of its success in isolated cases. Some +attempts have been made, however, to finish the whole matter by +sweeping statistical documents, which are intended to prove its +triumphant success over the common practice. + +It is well known to those who have had the good fortune to see the +"Homoeopathic Examiner," that this journal led off, in its first +number, with a grand display of everything the newly imported +doctrine had to show for itself. It is well remarked, on the twenty- +third page of this article, that "the comparison of bills of +mortality among an equal number of sick, treated by divers methods, +is a most poor and lame way to get at conclusions touching principles +of the healing art." In confirmation of which, the author proceeds +upon the twenty-fifth page to prove the superiority of the +Homoeopathic treatment of cholera, by precisely these very bills of +mortality. Now, every intelligent physician is aware that the poison +of cholera differed so much in its activity at different times and, +places, that it was next to impossible to form any opinion as to the +results of treatment, unless every precaution was taken to secure the +most perfectly corresponding conditions in the patients treated, and +hardly even then. Of course, then, a Russian Admiral, by the name of +Mordvinov, backed by a number of so-called physicians practising in +Russian villages, is singularly competent to the task of settling the +whole question of the utility of this or that kind of treatment; to +prove that, if not more than eight and a half per cent. of those +attacked with the disease perished, the rest owed their immunity to +Hahnemann. I can remember when more than a hundred patients in a +public institution were attacked with what, I doubt not, many +Homoeopathic physicians (to say nothing of Homoeopathic admirals) +would have called cholera, and not one of them died, though treated +in the common way, and it is my firm belief that, if such a result +had followed the administration of the omnipotent globules, it would +have been in the mouth of every adept in Europe, from Quin of London +to Spohr of Gandersheim. No longer ago than yesterday, in one of the +most widely circulated papers of this city, there was published an +assertion that the mortality in several Homoeopathic Hospitals was +not quite five in a hundred, whereas, in what are called by the +writer Allopathic Hospitals, it is said to be eleven in a hundred. +An honest man should be ashamed of such an argumentum ad ignorantiam. +The mortality of a hospital depends not merely on the treatment of +the patients, but on the class of diseases it is in the habit of +receiving, on the place where it is, on the season, and many other +circumstances. For instance, there are many hospitals in the great +cities of Europe that receive few diseases of a nature to endanger +life, and, on the other hand, there are others where dangerous +diseases are accumulated out of the common proportion. Thus, in the +wards of Louis, at the Hospital of La Pitie, a vast number of +patients in the last stages of consumption were constantly entering, +to swell the mortality of that hospital. It was because he was known +to pay particular attention to the diseases of the chest that +patients laboring under those fatal affections to an incurable extent +were so constantly coming in upon him. It is always a miserable +appeal to the thoughtlessness of the vulgar, to allege the naked fact +of the less comparative mortality in the practice of one hospital or +of one physician than another, as an evidence of the superiority of +their treatment. Other things being equal, it must always be +expected that those institutions and individuals enjoying to the +highest degree the confidence of the community will lose the largest +proportion of their patients; for the simple reason that they will +naturally be looked to by those suffering from the gravest class of +diseases; that many, who know that they are affected with mortal +disease, will choose to die under their care or shelter, while the +subjects of trifling maladies, and merely troublesome symptoms, amuse +themselves to any extent among the fancy practitioners. When, +therefore, Dr. Mublenbein, as stated in the "Homoeopathic Examiner," +and quoted in yesterday's "Daily Advertiser," asserts that the +mortality among his patients is only one per cent. since he has +practised Homoeopathy, whereas it was six per cent. when he employed +the common mode of practice, I am convinced by this, his own +statement, that the citizens of Brunswick, whenever they are +seriously sick, take good care not to send for Dr. Muhlenbein! + +It is evidently impossible that I should attempt, within the compass +of a single lecture, any detailed examination of the very numerous +cases reported in the Homoeopathic Treatises and Journals. Having +been in the habit of receiving the French "Archives of Homoeopathic +Medicine" until the premature decease of that Journal, I have had the +opportunity of becoming acquainted somewhat with the style of these +documents, and experiencing whatever degree of conviction they were +calculated to produce. Although of course I do not wish any value to +be assumed for my opinion, such as it is, I consider that you are +entitled to hear it. So far, then, as I am acquainted with the +general character of the cases reported by the Homoeopathic +physicians, they would for the most part be considered as wholly +undeserving a place in any English, French, or American periodical of +high standing, if, instead of favoring the doctrine they were +intended to support, they were brought forward to prove the efficacy +of any common remedy administered by any common practitioner. There +are occasional exceptions to this remark; but the general truth of it +is rendered probable by the fact that these cases are always, or +almost always, written with the single object of showing the efficacy +of the medicine used, or the skill of the practitioner, and it is +recognized as a general rule that such cases deserve very little +confidence. Yet they may sound well enough, one at a time, to those +who are not fully aware of the fallacies of medical evidence. Let me +state a case in illustration. Nobody doubts that some patients +recover under every form of practice. Probably all are willing to +allow that a large majority, for instance, ninety in a hundred, of +such cases as a physician is called to in daily practice, would +recover, sooner or later, with more or less difficulty, provided +nothing were done to interfere seriously with the efforts of nature. + +Suppose, then, a physician who has a hundred patients prescribes to +each of them pills made of some entirely inert substance, as starch, +for instance. Ninety of them get well, or if he chooses to use such +language, he cures ninety of them. It is evident, according to the +doctrine of chances, that there must be a considerable number of +coincidences between the relief of the patient and the administration +of the remedy. It is altogether probable that there will happen two +or three very striking coincidences out of the whole ninety cases, in +which it would seem evident that the medicine produced the relief, +though it had, as we assumed, nothing to do with it. Now suppose +that the physician publishes these cases, will they not have a +plausible appearance of proving that which, as we granted at the +outset, was entirely false? Suppose that instead of pills of starch +he employs microscopic sugarplums, with the five' million billion +trillionth part of a suspicion of aconite or pulsatilla, and then +publishes his successful cases, through the leaden lips of the press, +or the living ones of his female acquaintances,--does that make the +impression a less erroneous one? But so it is that in Homoeopathic +works and journals and gossip one can never, or next to never, find +anything but successful cases, which might do very well as a proof of +superior skill, did it not prove as much for the swindling +advertisers whose certificates disgrace so many of our newspapers. +How long will it take mankind to learn that while they listen to "the +speaking hundreds and units, who make the world ring "with the +pretended triumphs they have witnessed, the "dumb millions" of +deluded and injured victims are paying the daily forfeit of their +misplaced confidence! + +I am sorry to see, also, that a degree of ignorance as to the natural +course of diseases is often shown in these published cases, which, +although it may not be detected by the unprofessional reader, conveys +an unpleasant impression to those who are acquainted with the +subject. Thus a young woman affected with jaundice is mentioned in +the German "Annals of Clinical Homoeopathy" as having been cured in +twenty-nine days by pulsatilla and nux vomica. Rummel, a well-known +writer of the same school, speaks of curing a case of jaundice in +thirty-four days by Homoeopathic doses of pulsatilla, aconite, and +cinchona. I happened to have a case in my own household, a few weeks +since, which lasted about ten days, and this was longer than I have +repeatedly seen it in hospital practice, so that it was nothing to +boast of. + +Dr. Munneche of Lichtenburg in Saxony is called to a patient with +sprained ankle who had been a fortnight under the common treatment. +The patient gets well by the use of arnica in a little more than a +month longer, and this extraordinary fact is published in the French +"Archives of Homoeopathic Medicine." + +In the same Journal is recorded the case of a patient who with +nothing more, so far as any proof goes, than inluenza, gets down to +her shop upon the sixth day. + +And again, the cool way in which everything favorable in a case is +set down by these people entirely to their treatment, may be seen in +a case of croup reported in the "Homoeopathic Gazette" of Leipsic, +in which leeches, blistering, inhalation of hot vapor, and powerful +internal medicine had been employed, and yet the merit was all +attributed to one drop of some Homoeopathic fluid. + +I need not multiply these quotations, which illustrate the grounds of +an opinion which the time does not allow me to justify more at +length; other such cases are lying open before me; there is no end to +them if more were wanted; for nothing is necessary but to look into +any of the numerous broken-down Journals of Homoeopathy, the volumes +of which may be found on the shelves of those curious in such +matters. + +A number of public trials of Homoeopathy have been made in different +parts of the world. Six of these are mentioned in the Manifesto of +the "Homoeopathic Examiner." Now to suppose that any trial can +absolutely silence people, would be to forget the whole experience of +the past. Dr. Haygarth and Dr. Alderson could not stop the sale of +the five-guinea Tractors, although they proved that they could work +the same miracles with pieces of wood and tobacco-pipe. It takes +time for truth to operate as well as Homoeopathic globules. Many +persons thought the results of these trials were decisive enough of +the nullity of the treatment; those who wish to see the kind of +special pleading and evasion by which it is attempted to cover +results which, stated by the "Homoeopathic Examiner" itself, look +exceedingly like a miserable failure, may consult the opening +flourish of that Journal. I had not the intention to speak of these +public trials at all, having abundant other evidence on the point. +But I think it best, on the whole, to mention two of them in a few +words,--that instituted at Naples and that of Andral. + +There have been few names in the medical profession, for the last +half century, so widely known throughout the world of science as that +of M. Esquirol, whose life was devoted to the treatment of insanity, +and who was without a rival in that department of practical medicine. +It is from an analysis communicated by him to the "Gazette Medicale +de Paris" that I derive my acquaintance with the account of the trial +at Naples by Dr. Panvini, physician to the Hospital della Pace. This +account seems to be entirely deserving of credit. Ten patients were +set apart, and not allowed to take any medicine at all,--much against +the wish of the Homoeopathic physician. All of them got well, and of +course all of them would have been claimed as triumphs if they had +been submitted to the treatment. Six other slight cases (each of +which is specified) got well under the Homoeopathic treatment, none +of its asserted specific effects being manifested. + +All the rest were cases of grave disease; and so far as the trial, +which was interrupted about the fortieth day, extended, the patients +grew worse, or received no benefit. A case is reported on the page +before me of a soldier affected with acute inflammation in the chest, +who took successively aconite, bryonia, nux vomica, and pulsatilla, +and after thirty-eight days of treatment remained without any +important change in his disease. The Homoeopathic physician who +treated these patients was M. de Horatiis, who had the previous year +been announcing his wonderful cures. And M. Esquirol asserted to the +Academy of Medicine in 1835, that this M. de Horatiis, who is one of +the prominent personages in the "Examiner's" Manifesto published in +1840, had subsequently renounced Homoeopathy. I may remark, by the +way, that this same periodical, which is so very easy in explaining +away the results of these trials, makes a mistake of only six years +or a little more as to the time when this at Naples was instituted. + +M. Andral, the "eminent and very enlightened allopathist" of the +"Homoeopathic Examiner," made the following statement in March, 1835, +to the Academy of Medicine: "I have submitted this doctrine to +experiment; I can reckon at this time from one hundred and thirty to +one hundred and forty cases, recorded with perfect fairness, in a +great hospital, under the eye of numerous witnesses; to avoid every +objection--I obtained my remedies of M. Guibourt, who keeps a +Homoeopathic pharmacy, and whose strict exactness is well known; the +regimen has been scrupulously observed, and I obtained from the +sisters attached to the hospital a special regimen, such as Hahnemann +orders. I was told, however, some months since, that I had not been +faithful to all the rules of the doctrine. I therefore took the +trouble to begin again; I have studied the practice of the Parisian +Homoeopathists, as I had studied their books, and I became convinced +that they treated their patients as I had treated mine, and I affirm +that I have been as rigorously exact in the treatment as any other +person." + +And he expressly asserts the entire nullity of the influence of all +the Homoeopathic remedies tried by him in modifying, so far as he +could observe, the progress or termination of diseases. It deserves +notice that he experimented with the most boasted substances,-- +cinchona, aconite, mercury, bryonia, belladonna. Aconite, for +instance, he says he administered in more than forty cases of that +collection of feverish symptoms in which it exerts so much power, +according to Hahnemann, and in not one of them did it have the +slightest influence, the pulse and heat remaining as before. + +These statements look pretty honest, and would seem hard to be +explained away, but it is calmly said that he "did not know enough of +the method to select the remedies with any tolerable precision." +["Homoeopathic Examiner, vol. i. p. 22.] + +"Nothing is left to the caprice of the physician." (In a word, +instead of being dependent upon blind chance, that there is an +infallible law, guided by which; the physician MUST select the proper +remedies.') ['Ibid.,' in a notice of Menzel's paper.] Who are they +that practice Homoeopathy, and say this of a man with the Materia +Medica of Hahnemann lying before him? Who are they that send these +same globules, on which he experimented, accompanied by a little +book, into families, whose members are thought competent to employ +them, when they deny any such capacity to a man whose life has been +passed at the bedside of patients, the most prominent teacher in the +first Medical Faculty in the world, the consulting physician of the +King of France, and one of the most renowned practical writers, not +merely of his nation, but of his age? I leave the quibbles by which +such persons would try to creep out from under the crushing weight of +these conclusions to the unfortunates who suppose that a reply is +equivalent to an answer. + +Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris, +invited two Homoeopathic practitioners to experiment in his wards. +One of these was Curie, now of London, whose works are on the +counters of some of our bookstores, and probably in the hands of some +of my audience. This gentleman, whom Dr. Baillie declares to be an +enlightened man, and perfectly sincere in his convictions, brought +his own medicines from the pharmacy which furnished Hahnemann +himself, and employed them for four or five months upon patients in +his ward, and with results equally unsatisfactory, as appears from +Dr. Baillie's statement at a meeting of the Academy of Medicine. And +a similar experiment was permitted by the Clinical Professor of the +Hotel Dieu of Lyons, with the same complete failure. + +But these are old and prejudiced practitioners. Very well, then take +the statement of Dr. Fleury, a most intelligent young physician, who +treated homoeopathically more than fifty patients, suffering from +diseases which it was not dangerous to treat in this way, taking +every kind of precaution as to regimen, removal of disturbing +influences, and the state of the atmosphere, insisted upon by the +most vigorous partisans of the doctrine, and found not the slightest +effect produced by the medicines. And more than this, read nine of +these cases, which he has published, as I have just done, and observe +the absolute nullity of aconite, belladonna, and bryonia, against the +symptoms over which they are pretended to exert such palpable, such +obvious, such astonishing influences. In the view of these +statements, it is impossible not to realize the entire futility of +attempting to silence this asserted science by the flattest and most +peremptory results of experiment. Were all the hospital physicians +of Europe and America to devote themselves, for the requisite period, +to this sole pursuit, and were their results to be unanimous as to +the total worthlessness of the whole system in practice, this +slippery delusion would slide through their fingers without the +slightest discomposure, when, as they supposed, they had crushed +every joint in its tortuous and trailing body. + + +3. I have said, that to show the truth of the Homoeopathic doctrine, +as announced by Hahnemann, it would be necessary to show, in the +third place, that remedies never cure diseases when they are not +capable of producing similar symptoms! The burden of this somewhat +comprehensive demonstration lying entirely upon the advocates of this +doctrine, it may be left to their mature reflections. + + +It entered into my original plan to treat of the doctrine relating to +Psora, or itch,--an almost insane conception, which I am glad to get +rid of, for this is a subject one does not care to handle without +gloves. I am saved this trouble, however, by finding that many of +the disciples of Hahnemann, those disciples the very gospel of whose +faith stands upon his word, make very light of his authority on this +point, although he himself says, "It has cost me twelve years of +study and research to trace out the source of this incredible number +of chronic affections, to discover this great truth, which remained +concealed from all my predecessors and contemporaries, to establish +the basis of its demonstration, and find out, at the same time, the +curative medicines that were fit to combat this hydra in all its +different forms." + +But, in the face of all this, the following remarks are made by +Wolff, of Dresden, whose essays, according to the editor of the +"Homoeopathic Examiner," "represent the opinions of a large majority +of Homoeopathists in Europe." + +"It cannot be unknown to any one at all familiar with Homoeopathic +literature, that Hahnemann's idea of tracing the large majority of +chronic diseases to actual itch has met with the greatest opposition +from Homoeopathic physicians themselves." And again, "If the Psoric +theory has led to no proper schism, the reason is to be found in the +fact that it is almost without any influence in practice." + +We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Duke +of Baden," and a "distinguished" Homoeopathist, actually asked +Hahnemann for the proof that chronic diseases, such as dropsy, for +instance, never arise from any other cause than itch; and that, +according to common report, the venerable sage was highly incensed +(fort courrouce) with Dr. Hartmann, of Leipsic, another +"distinguished" Homoeopathist, for maintaining that they certainly +did arise from other causes. + +And Dr. Fielitz, in the "Homoeopathic Gazette" of Leipsic, after +saying, in a good-natured way, that Psora is the Devil in medicine, +and that physicians are divided on this point into diabolists and +exorcists, declares that, according to a remark of Hahnemann, the +whole civilized world is affected with Psora. I must therefore +disappoint any advocate of Hahnemann who may honor me with his +presence, by not attacking a doctrine on which some of the disciples +of his creed would be very happy to have its adversaries waste their +time and strength. I will not meddle with this excrescence, which, +though often used in time of peace, would be dropped, like the limb +of a shell-fish, the moment it was assailed; time is too precious, +and the harvest of living extravagances nods too heavily to my +sickle, that I should blunt it upon straw and stubble. + +I will close the subject with a brief examination of some of the +statements made in Homoeopathic works, and more particularly in the +brilliant Manifesto of the "Examiner," before referred to. And +first, it is there stated under the head of "Homoeopathic +Literature," that "SEVEN HUNDRED volumes have been issued from the +press developing the peculiarities of the system, and many of them +possessed of a scientific character that savans know well how to +respect." If my assertion were proper evidence in the case, I should +declare, that, having seen a good many of these publications, from +the year 1834, when I bought the work of the Rev. Thomas Everest," +[Dr. Curie speaks of this silly pamphlet as having been published in +1835.] to within a few weeks, when I received my last importation of +Homaeopathic literature, I have found that all, with a very few +exceptions, were stitched pamphlets varying from twenty or thirty +pages to somewhat less than a hundred, and generally resembling each +other as much as so many spelling-books. + +But not being evidence in the case, I will give you the testimony of +Dr. Trinks, of Dresden, who flourishes on the fifteenth page of the +same Manifesto as one of the most distinguished among the +Homoeopathists of Europe. I translate the sentence literally from +the "Archives de la Medecine Homoeopathique." + +"The literature of Homoeopathy, if that honorable name must be +applied to all kinds of book-making, has been degraded to the +condition of the humblest servitude. Productions without talent, +without spirit, without discrimination, flat and pitiful eulogies, +exaggerations surpassing the limits of the most robust faith, +invectives against such as dared to doubt the dogmas which had been +proclaimed, or catalogues of remedies; of such materials is it +composed! From distance to distance only, have appeared some memoirs +useful to science or practice, which appear as so many green oases in +the midst of this literary desert." + +It is a very natural as well as a curious question to ask, What has +been the success of Homoeopathy in the different countries of Europe, +and what is its present condition? + +The greatest reliance of the advocates of Homoeopathy is of course on +Germany. We know very little of its medical schools, its medical +doctrines, or its medical men, compared with those of England and +France. And, therefore, when an intelligent traveller gives a direct +account from personal inspection of the miserable condition of the +Homoeopathic hospital at Leipsic, the first established in Europe, +and the first on the list of the ever-memorable Manifesto, it is easy +enough answer or elude the fact by citing various hard names of +"distinguished" practitioners, which sound just as well to the +uninformed public as if they were Meckel, or Tiedemann, or +Langenbeck. Dr. Leo-Wolf, who, to be sure, is opposed to +Homoeopathy, but who is a scholar, and ought to know something +of his own countrymen, assures us that "Dr. Kopp is the only German +Homoeopathist, if we can call him so, who has been distinguished as +an author and practitioner before he examined this method." And Dr. +Lee, the same gentleman in whose travels the paragraph relating to +the Leipsic Hospital is to be found, says the same thing. And I will +cheerfully expose myself to any impertinent remark which it might +suggest, to assure my audience that I never heard or saw one +authentic Homoeopathic name of any country in Europe, which I had +ever heard mentioned before as connected with medical science by a +single word or deed sufficient to make it in any degree familiar to +my ears, unless Arnold of Heidelberg is the anatomist who discovered +a little nervous centre, called the otic ganglion. But you need ask +no better proof of who and what the German adherents of this doctrine +must be, than the testimony of a German Homoeopathist as to the +wretched character of the works they manufacture to enforce its +claims. + +As for the act of this or that government tolerating or encouraging +Homoeopathy, every person of common intelligence knows that it is a +mere form granted or denied according to the general principles of +policy adopted in different states, or the degree of influence which +some few persons who have adopted it may happen to have at court. +What may be the value of certain pompous titles with which many of +the advocates of Homoeopathy are honored, it might be disrespectful +to question. But in the mean time the judicious inquirer may ponder +over an extract which I translate from a paper relating to a +personage well known to the community as Williams the Oculist, with +whom I had the honor of crossing the Atlantic some years since, and +who himself handed me two copies of the paper in question. + +"To say that he was oculist of Louis XVIII. and of Charles X., and +that he now enjoys the same title with respect to His Majesty, Louis +Philippe, and the King of the Belgians, is unquestionably to say a +great deal; and yet it is one of the least of his titles to public +confidence. His reputation rests upon a basis more substantial even +than the numerous diplomas with which he is provided, than the +membership of the different medical societies which have chosen him +as their associate," etc., etc. + +And as to one more point, it is time that the public should fully +understand that the common method of supporting barefaced imposture +at the present day, both in Europe and in this country, consists in +trumping up "Dispensaries," "Colleges of Health," and other +advertising charitable clap-traps, which use the poor as decoy-ducks +for the rich, and the proprietors of which have a strong predilection +for the title of "Professor." These names, therefore, have come to +be of little or no value as evidence of the good character, still +less of the high pretensions of those who invoke their authority. +Nor does it follow, even when a chair is founded in connection with a +well-known institution, that it has either a salary or an occupant; +so that it may be, and probably is, a mere harmless piece of +toleration on the part of the government if a Professorship of +Homoeopathy is really in existence at Jena or Heidelberg. And +finally, in order to correct the error of any who might suppose that +the whole Medical Profession of Germany has long since fallen into +the delusions of Hahnemann, I will quote two lines which a celebrated +anatomist and surgeon (whose name will occur again in this lecture in +connection with a very pleasing letter) addressed to the French +Academy of Medicine in 1835. "I happened to be in Germany some +months since, at a meeting of nearly six hundred physicians; one of +them wished to bring up the question of Homoeopathy; they would not +even listen to him." This may have been very impolite and bigoted, +but that is not precisely the point in reference to which I mention +the circumstance. + +But if we cannot easily get at Germany, we can very easily obtain +exact information from France and England. I took the trouble to +write some months ago to two friends in Paris, in whom I could place +confidence, for information upon the subject. One of them answered +briefly to the effect that nothing was said about it. When the late +Curator of the Lowell Institute, at his request, asked about the +works upon the subject, he was told that they had remained a long +time on the shelves quite unsalable, and never spoken of. + +The other gentleman, [Dr. Henry T. Bigelow, now Professor of +Surgery in Harvard University] whose name is well known to my +audience, and who needs no commendation of mine, had the kindness to +procure for me many publications upon the subject, and some +information which sets the whole matter at rest, so far as Paris is +concerned. He went directly to the Baillieres, the principal and +almost the only publishers of all the Homoeopathic books and journals +in that city. The following facts were taken by him from the +account-books of this publishing firm. Four Homoeopathic Journals +have been published in Paris; three of them by the Baillieres. + +The reception they met with may be judged of by showing the number of +subscribers to each on the books of the publishing firm. + +A Review published by some other house, which lasted one year, and +had about fifty subscribers, appeared in 1834, 1835. + +There were only four Journals of Homoeopathy ever published in Paris. +The Baillieres informed my correspondent that the sale of +Homoeopathic books was much less than formerly, and that consequently +they should undertake to publish no new books upon the subject, +except those of Jahr or Hahnemann. "This man," says my +correspondent,--referring to one of the brothers,--"the publisher and +headquarters of Homoeopathy in Paris, informs me that it is going +down in England and Germany as well as in Paris." For all the facts +he had stated he pledged himself as responsible. + +Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and +since then has been going down. + +Louis told my correspondent that no person of distinction in Paris +had embraced Homoeopathy, and that it was declining. If you ask who +Louis is, I refer you to the well-known Homoeopathist, Peschier of +Geneva, who says, addressing him, "I respect no one more than +yourself; the feeling which guides your researches, your labors, and +your pen, is so honorable and rare, that I could not but bow down +before it; and I own, if there were any allopathist who inspired me +with higher veneration, it would be him and not yourself whom I +should address." + +Among the names of "Distinguished Homoeopathists," however, displayed +in imposing columns, in the index of the "Homoeopathic Examiner," are +those of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the +world of science, and the last of them identified with some of the +most valuable contributions which anatomical knowledge has received +since the commencement of the present century. One Dr. Chrysaora, +who stands sponsor for many facts in that Journal, makes the +following statement among the rest: "Professors, who are esteemed +among the most distinguished of the Faculty (Faculty de Medicine), +both as to knowledge and reputation, have openly confessed the power +of Homoeopathia in forms of disease where the ordinary method of +practice proved totally insufficient. It affords me the highest +pleasure to select from among these gentlemen, Marjolin, Amussat, and +Breschet." + +Here is a literal translation of an original letter, now in my +possession, from one of these Homoeopathists to my correspondent:-- + +"DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER: + +"You have had the kindness to inform me in your letter that a new +American Journal, the 'New World,' has made use of my name in +support of the pretended Homoeopathic doctrines, and that I am +represented as one of the warmest partisans of Homoeopathy in France. + +"I am vastly surprised at the reputation manufactured for me upon the +new continent; but I am obliged, in deference to truth, to reject it +with my whole energy. I spurn far from me everything which relates +to that charlatanism called Homoeopathy, for these pretended +doctrines cannot endure the scrutiny of wise and enlightened persons, +who are guided by honorable sentiments in the practice of the noblest +of arts. + +"PARIS, 3d November, 1841 + +"I am, etc., etc., + +"G. BRESCHET, + +"Professor in the Faculty of Medicine, Member of the Institute, +Surgeon of Hotel Dieu, and Consulting Surgeon to the King, etc." +[I first saw M. Breschet's name mentioned in that Journal] + +Concerning Amussat, my correspondent writes, that he was informed by +Madame Hahnemann, who converses in French more readily than her +husband, and therefore often speaks for him, that "he was not a +physician, neither Homoeopathist nor Allopathist, but that he was the +surgeon of their own establishment; that is, performed as a surgeon +all the operations they had occasion for in their practice." + +I regret not having made any inquiries as to Marjolin, who, I doubt +not, would strike his ponderous snuff-box until it resounded like the +Grecian horse, at hearing such a doctrine associated with his +respectable name. I was not aware, when writing to Paris, that this +worthy Professor, whose lectures I long attended, was included in +these audacious claims; but after the specimens I have given of the +accuracy of the foreign correspondence of the "Homoeopathic +Examiner," any further information I might obtain would seem so +superfluous as hardly to be worth the postage. + +Homoeopathy may be said, then, to be in a sufficiently miserable +condition in Paris. Yet there lives, and there has lived for years, +the illustrious Samuel Hahnemann, who himself assured my +correspondent that no place offered the advantages of Paris in its +investigation, by reason of the attention there paid to it. + +In England, it appears by the statement of Dr. Curie in October, +1839, about eight years after its introduction into the country, that +there were eighteen Homoeopathic physicians in the United Kingdom, of +whom only three were to be found out of London, and that many of +these practised Homoeopathy in secret. + +It will be seen, therefore, that, according to the recent statement +of one of its leading English advocates, Homoeopathy had obtained not +quite half as many practical disciples in England as Perkinism could +show for itself in a somewhat less period from the time of its first +promulgation in that country. + +Dr. Curie's letter, dated London, October 30, 1839, says there is +"one in Dublin, Dr. Luther; at Glasgow, Dr. Scott." The +"distinguished" Chrysaora writes from Paris, dating October 20, 1839, +"On the other hand, Homoeopathy is commencing to make an inroad into +England by the way of Ireland. At Dublin, distinguished physicians +have already embraced the new system, and a great part of the +nobility and gentry of that city have emancipated themselves from the +English fashion and professional authority." + +But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize +Homoeopathy; the Queen Dowager Adelaide has been treated by a +Homoeopathic physician. "Jarley is the delight of the nobility and +gentry." "The Royal Family are the patrons of Jarley." + +Let me ask if a Marquis and a Knight are better than two Lords, and +if the Dowager of Royalty is better than Royalty itself, all of which +illustrious dignities were claimed in behalf of Benjamin Douglass +Perkins? + +But if the balance is thought too evenly suspended in this case, +another instance can be given in which the evidence of British +noblemen and their ladies is shown to be as valuable in establishing +the character of a medical man or doctrine, as would be the testimony +of the Marquis of Waterford concerning the present condition and +prospects of missionary enterprise. I have before me an octavo +volume of more than four hundred pages, in which, among much similar +matter, I find highly commendatory letters from the Marchioness of +Ormond, Lady Harriet Kavanagh, the Countess of Buckinghamshire, the +Right Hon. Viscount Ingestre, M. P., and the Most Noble, the Marquis +of Sligo,--all addressed to "John St. John Long, Esq," a wretched +charlatan, twice tried for, and once convicted of, manslaughter at +the Old Bailey. + +This poor creature, too, like all of his tribe, speaks of the medical +profession as a great confederation of bigoted monopolists. He, too, +says that "If an innovator should appear, holding out hope to those +in despair, and curing disorders which the faculty have recorded as +irremediable, he is at once, and without inquiry, denounced as an +empiric and an impostor." He, too, cites the inevitable names of +Galileo and Harvey, and refers to the feelings excited by the great +discovery of Jenner. From the treatment of the great astronomer who +was visited with the punishment of other heretics by the +ecclesiastical authorities of a Catholic country some centuries +since, there is no very direct inference to be drawn to the medical +profession of the present time. His name should be babbled no +longer, after having been placarded for the hundredth time in the +pages of St. John Long. But if we are doomed to see constant +reference to the names of Harvey and Jenner in every worthless +pamphlet containing the prospectus of some new trick upon the public, +let us, once for all, stare the facts in the face, and see how the +discoveries of these great men were actually received by the medical +profession. + +In 1628, Harvey published his first work upon the circulation. His +doctrines were a complete revolution of the prevailing opinions of +all antiquity. They immediately found both champions and opponents; +of which last, one only, Riolanus, seemed to Harvey worthy of an +answer, on account of his "rank, fame, and learning." Controversy in +science, as in religion, was not, in those days, carried on with all +the courtesy which our present habits demand, and it is possible that +some hard words may have been applied to Harvey, as it is very +certain that he used the most contemptuous expressions towards +others. + +Harvey declares in his second letter to Riolanus, "Since the first +discovery of the circulation, hardly a day, or a moment, has passed +without my hearing it both well and ill spoken of; some attack it +with great hostility, others defend it with high encomiums; one party +believe that I have abundantly proved the truth of the doctrine +against all the weight of opposing arguments, by experiments, +observations, and dissections; others think it not yet sufficiently +cleared up, and free from objections." Two really eminent +Professors, Plempius of Louvain, and Walaeus of Leyden, were among +its early advocates. + +The opinions sanctioned by the authority of long ages, and the names +of Hippocrates and Galen, dissolved away, gradually, but certainly, +before the demonstrations of Harvey. Twenty-four years after the +publication of his first work, and six years before his death, his +bust in marble was placed in the Hall of the College of Physicians, +with a suitable inscription recording his discoveries. + +Two years after this he was unanimously invited to accept the +Presidency of that body; and he lived to see his doctrine +established, and all reputable opposition withdrawn. + +There were many circumstances connected with the discovery of Dr. +Jenner which were of a nature to excite repugnance and opposition. +The practice of inoculation for the small-pox had already disarmed +that disease of many of its terrors. The introduction of a +contagious disease from a brute creature into the human system +naturally struck the public mind with a sensation of disgust and +apprehension, and a part of the medical public may have shared these +feelings. I find that Jenner's discovery of vaccination was made +public in June, 1798. In July of the same year the celebrated +surgeon, Mr. Cline, vaccinated a child with virus received from Dr. +Jenner, and in communicating the success of this experiment, he +mentions that Dr. Lister, formerly of the Small-Pox Hospital, and +himself, are convinced of the efficacy of the cow-pox. In November +of the same year, Dr. Pearson published his "Inquiry," containing the +testimony of numerous practitioners in different parts of the +kingdom, to the efficacy of the practice. Dr. HAYGARTH, who was so +conspicuous in exposing the follies of Perkinism, was among the very +earliest to express his opinion in favor of vaccination. In 1801, +Dr. Lettsom mentions the circumstance "as being to the honor of the +medical professors, that they have very generally encouraged this +salutary practice, although it is certainly calculated to lessen +their pecuniary advantages by its tendency to extirpate a fertile +source of professional practice." + +In the same year the Medical Committee of Paris spoke of vaccination +in a public letter, as "the most brilliant and most important +discovery of the eighteenth century." The Directors of a Society for +the Extermination of the Small-Pox, in a Report dated October 1st, +1807, "congratulate the public on the very favorable opinion which +the Royal College of Physicians of London, after a most minute and +laborious investigation made by the command of his Majesty, have a +second time expressed on the subject of vaccination, in their Report +laid before the House of Commons, in the last session of Parliament; +in consequence of which the sum of twenty thousand pounds was voted +to Dr. Jenner, as a remuneration for his discovery, in addition to +ten thousand pounds before granted." (In June, 1802.) + +These and similar accusations, so often brought up against the +Medical Profession, are only one mode in which is manifested a spirit +of opposition not merely to medical science, but to all science, and +to all sound knowledge. It is a spirit which neither understands +itself nor the object at which it is aiming. It gropes among the +loose records of the past, and the floating fables of the moment, to +glean a few truths or falsehoods tending to prove, if they prove +anything, that the persons who have passed their lives in the study +of a branch of knowledge the very essence of which must always +consist in long and accurate observation, are less competent to judge +of new doctrines in their own department than the rest of the +community. It belongs to the clown in society, the destructive in +politics, and the rogue in practice. + +The name of Harvey, whose great discovery was the legitimate result +of his severe training and patient study, should be mentioned only to +check the pretensions of presumptuous ignorance. The example of +Jenner, who gave his inestimable secret, the result of twenty-two +years of experiment and researches, unpurchased, to the public,-- +when, as was said in Parliament, he might have made a hundred +thousand pounds by it as well as any smaller sum,--should be referred +to only to rebuke the selfish venders of secret remedies, among whom +his early history obliges us reluctantly to record Samuel Hahnemann. +Those who speak of the great body of physicians as if they were +united in a league to support the superannuated notions of the past +against the progress of improvement, have read the history of +medicine to little purpose. The prevalent failing of this profession +has been, on the contrary, to lend a too credulous ear to ambitious +and plausible innovators. If at the present time ten years of public +notoriety have passed over any doctrine professing to be of +importance in medical science, and if it has not succeeded in raising +up a powerful body of able, learned, and ingenious advocates for its +claims, the fault must be in the doctrine and not in the medical +profession. + +Homoeopathy has had a still more extended period of trial than this, +and we have seen with what results. It only remains to throw out a +few conjectures as to the particular manner in which it is to break +up and disappear. + +1. The confidence of the few believers in this delusion will never +survive the loss of friends who may die of any acute disease, under a +treatment such as that prescribed by Homoeopathy. It is doubtful how +far cases of this kind will be trusted to its tender mercies, but +wherever it acquires any considerable foothold, such cases must come, +and with them the ruin of those who practise it, should any highly +valued life be thus sacrificed. + +2. After its novelty has worn out, the ardent and capricious +individuals who constitute the most prominent class of its patrons +will return to visible doses, were it only for the sake of a change. + +3. The Semi-Homoeopathic practitioner will gradually withdraw from +the rotten half of his business and try to make the public forget his +connection with it. + +4. The ultra Homoeopathist will either recant and try to rejoin the +medical profession; or he will embrace some newer and if possible +equally extravagant doctrine; or he will stick to his colors and go +down with his sinking doctrine. Very few will pursue the course last +mentioned. + +A single fact may serve to point out in what direction there will +probably be a movement of the dissolving atoms of Homoeopathy. On +the 13th page of the too frequently cited Manifesto of the "Examiner" +I read the following stately paragraph: + +"Bigelius, M. D., physician to the Emperor of Russia, whose elevated +reputation is well known in Europe, has been an acknowledged advocate +of Hahnemann's doctrines for several years. He abandoned Allopathia +for Homoeopathia." The date of this statement is January, 1840. I +find on looking at the booksellers' catalogues that one Bigel, or +Bigelius, to speak more classically, has been at various times +publishing Homoeopathic books for some years. + +Again, on looking into the "Encyclographie des Sciences Medicales" +for April, 1840, I find a work entitled "Manual of HYDROSUDOPATHY, +or the Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel, +Physician of the School of Strasburg, Member of the Medico- +Chirurgical Institute of Naples, of the Academy of St. Petersburg,-- +Assessor of the College of the Empire of Russia, Physician of his +late Imperial Highness the Grand Duke Constantine, Chevalier of the +Legion of Honor, etc." Hydrosudopathy or Hydropathy, as it is +sometimes called, is a new medical doctrine or practice which has +sprung up in Germany since Homoeopathy, which it bids fair to drive +out of the market, if, as Dr. Bigel says, fourteen physicians +afflicted with diseases which defied themselves and their colleagues +came to Graefenberg, in the year 1836 alone, and were cured. Now Dr. +Bigel, "whose elevated reputation is well known in Europe," writes as +follows: "The reader will not fail to see in this defence of the +curative method of Graefenberg a profession of medical faith, and he +will be correct in so doing." And his work closes with the following +sentence, worthy of so distinguished an individual: "We believe, with +religion, that the water of baptism purifies the soul from its +original sin; let us believe also, with experience, that it is for +our corporeal sins the redeemer of the human body." If Bigel, +Physician to the late Grand Duke Constantine, is identical with Bigel +whom the "Examiner" calls Physician to the Emperor of Russia, it +appears that he is now actively engaged in throwing cold water at +once upon his patients and the future prospects of Homoeopathy. + +If, as must be admitted, no one of Hahnemann's doctrines is received +with tolerable unanimity among his disciples, except the central +axiom, Similia similibus curantur; if this axiom itself relies mainly +for its support upon the folly and trickery of Hahnemann, what can we +think of those who announce themselves ready to relinquish all the +accumulated treasures of our art, to trifle with life upon the +strength of these fantastic theories? What shall we think of +professed practitioners of medicine, if, in the words of Jahr, "from +ignorance, for their personal convenience, or through charlatanism, +they treat their patients one day Homoeopathically and the next +Allopathically;" if they parade their pretended new science before +the unguarded portion of the community; if they suffer their names to +be coupled with it wherever it may gain a credulous patient; and deny +all responsibility for its character, refuse all argument for its +doctrines, allege no palliation for the ignorance and deception +interwoven with every thread of its flimsy tissue, when they are +questioned by those competent to judge and entitled to an answer? + +Such is the pretended science of Homoeopathy, to which you are asked +to trust your lives and the lives of those dearest to you. A mingled +mass of perverse ingenuity, of tinsel erudition, of imbecile +credulity, and of artful misrepresentation, too often mingled in +practice, if we may trust the authority of its founder, with +heartless and shameless imposition. Because it is suffered so often +to appeal unanswered to the public, because it has its journals, its +patrons, its apostles, some are weak enough to suppose it can escape +the inevitable doom of utter disgrace and oblivion. Not many years +can pass away before the same curiosity excited by one of Perkins's +Tractors will be awakened at the sight of one of the Infinitesimal +Globules. If it should claim a longer existence, it can only be by +falling into the hands of the sordid wretches who wring their bread +from the cold grasp of disease and death in the hovels of ignorant +poverty. + +As one humble member of a profession which for more than two thousand +years has devoted itself to the pursuit of the best earthly interests +of mankind, always assailed and insulted from without by such as are +ignorant of its infinite perplexities and labors, always striving in +unequal contest with the hundred-armed giant who walks in the +noonday, and sleeps not in the midnight, yet still toiling, not +merely for itself and the present moment, but for the race and the +future, I have lifted my voice against this lifeless delusion, +rolling its shapeless bulk into the path of a noble science it is too +weak to strike, or to injure. + + + + + + +THE CONTAGIOUSNESS OF PUERPERAL FEVER +Printed in 1843; reprinted with additions, 1855. + + +THE POINT AT ISSUE. + + +THE AFFIRMATIVE. + +"The disease known as Puerperal Fever is so far contagious as to be +frequently carried from patient to patient by physicians and nurses." +O. W. Holmes, 1843. + + +THE NEGATIVE. + +"The result of the whole discussion will, I trust, serve, not only to +exalt your views of the value and dignity of our profession, but to +divest your minds of the overpowering dread that you can ever become, +especially to woman, under the extremely interesting circumstances of +gestation and parturition, the minister of evil; that you can ever +convey, in any possible manner, a horrible virus, so destructive in +its effects, and so mysterious in its operations as that attributed +to puerperal fever."--Professor Hodge, +1852. + +"I prefer to attribute them to accident, or Providence, of which I +can form a conception, rather than to a contagion of which I cannot +form any clear idea, at least as to this particular malady."-- +Professor Meigs, 1852. + +" . . . in the propagation of which they have no more to do, than +with the propagation of cholera from Jessore to San Francisco, and +from Mauritius to St. Petersburg."--Professor Meigs, 1854. + + --------------------- + +"I arrived at that certainty in the matter, that I could venture to +foretell what women would be affected with the disease, upon hearing +by what midwife they were to be delivered, or by what nurse they were +to be attended, during their lying-in; and, almost in every instance, +my prediction was verified."--Gordon, 1795. + +"A certain number of deaths is caused every year by the contagion of +puerperal fever, communicated by the nurses and medical attendants." +Farr, in Fifth Annual Report of Registrar-General of England, 1843. + +". . . boards of health, if such exist, or, without them, the +medical institutions of a country, should have the power of coercing, +or of inflicting some kind of punishment on those who recklessly go +from cases of puerperal fevers to parturient or puerperal females, +without using due precaution; and who, having been shown the risk, +criminally encounter it, and convey pestilence and death to the +persons they are employed to aid in the most interesting and +suffering period of female existence."--Copland's Medical +Dictionary, Art. Puerperal States and Diseases, 1852. + +"We conceive it unnecessary to go into detail to prove the contagious +nature of this disease, as there are few, if any, American +practitioners who do not believe in this doctrine."--Dr. Lee, in +Additions to Article last cited. + + ----------------------- + +[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion +arose in a Medical Society of which I was a member, involving the +subject of a certain supposed cause of disease, about which something +was known, a good deal suspected, and not a little feared. The +discussion was suggested by a case, reported at the preceding +meeting, of a physician who made an examination of the body of a +patient who had died with puerperal fever, and who himself died in +less than a week, apparently in consequence of a wound received at +the examination, having attended several women in confinement in the +mean time, all of whom, as it was alleged, were attacked with +puerperal fever. + +Whatever apprehensions and beliefs were entertained, it was plain +that a fuller knowledge of the facts relating to the subject would be +acceptable to all present. I therefore felt that it would be doing a +good service to look into the best records I could find, and inquire +of the most trustworthy practitioners I knew, to learn what +experience had to teach in the matter, and arrived at the results +contained in the following pages. + +The Essay was read before the Boston Society for Medical Improvement, +and, at the request of the Society, printed in the "New England +Quarterly Journal of Medicine and Surgery" for April, 1843. As this +Journal never obtained a large circulation, and ceased to be +published after a year's existence, and as the few copies I had +struck off separately were soon lost sight of among the friends to +whom they were sent, the Essay can hardly be said to have been fully +brought before the Profession. + +The subject of this Paper has the same profound interest for me at +the present moment as it had when I was first collecting the terrible +evidence out of which, as it seems to me, the commonest exercise of +reason could not help shaping the truth it involved. It is not +merely on account of the bearing of the question,--if there is a +question,--on all that is most sacred in human life and happiness, +that the subject cannot lose its interest. It is because it seems +evident that a fair statement of the facts must produce its proper +influence on a very large proportion of well-constituted and +unprejudiced minds. Individuals may, here and there, resist the +practical bearing of the evidence on their own feelings or interests; +some may fail to see its meaning, as some persons may be found who +cannot tell red from green; but I cannot doubt that most readers will +be satisfied and convinced, to loathing, long before they have +finished the dark obituary calendar laid before them. + +I do not know that I shall ever again have so good an opportunity of +being useful as was granted me by the raising of the question which +produced this Essay. For I have abundant evidence that it has made +many practitioners more cautious in their relations with puerperal +females, and I have no doubt it will do so still, if it has a chance +of being read, though it should call out a hundred counterblasts, +proving to the satisfaction of their authors that it proved nothing. +And for my part, I had rather rescue one mother from being poisoned +by her attendant, than claim to have saved forty out of fifty +patients to whom I had carried the disease. Thus, I am willing to +avail myself of any hint coming from without to offer this paper once +more to the press. The occasion has presented itself, as will be +seen, in a convenient if not in a flattering form. + + +I send this Essay again to the MEDICAL PROFESSION, without the change +of a word or syllable. I find, on reviewing it, that it anticipates +and eliminates those secondary questions which cannot be entertained +for a moment until the one great point of fact is peremptorily +settled. In its very statement of the doctrine maintained it avoids +all discussion of the nature of the disease "known as puerperal +fever," and all the somewhat stale philology of the word contagion. +It mentions, fairly enough, the names of sceptics, or unbelievers as +to the reality of personal transmission; of Dewees, of Tonnelle, of +Duges, of Baudelocque, and others; of course, not including those +whose works were then unwritten or unpublished; nor enumerating all +the Continental writers who, in ignorance of the great mass of +evidence accumulated by British practitioners, could hardly be called +well informed on this subject. It meets all the array of negative +cases,--those in which disease did not follow exposure,--by the +striking example of small-pox, which, although one of the most +contagious of diseases, is subject to the most remarkable +irregularities and seeming caprices in its transmission. It makes +full allowance for other causes besides personal transmission, +especially for epidemic influences. It allows for the possibility of +different modes of conveyance of the destructive principle. It +recognizes and supports the belief that a series of cases may +originate from a single primitive source which affects each new +patient in turn; and especially from cases of Erysipelas. It does +not undertake to discuss the theoretical aspect of the subject; that +is a secondary matter of consideration. Where facts are numerous, +and unquestionable, and unequivocal in their significance, theory +must follow them as it best may, keeping time with their step, and +not go before them, marching to the sound of its own drum and +trumpet. Having thus narrowed its area to a limited practical +platform of discussion, a matter of life and death, and not of +phrases or theories, it covers every inch of it with a mass of +evidence which I conceive a Committee of Husbands, who can count +coincidences and draw conclusions as well as a Synod of Accoucheurs, +would justly consider as affording ample reasons for an unceremonious +dismissal of a practitioner (if it is conceivable that such a step +could be waited for), after five or six funerals had marked the path +of his daily visits, while other practitioners were not thus +escorted. To the Profession, therefore, I submit the paper in its +original form, and leave it to take care of itself. + +To the MEDICAL STUDENTS, into whose hands this Essay may fall, some +words of introduction may be appropriate, and perhaps, to a small +number of them, necessary. There are some among them who, from +youth, or want of training, are easily bewildered and confused in any +conflict of opinions into which their studies lead them. They are +liable to lose sight of the main question in collateral issues, and +to be run away with by suggestive speculations. They confound belief +with evidence, often trusting the first because it is expressed with +energy, and slighting the latter because it is calm and +unimpassioned. They are not satisfied with proof; they cannot +believe a point is settled so long as everybody is not silenced. +They have not learned that error is got out of the minds that cherish +it, as the taenia is removed from the body, one joint, or a few +joints at a time, for the most part, rarely the whole evil at once. +They naturally have faith in their instructors, turning to them for +truth, and taking what they may choose to give them; babes in +knowledge, not yet able to tell the breast from the bottle, pumping +away for the milk of truth at all that offers, were it nothing better +than a Professor's shrivelled forefinger. + +In the earliest and embryonic stage of professional development, any +violent impression on the instructor's mind is apt to be followed by +some lasting effect on that of the pupil. No mother's mark is more +permanent than the mental naevi and moles, and excrescences, and +mutilations, that students carry with them out of the lecture-room, +if once the teeming intellect which nourishes theirs has been scared +from its propriety by any misshapen fantasy. Even an impatient or +petulant expression, which to a philosopher would be a mere index of +the low state of amiability of the speaker at the moment of its +utterance, may pass into the young mind as an element of its future +constitution, to injure its temper or corrupt its judgment. It is a +duty, therefore, which we owe to this younger class of students, to +clear any important truth which may have been rendered questionable +in their minds by such language, or any truth-teller against whom +they may have been prejudiced by hasty epithets, from the impressions +such words have left. Until this is done, they are not ready for the +question, where there is a question, for them to decide. Even if we +ourselves are the subjects of the prejudice, there seems to be no +impropriety in showing that this prejudice is local or personal, and +not an acknowledged conviction with the public at large. It may be +necessary to break through our usual habits of reserve to do this, +but this is the fault of the position in which others have placed us. + +Two widely-known and highly-esteemed practitioners, Professors in two +of the largest Medical Schools of the Union, teaching the branch of +art which includes the Diseases of Women, and therefore speaking with +authority; addressing in their lectures and printed publications +large numbers of young men, many of them in the tenderest immaturity +of knowledge, have recently taken ground in a formal way against the +doctrine maintained in this paper: + +On the Non-Contagious Character of Puerperal Fever: An Introductory +Lecture. By Hugh L. Hodge, M. D., Professor of Obstetrics in the +University of Pennsylvania. Delivered Monday, October 11, 1852. +Philadelphia, 1852. + +On the Nature, Signs, and Treatment of Childbed Fevers : in a Series +of Letters addressed to the Students of his Class. By Charles D. +Meigs, M. D., Professor of Midwifery and the Diseases of Women and +Children in Jefferson Medical College, Philadelphia, etc., etc. +Philadelphia, 1854. Letter VI. + + +The first of the two publications, Dr. Hodge's Lecture, while its +theoretical considerations and negative experiences do not seem to me +to require any further notice than such as lay ready for them in my +Essay written long before, is, I am pleased to say, unobjectionable +in tone and language, and may be read without offence. + +This can hardly be said of the chapter of Dr. Meigs's volume which +treats of Contagion in Childbed Fever. There are expressions used in +it which might well put a stop to all scientific discussions, were +they to form the current coin in our exchange of opinions. I leave +the "very young gentlemen," whose careful expositions of the results +of practice in more than six thousand cases are characterized as "the +jejune and fizenless dreamings of sophomore writers," to the +sympathies of those "dear young friends," and "dear young gentlemen," +who will judge how much to value their instructor's counsel to think +for themselves, knowing what they are to expect if they happen not to +think as he does. + +One unpalatable expression I suppose the laws of construction oblige +me to appropriate to myself, as my reward for a certain amount of +labor bestowed on the investigation of a very important question of +evidence, and a statement of my own practical conclusions. I take no +offence, and attempt no retort. No man makes a quarrel with me over +the counterpane that covers a mother, with her new-born infant at her +breast. There is no epithet in the vocabulary of slight and sarcasm +that can reach my personal sensibilities in such a controversy. Only +just so far as a disrespectful phrase may turn the student aside from +the examination of the evidence, by discrediting or dishonoring the +witness, does it call for any word of notice. + +I appeal from the disparaging language by which the Professor in the +Jefferson School of Philadelphia world dispose of my claims to be +listened to. I appeal, not to the vote of the Society for Medical +Improvement, although this was an unusual evidence of interest in the +paper in question, for it was a vote passed among my own townsmen; +nor to the opinion of any American, for none know better than the +Professors in the great Schools of Philadelphia how cheaply the +praise of native contemporary criticism is obtained. I appeal to the +recorded opinions of those whom I do not know, and who do not know +me, nor care for me, except for the truth that I may have uttered; to +Copland, in his "Medical Dictionary," who has spoken of my Essay in +phrases to which the pamphlets of American "scribblers" are seldom +used from European authorities; to Ramsbotham, whose compendious +eulogy is all that self-love could ask; to the "Fifth Annual Report" +of the Registrar-General of England, in which the second-hand +abstract of my Essay figures largely, and not without favorable +comment, in an important appended paper. These testimonies, half +forgotten until this circumstance recalled them, are dragged into the +light, not in a paroxysm of vanity, but to show that there may be +food for thought in the small pamphlet which the Philadelphia Teacher +treats so lightly. They were at least unsought for, and would never +have been proclaimed but for the sake of securing the privilege of a +decent and unprejudiced hearing. + +I will take it for granted that they have so far counterpoised the +depreciating language of my fellow-countryman and fellow-teacher as +to gain me a reader here and there among the youthful class of +students I am now addressing. It is only for their sake that I think +it necessary to analyze, or explain, or illustrate, or corroborate +any portion of the following Essay. But I know that nothing can be +made too plain for beginners; and as I do not expect the +practitioner, or even the more mature student, to take the trouble to +follow me through an Introduction which I consider wholly unnecessary +and superfluous for them, I shall not hesitate to stoop to the most +elementary simplicity for the benefit of the younger student. I do +this more willingly because it affords a good opportunity, as it +seems to me, of exercising the untrained mind in that medical logic +which does not seem to have been either taught or practised in our +schools of late, to the extent that might be desired. + +I will now exhibit, in a series of propositions reduced to their +simplest expression, the same essential statements and conclusions as +are contained in the Essay, with such commentaries and explanations +as may be profitable to the inexperienced class of readers addressed. + + +I. It has been long believed, by many competent observers, that +Puerperal Fever (so called) is sometimes carried from patient to +patient by medical assistants. + +II. The express object of this Essay is to prove that it is so +carried. + +III. In order to prove this point, it is not necessary to consult +any medical theorist as to whether or not it is consistent with his +preconceived notions that such a mode of transfer should exist. + +IV. If the medical theorist insists on being consulted, and we see +fit to indulge him, he cannot be allowed to assume that the alleged +laws of contagion, deduced from observation in other diseases, shall +be cited to disprove the alleged laws deduced from observation in +this. Science would never make progress under such conditions. +Neither the long incubation of hydrophobia, nor the protecting power +of vaccination, would ever have been admitted, if the results of +observation in these affections had been rejected as contradictory to +the previously ascertained laws of contagion. + +V. The disease in question is not a common one; producing, on the +average, about three deaths in a thousand births, according to the +English Registration returns which I have examined. + +VI. When an unusually large number of cases of this disease occur +about the same time, it is inferred, therefore, that there exists +some special cause for this increased frequency. If the disease +prevails extensively over a wide region of country, it is attributed +without dispute to an epidemic influence. If it prevails in a single +locality, as in a hospital, and not elsewhere, this is considered +proof that some local cause is there active in its production. + +VII. When a large number of cases of this disease occur in rapid +succession, in one individual's ordinary practice, and few or none +elsewhere, these cases appearing in scattered localities, in patients +of the same average condition as those who escape under the care of +others, there is the same reason for connecting the cause of the +disease with the person in this instance, as with the place in that +last mentioned. + +VIII. Many series of cases, answering to these conditions, are given +in this Essay, and many others will be referred to which have +occurred since it was written. + +IX. The alleged results of observation may be set aside; first, +because the so-called facts are in their own nature equivocal; +secondly, because they stand on insufficient authority; thirdly, +because they are not sufficiently numerous. But, in this case, the +disease is one of striking and well-marked character; the witnesses +are experts, interested in denying and disbelieving the facts; the +number of consecutive cases in many instances frightful, and the +number of series of cases such that I have no room for many of them +except by mere reference. + +X. These results of observation, being admitted, may, we will +suppose, be interpreted in different methods. Thus the coincidences +may be considered the effect of chance. I have had the chances +calculated by a competent person, that a given practitioner, A., +shall have sixteen fatal cases in a month, on the following data: +A. to average attendance upon two hundred and fifty births in a year; +three deaths in one thousand births to be assumed as the average from +puerperal fever; no epidemic to be at the time prevailing. It +follows, from the answer given me, that if we suppose every one of +the five hundred thousand annual births of England to have been +recorded during the last half-century, there would not be one chance +in a million million million millions that one such series should be +noted. No possible fractional error in this calculation can render +the chance a working probability. Applied to dozens of series of +various lengths, it is obviously an absurdity. Chance, therefore, is +out of the question as an explanation of the admitted coincidences. + +XI. There is, therefore, some relation of cause and effect between +the physician's presence and the patient's disease. + +XII. Until it is proved to what removable condition attaching to the +attendant the disease is owing, he is bound to stay away from his +patients so soon as he finds himself singled out to be tracked by the +disease. How long, and with what other precautions, I have +suggested, without dictating, at the close of my Essay. If the +physician does not at once act on any reasonable suspicion of his +being the medium of transfer, the families where he is engaged, if +they are allowed to know the facts, should decline his services for +the time. His feelings on the occasion, however interesting to +himself, should not be even named in this connection. A physician +who talks about ceremony and gratitude, and services rendered, and +the treatment he got, surely forgets himself; it is impossible that +he should seriously think of these small matters where there is even +a question whether he may not carry disease, and death, and +bereavement into any one of "his families," as they are sometimes +called. + + +I will now point out to the young student the mode in which he may +relieve his mind of any confusion, or possibly, if very young, any +doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised +in his mind. + +The most prominent ideas of the Letter are, first, that the +transmissible nature of puerperal fever appears improbable, and, +secondly, that it would be very inconvenient to the writer. +Dr. Woodville, Physician to the Small-Pox and Inoculation Hospital in +London, found it improbable, and exceedingly inconvenient to himself, +that cow pox should prevent small-pox; but Dr. Jenner took the +liberty to prove the fact, notwithstanding. + +I will first call the young student's attention to the show of +negative facts (exposure without subsequent disease), of which much +seems to be thought. And I may at the same time refer him to Dr. +Hodge's Lecture, where he will find the same kind of facts and +reasoning. Let him now take up Watson's Lectures, the good sense and +spirit of which have made his book a universal favorite, and open to +the chapter on Continued Fever. He will find a paragraph containing +the following sentence: "A man might say, 'I was in the battle of +Waterloo, and saw many men around me fall down and die, and it was +said that they were struck down by musket-balls; but I know better +than that, for I was there all the time, and so were many of my +friends, and we were never hit by any musket-balls. Musket-balls, +therefore, could not have been the cause of the deaths we witnessed.' +And if, like contagion, they were not palpable to the senses, such a +person might go on to affirm that no proof existed of there being any +such thing as musket-balls." Now let the student turn back to the +chapter on Hydrophobia in the same volume. He will find that John +Hunter knew a case in which, of twenty-one persons bitten, only one +died of the disease. He will find that one dog at Charenton was +bitten at different times by thirty different mad dogs, and outlived +it all. Is there no such thing, then, as hydrophobia? Would one +take no especial precautions if his wife, about to become a mother, +had been bitten by a rabid animal, because so many escape? Or let +him look at "Underwood on Diseases of Children,"[Philadelphia, 1842, +p. 244, note.] and he will find the case of a young woman who was +inoculated eight times in thirty days, at the same time attending +several children with smallpox, and yet was not infected. But seven +weeks afterwards she took the disease and died. + +It would seem as if the force of this argument could hardly fail to +be seen, if it were granted that every one of these series of cases +were so reported as to prove that there could have been no transfer +of disease. There is not one of them so reported, in the Lecture or +the Letter, as to prove that the disease may not have been carried by +the practitioner. I strongly suspect that it was so carried in some +of these cases, but from the character of the very imperfect evidence +the question can never be settled without further disclosures. + +Although the Letter is, as I have implied, principally taken up with +secondary and collateral questions, and might therefore be set aside +as in the main irrelevant, I am willing, for the student's sake, to +touch some of these questions briefly, as an illustration of its +logical character. + +The first thing to be done, as I thought when I wrote my Essay, was +to throw out all discussions of the word contagion, and this I did +effectually by the careful wording of my statement of the subject to +be discussed. My object was not to settle the etymology or +definition of a word, but to show that women had often died in +childbed, poisoned in some way by their medical attendants. On the +other point, I, at least, have no controversy with anybody, and I +think the student will do well to avoid it in this connection. If I +must define my position, however, as well as the term in question, I +am contented with Worcester's definition; provided always this avowal +do not open another side controversy on the merits of his Dictionary, +which Dr. Meigs has not cited, as compared with Webster's, which he +has. + +I cannot see the propriety of insisting that all the laws of the +eruptive fevers must necessarily hold true of this peculiar disease +of puerperal women. If there were any such propriety, the laws of +the eruptive fevers must at least be stated correctly. It is not +true, for instance, as Dr. Meigs states, that contagion is "no +respecter of persons;" that "it attacks all individuals alike." To +give one example: Dr. Gregory, of the Small-Pox Hospital, who ought +to know, says that persons pass through life apparently insensible to +or unsusceptible of the small-pox virus, and that the same persons do +not take the vaccine disease. + +As to the short time of incubation, of which so much is made, we have +no right to decide beforehand whether it shall be long or short, in +the cases we are considering. A dissection wound may produce +symptoms of poisoning in six hours; the bite of a rabid animal may +take as many months. + +After the student has read the case in Dr. Meigs's 136th paragraph, +and the following one, in which he exclaims against the idea of +contagion, because the patient, delivered on the 26th of December, +was attacked in twenty-four hours, and died on the third day, let him +read what happened at the "Black Assizes" of 1577 and 1750. In the +first case, six hundred persons sickened the same night of the +exposure, and three hundred more in three days. [Elliotson's +Practice, p. 298.] Of those attacked in the latter year, the +exposure being on the 11th of May, Alderman Lambert died on the 13th, +Under-Sheriff Cox on the 14th, and many of note before the +20th. But these are old stories. Let the student listen then to Dr. +Gerhard, whose reputation as a cautious observer he may be supposed +to know. "The nurse was shaving a man, who died in a few hours after +his entrance; he inhaled his breath, which had a nauseous taste, and +in an hour afterwards was taken with nausea, cephalalgia, and singing +of the ears. From that moment the attack began, and assumed a severe +character. The assistant was supporting another patient, who died +soon afterwards; he felt the pungent heat upon his skin, and was +taken immediately with the symptoms of typhus."[Am. Jour. Med. +Sciences, Feb. 1837, p. 299.] It is by notes of cases, rather +than notes of admiration, that we must be guided, when we study the +Revised Statutes of Nature, as laid down from the curule chairs of +Medicine. + +Let the student read Dr. Meigs's 140th paragraph soberly, and then +remember, that not only does he infer, suspect, and surmise, but he +actually asserts (page 154), "there was poison in the house," because +three out of five patients admitted into a ward had puerperal fever +and died. Have I not as much right to draw a positive inference from +"Dr. A.'s" seventy exclusive cases as he from the three cases in the +ward of the Dublin Hospital? All practical medicine, and all action +in common affairs, is founded on inferences. How does Dr. Meigs know +that the patients he bled in puerperal fever would not have all got +well if he had not bled them? + +"You see a man discharge a gun at another; you see the flash, you +hear the report, you see the person fall a lifeless corpse; and you +infer, from all these circumstances, that there was a ball discharged +from the gun, which entered his body and caused his death, because +such is the usual and natural cause of such an effect. But you did +not see the ball leave the gun, pass through the air, and enter the +body of the slain; and your testimony to the fact of killing is, +therefore, only inferential,--in other words, circumstantial. It is +possible that no ball was in the gun; and we infer that there was, +only because we cannot account for death on any other supposition." +[Chief Justice Gibson, in Am. Law Journal, vol. vi. p. 123.] + +"The question always comes to this: Is the circumstance of +intercourse with the sick followed by the appearance of the disease +in a proportion of cases so much greater than any other circumstance +common to any portion of the inhabitants of the place under +observation, as to make it inconceivable that the succession of cases +occurring in persons having that intercourse should have been the +result of chance? If so, the inference is unavoidable, that that +intercourse must have acted as a cause of the disease. All +observations which do not bear strictly on that point are irrelevant, +and, in the case of an epidemic first appearing in a town or +district, a succession of two cases is sometimes sufficient to +furnish evidence which, on the principle I have stated, is nearly +irresistible." + +Possibly an inexperienced youth may be awe-struck by the quotation +from Cuvier. These words, or their equivalent, are certainly to be +found in his Introduction. So are the words "top not come down"! +to be found in the Bible, and they were as much meant for the ladies' +head-dresses as the words of Cuvier were meant to make clinical +observation wait for a permit from anybody to look with its eyes and +count on its fingers. Let the inquiring youth read the whole +Introduction, and he will see what they mean. + +I intend no breach of courtesy, but this is a proper place to warn +the student against skimming the prefaces and introductions of works +for mottoes and embellishments to his thesis. He cannot learn +anatomy by thrusting an exploring needle into the body. He will be +very liable to misquote his author's meaning while he is picking off +his outside sentences. He may make as great a blunder as that simple +prince who praised the conductor of his orchestra for the piece just +before the overture; the musician was too good a courtier to tell him +that it was only the tuning of the instruments. + +To the six propositions in the 142d paragraph, and the remarks about +"specific" diseases, the answer, if any is necessary, seems very +simple. An inflammation of a serous membrane may give rise to +secretions which act as a poison, whether that be a "specific" poison +or not, as Dr. Homer has told his young readers, and as dissectors +know too well; and that poison may produce its symptoms in a few +hours after the system has received it, as any may see in Druitt's +"Surgery," if they care to look. Puerperal peritonitis may produce +such a poison, and puerperal women may be very sensible to its +influences, conveyed by contact or exhalation. Whether this is so or +not, facts alone can determine, and to facts we have had recourse to +settle it. + +The following statement is made by Dr. Meigs in his 142d paragraph, +and developed more at length, with rhetorical amplifications, in the +134th. "No human being, save a pregnant or parturient woman, is +susceptible to the poison." This statement is wholly incorrect, as I +am sorry to have to point out to a Teacher in Dr. Meigs's position. +I do not object to the erudition which quotes Willis and Fernelius, +the last of whom was pleasantly said to have "preserved the dregs of +the Arabs in the honey of his Latinity." But I could wish that more +modern authorities had not been overlooked. On this point, for +instance, among the numerous facts disproving the statement, the +"American Journal of Medical Sciences," published not far from his +lecture-room, would have presented him with a respectable catalog of +such cases. Thus he might refer to Mr. Storrs's paper "On the +Contagious Effects of Puerperal Fever on the Male Subject; or on +Persons not Childbearing"(Jan. 1846), or to Dr. Reid's case (April, +1846), or to Dr. Barron's statement of the children's dying of +peritonitis in an epidemic of puerperal fever at the Philadelphia +Hospital (Oct. 1842), or to various instances cited in Dr. +Kneeland's article (April, 186). Or, if he would have referred to +the "New York Journal," he might have seen Prof. Austin Flint's +cases. Or, if he had honored my Essay so far, he might have found +striking instances of the same kind in the first of the new series of +cases there reported and elsewhere. I do not see the bearing of his +proposition, if it were true. But it is one of those assertions that +fall in a moment before a slight examination of the facts; and I +confess my surprise, that a professor who lectures on the Diseases of +Women should have ventured to make it. + +Nearly seven pages are devoted to showing that I was wrong in saying +I would not be "understood to imply that there exists a doubt in the +mind of any well-informed member of the medical profession as to the +fact that puerperal fever is sometimes communicated from one person +to another, both directly and indirectly." I will devote seven lines +to these seven pages, which seven lines, if I may say it without +offence, are, as it seems to me, six more than are strictly +necessary. + +The following authors are cited as sceptics by Dr. Meigs: +Dewees.--I cited the same passage. Did not know half the facts. +Robert Lee.--Believes the disease is sometimes communicable by +contagion. Tonnelle, Baudelocque. Both cited by me. Jacquemier. +--Published three years after my Essay. Kiwisch. Behindhand in +knowledge of Puerperal Fever." [B. & F. Med. Rev. Jan. 1842.] +Paul Dubois.--Scanzoni. + +These Continental writers not well informed on this point.[See Dr. +Simpson's Remarks at Meeting of Edin. Med. Chir. Soc. (Am. Jour. +Oct. 1851.)] + +The story of Von Busch is of interest and value, but there is nothing +in it which need perplex the student. It is not pretended that the +disease is always, or even, it may be, in the majority of cases, +carried about by attendants; only that it is so carried in certain +cases. That it may have local and epidemic causes, as well as that +depending on personal transmission, is not disputed. Remember how +small-pox often disappears from a community in spite of its +contagious character, and the necessary exposure of many persons to +those suffering from it; in both diseases contagion is only one of +the coefficients of the disease. + +I have already spoken of the possibility that Dr. Meigs may have been +the medium of transfer of puerperal fever in some of the cases he has +briefly catalogued. Of Dr. Rutter's cases I do not know how to +speak. I only ask the student to read the facts stated by Dr. +Condie, as given in my Essay, and say whether or not a man should +allow his wife to be attended by a practitioner in whose hands +"scarcely a female that has been delivered for weeks past has escaped +an attack," "while no instance of the disease has occurred in the +patients of any other accoucheur practising in the same district." +If I understand Dr. Meigs and Dr. Hodge, they would not warn the +physician or spare the patient under such circumstances. They would +"go on," if I understand them, not to seven, or seventy, only, but to +seventy times seven, if they could find patients. If this is not +what they mean, may we respectfully ask them to state what they do +mean, to their next classes, in the name of humanity, if not of +science! + +I might repeat the question asked concerning Dr. Rutter's cases, with +reference to those reported by Dr. Roberton. Perhaps, however, the +student would like to know the opinion of a person in the habit of +working at matters of this kind in a practical point of view. To +satisfy him on this ground, I addressed the following question to the +President of one of our principal Insurance Companies, leaving Dr. +Meigs's book and my Essay in his hands at the same time. + +Question. "If such facts as Roberton's cases were before you, and +the attendant had had ten, or even five fatal cases, or three, or two +even, would you, or would you not, if insuring the life of the next +patient to be taken care of by that attendant, expect an extra +premium over that of an average case of childbirth?" + +Answer. "Of course I should require a very large extra premium, if +I would take take risk at all." + +But I do not choose to add the expressions of indignation which the +examination of the facts before him called out. I was satisfied from +the effect they produced on him, that if all the hideous catalogues +of cases now accumulated were fully brought to the knowledge of the +public, nothing, since the days of Burke and Hare, has raised such a +cry of horror as would be shrieked in the ears of the Profession. + +Dr. Meigs has elsewhere invoked "Providence" as the alternative of +accident, to account for the "coincidences." ("Obstetrics," Phil. +1852, p. 631.) If so, Providence either acts through the agency of +secondary causes, as in other diseases, or not. If through such +causes, let us find out what they are, as we try to do in other +cases. It may be true that offences, or diseases, will come, but +"woe unto him through whom they come," if we catch him in the +voluntary or careless act of bringing them! But if Providence does +not act through secondary causes in this particular sphere of +etiology, then why does Dr. Meigs take such pains to reason so +extensively about the laws of contagion, which, on that supposition, +have no more to do with this case than with the plague which +destroyed the people after David had numbered them? Above all, what +becomes of the theological aspect of the question, when he asserts +that a practitioner was "only unlucky in meeting with the epidemic +cases?" (Op. cit. p. 633.) We do not deny that the God of battles +decides the fate of nations; but we like to have the biggest +squadrons on our side, and we are particular that our soldiers should +not only say their prayers, but also keep their powder dry. We do +not deny the agency of Providence in the disaster at Norwalk, but we +turn off the engineer, and charge the Company five thousand dollars +apiece for every life that is sacrificed. + +Why a grand jury should not bring in a bill against a physician who +switches off a score of women one after the other along his private +track, when he knows that there is a black gulf at the end of it, +down which they are to plunge, while the great highway is clear, is +more than I can answer. It is not by laying the open draw to +Providence that he is to escape the charge of manslaughter. + +To finish with all these lesser matters of question, I am unable to +see why a female must necessarily be unattended in her confinement, +because she declines the services of a particular practitioner. In +all the series of cases mentioned, the death-carrying attendant was +surrounded by others not tracked by disease and its consequences. +Which, I would ask, is worse,--to call in another, even a rival +practitioner, or to submit an unsuspecting female to a risk which an +Insurance Company would have nothing to do with? + +I do not expect ever to return to this subject. There is a point of +mental saturation, beyond which argument cannot be forced without +breeding impatient, if not harsh, feelings towards those who refuse +to be convinced. If I have so far manifested neither, it is well to +stop here, and leave the rest to those younger friends who may have +more stomach for the dregs of a stale argument. + +The extent of my prefatory remarks may lead some to think that I +attach too much importance to my own Essay. Others may wonder that I +should expend so many words upon the two productions referred to, the +Letter and the Lecture. I do consider my Essay of much importance so +long as the doctrine it maintains is treated as a question, and so +long as any important part of the defence of that doctrine is thought +to rest on its evidence or arguments. I cannot treat as +insignificant any opinions bearing on life, and interests dearer than +life, proclaimed yearly to hundreds of young men, who will carry them +to their legitimate results in practice. + +The teachings of the two Professors in the great schools of +Philadelphia are sure to be listened to, not only by their immediate +pupils, but by the Profession at large. I am too much in earnest for +either humility or vanity, but I do entreat those who hold the keys +of life and death to listen to me also for this once. I ask no +personal favor; but I beg to be heard in behalf of the women whose +lives are at stake, until some stronger voice shall plead for them. + +I trust that I have made the issue perfectly distinct and +intelligible. And let it be remembered that this is no subject to be +smoothed over by nicely adjusted phrases of half-assent and half- +censure divided between the parties. The balance must be struck +boldly and the result declared plainly. If I have been hasty, +presumptuous, ill-informed, illogical; if my array of facts means +nothing; if there is no reason for any caution in the view of these +facts; let me be told so on such authority that I must believe it, +and I will be silent henceforth, recognizing that my mind is in a +state of disorganization. If the doctrine I have maintained is a +mournful truth; if to disbelieve it, and to practise on this +disbelief, and to teach others so to disbelieve and practise, is to +carry desolation, and to charter others to carry it, into confiding +families, let it be proclaimed as plainly what is to be thought of +the teachings of those who sneer at the alleged dangers, and scout +the very idea of precaution. Let it be remembered that persons are +nothing in this matter; better that twenty pamphleteers should be +silenced, or as many professors unseated, than that one mother's life +should be taken. There is no quarrel here between men, but there is +deadly incompatibility and exterminating warfare between doctrines. +Coincidences, meaning nothing, though a man have a monopoly of the +disease for weeks or months; or cause and effect, the cause being in +some way connected with the person; this is the question. If I am +wrong, let me be put down by such a rebuke as no rash declaimer has +received since there has been a public opinion in the medical +profession of America; if I am right, let doctrines which lead to +professional homicide be no longer taught from the chairs of those +two great Institutions. Indifference will not do here; our +Journalists and Committees have no right to take up their pages with +minute anatomy and tediously detailed cases, while it is a question +whether or not the "blackdeath" of child-bed is to be scattered +broadcast by the agency of the mother's friend and adviser. Let the +men who mould opinions look to it; if there is any voluntary +blindness, any interested oversight, any culpable negligence, even, +in such a matter, and the facts shall reach the public ear; the +pestilence-carrier of the lying-in chamber must look to God for +pardon, for man will never forgive him. + + + THE CONTAGIOUSNESS OF PUERPERAL FEVER. + +In collecting, enforcing, and adding to the evidence accumulated upon +this most serious subject, I would not be understood to imply that +there exists a doubt in the mind of any well-informed member of the +medical profession as to the fact that puerperal fever is sometimes +communicated from one person to another, both directly and +indirectly. In the present state of our knowledge upon this point I +should consider such doubts merely as a proof that the sceptic had +either not examined the evidence, or, having examined it, refused to +accept its plain and unavoidable consequences. I should be sorry to +think, with Dr. Rigby, that it was a case of "oblique vision;" I +should be unwilling to force home the argumentum ad hominem of Dr. +Blundell, but I would not consent to make a question of a momentous +fact which is no longer to be considered as a subject for trivial +discussions, but to be acted upon with silent promptitude. It +signifies nothing that wise and experienced practitioners have +sometimes doubted the reality of the danger in question; no man has +the right to doubt it any longer. No negative facts, no opposing +opinions, be they what they may, or whose they may, can form any +answer to the series of cases now within the reach of all who choose +to explore the records of medical science. + +If there are some who conceive that any important end would be +answered by recording such opinions, or by collecting the history of +all the cases they could find in which no evidence of the influence +of contagion existed, I believe they are in error. Suppose a few +writers of authority can be found to profess a disbelief in +contagion,--and they are very few compared with those who think +differently,--is it quite clear that they formed their opinions on a +view of all the facts, or is it not apparent that they relied mostly +on their own solitary experience? Still further, of those whose +names are quoted, is it not true that scarcely a single one could by +any possibility have known the half or the tenth of the facts bearing +on the subject which have reached such a frightful amount within the +last few years? Again, as to the utility of negative facts, as we +may briefly call them,--instances, namely, in which exposure has not +been followed by disease,--although, like other truths, they may be +worth knowing, I do not see that they are like to shed any important +light upon the subject before us. Every such instance requires a +good deal of circumstantial explanation before it can be accepted. +It is not enough that a practitioner should have had a single case of +puerperal fever not followed by others. It must be known whether he +attended others while this case was in progress, whether he went +directly from one chamber to others, whether he took any, and what +precautions. It is important to know that several women were exposed +to infection derived from the patient, so that allowance may be made +for want of predisposition. Now if of negative facts so sifted there +could be accumulated a hundred for every one plain instance of +communication here recorded, I trust it need not be said that we are +bound to guard and watch over the hundredth tenant of our fold, +though the ninety and nine may be sure of escaping the wolf at its +entrance. If any one is disposed, then, to take a hundred instances +of lives endangered or sacrificed out of those I have mentioned, and +make it reasonably clear that within a similar time and compass ten +thousand escaped the same exposure, I shall thank him for his +industry, but I must be permitted to hold to my own practical +conclusions, and beg him to adopt or at least to examine them also. +Children that walk in calico before open fires are not always burned +to death; the instances to the contrary may be worth recording; but +by no means if they are to be used as arguments against woollen +frocks and high fenders. + +I am not sure that this paper will escape another remark which it +might be wished were founded in justice. It may be said that the +facts are too generally known and acknowledged to require any formal +argument or exposition, that there is nothing new in the positions +advanced, and no need of laying additional statements before the +Profession. But on turning to two works, one almost universally, and +the other extensively appealed to as authority in this country, I see +ample reason to overlook this objection. In the last edition of +Dewees's Treatise on the "Diseases of Females," it is expressly said, +"In this country, under no circumstance that puerperal fever has +appeared hitherto, does it afford the slightest ground for the belief +that it is contagious." In the "Philadelphia Practice of Midwifery" +not one word can be found in the chapter devoted to this disease +which would lead the reader to suspect that the idea of contagion had +ever been entertained. It seems proper, therefore, to remind those +who are in the habit of referring to these works for guidance, that +there may possibly be some sources of danger they have slighted or +omitted, quite as important as a trifling irregularity of diet, or a +confined state of the bowels, and that whatever confidence a +physician may have in his own mode of treatment, his services are of +questionable value whenever he carries the bane as well as the +antidote about his person. + +The practical point to be illustrated is the following: + +The disease known as Puerperal Fever is so far contagious as to be +frequently carried from patient to patient by physicians and nurses. + + +Let me begin by throwing out certain incidental questions, which, +without being absolutely essential, would render the subject more +complicated, and by making such concessions and assumptions as may be +fairly supposed to be without the pale of discussion. + +1. It is granted that all the forms of what is called puerperal +fever may not be, and probably are not, equally contagious or +infectious. I do not enter into the distinctions which have been +drawn by authors, because the facts do not appear to me sufficient to +establish any absolute line of demarcation between such forms as may +be propagated by contagion and those which are never so propagated. +This general result I shall only support by the authority of Dr. +Ramsbotham, who gives, as the result of his experience, that the same +symptoms belong to what he calls the infectious and the sporadic +forms of the disease, and the opinion of Armstrong in his original +Essay. If others can show any such distinction, I leave it to them +to do it. But there are cases enough that show the prevalence of the +disease among the patients of a single practitioner when it was in no +degree epidemic, in the proper sense of the term. I may refer to +those of Mr. Roberton and of Dr. Peirson, hereafter to be cited, as +examples. + +2. I shall not enter into any dispute about the particular mode of +infection, whether it be by the atmosphere the physician carries +about him into the sick-chamber, or by the direct application of the +virus to the absorbing surfaces with which his hand comes in contact. +Many facts and opinions are in favor of each of these modes of +transmission. But it is obvious that in the majority of cases it +must be impossible to decide by which of these channels the disease +is conveyed, from the nature of the intercourse between the physician +and the patient. + +3. It is not pretended that the contagion of puerperal fever must +always be followed by the disease. It is true of all contagious +diseases, that they frequently spare those who appear to be fully +submitted to their influence. Even the vaccine virus, fresh from the +subject, fails every day to produce its legitimate effect, though +every precaution is taken to insure its action. This is still more +remarkably the case with scarlet fever and some other diseases. + +4. It is granted that the disease may be produced and variously +modified by many causes besides contagion, and more especially by +epidemic and endemic influences. But this is not peculiar to the +disease in question. There is no doubt that small-pox is propagated +to a great extent by contagion, yet it goes through the same periods +of periodical increase and diminution which have been remarked in +puerperal fever. If the question is asked how we are to reconcile +the great variations in the mortality of puerperal fever in different +seasons and places with the supposition of contagion, I will answer +it by another question from Mr. Farr's letter to the Registrar- +General. He makes the statement that "five die weekly of small-pox +in the metropolis when the disease is not epidemic,"--and adds, "The +problem for solution is,--Why do the five deaths become 10, 15, 20, +31, 58, 88, weekly, and then progressively fall through the same +measured steps?" + +5. I take it for granted, that if it can be shown that great numbers +of lives have been and are sacrificed to ignorance or blindness on +this point, no other error of which physicians or nurses may be +occasionally suspected will be alleged in palliation of this; but +that whenever and wherever they can be shown to carry disease and +death instead of health and safety, the common instincts of humanity +will silence every attempt to explain away their responsibility. + + +The treatise of Dr. Gordon of Aberdeen was published in the year +1795, being among the earlier special works upon the disease. Apart +of his testimony has been occasionally copied into other works, but +his expressions are so clear, his experience is given with such manly +distinctness and disinterested honesty, that it may be quoted as a +model which might have been often followed with advantage. + +"This disease seized such women only as were visited, or delivered by +a practitioner, or taken care of by a nurse, who had previously +attended patients affected with the disease." + +"I had evident proofs of its infectious nature, and that the +infection was as readily communicated as that of the small-pox or +measles, and operated more speedily than any other infection with +which I am acquainted." + +"I had evident proofs that every person who had been with a patient +in the puerperal fever became charged with an atmosphere of +infection, which was communicated to every pregnant woman who +happened to come within its sphere. This is not an assertion, but a +fact, admitting of demonstration, as may be seen by a perusal of the +foregoing table,"--referring to a table of seventy-seven cases, in +many of which the channel of propagation was evident. + +He adds, "It is a disagreeable declaration for me to mention, that I +myself was the means of carrying the infection to a great number of +women." He then enumerates a number of instances in which the +disease was conveyed by midwives and others to the neighboring +villages, and declares that "these facts fully prove that the cause +of the puerperal fever, of which I treat, was a specific contagion, +or infection, altogether unconnected with a noxious constitution of +the atmosphere." + +But his most terrible evidence is given in these words: "I ARRIVED AT +THAT CERTAINTY IN THE MATTER, THAT I COULD VENTURE TO FORETELL WHAT +WOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT +MIDWIFE THEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE +ATTENDED, DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE, MY +PREDICTION WAS VERIFIED." + +Even previously to Gordon, Mr. White of Manchester had said, "I am +acquainted with two gentlemen in another town, where the whole +business of midwifery is divided betwixt them, and it is very +remarkable that one of them loses several patients every year of the +puerperal fever, and the other never so much as meets with the +disorder,"--a difference which he seems to attribute to their various +modes of treatment. [On the Management of Lying-in Women, p. 120.] + +Dr. Armstrong has given a number of instances in his Essay on +Puerperal Fever, of the prevalence of the disease among the patients +of a single practitioner. At Sunderland, "in all, forty-three cases +occurred from the 1st of January to the 1st of October, when the +disease ceased; and of this number forty were witnessed by Mr. +Gregson and his assistant, Mr. Gregory, the remainder having been +separately seen by three accoucheurs." There is appended to the +London edition of this Essay, a letter from Mr. Gregson, in which +that gentleman says, in reference to the great number of cases +occurring in his practice, "The cause of this I cannot pretend fully +to explain, but I should be wanting in common liberality if I were to +make any hesitation in asserting, that the disease which appeared in +my practice was highly contagious, and communicable from one +puerperal woman to another." "It is customary among the lower and +middle ranks of people to make frequent personal visits to puerperal +women resident in the same neighborhood, and I have ample evidence +for affirming that the infection of the disease was often carried +about in that manner; and, however painful to my feelings, I must in +candor declare, that it is very probable the contagion was conveyed, +in some instances, by myself, though I took every possible care to +prevent such a thing from happening, the moment that I ascertained +that the distemper was infectious." Dr. Armstrong goes on to mention +six other instances within his knowledge, in which the disease had at +different times and places been limited, in the same singular manner, +to the practice of individuals, while it existed scarcely if at all +among the patients of others around them. Two of the gentlemen +became so convinced of their conveying the contagion, that they +withdrew for a time from practice. + +I find a brief notice, in an American Journal, of another series of +cases, first mentioned by Mr. Davies, in the "Medical Repository." +This gentleman stated his conviction that the disease is contagious. + +"In the autumn of 1822 he met with twelve cases, while his medical +friends in the neighborhood did not meet with any, 'or at least very +few.' He could attribute this circumstance to no other cause than +his having been present at the examination, after death, of two +cases, some time previous, and of his having imparted the disease to +his patients, notwithstanding every precaution." + +Dr. Gooch says, "It is not uncommon for the greater number of cases +to occur in the practice of one man, whilst the other practitioners +of the neighborhood, who are not more skilful or more busy, meet with +few or none. A practitioner opened the body of a woman who had died +of puerperal fever, and continued to wear the same clothes. A lady +whom he delivered a few days afterwards was attacked with and died of +a similar disease; two more of his lying-in patients, in rapid +succession, met with the same fate; struck by the thought, that he +might have carried contagion in his clothes, he instantly changed +them, and 'met with no more cases of the kind.' A woman in the +country, who was employed as washerwoman and nurse, washed the linen +of one who had died of puerperal fever; the next lying-in patient she +nursed died of the same disease; a third nursed by her met with the +same fate, till the neighborhood, getting afraid of her, ceased to +employ her." + +In the winter of the year 1824, "Several instances occurred of its +prevalence among the patients of particular practitioners, whilst +others who were equally busy met with few or none. One instance of +this kind was very remarkable. A general practitioner, in large +midwifery practice, lost so many patients from puerperal fever, that +he determined to deliver no more for some time, but that his partner +should attend in his place. This plan was pursued for one month, +during which not a case of the disease occurred in their practice. +The elder practitioner, being then sufficiently recovered, returned +to his practice, but the first patient he attended was attacked by +the disease and died. A physician, who met him in consultation soon +afterwards, about a case of a different kind, and who knew nothing of +his misfortune, asked him whether puerperal fever was at all +prevalent in his neighborhood, on which he burst into tears, and +related the above circumstances. + +"Among the cases which I saw this season in consultation, four +occurred in one month in the practice of one medical man, and all of +them terminated fatally." [Lond. Med. Gaz. May 2, 1835.] + +Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that he +had known the disease spread through a particular district, or be +confined to the practice of a particular person, almost every patient +being attacked with it, while others had not a single case. It +seemed capable, he thought, of conveyance, not only by common modes; +but through the dress of the attendants upon the patient. + +In a letter to be found in the "London Medical Gazette" for January, +1840, Mr. Roberton of Manchester makes the statement which I here +give in a somewhat condensed form. + +A midwife delivered a woman on the 4th of December, 1830, who died +soon after with the symptoms of puerperal fever. In one month from +this date the same midwife delivered thirty women, residing in +different parts of an extensive suburb, of which number sixteen +caught the disease and all died. These were the only cases which had +occurred for a considerable time in Manchester. The other midwives +connected with the same charitable institution as the woman already +mentioned are twenty-five in number, and deliver, on an average, +ninety women a week, or about three hundred and eighty a month. None +of these women had a case of puerperal fever. "Yet all this time +this woman was crossing the other midwives in every direction, scores +of the patients of the charity being delivered by them in the very +same quarters where her cases of fever were happening." + +Mr. Roberton remarks, that little more than half the women she +delivered during this month took the fever; that on some days all +escaped, on others only one or more out of three or four; a +circumstance similar to what is seen in other infectious maladies. + +Dr. Blundell says, "Those who have never made the experiment can have +but a faint conception how difficult it is to obtain the exact truth +respecting any occurrence in which feelings and interests are +concerned. Omitting particulars, then, I content myself with +remarking, generally, that from more than one district I have +received accounts of the prevalence of puerperal fever in the +practice of some individuals, while its occurrence in that of others, +in the same neighborhood, was not observed. Some, as I have been +told, have lost ten, twelve, or a greater number of patients, in +scarcely broken succession; like their evil genius, the puerperal +fever has seemed to stalk behind them wherever they went. Some have +deemed it prudent to retire for a time from practice. In fine, that +this fever may occur spontaneously, I admit; that its infectious +nature may be plausibly disputed, I do not deny; but I add, +considerately, that in my own family I had rather that those I +esteemed the most should be delivered, unaided, in a stable, by the +manger-side, than that they should receive the best help, in the +fairest apartment, but exposed to the vapors of this pitiless +disease. Gossiping friends, wet-nurses, monthly nurses, the +practitioner himself, these are the channels by which, as I suspect, +the infection is principally conveyed." + +At a meeting of the Royal Medical and Chirurgical Society, Dr. King +mentioned that some years since a practitioner at Woolwich lost +sixteen patients from puerperal fever in the same year. He was +compelled to give up practice for one or two years, his business +being divided among the neighboring practitioners. No case of +puerperal fever occurred afterwards, neither had any of the +neighboring surgeons any cases of this disease. + +At the same meeting Mr. Hutchinson mentioned the occurrence of three +consecutive cases of puerperal fever, followed subsequently by two +others, all in the practice of one accoucheur.[Lancet, May 2, 1840.] + +Dr. Lee makes the following statement: "In the last two weeks of +September, 1827, five fatal cases of uterine inflammation came under +our observation. All the individuals so attacked had been attended +in labor by the same midwife, and no example of a febrile or +inflammatory disease of a serious nature occurred during that period +among the other patients of the Westminster General Dispensary, who +had been attended by the other midwives belonging to that +institution." + +The recurrence of long series of cases like those I have cited, +reported by those most interested to disbelieve in contagion, +scattered along through an interval of half a century, might have +been thought sufficient to satisfy the minds of all inquirers that +here was something more than a singular coincidence. But if, on a +more extended observation, it should be found that the same ominous +groups of cases clustering about individual practitioners were +observed in a remote country, at different times, and in widely +separated regions, it would seem incredible that any should be found +too prejudiced or indolent to accept the solemn truth knelled into +their ears by the funeral bells from both sides of the ocean,--the +plain conclusion that the physician and the disease entered, hand in +hand, into the chamber of the unsuspecting patient. + +That such series of cases have been observed in this country, and in +this neighborhood, I proceed to show. + +In Dr. Francis's "Notes to Denman's Midwifery," a passage is cited +from Dr. Hosack, in which he refers to certain puerperal cases which +proved fatal to several lying-in women, and in some of which the +disease was supposed to be conveyed by the accoucheurs themselves. + +A writer in the "New York Medical and Physical Journal" for October, +1829, in speaking of the occurrence of puerperal fever, confined to +one man's practice, remarks, "We have known cases of this kind occur, +though rarely, in New York." + +I mention these little hints about the occurrence of such cases, +partly because they are the first I have met with in American medical +literature, but more especially because they serve to remind us that +behind the fearful array of published facts there lies a dark list of +similar events, unwritten in the records of science, but long +remembered by many a desolated fireside. + +Certainly nothing can be more open and explicit than the account +given by Dr. Peirson of Salem, of the cases seen by him. In the +first nineteen days of January, 1829, he had five consecutive cases +of puerperal fever, every patient he attended being attacked, and the +three first cases proving fatal. In March of the same year he had +two moderate cases, in June, another case, and in July, another, +which proved fatal. "Up to this period," he remarks, "I am not +informed that a single case had occurred in the practice of any other +physician. Since that period I have had no fatal case in my +practice, although I have had several dangerous cases. I have +attended in all twenty cases of this disease, of which four have been +fatal. I am not aware that there has been any other case in the town +of distinct puerperal peritonitis, although I am willing to admit my +information may be very defective on this point. I have been told of +some I 'mixed cases,' and 'morbid affections after delivery.'" + +In the "Quarterly Summary of the Transactions of the College of +Physicians of Philadelphia" may be found some most extraordinary +developments respecting a series of cases occurring in the practice +of a member of that body. + +Dr. Condie called the attention of the Society to the prevalence, at +the present time, of puerperal fever of a peculiarly insidious and +malignant character. "In the practice of one gentleman extensively +engaged as an obstetrician, nearly every female he has attended in +confinement, during several weeks past, within the above limits" (the +southern sections and neighboring districts), "had been attacked by +the fever." + +"An important query presents itself, the Doctor observed, in +reference to the particular form of fever now prevalent. Is it, +namely, capable of being propagated by contagion, and is a physician +who has been in attendance upon a case of the disease warranted in +continuing, without interruption, his practice as an obstetrician? +Dr. C., although not a believer in the contagious character of many +of those affections generally supposed to be propagated in this +manner, has nevertheless become convinced by the facts that have +fallen under his notice, that the puerperal fever now prevailing is +capable of being communicated by contagion. How otherwise can be +explained the very curious circumstance of the disease in one +district being exclusively confined to the practice of a single +physician, a Fellow of this College, extensively engaged in +obstetrical practice,--while no instance of the disease has occurred +in the patients under the care of any other accoucheur practising +within the same district; scarcely a female that has been delivered +for weeks past has escaped an attack?" + +Dr. Rutter, the practitioner referred to, "observed that, after the +occurrence of a number of cases of the disease in his practice, he +had left the city and remained absent for a week, but on returning, +no article of clothing he then wore having been used by him before, +one of the very first cases of parturition he attended was followed +by an attack of the fever, and terminated fatally; he cannot, +readily, therefore, believe in the transmission of the disease from +female to female, in the person or clothes of the physician." + +The meeting at which these remarks were made was held on the 3d of +May, 1842. In a letter dated December 20, 1842, addressed to Dr. +Meigs, and to be found in the "Medical Examiner," he speaks of +"those horrible cases of puerperal fever, some of which you did me +the favor to see with me during the past summer," and talks of his +experience in the disease, "now numbering nearly seventy cases, all +of which have occurred within less than a twelvemonth past." + +And Dr. Meigs asserts, on the same page, "Indeed, I believe that his +practice in that department of the profession was greater than that +of any other gentleman, which was probably the cause of his seeing a +greater number of the cases." This from a professor of midwifery, +who some time ago assured a gentleman whom he met in consultation, +that the night on which they met was the eighteenth in succession +that he himself had been summoned from his repose, seems hardly +satisfactory. + +I must call the attention of the inquirer most particularly to the +Quarterly Report above referred to, and the letters of Dr. Meigs and +Dr. Rutter, to be found in the "Medical Examiner." Whatever +impression they may produce upon his mind, I trust they will at least +convince him that there is some reason for looking into this +apparently uninviting subject. + +At a meeting of the College of Physicians just mentioned, Dr. +Warrington stated, that a few days after assisting at an autopsy of +puerperal peritonitis, in which he laded out the contents of the +abdominal cavity with his hands, he was called upon to deliver three +women in rapid succession. All of these women were attacked with +different forms of what is commonly called puerperal fever. Soon +after these he saw two other patients, both on the same day, with the +same disease. Of these five patients two died. + +At the same meeting, Dr. West mentioned a fact related to him by Dr. +Samuel Jackson of Northumberland. Seven females, delivered by Dr. +Jackson in rapid succession, while practising in Northumberland +County, were all attacked with puerperal fever, and five of them +died. "Women," he said, "who had expected me to attend upon them, +now becoming alarmed, removed out of my reach, and others sent for a +physician residing several miles distant. These women, as well as +those attended by midwives; all did well; nor did we hear of any +deaths in child-bed within a radius of fifty miles, excepting two, +and these I afterwards ascertained to have been caused by other +diseases." He underwent, as he thought, a thorough purification, and +still his next patient was attacked with the disease and died. He +was led to suspect that the contagion might have been carried in the +gloves which he had worn in attendance upon the previous cases. Two +months or more after this he had two other cases. He could find +nothing to account for these, unless it were the instruments for +giving enemata, which had been used in two of the former cases, and +were employed by these patients. When the first case occurred, he +was attending and dressing a limb extensively mortified from +erysipelas, and went immediately to the accouchement with his clothes +and gloves most thoroughly imbued with its efluvia. And here I may +mention, that this very Dr. Samuel Jackson of Northumberland is one +of Dr. Dewees's authorities against contagion. + +The three following statements are now for the first time given to +the public. All of the cases referred to occurred within this State, +and two of the three series in Boston and its immediate vicinity. + +I. The first is a series of cases which took place during the last +spring in a town at some distance from this neighborhood. A +physician of that town, Dr. C., had the following consecutive cases. + +No. 1, delivered March 20, died March 24. + " 2, " April 9, " April 14. + " 3, " " 10, " " 14. + " 4, " " 11, " " 18. + " 5, " " 27, " May 3. + " 6, " " 28, had some symptoms,(recovered.) + " 7, " May 8, had some symptoms,(also recovered.) + +These were the only cases attended by this physician during the +period referred to. "They were all attended by him until their +termination, with the exception of the patient No. 6, who fell into +the hands of another physician on the 2d of May. (Dr. C. left town +for a few days at this time.) Dr. C. attended cases immediately +before and after the above-named periods, none of which, however, +presented any peculiar symptoms of the disease." + +About the 1st of July he attended another patient in a neighboring +village, who died two or three days after delivery. + +The first patient, it is stated, was delivered on the 20th of March. +"On the 19th, Dr. C. made the autopsy of a man who died suddenly, +sick only forty-eight hours; had oedema of the thigh, and gangrene +extending from a little above the ankle into the cavity of the +abdomen." Dr. C. wounded himself, very slightly, in the right hand +during the autopsy. The hand was quite painful the night following, +during his attendance on the patient No. 1. He did not see this +patient after the 20th, being confined to the house, and very sick +from the wound just mentioned, from this time until the 3d of April. + +Several cases of erysipelas occurred in the house where the autopsy +mentioned above took place, soon after the examination. There were +also many cases of erysipelas in town at the time of the fatal +puerperal cases which have been mentioned. + +The nurse who laid out the body of the patient No. 3 was taken on the +evening of the same day with sore throat and erysipelas, and died in +ten days from the first attack. + +The nurse who laid out the body of the patient No. 4 was taken on the +day following with symptoms like those of this patient, and died in a +week, without any external marks of erysipelas. + +"No other cases of similar character with those of Dr. C. occurred in +the practice of any of the physicians in the town or vicinity at the +time. Deaths following confinement have occurred in the practice of +other physicians during the past year, but they were not cases of +puerperal fever. No post-mortem examinations were held in any of +these puerperal cases." + +Some additional statements in this letter are deserving of insertion. + +"A physician attended a woman in the immediate neighborhood of the +cases numbered 2, 3, and 4. This patient was confined the morning of +March 1st, and died on the night of March 7th. It is doubtful +whether this should be considered a case of puerperal fever. She had +suffered from canker, indigestion, and diarrhoea for a year previous +to her delivery. Her complaints were much aggravated for two or +three months previous to delivery; she had become greatly emaciated, +and weakened to such an extent that it had not been expected that she +would long survive her confinement, if indeed she reached that +period. Her labor was easy enough; she flowed a good deal, seemed +exceedingly prostrated, had ringing in the ears, and other symptoms +of exhaustion; the pulse was quick and small. On the second and +third day there was some tenderness and tumefaction of the abdomen, +which increased somewhat on the fourth and fifth. He had cases in +midwifery before and after this, which presented nothing peculiar." + +It is also mentioned in the same letter, that another physician had a +case during the last summer and another last fall, both of which +recovered. + +Another gentleman reports a case last December, a second case five +weeks, and another three weeks since. All these recovered. A case +also occurred very recently in the practice of a physician in the +village where the eighth patient of Dr. C. resides, which proved +fatal. "This patient had some patches of erysipelas on the legs and +arms. The same physician has delivered three cases since, which have +all done well. There have been no other cases in this town or its +vicinity recently. There have been some few cases of erysipelas." +It deserves notice that the partner of Dr. C., who attended the +autopsy of the man above mentioned and took an active part in it; who +also suffered very slightly from a prick under the thumb-nail +received during the examination, had twelve cases of midwifery +between March 26th and April 12th, all of which did well, and +presented no peculiar symptoms. It should also be stated, that +during these seventeen days he was in attendance on all the cases of +erysipelas in the house where the autopsy had been performed. + +I owe these facts to the prompt kindness of a gentleman whose +intelligence and character are sufficient guaranty for their +accuracy. + +The two following letters were addressed to my friend Dr. Scorer, by +the gentleman in whose practice the cases of puerperal fever +occurred. His name renders it unnecessary to refer more particularly +to these gentlemen, who on their part have manifested the most +perfect freedom and courtesy in affording these accounts of their +painful experience. + + +"January 28, 1843. + +II. . . . "The time to which you allude was in 1830. The first +case was in February, during a very cold time. She was confined the +4th, and died the 12th. Between the 10th and 28th of this month, I +attended six women in labor, all of whom did well except the last, as +also two who were confined March 1st and 5th. Mrs. E., confined +February 28th, sickened, and died March 8th. The next day, 9th, I +inspected the body, and the night after attended a lady, Mrs. B., who +sickened, and died 16th. The 10th, I attended another, Mrs. G., who +sickened, but recovered. March 16th, I went from Mrs. G.'s room to +attend a Mrs. H., who sickened, and died 21st. The 17th, I inspected +Mrs. B. On the 19th, I went directly from Mrs. H.'s room to attend +another lady, Mrs. G., who also sickened, and died 22d. While Mrs. +B. was sick, on 15th, I went directly from her room a few rods, and +attended another woman, who was not sick. Up to 20th of this month I +wore the same clothes. I now refused to attend any labor, and did +not till April 21st, when, having thoroughly cleansed myself, I +resumed my practice, and had no more puerperal fever. + +"The cases were not confined to a narrow space. The two nearest were +half a mile from each other, and half that distance from my +residence. The others were from two to three miles apart, and nearly +that distance from my residence. There were no other cases in their +immediate vicinity which came to my knowledge. The general health of +all the women was pretty good, and all the labors as good as common, +except the first. This woman, in consequence of my not arriving in +season, and the child being half-born at some time before I arrived, +was very much exposed to the cold at the time of confinement, and +afterwards, being confined in a very open, cold room. Of the six +cases you perceive only one recovered. + +"In the winter of 1817 two of my patients had puerperal fever, one +very badly, the other not so badly. Both recovered. One other had +swelled leg, or phlegmasia dolens, and one or two others did not +recover as well as usual. + +"In the summer of 1835 another disastrous period occurred in my +practice. July 1st, I attended a lady in labor, who was afterwards +quite ill and feverish; but at the time I did not consider her case a +decided puerperal fever. On the 8th, I attended one who did well. +On the 12th, one who was seriously sick. This was also an equivocal +case, apparently arising from constipation and irritation of the +rectum. These women were ten miles apart and five from my residence. +On 15th and 20th, two who did well. On 25th, I attended another. +This was a severe labor, and followed by unequivocal puerperal fever, +or peritonitis. She recovered. August 2d and 3d, in about twenty- +four hours I attended four persons. Two of them did very well; one +was attacked with some of the common symptoms, which however subsided +in a day or two, and the other had decided puerperal fever, but +recovered. This woman resided five miles from me. Up to this time I +wore the same coat. All my other clothes had frequently been +changed. On 6th, I attended two women, one of whom was not sick at +all; but the other, Mrs. L., was afterwards taken ill. On 10th, I +attended a lady, who did very well. I had previously changed all my +clothes, and had no garment on which had been in a puerperal room. +On 12th, I was called to Mrs. S., in labor. While she was ill, I +left her to visit Mrs. L., one of the ladies who was confined on 6th. +Mrs. L. had been more unwell than usual, but I had not considered +her case anything more than common till this visit. I had on a +surtout at this visit, which, on my return to Mrs. S., I left in +another room. Mrs. S. was delivered on 13th with forceps. These +women both died of decided puerperal fever. + +"While I attended these women in their fevers, I changed my clothes, +and washed my hands in a solution of chloride of lime after each +visit. I attended seven women in labor during this period, all of +whom recovered without sickness. + +"In my practice I have had several single cases of puerperal fever, +some of whom have died and some have recovered. Until the year 1830 +I had no suspicion that the disease could be communicated from one +patient to another by a nurse or midwife; but I now think the +foregoing facts strongly favor that idea. I was so much convinced of +this fact, that I adopted the plan before related. + +"I believe my own health was as good as usual at each of the above +periods. I have no recollections to the contrary. + +"I believe I have answered all your questions. I have been more +particular on some points perhaps than necessary; but I thought you +could form your own opinion better than to take mine. In 1830 I +wrote to Dr. Charming a more particular statement of my cases. If I +have not answered your questions sufficiently, perhaps Dr. C. may +have my letter to him, and you can find your answer there." [In a +letter to myself, this gentleman also stated, "I do not recollect +that there was any erysipelas or any other disease particularly +prevalent at the time."] + + + +"BOSTON, February 3, 1843. + +III. "MY DEAR SIR,--I received a note from you last evening, +requesting me to answer certain questions therein proposed, touching +the cases of puerperal fever which came under my observation the past +summer. It gives me pleasure to comply with your request, so far as +it is in my power so to do, but, owing to the hurry in preparing for +a journey, the notes of the cases I had then taken were lost or +mislaid. The principal facts, however, are too vivid upon my +recollection to be soon forgotten. I think, therefore, that I shall +be able to give you all the information you may require. + +"All the cases that occurred in my practice took place between the +7th of May and the 17th of June 1842. + +"They were not confined to any particular part of the city. The +first two cases were patients residing at the South End, the next was +at the extreme North End, one living in Sea Street and the other in +Roxbury. The following is the order in which they occurred: + +"Case 1. Mrs._____ was confined on the 7th of May, at 5 o'clock, +P. M., after a natural labor of six hours. At 12 o'clock at night, +on the 9th (thirty-one hours after confinement), she was taken with +severe chill, previous to which she was as comfortable as women +usually are under the circumstances. She died on the 10th. + +"Case 2. Mrs._____ was confined on the 10th of June (four weeks +after Mrs. C.), at 11 A. M., after a natural, but somewhat severe +labor of five hours. At 7 o'clock, on the morning of the 11th, she +had a chill. Died on the 12th. + +"Case 3. Mrs._____ , confined on the 14th of June, was comfortable +until the 18th, when symptoms of puerperal fever were manifest. She +died on the 20th. + +"Case 4. Mrs._____ , confined June 17th, at 5 o'clock, A. M., was +doing well until the morning of the 19th. She died on the evening of +the 21st. + +"Case 5. Mrs._____ was confined with her fifth child on the 17th of +June, at 6 o'clock in the evening. This patient had been attacked +with puerperal fever, at three of her previous confinements, but the +disease yielded to depletion and other remedies without difficulty. +This time, I regret to say, I was not so fortunate. She was not +attacked, as were the other patients, with a chill, but complained of +extreme pain in abdomen, and tenderness on pressure, almost from the +moment of her confinement. In this as in the other cases, the +disease resisted all remedies, and she died in great distress on the +22d of the same month. Owing to the extreme heat of the season, and +my own indisposition, none of the subjects were examined after death. +Dr. Channing, who was in attendance with me on the three last cases, +proposed to have a post-mortem examination of the subject of case No. +5, but from some cause which I do not now recollect it was not +obtained. + +"You wish to know whether I wore the same clothes when attending the +different cases. I cannot positively say, but I should think I did +not, as the weather became warmer after the first two cases; I +therefore think it probable that I made a change of at least a part +of my dress. I have had no other case of puerperal fever in my own +practice for three years, save those above related, and I do not +remember to have lost a patient before with this disease. While +absent, last July, I visited two patients sick with puerperal fever, +with a friend of mine in the country. Both of them recovered. + +"The cases that I have recorded were not confined to any particular +constitution or temperament, but it seized upon the strong and the +weak, the old and the young,--one being over forty years, and the +youngest under eighteen years of age . . . . If the disease is of +an erysipelatous nature, as many suppose, contagionists may perhaps +find some ground for their belief in the fact, that, for two weeks +previous to my first case of puerperal fever, I had been attending a +severe case of erysipelas, and the infection may have been conveyed +through me to the patient; but, on the other hand, why is not this +the case with other physicians, or with the same physician at all +times, for since my return from the country I have had a more +inveterate case of erysipelas than ever before, and no difficulty +whatever has attended any of my midwifery cases?" + + +I am assured, on unquestionable authority, that "About three years +since, a gentleman in extensive midwifery business, in a neighboring +State, lost in the course of a few weeks eight patients in child-bed, +seven of them being undoubted cases of puerperal fever. No other +physician of the town lost a single patient of this disease during +the same period." And from what I have heard in conversation with +some of our most experienced practitioners, I am inclined to think +many cases of the kind might be brought to light by extensive +inquiry. + + +This long catalogue of melancholy histories assumes a still darker +aspect when we remember how kindly nature deals with the parturient +female, when she is not immersed in the virulent atmosphere of an +impure lying-in hospital, or poisoned in her chamber by the +unsuspected breath of contagion. From all causes together, not more +than four deaths in a thousand births and miscarriages happened in +England and Wales during the period embraced by the first "Report of +the Registrar-General." In the second Report the mortality was shown +to be about five in one thousand. In the Dublin Lying-in Hospital, +during the seven years of Dr. Collins's mastership, there was one +case of puerperal fever to 178 deliveries, or less than six to the +thousand, and one death from this disease in 278 cases, or between +three and four to the thousand a yet during this period the disease +was endemic in the hospital, and might have gone on to rival the +horrors of the pestilence of the Maternite, had not the poison been +destroyed by a thorough purification. + +In private practice, leaving out of view the cases that are to be +ascribed to the self-acting system of propagation, it would seem that +the disease must be far from common. Mr. White of Manchester says, +"Out of the whole number of lying-in patients whom I have delivered +(and I may safely call it a great one), I have never lost one, nor to +the best of my recollection has one been greatly endangered, by the +puerperal, miliary, low nervous, putrid malignant, or milk fever." +Dr. Joseph Clarke informed Dr. Collins, that in the course of forty- +five years' most extensive practice he lost but four patients from +this disease. One of the most eminent practitioners of Glasgow, who +has been engaged in very extensive practice for upwards of a quarter +of a century, testifies that he never saw more than twelve cases of +real puerperal fever.[Lancet, May 4, 1833] + +I have myself been told by two gentlemen practising in this city, and +having for many years a large midwifery business, that they had +neither of them lost a patient from this disease, and by one of them +that he had only seen it in consultation with other physicians. In +five hundred cases of midwifery, of which Dr. Storer has given an +abstract in the first number of this Journal, there was only one +instance of fatal puerperal peritonitis. + +In the view of these facts, it does appear a singular coincidence, +that one man or woman should have ten, twenty, thirty, or seventy +cases of this rare disease following his or her footsteps with the +keenness of a beagle, through the streets and lanes of a crowded +city, while the scores that cross the same paths on the same errands +know it only by name. It is a series of similar coincidences which +has led us to consider the dagger, the musket, and certain innocent- +looking white powders as having some little claim to be regarded as +dangerous. It is the practical inattention to similar coincidences +which has given rise to the unpleasant but often necessary documents +called indictments, which has sharpened a form of the cephalotome +sometimes employed in the case of adults, and adjusted that +modification of the fillet which delivers the world of those who +happen to be too much in the way while such striking coincidences are +taking place. + +I shall now mention a few instances in which the disease appears to +have been conveyed by the process of direct inoculation. + +Dr. Campbell of Edinburgh states that in October, 1821, he assisted +at the post-mortem examination of a patient who died with puerperal +fever. He carried the pelvic viscera in his pocket to the class- +room. The same evening he attended a woman in labor without +previously changing his clothes; this patient died. The next morning +he delivered a woman with the forceps; she died also, and of many +others who were seized with the disease within a few weeks, three +shared the same fate in succession. + +In June, 1823, he assisted some of his pupils at the autopsy of a +case of puerperal fever. He was unable to wash his hands with proper +care, for want of the necessary accommodations. On getting home he +found that two patients required his assistance. He went without +further ablution, or changing his clothes; both these patients died +with puerperal fever. This same Dr. Campbell is one of Dr. +Churchill's authorities against contagion. + +Mr. Roberton says that in one instance within his knowledge a +practitioner passed the catheter for a patient with puerperal fever +late in the evening; the same night he attended a lady who had the +symptoms of the disease on the second day. In another instance a +surgeon was called while in the act of inspecting the body of a woman +who had died of this fever, to attend a labor; within forty-eight +hours this patient was seized with the fever.' + +On the 16th of March, 1831, a medical practitioner examined the body +of a woman who had died a few days after delivery, from puerperal +peritonitis. On the evening of the 17th he delivered a patient, who +was seized with puerperal fever on the 19th, and died on the 24th. +Between this period and the 6th of April, the same practitioner +attended two other patients, both of whom were attacked with the same +disease and died. + +In the autumn of 1829 a physician was present at the examination of a +case of puerperal fever, dissected out the organs, and assisted in +sewing up the body. He had scarcely reached home when he was +summoned to attend a young lady in labor. In sixteen hours she was +attacked with the symptoms of puerperal fever, and narrowly escaped +with her life. + +In December, 1830, a midwife, who had attended two fatal cases of +puerperal fever at the British Lying-in Hospital, examined a patient +who had just been admitted, to ascertain if labor had commenced. +This patient remained two days in the expectation that labor would +come on, when she returned home and was then suddenly taken in labor +and delivered before she could set out for the hospital. She went on +favorably for two days, and was then taken with puerperal fever and +died in thirty-six hours. + +"A young practitioner, contrary to advice, examined the body of a +patient who had died from puerperal fever; there was no epidemic at +the time; the case appeared to be purely sporadic. He delivered +three other women shortly afterwards; they all died with puerperal +fever, the symptoms of which broke out very soon after labor. The +patients of his colleague did well, except one, where he assisted to +remove some coagula from the uterus; she was attacked in the same +manner as those whom he had attended, and died also." The writer in +the "British and Foreign Medical Review," from whom I quote this +statement,--and who is no other than Dr. Rigby, adds, "We trust that +this fact alone will forever silence such doubts, and stamp the well- +merited epithet of 'criminal,' as above quoted, upon such attempts." +[Brit. and For. Medical Review for Jan. 1842, p. 112.] + +From the cases given by Mr. Ingleby, I select the following. Two +gentlemen, after having been engaged in conducting the post-mortem +examination of a case of puerperal fever, went in the same dress, +each respectively, to a case of midwifery. "The one patient was +seized with the rigor about thirty hours afterwards. The other +patient was seized with a rigor the third morning after delivery. +One recovered, one died." [Edin. Med. and Surg. Journal, April, +1838.] + +One of these same gentlemen attended another woman in the same +clothes two days after the autopsy referred to. "The rigor did not +take place until the evening of the fifth day from the first visit. +Result fatal." These cases belonged to a series of seven, the first +of which was thought to have originated in a case of erysipelas. +"Several cases of a mild character followed the foregoing seven, and +their nature being now most unequivocal, my friend declined visiting +all midwifery cases for a time, and there was no recurrence of the +disease." These cases occurred in 1833. Five of them proved fatal. +Mr. Ingleby gives another series of seven eases which occurred to a +practitioner in 1836, the first of which was also attributed to his +having opened several erysipelatous abscesses a short time +previously. + +I need not refer to the case lately read before this Society, in +which a physician went, soon after performing an autopsy of a case of +puerperal fever, to a woman in labor, who was seized with the same +disease and perished. The forfeit of that error has been already +paid. + +At a meeting of the Medical and Chirurgical Society before referred +to, Dr. Merriman related an instance occurring in his own practice, +which excites a reasonable suspicion that two lives were sacrificed +to a still less dangerous experiment. He was at the examination of a +case of puerperal fever at two o'clock in the afternoon. He took +care not to touch the body. At nine o'clock the same evening he +attended a woman in labor; she was so nearly delivered that he had +scarcely anything to do. The next morning she had severe rigors, and +in forty-eight hours she was a corpse. Her infant had erysipelas and +died in two days. [Lancet, May 2, 1840.] + +In connection with the facts which have been stated, it seems proper +to allude to the dangerous and often fatal effects which have +followed from wounds received in the post-mortem examination of +patients who have died of puerperal fever. The fact that such wounds +are attended with peculiar risk has been long noticed. I find that +Chaussier was in the habit of cautioning his students against the +danger to which they were exposed in these dissections. [Stein, L'Art +d'Accoucher, 1794; Dict. des Sciences Medicales, art. "Puerperal."] +The head pharmacien of the Hotel Dieu, in his analysis of the fluid +effused in puerperal peritonitis, says that practitioners are +convinced of its deleterious qualities, and that it is very dangerous +to apply it to the denuded skin. [Journal de Pharmacie, January, +1836.] Sir Benjamin Brodie speaks of it as being well known that the +inoculation of lymph or pus from the peritoneum of a puerperal +patient is often attended with dangerous and even fatal symptoms. +Three cases in confirmation of this statement, two of them fatal, +have been reported to this Society within a few months. + +Of about fifty cases of injuries of this kind, of various degrees of +severity, which I have collected from different sources, at least +twelve were instances of infection from puerperal peritonitis. Some +of the others are so stated as to render it probable that they may +have been of the same nature. Five other cases were of peritoneal +inflammation; three in males. Three were what was called enteritis, +in one instance complicated with erysipelas; but it is well known +that this term has been often used to signify inflammation of the +peritoneum covering the intestines. On the other hand, no case of +typhus or typhoid fever is mentioned as giving rise to dangerous +consequences, with the exception of the single instance of an +undertaker mentioned by Mr. Travers, who seems to have been poisoned +by a fluid which exuded from the body. The other accidents were +produced by dissection, or some other mode of contact with bodies of +patients who had died of various affections. They also differed much +in severity, the cases of puerperal origin being among the most +formidable and fatal. Now a moment's reflection will show that the +number of cases of serious consequences ensuing from the dissection +of the bodies of those who had perished of puerperal fever is so +vastly disproportioned to the relatively small number of autopsies +made in this complaint as compared with typhus or pneumonia (from +which last disease not one case of poisoning happened), and still +more from all diseases put together, that the conclusion is +irresistible that a most fearful morbid poison is often generated in +the course of this disease. Whether or not it is sui generis, +confined to this disease, or produced in some others, as, for +instance, erysipelas, I need, not stop to inquire. + +In connection with this may be taken the following statement of Dr. +Rigby. "That the discharges from a patient under puerperal fever are +in the highest degree contagious we have abundant evidence in the +history of lying-in hospitals. The puerperal abscesses are also +contagious, and may be communicated to healthy lying-in women by +washing with the same sponge; this fact has been repeatedly proved in +the Vienna Hospital; but they are equally communicable to women not +pregnant; on more than one occasion the women engaged in washing the +soiled bed-linen of the General Lying-in Hospital have been attacked +with abscess in the fingers or hands, attended with rapidly spreading +inflammation of the cellular tissue." + +Now add to all this the undisputed fact, that within the walls of +lying-in hospitals there is often generated a miasm, palpable as the +chlorine used to destroy it, tenacious so as in some cases almost to +defy extirpation, deadly in some institutions as the plague; which +has killed women in a private hospital of London so fast that they +were buried two in one coffin to conceal its horrors; which enabled +Tonnelle to record two hundred and twenty-two autopsies at the +Maternite of Paris; which has led Dr. Lee to express his deliberate +conviction that the loss of life occasioned by these institutions +completely defeats the objects of their founders; and out of this +train of cumulative evidence, the multiplied groups of cases +clustering about individuals, the deadly results of autopsies, the +inoculation by fluids from the living patient, the murderous poison +of hospitals,--does there not result a conclusion that laughs all +sophistry to scorn, and renders all argument an insult? + +I have had occasion to mention some instances in which there was an +apparent relation between puerperal fever and erysipelas. The length +to which this paper has extended does not allow me to enter into the +consideration of this most important subject. I will only say, that +the evidence appears to me altogether satisfactory that some most +fatal series of puerperal fever have been produced by an infection +originating in the matter or effluvia of erysipelas. In evidence of +some connection between the two diseases, I need not go back to the +older authors, as Pouteau or Gordon, but will content myself with +giving the following references, with their dates; from which it will +be seen that the testimony has been constantly coming before the +profession for the last few years. + +"London Cyclopaedia of Practical Medicine," article Puerperal Fever, +1833. + +Mr. Ceeley's Account of the Puerperal Fever at Aylesbury. "Lancet," +1835. + +Dr. Ramsbotham's Lecture. "London Medical Gazette," 1835. + +Mr. Yates Ackerly's Letter in the same Journal, 1838. + +Mr. Ingleby on Epidemic Puerperal Fever. "Edinburgh Medical and +Surgical Journal," 1838. + +Mr. Paley's Letter. "London Medical Gazette," 1839. + +Remarks at the Medical and Chirurgical Society. "Lancet," 1840. + +Dr. Rigby's "System of Midwifery." 1841. + +"Nunneley on Erysipelas,"--a work which contains a large number of +references on the subject. 1841. + +"British and Foreign Quarterly Review," 1842. + +Dr. S. Jackson of Northumberland, as already quoted from the Summary +of the College of Physicians, 1842. + +And lastly, a startling series of cases by Mr. Storrs of Doncaster, +to be, found in the "American Journal of the Medical Sciences" for +January, 1843. + +The relation of puerperal fever with other continued fevers would +seem to be remote and rarely obvious. Hey refers to two cases of +synochus occurring in the Royal Infirmary of Edinburgh, in women who +had attended upon puerperal patients. Dr. Collins refers to several +instances in which puerperal fever has appeared to originate from a +continued proximity to patients suffering with typhus. + +Such occurrences as those just mentioned, though most important to be +remembered and guarded against, hardly attract our notice in the +midst of the gloomy facts by which they are surrounded. Of these +facts, at the risk of fatiguing repetitions, I have summoned a +sufficient number, as I believe, to convince the most incredulous +that every attempt to disguise the truth which underlies them all is +useless. + +It is true that some of the historians of the disease, especially +Hulme, Hull, and Leake, in England; Tonnelle, Duges, and Baudelocque, +in France, profess not to have found puerperal fever contagious. At +the most they give us mere negative facts, worthless against an +extent of evidence which now overlaps the widest range of doubt, and +doubles upon itself in the redundancy of superfluous demonstration. +Examined in detail, this and much of the show of testimony brought up +to stare the daylight of conviction out of countenance, proves to be +in a great measure unmeaning and inapplicable, as might be easily +shown were it necessary. Nor do I feel the necessity of enforcing +the conclusion which arises spontaneously from the facts which have +been enumerated, by formally citing the opinions of those grave +authorities who have for the last half-century been sounding the +unwelcome truth it has cost so many lives to establish. + +"It is to the British practitioner," says Dr. Rigby, "that we are +indebted for strongly insisting upon this important and dangerous +character of puerperal fever." + +The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton, +Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee, +Ingleby, Locock, Abercrombie, Alison; Travers, Rigby, and Watson, +many of whose writings I have already referred to, may have some +influence with those who prefer the weight of authorities to the +simple deductions of their own reason from the facts laid before +them. A few Continental writers have adopted similar conclusions. It +gives me pleasure to remember, that while the doctrine has been +unceremoniously discredited in one of the leading Journals, and made +very light of by teachers in two of the principal Medical Schools, of +this country, Dr. Channing has for many years inculcated, and +enforced by examples, the danger to be apprehended and the +precautions to be taken in the disease under consideration. + +I have no wish to express any harsh feeling with regard to the +painful subject which has come before us. If there are any so far +excited by the story of these dreadful events that they ask for some +word of indignant remonstrance to show that science does not turn the +hearts of its followers into ice or stone, let me remind them that +such words have been uttered by those who speak with an authority I +could not claim. It is as a lesson rather than as a reproach that I +call up the memory of these irreparable errors and wrongs. No tongue +can tell the heart-breaking calamity they have caused; they have +closed the eyes just opened upon a new world of love and happiness; +they have bowed the strength of manhood into the dust; they have cast +the helplessness of infancy into the stranger's arms, or bequeathed +it, with less cruelty, the death of its dying parent. There is no +tone deep enough for regret, and no voice loud enough for warning. +The woman about to become a mother, or with her new-born infant upon +her bosom, should be the object of trembling care and sympathy +wherever she bears her tender burden, or stretches her aching limbs. +The very outcast of the streets has pity upon her sister in +degradation, when the seal of promised maternity is impressed upon +her. The remorseless vengeance of the law, brought down upon its +victim by a machinery as sure as destiny, is arrested in its fall at +a word which reveals her transient claim for mercy. The solemn +prayer of the liturgy singles out her sorrows from the multiplied +trials of life, to plead for her in the hour of peril. God forbid +that any member of the profession to which she trusts her life, +doubly precious at that eventful period, should hazard it +negligently, unadvisedly, or selfishly! + +There may be some among those whom I address who are disposed to ask +the question, What course are we to follow in relation to this +matter? The facts are before them, and the answer must be left to +their own judgment and conscience. If any should care to know my own +conclusions, they are the following; and in taking the liberty to +state them very freely and broadly, I would ask the inquirer to +examine them as freely in the light of the evidence which has been +laid before him. + +1. A physician holding himself in readiness to attend cases of +midwifery should never take any active part in the post-mortem +examination of cases of puerperal fever. + +2. If a physician is present at such autopsies, he should use +thorough ablution, change every article of dress, and allow twenty- +four hours or more to elapse before attending to any case of +midwifery. It may be well to extend the same caution to cases of +simple peritonitis. + +3. Similar precautions should be taken after the autopsy or surgical +treatment of cases of erysipelas, if the physician is obliged to +unite such offices with his obstetrical duties, which is in the +highest degree inexpedient. + +4. On the occurrence of a single case of puerperal fever in his +practice, the physician is bound to consider the next female he +attends in labor, unless some weeks at least have elapsed, as in +danger of being infected by him, and it is his duty to take every +precaution to diminish her risk of disease and death. + +5. If within a short period two cases of puerperal fever happen +close to each other, in the practice of the same physician, the +disease not existing or prevailing in the neighborhood, he would do +wisely to relinquish his obstetrical practice for at least one month, +and endeavor to free himself by every available means from any +noxious influence he may carry about with him. + +6. The occurrence of three or more closely connected cases, in the +practice of one individual, no others existing in the neighborhood, +and no other sufficient cause being alleged for the coincidence, is +prima facie evidence that he is the vehicle of contagion. + +7. It is the duty of the physician to take every precaution that the +disease shall not be introduced by nurses or other assistants, by +making proper inquiries concerning them, and giving timely warning of +every suspected source of danger. + +8. Whatever indulgence may be granted to those who have heretofore +been the ignorant causes of so much misery, the time has come when +the existence of a private pestilence in the sphere of a single +physician should be looked upon, not as a misfortune, but a crime; +and in the knowledge of such occurrences the duties of the +practitioner to his profession should give way to his paramount +obligations to society. + + +ADDITIONAL REFERENCES AND CASES. + +Fifth Annual Report of the Registrar-General of England, + +1843. Appendix. Letter from William Farr, Esq.--Several new series +of cases are given in the Letter of Mr. Stows, contained in the +Appendix to this Report. Mr. Stows suggests precautions similar to +those I have laid down, and these precautions are strongly enforced +by Mr. Farr, who is, therefore, obnoxious to the same criticisms as +myself. + +Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844.- +Cases of puerperal fever seeming to originate in erysipelas. + +Elkington, of Birmingham, in Provincial Med. Journal, cited in Am. +Journ. Med. Se. for April, 1844.--Six cases in less than a +fortnight, seeming to originate in a case of erysipelas. + +West's Reports, in Brit. and For. Med. Review for October, 1845, +and January, 1847.--Affection of the arm, resembling malignant +pustule, after removing the placenta of a patient who died from +puerperal fever. Reference to cases at Wurzburg, as proving +contagion, and to Keiller's cases in the Monthly Journal for +February, 1846, as showing connection of puerperal fever and +erysipelas. + +Kneeland.--Contagiousness of Puerperal Fever. Am. Jour. Med. +Se., January, 1846. Also, Connection between Puerperal Fever and +Epidemic Erysipelas. Ibid., April, 1846. + +Robert Storrs.--Contagious Effects of Puerperal Fever on the Male +Subject; or on Persons not Child-bearing. (From Provincial Med. and +Surg. Journal.) Am. Jour. Med. Sc., January, 184,6. Numerous +cases. See also Dr. Reid's case in same Journal for April, 1846. + +Routh's paper in Proc. of Royal Med. Chir. Soc., Am. Jour. Med. +Sc., April, 1849, also in B. and F. Med. Chir. Review, April, +1850. + +Hill, of Leuchars.--A Series of Cases illustrating the Contagious +Nature of Erysipelas and of Puerperal Fever, and their Intimate +Pathological Connection. (From Monthly Journal of Med. Sc.) Am. +Jour. Med. Se., July, 1850. + +Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, +from inoculation with different morbid secretions.) Am. Jour. Med. +Se., October, 1850. + +Arneth. Paper read before the National Academy of Medicine. Annales +d'Hygiene, Tome LXV. 2e Partie. (Means of Disinfection proposed by +M. "Semmeliveis" (Semmelweiss.) Lotions of chloride of lime and use +of nail-brush before admission to lying-in wards. Alleged sudden and +great decrease of mortality from puerperal fever. Cause of disease +attributed to inoculation with cadaveric matters.) See also Routh's +paper, mentioned above. + +Moir. Remarks at a meeting of the Edinburgh Medico-Chirurgical +Society. Refers to cases of Dr. Kellie, of Leith. Sixteen in +succession, all fatal. Also to several instances of individual +pupils having had a succession of cases in various quarters of the +town, while others, practising as extensively in the same localities, +had none. Also to several special cases not mentioned elsewhere. +Am. Jour. Med. Se. for October, 1851. (From New Monthly Journal +of Med. Science.) + +Simpson.--Observations at a Meeting of the Edinburgh Obstetrical +Society. (An "eminent gentleman," according to Dr. Meigs, whose +"name is as well known in America as in (his) native land." +Obstetrics. Phil. 1852, pp. 368, 375.) The student is referred to +this paper for a valuable resume of many of the facts, and the +necessary inferences, relating to this subject. Also for another +series of cases, Mr. Sidey's, five or six in rapid succession. +Dr. Simpson attended the dissection of two of Dr. Sidey's cases, and +freely handled the diseased parts. His next four child-bed patients +were affected with puerperal fever, and it was the first time he had +seen it in practice. As Dr. Simpson is a gentleman (Dr. Meigs, as +above), and as "a gentleman's hands are clean" (Dr. Meigs' Sixth +Letter), it follows that a gentleman with clean hands may carry the +disease. Am. Jour. Med. Sc., October, 1851. + +Peddle.--The five or six cases of Dr. Sidey, followed by the four of +Dr. Simpson, did not end the series. A practitioner in Leith having +examined in Dr. Simpson's house, a portion of the uterus obtained +from one of the patients, had immediately afterwards three fatal +cases of puerperal fever. Dr. Veddie referred to two distinct +series of consecutive cases in his own practice. He had since taken +precautions, and not met with any such cases. Am. Jour. Med. Sc., +October, 1851. + +Copland. Considers it proved that puerperal fever maybe propagated +by the hands and the clothes, or either, of a third person, the bed- +clothes or body-clothes of a patient. Mentions a new series of +cases, one of which he saw, with the practitioner who had attended +them. She was the sixth he had had within a few days. All died. +Dr. Copland insisted that contagion had caused these cases; advised +precautionary measures, and the practitioner had no other cases for a +considerable time. Considers it criminal, after the evidence +adduced,--which he could have quadrupled,--and the weight of +authority brought forward, for a practitioner to be the medium of +transmitting contagion and death to his patients. Dr. Copland lays +down rules similar to those suggested by myself, and is therefore +entitled to the same epithet for so doing. Medical Dictionary, New +York, 1852. Article, Puerperal States and Diseases. + +If there is any appetite for facts so craving as to be yet +unappeased,--Lesotho, necdum satiata,--more can be obtained. +Dr. Hodge remarks that "the frequency and importance of this +singular circumstance (that the disease is occasionally more +prevalent with one practitioner than another) has been exceedingly +overrated." More than thirty strings of cases, more than two hundred +and fifty sufferers from puerperal fever, more than one hundred and +thirty deaths appear as the results of a sparing estimate of such +among the facts I have gleaned as could be numerically valued. These +facts constitute, we may take it for granted, but a small fraction of +those that have actually occurred. The number of them might be +greater, but "'t is enough, 't will serve," in Mercutio's modest +phrase, so far as frequency is concerned. For a just estimate of the +importance of the singular circumstance, it might be proper to +consult the languid survivors, the widowed husbands, and the +motherless children, as well as "the unfortunate accoucheur." + + + + + + +III + +CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE + +An Address delivered before the Massachusetts Medical Society, at the +Annual Meeting, May 30, 1860. + + "Facultate magis quam violentia." + HIPPOCRATES. + +Our Annual Meeting never fails to teach us at least one lesson. The +art whose province it is to heal and to save cannot protect its own +ranks from the inroads of disease and the waste of the Destroyer. + +Seventeen of our associates have been taken from us since our last +Anniversary. Most of them followed their calling in the villages or +towns that lie among the hills or along the inland streams. Only +those who have lived the kindly, mutually dependent life of the +country, can tell how near the physician who is the main reliance in +sickness of all the families throughout a thinly settled region comes +to the hearts of the people among whom he labors, how they value him +while living, how they cherish his memory when dead. For these +friends of ours who have gone before, there is now no more toil; they +start from their slumbers no more at the cry of pain; they sally +forth no more into the storms; they ride no longer over the lonely +roads that knew them so well; their wheels are rusting on their axles +or rolling with other burdens; their watchful eyes are closed to all +the sorrows they lived to soothe. Not one of these was famous in the +great world; some were almost unknown beyond their own immediate +circle. But they have left behind them that loving remembrance which +is better than fame, and if their epitaphs are chiselled briefly in +stone, they are written at full length on living tablets in a +thousand homes to which they carried their ever-welcome aid and +sympathy. + +One whom we have lost, very widely known and honored, was a leading +practitioner of this city. His image can hardly be dimmed in your +recollection, as he stood before you only three years ago, filling +the same place with which I am now honored. To speak of him at all +worthily, would be to write the history of professional success, won +without special aid at starting, by toil, patience, good sense, pure +character, and pleasing manners; won in a straight uphill ascent, +without one breathing-space until he sat down, not to rest, but to +die. If prayers could have shielded him from the stroke, if love +could have drawn forth the weapon, and skill could have healed the +wound, this passing tribute might have been left to other lips and to +another generation. + +Let us hope that our dead have at last found that rest which neither +summer nor winter, nor day nor night, had granted to their unending +earthly labors! And let us remember that our duties to our brethren +do not cease when they become unable to share our toils, or leave +behind them in want and woe those whom their labor had supported. It +is honorable to the Profession that it has organized an Association a +for the relief of its suffering members and their families; it owes +this tribute to the ill-rewarded industry and sacrifices of its less +fortunate brothers who wear out health and life in the service of +humanity. I have great pleasure in referring to this excellent +movement, which gives our liberal profession a chance to show its +liberality, and serves to unite us all, the successful and those whom +fortune has cast down, in the bonds of a true brotherhood. + +A medical man, as he goes about his daily business after twenty years +of practice, is apt to suppose that he treats his patients according +to the teachings of his experience. No doubt this is true to some +extent; to what extent depending much on the qualities of the +individual. But it is easy to prove that the prescriptions of even +wise physicians are very commonly founded on something quite +different from experience. Experience must be based on the permanent +facts of nature. But a glance at the prevalent modes of treatment of +any two successive generations will show that there is a changeable +as well as a permanent element in the art of healing; not merely +changeable as diseases vary, or as new remedies are introduced, but +changeable by the going out of fashion of special remedies, by the +decadence of a popular theory from which their fitness was deduced, +or other cause not more significant. There is no reason to suppose +that the present time is essentially different in this respect from +any other. Much, therefore, which is now very commonly considered to +be the result of experience, will be recognized in the next, or in +some succeeding generation, as no such result at all, but as a +foregone conclusion, based on some prevalent belief or fashion of the +time. + +There are, of course, in every calling, those who go about the work +of the day before them, doing it according to the rules of their +craft, and asking no questions of the past or of the future, or of +the aim and end to which their special labor is contributing. These +often consider and call themselves practical men. They pull the oars +of society, and have no leisure to watch the currents running this or +that way; let theorists and philosophers attend to them. In the mean +time, however, these currents are carrying the practical men, too, +and all their work may be thrown away, and worse than thrown away, if +they do not take knowledge of them and get out of the wrong ones and +into the right ones as soon as they may. Sir Edward Parry and his +party were going straight towards the pole in one of their arctic +expeditions, travelling at the rate of ten miles a day. But the ice +over which they travelled was drifting straight towards the equator, +at the rate of twelve miles a day, and yet no man among them would +have known that he was travelling two miles a day backward unless he +had lifted his eyes from the track in which he was plodding. It is +not only going backward that the plain practical workman is liable +to, if he will not look up and look around; he may go forward to ends +he little dreams of. It is a simple business for a mason to build up +a niche in a wall; but what if, a hundred years afterwards when the +wall is torn down, the skeleton of a murdered man drop out of the +niche? It was a plain practical piece of carpentry for a Jewish +artisan to fit two pieces of timber together according to the legal +pattern in the time of Pontius Pilate; he asked no questions, +perhaps, but we know what burden the cross bore on the morrow! And +so, with subtler tools than trowels or axes, the statesman who works +in policy without principle, the theologian who works in forms +without a soul, the physician who, calling himself a practical man, +refuses to recognize the larger laws which govern his changing +practice, may all find that they have been building truth into the +wall, and hanging humanity upon the cross. + +The truth is, that medicine, professedly founded on observation, is +as sensitive to outside influences, political, religious, +philosophical, imaginative, as is the barometer to the changes of +atmospheric density. Theoretically it ought to go on its own +straightforward inductive path, without regard to changes of +government or to fluctuations of public opinion. But look a moment +while I clash a few facts together, and see if some sparks do not +reveal by their light a closer relation between the Medical Sciences +and the conditions of Society and the general thought of the time, +than would at first be suspected. + +Observe the coincidences between certain great political and +intellectual periods and the appearance of illustrious medical +reformers and teachers. It was in the age of Pericles, of Socrates, +of Plato, of Phidias, that Hippocrates gave to medical knowledge the +form which it retained for twenty centuries. With the world- +conquering Alexander, the world-embracing Aristotle, appropriating +anatomy and physiology, among his manifold spoils of study, marched +abreast of his royal pupil to wider conquests. Under the same +Ptolemies who founded the Alexandrian Library and Museum, and ordered +the Septuagint version of the Hebrew Scriptures, the infallible +Herophilus ["Contradicere Herophilo in anatomicis, est contradicere +evangelium," was a saying of Fallopius.] made those six hundred +dissections of which Tertullian accused him, and the sagacious +Erasistratus introduced his mild antiphlogistic treatment in +opposition to the polypharmacy and antidotal practice of his time. +It is significant that the large-minded Galen should have been the +physician and friend of the imperial philosopher Marcus Aurelius. +The Arabs gave laws in various branches of knowledge to those whom +their arms had invaded, or the terror of their spreading dominion had +reached, and the point from which they started was, as Humboldt +acknowledges, "the study of medicine, by which they long ruled the +Christian Schools," and to which they added the department of +chemical pharmacy. + +Look at Vesalius, the contemporary of Luther. Who can fail to see +one common spirit in the radical ecclesiastic and the reforming +court-physician? Both still to some extent under the dominion of the +letter: Luther holding to the real presence; Vesalius actually +causing to be drawn and engraved two muscles which he knew were not +found in the human subject, because they had been described by Galen, +from dissections of the lower animals. Both breaking through old +traditions in the search of truth; one, knife in hand, at the risk of +life and reputation, the other at the risk of fire and fagot, with +that mightier weapon which all the devils could not silence, though +they had been thicker than the tiles on the house-tops. How much the +physician of the Catholic Charles V. had in common with the great +religious destructive, may be guessed by the relish with which he +tells the story how certain Pavian students exhumed the body of an +"elegans scortum," or lovely dame of ill repute, the favorite of a +monk of the order of St. Anthony, who does not seem to have resisted +temptation so well as the founder of his order. We have always +ranked the physician Rabelais among the early reformers, but I do not +know that Vesalius has ever been thanked for his hit at the morals of +the religious orders, or for turning to the good of science what was +intended for the "benefit of clergy." + +Our unfortunate medical brother, Michael Servetus, the spiritual +patient to whom the theological moxa was applied over the entire +surface for the cure of his heresy, came very near anticipating +Harvey. The same quickened thought of the time which led him to +dispute the dogma of the Church, opened his mind to the facts which +contradicted the dogmas of the Faculty. + +Harvey himself was but the posthumous child of the great Elizabethan +period. Bacon was at once his teacher and his patient. The founder +of the new inductive philosophy had only been dead two years when the +treatise on the Circulation, the first-fruit of the Restoration of +Science, was given to the world. + +And is it to be looked at as a mere accidental coincidence, that +while Napoleon was modernizing the political world, Bichat was +revolutionizing the science of life and the art that is based upon +it; that while the young general was scaling the Alps, the young +surgeon was climbing the steeper summits of unexplored nature; that +the same year read the announcement of those admirable "Researches on +Life and Death," and the bulletins of the battle of Marengo? + +If we come to our own country, who can fail to recognize that +Benjamin Rush, the most conspicuous of American physicians, was the +intellectual offspring of the movement which produced the Revolution? +"The same hand," says one of his biographers," which subscribed the +declaration of the political independence of these States, +accomplished their emancipation from medical systems formed in +foreign countries, and wholly unsuitable to the state of diseases in +America." + +Following this general course of remark, I propose to indicate in a +few words the direction of the main intellectual current of the time, +and to point out more particularly some of the eddies which tend to +keep the science and art of medicine from moving with it, or even to +carry them backwards. + +The two dominant words of our time are law and average, both pointing +to the uniformity of the order of being in which we live. Statistics +have tabulated everything,--population, growth, wealth, crime, +disease. We have shaded maps showing the geographical distribution +of larceny and suicide. Analysis and classification have been at +work upon all tangible and visible objects. The Positive Philosophy +of Comte has only given expression to the observing and computing +mind of the nineteenth century. + +In the mean time, the great stronghold of intellectual conservatism, +traditional belief, has been assailed by facts which would have been +indicted as blasphemy but a few generations ago. Those new tables of +the law, placed in the hands of the geologist by the same living God +who spoke from Sinai to the Israelites of old, have remodelled the +beliefs of half the civilized world. The solemn scepticism of +science has replaced the sneering doubts of witty philosophers. The +more positive knowledge we gain, the more we incline to question all +that has been received without absolute proof. + +As a matter of course, this movement has its partial reactions. The +province of faith is claimed as a port free of entry to unsupported +individual convictions. The tendency to question is met by the +unanalyzing instinct of reverence. The old church calls back its +frightened truants. Some who have lost their hereditary religious +belief find a resource in the revelations of Spiritualism. By a +parallel movement, some of those who have become medical infidels +pass over to the mystic band of believers in the fancied miracles of +Homoeopathy. + +Under these influences transmitted to, or at least shared by, the +medical profession, the old question between "Nature," so called, and +"Art," or professional tradition, has reappeared with new interest. +I say the old question, for Hippocrates stated the case on the side +of "Nature" more than two thousand years ago. Miss Florence +Nightingale,--and if I name her next to the august Father of the +Healing Art, its noblest daughter well deserves that place of honor, +--Miss Florence Nightingale begins her late volume with a paraphrase +of his statement. But from a very early time to this there has +always been a strong party against "Nature." Themison called the +practice of Hippocrates "a meditation upon death." Dr. Rush says: +"It is impossible to calculate the mischief which Hippocrates, has +done, by first marking Nature with his name and afterwards letting +her loose upon sick people. Millions have perished by her hands in +all ages and countries." Sir John Forbes, whose defence of "Nature" +in disease you all know, and to the testimonial in whose honor four +of your Presidents have contributed, has been recently greeted, on +retiring from the profession, with a wish that his retirement had +been twenty years sooner, and the opinion that no man had done so +much to destroy the confidence of the public in the medical +profession. + +In this Society we have had the Hippocratic and the Themisonic side +fairly represented. The treatise of one of your early Presidents on +the Mercurial Treatment is familiar to my older listeners. Others +who have held the same office have been noted for the boldness of +their practice, and even for partiality to the use of complex +medication. + +On the side of "Nature" we have had, first of all, that remarkable +discourse on Self-Limited Diseases, [On Self-Limited Diseases. A +Discourse delivered before the Massachusetts Medical Society, at +their Annual Meeting, May 27, 1835. By Jacob Bigelow, M. D.] which +has given the key-note to the prevailing medical tendency of this +neighborhood, at least, for the quarter of a century since it was +delivered. Nor have we forgotten the address delivered at +Springfield twenty years later, [Search out the Secrets, of Nature. +By Augustus A. Gould, M. D. Read at the Annual Meeting, June 27, +1855.] full of good sense and useful suggestions, to one of which +suggestions we owe the learned, impartial, judicious, well-written +Prize Essay of Dr. Worthington Hooker. [Rational Therapeutics. A +Prize Essay. By Worthington Hooker, M. D., of New Haven. Boston. +1857.] We should not omit from the list the important address of +another of our colleagues, [On the Treatment of Compound and +Complicated Fractures. By William J. Walker, M. D. Read at the +Annual Meeting, May 29, 1845.] showing by numerous cases the power of +Nature in healing compound fractures to be much greater than is +frequently supposed,--affording, indeed, more striking illustrations +than can be obtained from the history of visceral disease, of the +supreme wisdom, forethought, and adaptive dexterity of that divine +Architect, as shown in repairing the shattered columns which support +the living temple of the body. + +We who are on the side of "Nature" please ourselves with the idea +that we are in the great current in which the true intelligence of +the time is moving. We believe that some who oppose, or fear, or +denounce our movement are themselves caught in various eddies that +set back against the truth. And we do most earnestly desire and most +actively strive, that Medicine, which, it is painful to remember, has +been spoken of as "the withered branch of science" at a meeting of +the British Association, shall be at length brought fully to share, +if not to lead, the great wave of knowledge which rolls with the +tides that circle the globe. + +If there is any State or city which might claim to be the American +headquarters of the nature-trusting heresy, provided it be one, that +State is Massachusetts, and that city is its capital. The effect +which these doctrines have upon the confidence reposed in the +profession is a matter of opinion. For myself, I do not believe this +confidence can be impaired by any investigations which tend to limit +the application of troublesome, painful, uncertain, or dangerous +remedies. Nay, I will venture to say this, that if every specific +were to fail utterly, if the cinchona trees all died out, and the +arsenic mines were exhausted, and the sulphur regions were burned up, +if every drug from the vegetable, animal, and mineral kingdom were to +disappear from the market, a body of enlightened men, organized as a +distinct profession, would be required just as much as now, and +respected and trusted as now, whose province should be to guard +against the causes of disease, to eliminate them if possible when +still present, to order all the conditions of the patient so as to +favor the efforts of the system to right itself, and to give those +predictions of the course of disease which only experience can +warrant, and which in so many cases relieve the exaggerated fears of +sufferers and their friends, or warn them in season of impending +danger. Great as the loss would be if certain active remedies could +no longer be obtained, it would leave the medical profession the most +essential part of it's duties, and all, and more than all, its +present share of honors; for it would be the death-blow to +charlatanism, which depends for its success almost entirely on drugs, +or at least on a nomenclature that suggests them. + +There is no offence, then, or danger in expressing the opinion, that, +after all which has been said, the community is still overdosed: The +best proof of it is, that "no families take so little medicine as +those of doctors, except those of apothecaries, and that old +practitioners are more sparing of active medicines than younger +ones." [Dr. James Jackson has kindly permitted me to make the +following extract from a letter just received by him from Sir James +Clark, and dated May 26, 1860: "As a physician advances in age, he +generally, I think, places less confidence in the ordinary medical +treatment than he did, not only during his early, but even his middle +period of life."] The conclusion from these facts is one which the +least promising of Dr. Howe's pupils in the mental department could +hardly help drawing. + +Part of the blame of over-medication must, I fear, rest with the +profession, for yielding to the tendency to self-delusion, which +seems inseparable from the practice of the art of healing. I need +only touch on the common modes of misunderstanding or misapplying the +evidence of nature. + +First, there is the natural incapacity for sound observation, which +is like a faulty ear in music. We see this in many persons who know +a good deal about books, but who are not sharp-sighted enough to buy +a horse or deal with human diseases. + +Secondly, there is in some persons a singular inability to weigh the +value of testimony; of which, I think, from a pretty careful +examination of his books, Hahnemann affords the best specimen outside +the walls of Bedlam. + +The inveterate logical errors to which physicians have always been +subject are chiefly these: + +The mode of inference per enumerationem simplicem, in scholastic +phrase; that is, counting only their favorable cases. This is the +old trick illustrated in Lord Bacon's story of the gifts of the +shipwrecked people, hung up in the temple.--Behold! they vowed these +gifts to the altar, and the gods saved them. Ay, said a doubting +bystander, but how many made vows of gifts and were shipwrecked +notwithstanding? The numerical system is the best corrective of this +and similar errors. The arguments commonly brought against its +application to all matters of medical observation, treatment +included, seem to apply rather to the tabulation of facts ill +observed, or improperly classified, than to the method itself. + +The post hoc ergo propter hoc error: he got well after taking my +medicine; therefore in consequence of taking it. + +The false induction from genuine facts of observation, leading to the +construction of theories which are then deductively applied in the +face of the results of direct observation. The school of Broussais +has furnished us with a good example of this error. + +And lastly, the error which Sir Thomas Browne calls giving "a reason +of the golden tooth;" that is, assuming a falsehood as a fact, and +giving reasons for it, commonly fanciful ones, as is constantly done +by that class of incompetent observers who find their "golden tooth" +in the fabulous effects of the homoeopathie materia medica,--which +consists of sugar of milk and a nomenclature. + +Another portion of the blame rests with the public itself, which +insists on being poisoned. Somebody buys all the quack medicines +that build palaces for the mushroom, say rather, the toadstool +millionaires. Who is it? These people have a constituency of +millions. The popular belief is all but universal that sick persons +should feed on noxious substances. One of our members was called not +long since to a man with a terribly sore mouth. On inquiry he found +that the man had picked up a box of unknown pills, in Howard Street, +and had proceeded to take them, on general principles, pills being +good for people. They happened to contain mercury, and hence the +trouble for which he consulted our associate. + +The outside pressure, therefore, is immense upon the physician, +tending to force him to active treatment of some kind. Certain old +superstitions, still lingering in the mind of the public, and not yet +utterly expelled from that of the profession, are at the bottom of +this, or contribute to it largely. One of the most ancient is, that +disease is a malignant agency, or entity, to be driven out of the +body by offensive substances, as the smoke of the fish's heart and +liver drove the devil out of Tobit's bridal chamber, according to the +Apochrypha. Epileptics used to suck the blood from the wounds of +dying gladiators. [Plinii Hist. Mundi. lib. xxviii. c. 4.] The +Hon. Robert Boyle's little book was published some twenty or thirty +years before our late President, Dr. Holyoke, was born. [A Collection +of Choice and Safe Remedies. The Fifth Edition, corrected. London, +1712. Dr. Holyoke was born in 1728.] In it he recommends, as +internal medicines, most of the substances commonly used as +fertilizers of the soil. His "Album Graecum" is best left +untranslated, and his "Zebethum Occidentale" is still more +transcendentally unmentionable except in a strange dialect. It +sounds odiously to us to hear him recommend for dysentery a powder +made from "the sole of an old shoe worn by some man that walks much." +Perhaps nobody here ever heard of tying a stocking, which had been +worn during the day, round the neck at night for a sore throat. The +same idea of virtue in unlovely secretions! [The idea is very +ancient. "Sordes hominis" "Sudore et oleo medicinam facientibus." +--Plin. xxviii. 4.] + +Even now the Homoeopathists have been introducing the venom of +serpents, under the learned title of Lachesis, and outraging human +nature with infusions of the pediculus capitis; that is, of course, +as we understand their dilutions, the names of these things; for if a +fine-tooth-comb insect were drowned in Lake Superior, we cannot agree +with them in thinking that every drop of its waters would be +impregnated with all the pedicular virtues they so highly value. +They know what they are doing. They are appealing to the detestable +old superstitious presumption in favor of whatever is nauseous and +noxious as being good for the sick. + +Again, we all occasionally meet persons stained with nitrate of +silver, given for epilepsy. Read what Dr. Martin says, about the way +in which it came to be used, in his excellent address before the +Norfolk County Medical Society, and the evidence I can show, but have +not time for now, and then say what you think of the practice which +on such presumptions turns a white man as blue as the double-tattooed +King of the Cannibal Islands! [Note A.] + +If medical superstitions have fought their way down through all the +rationalism and scepticism of the nineteenth century, of course the +theories of the schools, supported by great names, adopted into the +popular belief and incorporated with the general mass of +misapprehension with reference to disease, must be expected to meet +us at every turn in the shape of bad practice founded on false +doctrine. A French patient complains that his blood heats him, and +expects his doctor to bleed him. An English or American one says he +is bilious, and will not be easy without a dose of calomel. A doctor +looks at a patient's tongue, sees it coated, and says the stomach is +foul; his head full of the old saburral notion which the extreme +inflammation-doctrine of Broussais did so much to root out, but which +still leads, probably, to much needless and injurious wrong of the +stomach and bowels by evacuants, when all they want is to be let +alone. It is so hard to get anything out of the dead hand of medical +tradition! The mortmain of theorists extinct in science clings as +close as that of ecclesiastics defunct in law. + +One practical hint may not be out of place here. It seems to be +sometimes forgotten, by those who must know the fact, that the tongue +is very different, anatomically and physiologically, from the +stomach. Its condition does not in the least imply a similar one of +the stomach, which is a very different structure, covered with a +different kind of epithelium, and furnished with entirely different +secretions. A silversmith will, for a dollar, make a small hoe, of +solid silver, which will last for centuries, and will give a patient +more comfort, used for the removal of the accumulated epithelium and +fungous growths which constitute the "fur," than many a prescription +with a split-footed Rx before it, addressed to the parts out of +reach. + +I think more of this little implement on account of its agency in +saving the Colony at Plymouth in the year 1623. Edward Winslow heard +that Massasoit was sick and like to die. He found him with a +houseful of people about him, women rubbing his arms and legs, and +friends "making such a hellish noise" as they probably thought would +scare away the devil of sickness. Winslow gave him some conserve, +washed his mouth, scraped his tongue, which was in a horrid state, +got down some drink, made him some broth, dosed him with an infusion +of strawberry leaves and sassafras root, and had the satisfaction of +seeing him rapidly recover. Massasoit, full of gratitude, revealed +the plot which had been formed to destroy the colonists, whereupon +the Governor ordered Captain Miles Standish to see to them; who +thereupon, as everybody remembers, stabbed Pecksuot with his own +knife, broke up the plot, saved the colony, and thus rendered +Massachusetts and the Massachusetts Medical Society a possibility, as +they now are a fact before us. So much for this parenthesis of the +tongue-scraper, which helped to save the young colony from a much +more serious scrape, and may save the Union yet, if a Presidential +candidate should happen to be taken sick as Massasoit was, and his +tongue wanted cleaning,--which process would not hurt a good many +politicians, with or without a typhoid fever. + +Again, see how the "bilious" theory works in every-day life here and +now, illustrated by a case from actual life. A youthful +practitioner, whose last molars have not been a great while cut, +meets an experienced and noted physician in consultation. This is +the case. A slender, lymphatic young woman is suckling two lusty +twins, the intervals of suction being occupied on her part with +palpitations, headaches, giddiness, throbbing in the head, and +various nervous symptoms, her cheeks meantime getting bloodless, and +her strength running away in company with her milk. The old +experienced physician, seeing the yellowish waxy look which is common +in anaemic patients, considers it a "bilious" case, and is for giving +a rousing emetic. Of course, he has to be wheedled out of this, a +recipe is written for beefsteaks and porter, the twins are +ignominiously expelled from the anaemic bosom, and forced to take +prematurely to the bottle, and this prolific mother is saved for +future usefulness in the line of maternity. + +The practice of making a profit on the medicine ordered has been held +up to reprobation by one at least of the orators who have preceded +me. That the effect of this has been ruinous in English practice I +cannot doubt, and that in this country the standard of practice was +in former generations lowered through the same agency is not +unlikely. I have seen an old account-book in which the physician +charged an extra price for gilding his rich patients' pills. If all +medicine were very costly, and the expense of it always came out of +the physician's fee, it would really be a less objectionable +arrangement than this other most pernicious one. He would naturally +think twice before he gave an emetic or cathartic which evacuated his +own pocket, and be sparing of the cholagogues that emptied the +biliary ducts of his own wallet, unless he were sure they were +needed. If there is any temptation, it should not be in favor of +giving noxious agents, as it clearly must be in the case of English +druggists and "General Practitioners." The complaint against the +other course is a very old one. Pliny, inspired with as truly Roman +horror of quackery as the elder Cato,--who declared that the Greek +doctors had sworn to exterminate all barbarians, including the +Romans, with their drugs, but is said to have physicked his own wife +to death, notwithstanding,--Pliny says, in so many words, that the +cerates and cataplasms, plasters, collyria, and antidotes, so +abundant in his time, as in more recent days, were mere tricks to +make money. + + +A pretty strong eddy, then, or rather many eddies, setting constantly +back from the current of sober observation of nature, in the +direction of old superstitions and fancies, of exploded theories, of +old ways of making money, which are very slow to pass out of fashion + +But there are other special American influences which we are bound to +take cognizance of. If I wished to show a student the difficulties +of getting at truth from medical experience, I would give him the +history of epilepsy to read. If I wished him to understand the +tendencies of the American medical mind, its sanguine enterprise, its +self-confidence, its audacious handling of Nature, its impatience +with her old-fashioned ways of taking time to get a sick man well, I +would make him read the life and writings of Benjamin Rush. Dr. Rush +thought and said that there were twenty times more intellect and a +hundred times more knowledge in the country in 1799 than before the +Revolution. His own mind was in a perpetual state of exaltation +produced by the stirring scenes in which he had taken a part, and the +quickened life of the time in which he lived. It was not the state +to favor sound, calm observation. He was impatient, and Nature is +profoundly imperturbable. We may adjust the beating of our hearts to +her pendulum if we will and can, but we may be very sure that she +will not change the pendulum's rate of going because our hearts are +palpitating. He thought he had mastered yellow-fever. "Thank God," +he said, "out of one hundred patients whom I have visited or +prescribed for this day, I have lost none." Where was all his legacy +of knowledge when Norfolk was decimated? Where was it when the blue +flies were buzzing over the coffins of the unburied dead piled up in +the cemetery of New Orleans, at the edge of the huge trenches yawning +to receive them? + +One such instance will do as well as twenty. Dr. Rush must have been +a charming teacher, as he was an admirable man. He was observing, +rather than a sound observer; eminently observing, curious, even, +about all manner of things. But he could not help feeling as if +Nature had been a good deal shaken by the Declaration of +Independence, and that American art was getting to be rather too much +for her,--especially as illustrated in his own practice. He taught +thousands of American students, he gave a direction to the medical +mind of the country more than any other one man; perhaps he typifies +it better than any other. It has clearly tended to extravagance in +remedies and trust in remedies, as in everything else. How could a +people which has a revolution once in four years, which has contrived +the Bowie-knife and the revolver, which has chewed the juice out of +all the superlatives in the language in Fourth of July orations, and +so used up its epithets in the rhetoric of abuse that it takes two +great quarto dictionaries to supply the demand; which insists in +sending out yachts and horses and boys to out-sail, out-run, out- +fight, and checkmate all the rest of creation; how could such a +people be content with any but "heroic" practice? What wonder that +the stars and stripes wave over doses of ninety grains of sulphate of +quinine, [More strictly, ninety-six grains in two hours. Dunglison's +Practice, 1842, vol. ii. p. 520. Eighty grains in one dose. +Ibid. p. 536. Ninety-six grains of sulphate of quinine are equal +to eight ounces of good bark.--Wood & Bache.] and that the American +eagle screams with delight to see three drachms of calomel given at a +single mouthful? + +Add to this the great number of Medical Journals, all useful, we +hope, most of them necessary, we trust, many of them excellently well +conducted, but which must find something to fill their columns, and +so print all the new plans of treatment and new remedies they can get +hold of, as the newspapers, from a similar necessity, print the +shocking catastrophes and terrible murders. + +Besides all this, here are we, the great body of teachers in the +numberless medical schools of the Union, some of us lecturing to +crowds who clap and stamp in the cities, some of us wandering over +the country, like other professional fertilizers, to fecundate the +minds of less demonstrative audiences at various scientific stations; +all of us talking habitually to those supposed to know less than +ourselves, and loving to claim as much for our art as we can, not to +say for our own schools, and possibly indirectly for our own +practical skill. Hence that annual crop of introductory lectures; +the useful blossoming into the ornamental, as the cabbage becomes +glorified in the cauliflower; that lecture-room literature of +adjectives, that declamatory exaggeration, that splendid show of +erudition borrowed from D'Israeli, and credited to Lord Bacon and the +rest, which have suggested to our friends of the Medical Journals an +occasional epigram at our expense. Hence the tendency in these +productions, and in medical lectures generally, to overstate the +efficacy of favorite methods of cure, and hence the premium offered +for showy talkers rather than sagacious observers, for the men of +adjectives rather than of nouns substantive in the more ambitious of +these institutions. + +Such are some of the eddies in which we are liable to become involved +and carried back out of the broad stream of philosophical, or, in +other words, truth-loving, investigations. The causes of disease, in +the mean time, have been less earnestly studied in the eagerness of +the search for remedies. Speak softly! Women have been borne out +from an old-world hospital, two in one coffin, that the horrors of +their prison-house might not be known, while the very men who were +discussing the treatment of the disease were stupidly conveying the +infection from bed to bed, as rat-killers carry their poisons from +one household to another. Do not some of you remember that I have +had to fight this private-pestilence question against a scepticism +which sneered in the face of a mass of evidence such as the calm +statisticians of the Insurance office could not listen to without +horror and indignation? ["The Contagiousness of Puerperal Fever."-- +N. E. Quar. Jour. of Medicine and Surgery, April, 1843. Reprinted, +with Additions. Boston: Ticknor & Fields. 1855.] Have we forgotten +what is told in one of the books published under our own sanction, +that a simple measure of ventilation, proposed by Dr. John Clark, had +saved more than sixteen thousand children's lives in a single +hospital? How long would it have taken small doses of calomel and +rhubarb to save as many children? These may be useful in prudent +hands, but how insignificant compared to the great hygienic +conditions! Causes, causes, and again causes,--more and more we fall +back on these as the chief objects of our attention. The shortest +system of medical practice that I know of is the oldest, but not the +worst. It is older than Hippocrates, older than Chiron the Centaur. +Nature taught it to the first mother when she saw her first-born +child putting some ugly pebble or lurid berry into its mouth. I know +not in what language it was spoken, but I know that in English it +would sound thus: Spit it out! + +Art can do something more than say this. It can sometimes reach the +pebble or berry after it has been swallowed. But the great thing is +to keep these things out of children's mouths, and as soon as they +are beyond our reach, to be reasonable and patient with Nature, who +means well, but does not like to hurry, and who took nine calendar +months, more or less, to every mother's son among us, before she +thought he was fit to be shown to the public. + +Suffer me now to lay down a few propositions, whether old or new it +matters little, not for your immediate acceptance, nor yet for your +hasty rejection, but for your calm consideration. + +But first, there are a number of terms which we are in the habit of +using in a vague though not unintelligible way, and which it is as +well now to define. These terms are the tools with which we are to +work, and the first thing is to sharpen them. It is nothing to us +that they have been sharpened a thousand times before; they always +get dull in the using, and every new workman has a right to carry +them to the grindstone and sharpen them to suit himself. + +Nature, in medical language, as opposed to Art, means trust in the +reactions of the living system against, ordinary normal impressions. + +Art, in the same language, as opposed to Nature, means an intentional +resort to extraordinary abnormal impressions for the relief of +disease. + +The reaction of the living system is the essence of both. Food is +nothing, if there is no digestive act to respond to it. We cannot +raise a blister on a dead man, or hope that a carminative forced +between his lips will produce its ordinary happy effect. + +Disease, dis-ease,--disturbed quiet, uncomfortableness,--means +imperfect or abnormal reaction of the living system, and its more or +less permanent results. + +Food, in its largest sense, is whatever helps to build up the normal +structures, or to maintain their natural actions. + +Medicine, in distinction from food, is every unnatural or noxious +agent applied for the relief of disease. + +Physic means properly the Natural art, and Physician is only the +Greek synonyme of Naturalist. + +With these few explanations I proceed to unfold the propositions I +have mentioned. + +Disease and death, if we may judge by the records of creation, are +inherently and essentially necessary in the present order of things. +A perfect intelligence, trained by a perfect education, could do no +more than keep the laws of the physical and spiritual universe. An +imperfect intelligence, imperfectly taught,--and this is the +condition of our finite humanity,--will certainly fail to keep all +these laws perfectly. Disease is one of the penalties of one of the +forms of such failure. It is prefigured in the perturbations of the +planets, in the disintegration of the elemental masses; it has left +its traces in the fossil organisms of extinct creations. [Professor +Agassiz has kindly handed me the following note: "There are abnormal +structures in animals of all ages anterior to the creation of +mankind. Malformed specimens of Crinoids are known from the Triassic +and Jurassic deposits. Malformed and diseased bones of tertiary +mammalia have been collected in the caverns of Gailenreuth with +traces of healing."] + +But it is especially the prerogative, I had almost said privilege, of +educated and domesticated beings, from man down to the potato, +serving to teach them, and such as train them, the laws of life, and +to get rid of those who will not mind or cannot be kept subject to +these laws. + +Disease, being always an effect, is always in exact proportion to the +sum of its causes, as much in the case of Spigelius, who dies of a +scratch, as in that of the man who recovers after an iron bar has +been shot through his brain. The one prevalent failing of the +medical art is to neglect the causes and quarrel with the effect. + +There are certain general facts which include a good deal of what is +called and treated as disease. Thus, there are two opposite +movements of life to be seen in cities and elsewhere, belonging to +races which, from various persistent causes, are breeding down and +tending to run out, and to races which are breeding up, or +accumulating vital capital,--a descending and an ascending series. +Let me give an example of each; and that I may incidentally remove a +common impression about this country as compared with the Old World, +an impression which got tipsy with conceit and staggered into the +attitude of a formal proposition in the work of Dr. Robert Knox, I +will illustrate the downward movement from English experience, and +the upward movement from a family history belonging to this immediate +neighborhood. + +Miss Nightingale speaks of "the fact so often seen of a +great-grandmother, who was a tower of physical vigor, descending into +a grandmother perhaps a little less vigorous, but still sound as a +bell, and healthy to the core, into a mother languid and confined to +her carriage and house; and lastly into a daughter sickly and +confined to her bed." So much for the descending English series; now +for the ascending American series. + +Something more than one hundred and thirty years ago there graduated +at Harvard College a delicate youth, who lived an invalid life and +died at the age of about fifty. His two children were both of +moderate physical power, and one of them diminutive in stature. The +next generation rose in physical development, and reached eighty +years of age and more in some of its members. The fourth generation +was of fair average endowment. The fifth generation, great-great- +grandchildren of the slender invalid, are several of, them of +extraordinary bodily and mental power; large in stature, formidable +alike with their brains and their arms, organized on a more extensive +scale than either of their parents. + +This brief account illustrates incidentally the fallacy of the +universal-degeneration theory applied to American life; the same on +which one of our countrymen has lately brought some very forcible +facts to bear in a muscular discussion of which we have heard rather +more than is good for us. But the two series, American and English, +ascending and descending, were adduced with the main purpose of +showing the immense difference of vital endowments in different +strains of blood; a difference to which all ordinary medication is in +all probability a matter of comparatively trivial purport. Many +affections which art has to strive against might be easily shown to +be vital to the well-being of society. Hydrocephalus, tabes +mesenterica, and other similar maladies, are natural agencies which +cut off the children of races that are sinking below the decent +minimum which nature has established as the condition of viability, +before they reach the age of reproduction. They are really not so +much diseases, as manifestations of congenital incapacity for life; +the race would be ruined if art could ever learn always to preserve +the individuals subject to them. We must do the best we can for +them, but we ought also to know what these "diseases" mean. + +Again, invalidism is the normal state of many organizations. It can +be changed to disease, but never to absolute health by medicinal +appliances. There are many ladies, ancient and recent, who are +perpetually taking remedies for irremediable pains and aches. They +ought to have headaches and back-aches and stomach-aches; they are +not well if they do not have them. To expect them to live without +frequent twinges is like expecting a doctor's old chaise to go +without creaking; if it did, we might be sure the springs were +broken. There is no doubt that the constant demand for medicinal +remedies from patients of this class leads to their over-use; often +in the case of cathartics, sometimes in that of opiates. I have been +told by an intelligent practitioner in a Western town, that the +constant prescription of opiates by certain physicians in his +vicinity has rendered the habitual use of that drug in all that +region very prevalent; more common, I should think, than alcoholic +drunkenness in the most intemperate localities of which I have known +anything. A frightful endemic demoralization betrays itself in the +frequency with which the haggard features and drooping shoulders of +the opium-drunkards are met with in the streets. + +The next proposition I would ask you to consider is this: +The presumption always is that every noxious agent, including +medicines proper, which hurts a well man, hurts a sick one. +[ Note B.] + +Let me illustrate this proposition before you decide upon it. If it +were known that a prize-fighter were to have a drastic purgative +administered two or three days before a contest, or a large blister +applied to his back, no one will question that it would affect the +betting on his side unfavorably; we will say to the amount of five +per cent. Now the drain upon the resources of the system produced in +such a case must be at its minimum, for the subject is a powerful +man, in the prime of life, and in admirable condition. If the drug +or the blister takes five per cent. from his force of resistance, it +will take at least as large a fraction from any invalid. But this +invalid has to fight a champion who strikes hard but cannot be hit in +return, who will press him sharply for breath, but will never pant +himself while the wind can whistle through his fleshless ribs. The +suffering combatant is liable to want all his stamina, and five per +cent. may lose him the battle. + +All noxious agents, all appliances which are not natural food or +stimuli, all medicines proper, cost a patient, on the average, five +per cent. of his vital force, let us say. Twenty times as much waste +of force produced by any of them, that is, would exactly kill him, +nothing less than kill him, and nothing more. If this, or something +like this, is true, then all these medications are, prima facie, +injurious. + +In the game of Life-or-Death, Rouge et Noir, as played between the +Doctor and the Sexton, this five per cent., this certain small injury +entering into the chances is clearly the sexton's perquisite for +keeping the green table, over which the game is played, and where he +hoards up his gains. Suppose a blister to diminish a man's pain, +effusion or dyspnoea to the saving of twenty per cent. in vital +force; his profit from it is fifteen, in that case, for it always +hurts him five to begin with, according to our previous assumption. + +Presumptions are of vast importance in medicine, as in law. A man is +presumed innocent until he is proved guilty. A medicine--that is, a +noxious agent, like a blister, a seton, an emetic, or a cathartic-- +should always be presumed to be hurtful. It always is directly +hurtful; it may sometimes be indirectly beneficial. If this +presumption were established, and disease always assumed to be the +innocent victim of circumstances, and not punishable by medicines, +that is, noxious agents, or poisons, until the contrary was shown, we +should not so frequently hear the remark commonly, perhaps +erroneously, attributed to Sir Astley Cooper, but often repeated by +sensible persons, that, on the whole, more harm than good is done by +medication. Throw out opium, which the Creator himself seems to +prescribe, for we often see the scarlet poppy growing in the +cornfields, as if it were foreseen that wherever there is hunger to +be fed there must also be pain to be soothed; throw out a few +specifics which our art did not discover, and is hardly needed to +apply [ Note C.]; throw out wine, which is a food, and the vapors +which produce the miracle of anaesthesia, and I firmly believe that +if the whole materia medica, as now used, could be sunk to the bottom +of the sea, it would be all the better for mankind,--and all the +worse for the fishes. + +But to justify this proposition, I must add that the injuries +inflicted by over-medication are to a great extent masked by disease. +Dr. Hooker believes that the typhus syncopatia of a preceding +generation in New England "was often in fact a brandy and opium +disease." How is a physician to distinguish the irritation produced +by his blister from that caused by the inflammation it was meant to +cure? How can he tell the exhaustion produced by his evacuants from +the collapse belonging to the disease they were meant to remove? + +Lastly, medication without insuring favorable hygienic conditions is +like amputation without ligatures. I had a chance to learn this well +of old, when physician to the Broad Street district of the Boston +Dispensary. There, there was no help for the utter want of wholesome +conditions, and if anybody got well under my care, it must have been +in virtue of the rough-and-tumble constitution which emerges from the +struggle for life in the street gutters, rather than by the aid of my +prescriptions. + +But if the materia medica were lost overboard, how much more pains +would be taken in ordering all the circumstances surrounding the +patient (as can be done everywhere out of the crowded pauper +districts), than are taken now by too many who think they do their +duty and earn their money when they write a recipe for a patient left +in an atmosphere of domestic malaria, or to the most negligent kind +of nursing! I confess that I should think my chance of recovery from +illness less with Hippocrates for my physician and Mrs. Gamp for my +nurse, than if I were in the hands of Hahnemann himself, with +Florence Nightingale or good Rebecca Taylor to care for me. + +If I am right in maintaining that the presumption is always against +the use of noxious agents in disease, and if any whom I might +influence should adopt this as a principle of practice, they will +often find themselves embarrassed by the imperative demand of +patients and their friends for such agents where a case is not made +out against this standing presumption. I must be permitted to say, +that I think the French, a not wholly uncivilized people, are in +advance of the English and ourselves in the art of prescribing for +the sick without hurting them. And I do confess that I think their +varied ptisans and syrups are as much preferable to the mineral +regimen of bug-poison and ratsbane, so long in favor on the other +side of the Channel, as their art of preparing food for the table to +the rude cookery of those hard-feeding and much-dosing islanders. +We want a reorganized cuisine of invalidism perhaps as much as the +culinary, reform, for which our lyceum lecturers, and others who live +much at hotels and taverns, are so urgent. Will you think I am +disrespectful if I ask whether, even in Massachusetts, a dose of +calomel is not sometimes given by a physician on the same principle +as that upon which a landlord occasionally prescribes bacon and +eggs,--because he cannot think of anything else quite so handy? I +leave my suggestion of borrowing a hint from French practice to your +mature consideration. + +I may, however, call your attention, briefly, to the singular fact, +that English and American practitioners are apt to accuse French +medical practice of inertness, and French surgical practice of +unnecessary activity. Thus, Dr. Bostock considers French medical +treatment, with certain exceptions, as "decidedly less effective" +than that of his own country. Mr. S. Cooper, again, defends the +simple British practice of procuring union by the first intention +against the attacks of M. Roux and Baron Larrey. [Cooper's Surg. +Diet. art. "Wounds." Yet Mr. John Bell gives the French surgeons +credit for introducing this doctrine of adhesion, and accuses +O'Halloran of "rudeness and ignorance," and "bold, uncivil language," +in disputing their teaching. Princ. of Surgery, vol. i. p. 42. +Mr. Hunter succeeded at last in naturalizing the doctrine and +practice, but even he had to struggle against the perpetual jealousy +of rivals, and died at length assassinated by an insult.] We have +often heard similar opinions maintained by our own countrymen. While +Anglo-American criticism blows hot or cold on the two departments of +French practice, it is not, I hope, indecent to question whether all +the wisdom is necessarily with us in both cases. + +Our art has had two or three lessons which have a deep meaning to +those who are willing to read them honestly. The use of water- +dressings in surgery completed the series of reforms by which was +abolished the "coarse and cruel practice" of the older surgeons, who +with their dressings and acrid balsams, their tents and leaden tubes, +"absolutely delayed the cure." The doctrine of Broussais, transient +as was its empire, reversed the practice of half of Christendom for a +season, and taught its hasty disciples to shun their old favorite +remedies as mortal poisons. This was not enough permanently to shift +the presumption about drugs where it belonged, and so at last, just +as the sympathetic powder and the Unguentum Armarium came in a +superstitious age to kill out the abuses of external over-medication, +the solemn farce of Homoeopathy was enacted in the face of our own +too credulous civilization, that under shelter of its pretences the +"inward bruises" of over-drugged viscera might be allowed to heal by +the first intention. Its lesson we must accept, whether we will or +not; its follies we are tired of talking about. The security of the +medical profession against this and all similar fancies is in the +average constitution of the human. mind with regard to the laws of +evidence. + +My friends and brothers in Art! There is nothing to be feared from +the utterance of any seeming heresy to which you may have listened. +I cannot compromise your collective wisdom. If I have strained the +truth one hair's breadth for the sake of an epigram or an antithesis, +you are accustomed to count the normal pulse-beats of sound judgment, +and know full well how to recognize the fever-throbs of conceit and +the nervous palpitations of rhetoric. + +The freedom with which each of us speaks his thought in this +presence, belongs in part to the assured position of the Profession +in our Commonwealth, to the attitude of Science, which is always +fearless, and to the genius of the soil on which we stand, from which +Nature withheld the fatal gift of malaria only to fill it with +exhalations that breed the fever of inquiry in our blood and in our +brain. But mainly we owe the large license of speech we enjoy to +those influences and privileges common to us all as self-governing +Americans. + +This Republic is the chosen home of minorities, of the less power in +the presence of the greater. It is a common error to speak of our +distinction as consisting in the rule of the majority. Majorities, +the greater material powers, have always ruled before. The history +of most countries has been that of majorities, mounted majorities, +clad in iron, armed with death treading down the tenfold more +numerous minorities. In the old civilizations they root themselves +like oaks in the soil; men must live in their shadow or cut them +down. With us the majority is only the flower of the passing noon, +and the minority is the bud which may open in the next morning's sun. +We must be tolerant, for the thought which stammers on a single +tongue today may organize itself in the growing consciousness of the +time, and come back to us like the voice of the multitudinous waves +of the ocean on the morrow. + +Twenty-five years have passed since one of your honored Presidents +spoke to this Society of certain limitations to the power of our Art, +now very generally conceded. Some were troubled, some were almost +angry, thinking the Profession might suffer from such concessions. +It has certainly not suffered here; if, as some affirm, it has lost +respect anywhere, it was probably for other, and no doubt sufficient +reasons. + +Since that time the civilization of this planet has changed hands. +Strike out of existence at this moment every person who was breathing +on that day, May 27, 1835, and every institution of society, every +art and every science would remain intact and complete in the living +that would be left. Every idea the world then held has been since +dissolved and recrystallized. + +We are repeating the same process. Not to make silver shrines for +our old divinities, even though by this craft we should have our +wealth, was this Society organized and carried on by the good men and +true who went before us. Not for this, but to melt the gold out of +the past, though its dross should fly in dust to all the winds of +heaven, to save all our old treasures of knowledge and mine deeply +for new, to cultivate that mutual respect of which outward courtesy +is the sign, to work together, to feel together, to take counsel +together, and to stand together for the truth, now, always, here, +everywhere; for this our fathers instituted, and we accept, the +offices and duties of this time-honored Society. + + + + + + + +BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE. + +An Introductory Lecture delivered before the Medical Class +of Harvard University, November 6, 1861. + + +[This Lecture appears as it would have been delivered had the time +allowed been less strictly, limited. Passages necessarily omitted +have been restored, and points briefly touched have been more fully +considered. A few notes have been added for the benefit of that +limited class of students who care to track an author through the +highways and by-ways of his reading. I owe my thanks to several of +my professional brethren who have communicated with me on subjects +with which they are familiar; especially to Dr. John Dean, for the +opportunity of profiting by his unpublished labors, and to Dr. Hasket +Derby, for information and references to recent authorities relating +to the anatomy and physiology of the eye.] + + +The entrance upon a new course of Lectures is always a period of +interest to instructors and pupils. As the birth of a child to a +parent, so is the advent of a new class to a teacher. As the light +of the untried world to the infant, so is the dawning of the light +resting over the unexplored realms of science to the student. In the +name of the Faculty I welcome you, Gentlemen of the Medical Class, +new-born babes of science, or lustier nurslings, to this morning of +your medical life, and to the arms and the bosom of this ancient +University. Fourteen years ago I stood in this place for the first +time to address those who occupied these benches. As I recall these +past seasons of our joint labors, I feel that they have been on the +whole prosperous, and not undeserving of their prosperity. + +For it has been my privilege to be associated with a body of true and +faithful workers; I cannot praise them freely to their faces, or I +should be proud to discourse of the harmonious diligence and the +noble spirit in which they have toiled together, not merely to teach +their several branches, but to elevate the whole standard of +teaching. + +I may speak with less restraint of those gentlemen who have aided me +in the most laborious part of my daily duties, the Demonstrators, to +whom the successive classes have owed so much of their instruction. +They rise before me, the dead and the living, in the midst of the +most grateful recollections. The fair, manly face and stately figure +of my friend, Dr. Samuel Parkman, himself fit for the highest offices +of teaching, yet willing to be my faithful assistant in the time of +need, come back to me with the long sigh of regret for his early loss +to our earthly companionship. Every year I speak the eulogy of Dr. +Ainsworth's patient toil as I show his elaborate preparations: When I +take down my "American Cyclopaedia" and borrow instruction from the +learned articles of Dr. Kneeland, I cease to regret that his +indefatigable and intelligent industry was turned into a broader +channel. And what can I say too cordial of my long associated +companion and friend, Dr. Hodges, whose admirable skill, working +through the swiftest and surest fingers that ever held a scalpel +among us, has delighted class after class, and filled our Museum with +monuments which will convey his name to unborn generations? + +This day belongs, however, not to myself and my recollections, but to +all of us who teach and all of you who listen, whether experts in our +specialties or aliens to their mysteries, or timid neophytes just +entering the portals of the hall of science. Look in with me, then, +while I attempt to throw some rays into its interior, which shall +illuminate a few of its pillars and cornices, and show at the same +time how many niches and alcoves remain in darkness. + + +SCIENCE is the topography of ignorance. From a few elevated points +we triangulate vast spaces, inclosing infinite unknown details. We +cast the lead, and draw up a little sand from abysses we may never +reach with our dredges. + +The best part of our knowledge is that which teaches us where +knowledge leaves off and ignorance begins. Nothing more clearly +separates a vulgar from a superior mind, than the confusion in the +first between the little that it truly knows, on the one hand, and +what it half knows and what it thinks it knows on the other. + +That which is true of every subject is especially true of the branch +of knowledge which deals with living beings. Their existence is a +perpetual death and reanimation. Their identity is only an idea, for +we put off our bodies many times during our lives, and dress in new +suits of bones and muscles. + + "Thou art not thyself; + For thou exist'st on many a thousand grains + That issue out of dust." + +If it is true that we understand ourselves but imperfectly in health, +this truth is more signally manifested in disease, where natural +actions imperfectly understood, disturbed in an obscure way by half- +seen causes, are creeping and winding along in the dark toward their +destined issue, sometimes using our remedies as safe stepping-stones, +occasionally, it may be, stumbling over them as obstacles. + +I propose in this lecture to show you some points of contact between +our ignorance and our knowledge in several of the branches upon the +study of which you are entering. I may teach you a very little +directly, but I hope much more from the trains of thought I shall +suggest. Do not expect too much ground to be covered in this rapid +survey. Our task is only that of sending out a few pickets under the +starry flag of science to the edge of that dark domain where the +ensigns of the obstinate rebel, Ignorance, are flying undisputed. We +are not making a reconnoissance in force, still less advancing with +the main column. But here are a few roads along which we have to +march together, and we wish to see clearly how far our lines extend, +and where the enemy's outposts begin. + +Before touching the branches of knowledge that deal with organization +and vital functions, let us glance at that science which meets you at +the threshold of your study, and prepares you in some measure to deal +with the more complex problems of the living laboratory. + + +CHEMISTRY. includes the art of separating and combining the elements +of matter, and the study of the changes produced by these operations. +We can hardly say too much of what it has contributed to our +knowledge of the universe and our power of dealing with its +materials. It has given us a catalogue raisonne of the substances +found upon our planet, and shown how everything living and dead is +put together from them. It is accomplishing wonders before us every +day, such as Arabian story-tellers used to string together in their +fables. It spreads the, sensitive film on the artificial retina +which looks upon us through the optician's lens for a few seconds, +and fixes an image that will outlive its original. It questions the +light of the sun, and detects the vaporized metals floating around +the great luminary,--iron, sodium, lithium, and the rest,--as if the +chemist of our remote planet could fill his bell-glasses from its +fiery atmosphere. It lends the power which flashes our messages in +thrills that leave the lazy chariot of day behind them. It seals up +a few dark grains in iron vases, and lo! at the touch of a single +spark, rises in smoke and flame a mighty Afrit with a voice like +thunder and an arm that shatters like an earthquake. The dreams of +Oriental fancy have become the sober facts of our every-day life, and +the chemist is the magician to whom we owe them. + +To return to the colder scientific aspect of chemistry. It has shown +us how bodies stand affected to each other through an almost +boundless range of combinations. It has given us a most ingenious +theory to account for certain fixed relations in these combinations. +It has successfully eliminated a great number of proximate compounds, +more or less stable, from organic structures. It has invented others +which form the basis of long series of well-known composite +substances. In fact, we are perhaps becoming overburdened with our +list of proximate principles, demonstrated and hypothetical. + +How much nearer have we come to the secret of force than Lully and +Geber and the whole crew of juggling alchemists? We have learned a +great deal about the how, what have we learned about the why? + +Why does iron rust, while gold remains untarnished, and gold +amalgamate, while iron refuses the alliance of mercury? + +The alchemists called gold Sol, the sun, and iron Mars, and pleased +themselves with fancied relations between these substances and the +heavenly bodies, by which they pretended to explain the facts they +observed. Some of their superstitions have lingered in practical +medicine to the present day, but chemistry has grown wise enough to +confess the fact of absolute ignorance. + +What is it that makes common salt crystallize in the form of cubes, +and saltpetre in the shape of six-sided prisms? We see no reason why +it should not have been just the other way, salt in prisms and +saltpetre in cubes, or why either should take an exact geometrical +outline, any more than coagulating albumen. + +But although we had given up attempting to explain the essential +nature of affinities and of crystalline types, we might have supposed +that we had at least fixed the identity of the substances with which +we deal, and determined the laws of their combination. All at once +we find that a simple substance changes face, puts off its +characteristic qualities and resumes them at will;--not merely when +we liquefy or vaporize a solid, or reverse the process; but that a +solid is literally transformed into another solid under our own eyes. +We thought we knew phosphorus. We warm a portion of it sealed in an +empty tube, for about a week. It has become a brown infusible +substance, which does not shine in the dark nor oxidate in the air. +We heat it to 500 F., and it becomes common phosphorus again. We +transmute sulphur in the same singular way. Nature, you know, gives +us carbon in the shape of coal and in that of the diamond. It is +easy to call these changes by the name allotropism, but not the less +do they confound our hasty generalizations. + +These facts of allotropism have some corollaries connected with them +rather startling to us of the nineteenth century. There may be other +transmutations possible besides those of phosphorus and sulphur. +When Dr. Prout, in 1840, talked about azote and carbon being "formed" +in the living system, it was looked upon as one of those freaks of +fancy to which philosophers, like other men, are subject. But when +Professor Faraday, in 1851, says, at a meeting of the British +Association, that "his hopes are in the direction of proving that +bodies called simple were really compounds, and may be formed +artificially as soon as we are masters of the laws influencing their +combinations,"--when he comes forward and says that he has tried +experiments at transmutation, and means, if his life is spared, to +try them again,--how can we be surprised at the popular story of +1861, that Louis Napoleon has established a gold-factory and is +glutting the mints of Europe with bullion of his own making? + +And so with reference to the law of combinations. The old maxim was, +Corpora non agunt nisi soluta. If two substances, a and b, are +inclosed in a glass vessel, c, we do not expect the glass to change +them, unless a or b or the compound a b has the power of dissolving +the glass. But if for a I take oxygen, for b hydrogen, and for c a +piece of spongy platinum, I find the first two combine with the +common signs of combustion and form water, the third in the mean time +undergoing no perceptible change. It has played the part of the +unwedded priest, who marries a pair without taking a fee or having +any further relation with the parties. We call this catalysis, +catalytic action, the action of presence, or by what learned name we +choose. Give what name to it we will, it is a manifestation of power +which crosses our established laws of combination at a very open +angle of intersection. I think we may find an analogy for it in +electrical induction, the disturbance of the equilibrium of the +electricity of a body by the approach of a charged body to it, +without interchange of electrical conditions between the two bodies. +But an analogy is not an explanation, and why a few drops of yeast +should change a saccharine mixture to carbonic acid and alcohol,--a +little leaven leavening the whole lump,--not by combining with it, +but by setting a movement at work, we not only cannot explain, but +the fact is such an exception to the recognized laws of combination +that Liebig is unwilling to admit the new force at all to which +Berzelius had given the name so generally accepted. + +The phenomena of isomerism, or identity of composition and +proportions of constituents with difference of qualities, and of +isomorphism, or identity of form in crystals which have one element +substituted for another, were equally surprises to science; and +although the mechanism by which they are brought about can be to a +certain extent explained by a reference to the hypothetical atoms of +which the elements are constituted, yet this is only turning the +difficulty into a fraction with an infinitesimal denominator and an +infinite numerator. + +So far we have studied the working of force and its seeming anomalies +in purely chemical phenomena. But we soon find that chemical force +is developed by various other physical agencies,--by heat, by light, +by electricity, by magnetism, by mechanical agencies; and, vice +versa, that chemical action develops heat, light, electricity, +magnetism, mechanical force, as we see in our matches, galvanic +batteries, and explosive compounds. Proceeding with our experiments, +we find that every kind of force is capable of producing all other +kinds, or, in Mr. Faraday's language, that "the various forms under +which the forces of matter are made manifest have a common origin, +or, in other words, are so directly related and mutually dependent +that they are convertible one into another." + +Out of this doctrine naturally springs that of the conservation of +force, so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr. +Faraday. This idea is no novelty, though it seems so at first sight. +It was maintained and disputed among the giants of philosophy. +Des Cartes and Leibnitz denied that any new motion originated in +nature, or that any ever ceased to exist; all motion being in a +circle, passing from one body to another, one losing what the other +gained. Newton, on the other hand, believed that new motions were +generated and existing ones destroyed. On the first supposition, +there is a fixed amount of force always circulating in the universe. +On the second, the total amount may be increasing or diminishing. +You will find in the "Annual of Scientific Discovery" for 1858 a very +interesting lecture by Professor Helmholtz of Bonn, in which it is +maintained that a certain portion of force is lost in every natural +process, being converted into unchangeable heat, so that the universe +will come to a stand-still at last, all force passing into heat, and +all heat into a state of equilibrium. + +The doctrines of the convertibility or specific equivalence of the +various forms of force, and of its conservation, which is its logical +consequence, are very generally accepted, as I believe, at the +present time, among physicists. We are naturally led to the +question, What is the nature of force? The three illustrious +philosophers just referred to agree in attributing the general +movements of the universe to the immediate Divine action. The +doctrine of "preestablished harmony" was an especial contrivance of +Leibnitz to remove the Creator from unworthy association with the +less divine acts of living beings. Obsolete as this expression +sounds to our ears, the phrase laws of the universe, which we use so +constantly with a wider application, appears to me essentially +identical with it. + +Force does not admit of explanation, nor of proper definition, any +more than the hypothetical substratum of matter. If we assume the +Infinite as omnipresent, omniscient, omnipotent, we cannot suppose +Him excluded from any part of His creation, except from rebellious +souls which voluntarily exclude Him by the exercise of their fatal +prerogative of free-will. Force, then, is the act of immanent +Divinity. I find no meaning in mechanical explanations. Newton's +hypothesis of an ether filling the heavenly spaces does not, I +confess, help my conceptions. I will, and the muscles of my vocal +organs shape my speech. God wills, and the universe articulates His +power, wisdom, and goodness. That is all I know. There is no bridge +my mind can throw from the "immaterial" cause to the "material" +effect. + +The problem of force meets us everywhere, and I prefer to encounter +it in the world of physical phenomena before reaching that of living +actions. It is only the name for the incomprehensible cause of +certain changes known to our consciousness, and assumed to be outside +of it. For me it is the Deity Himself in action. + +I can therefore see a large significance in the somewhat bold +language of Burdach: "There is for me but one miracle, that of +infinite existence, and but one mystery, the manner in which the +finite proceeds from the infinite. So soon as we recognize this +incomprehensible act as the general and primordial miracle, of which +our reason perceives the necessity, but the manner of which our +intelligence cannot grasp, so soon as we contemplate the nature known +to us by experience in this light, there is for us no other +impenetrable miracle or mystery." + +Let us turn to a branch of knowledge which deals with certainties up +to the limit of the senses, and is involved in no speculations beyond +them. In certain points of view, HUMAN ANATOMY may be considered an +almost exhausted science. From time to time some small organ which +had escaped earlier observers has been pointed out,--such parts as +the tensor tarsi, the otic ganglion, or the Pacinian bodies; but some +of our best anatomical works are those which have been classic for +many generations. The plates of the bones in Vesalius, three +centuries old, are still masterpieces of accuracy, as of art. The +magnificent work of Albinus on the muscles, published in 1747, is +still supreme in its department, as the constant references of the +most thorough recent treatise on the subject, that of Theile, +sufficiently show. More has been done in unravelling the mysteries +of the fasciae, but there has been a tendency to overdo this kind of +material analysis. Alexander Thomson split them up into cobwebs, as +you may see in the plates to Velpeau's Surgical Anatomy. I well +remember how he used to shake his head over the coarse work of Scarpa +and Astley Cooper,--as if Denner, who painted the separate hairs of +the beard and pores of the skin in his portraits, had spoken lightly +of the pictures of Rubens and Vandyk. + +Not only has little been added to the catalogue of parts, but some +things long known had become half-forgotten. Louis and others +confounded the solitary glands of the lower part of the small +intestine with those which "the great Brunner," as Haller calls him, +described in 1687 as being found in the duodenum. The display of the +fibrous structure of the brain seemed a novelty as shown by +Spurzheim. One is startled to find the method anticipated by Raymond +Vieussens nearly two centuries ago. I can hardly think Gordon had +ever looked at his figures, though he names their author, when he +wrote the captious and sneering article which attracted so much +attention in the pages of the "Edinburgh Review." + +This is the place, if anywhere, to mention any observations I could +pretend to have made in the course of my teaching the structure of +the human body. I can make no better show than most of my +predecessors in this well-reaped field. The nucleated cells found +connected with the cancellated structure of the bones, which I first +pointed out and had figured in 1847, and have shown yearly from that +time to the present, and the fossa masseterica, a shallow concavity +on the ramus of the lower jaw, for the lodgment of the masseter +muscle, which acquires significance when examined by the side of the +deep cavity on the corresponding part in some carnivora to which it +answers, may perhaps be claimed as deserving attention. I have also +pleased myself by making a special group of the six radiating muscles +which diverge from the spine of the axis, or second cervical +vertebra, and by giving to it the name stella musculosa nuchaee. But +this scanty catalogue is only an evidence that one may teach long and +see little that has not been noted by those who have gone before him. +Of course I do not think it necessary to include rare, but already +described anomalies, such as the episternal bones, the rectus +sternalis, and other interesting exceptional formations I have +encountered, which have shown a curious tendency to present +themselves several times in the same season, perhaps because the +first specimen found calls our attention to any we may subsequently +meet with. + +The anatomy of the scalpel and the amphitheatre was, then, becoming +an exhausted branch of investigation. But during the present century +the study of the human body has changed its old aspect, and become +fertile in new observations. This rejuvenescence was effected by +means of two principal agencies,--new methods and a new instrument. + +Descriptive anatomy, as known from an early date, is to the body what +geography is to the planet. Now geography was pretty well known so +long ago as when Arrowsmith, who was born in 1750, published his +admirable maps. But in that same year was born Werner, who taught a +new way of studying the earth, since become familiar to us all under +the name of Geology. + +What geology has done for our knowledge of the earth, has been done +for our knowledge of the body by that method of study to which is +given the name of General Anatomy. It studies, not the organs as +such, but the elements out of which the organs are constructed. It +is the geology of the body, as that is the general anatomy of the +earth. The extraordinary genius of Bichat, to whom more than any +other we owe this new method of study, does not require Mr. Buckle's +testimony to impress the practitioner with the importance of its +achievements. I have heard a very wise physician question whether +any important result had accrued to practical medicine from Harvey's +discovery of the circulation. But Anatomy, Physiology, and Pathology +have received a new light from this novel method of contemplating the +living structures, which has had a vast influence in enabling the +practitioner at least to distinguish and predict the course of +disease. We know as well what differences to expect in the habits of +a mucous and of a serous membrane, as what mineral substances to look +for in the chalk or the coal measures. You have only to read +Cullen's description of inflammation of the lungs or of the bowels, +and compare it with such as you may find in Laennec or Watson, to see +the immense gain which diagnosis and prognosis have derived from +general anatomy. + +The second new method of studying the human structure, beginning with +the labors of Scarpa, Burns, and Colles, grew up principally during +the first third of this century. It does not deal with organs, as +did the earlier anatomists, nor with tissues, after the manner of +Bichat. It maps the whole surface of the body into an arbitrary +number of regions, and studies each region successively from the +surface to the bone, or beneath it. This hardly deserves the name of +a science, although Velpeau has dignified it with that title, but it +furnishes an admirable practical way for the surgeon who has to +operate on a particular region of the body to study that region. If +we are buying a farm, we are not content with the State map or a +geological chart including the estate in question. We demand an +exact survey of that particular property, so that we may know what we +are dealing with. This is just what regional, or, as it is sometimes +called, surgical anatomy, does for the surgeon with reference to the +part on which his skill is to be exercised. It enables him to see +with the mind's eye through the opaque tissues down to the bone on +which they lie, as if the skin were transparent as the cornea, and +the organs it covers translucent as the gelatinous pulp of a medusa. + +It is curious that the Japanese should have anticipated Europe in a +kind of rude regional anatomy. I have seen a manikin of Japanese +make traced all over with lines, and points marking their +intersection. By this their doctors are guided in the performance of +acupuncture, marking the safe places to thrust in needles, as we buoy +out our ship-channels, and doubtless indicating to learned eyes the +spots where incautious meddling had led to those little accidents of +shipwreck to which patients are unfortunately liable. + +A change of method, then, has given us General and Regional Anatomy. +These, too, have been worked so thoroughly, that, if not exhausted, +they have at least become to a great extent fixed and positive +branches of knowledge. But the first of them, General Anatomy, would +never, have reached this positive condition but for the introduction +of that, instrument which I have mentioned as the second great aid to +modern progress. + +This instrument is the achromatic microscope. For the history of the +successive steps by which it became the effective scientific +implement we now possess, I must refer you to the work of Mr. +Quekett, to an excellent article in the "Penny Cyclopaedia," or to +that of Sir David Brewster in the "Encyclopaedia Britannica." It is +a most interesting piece of scientific history, which shows how the +problem which Biot in 1821 pronounced insolvable was in the course of +a few years practically solved, with a success equal to that which +Dollond had long before obtained with the telescope. It is enough +for our purpose that we are now in possession of an instrument freed +from all confusions and illusions, which magnifies a thousand +diameters,--a million times in surface,--without serious distortion +or discoloration of its object. + +A quarter of a century ago, or a little more, an instructor would not +have hesitated to put John Bell's "Anatomy" and Bostock's +"Physiology" into a student's hands, as good authority on their +respective subjects. Let us not be unjust to either of these +authors. John Bell is the liveliest medical writer that I can +remember who has written since the days of delightful old Ambroise +Pare. His picturesque descriptions and bold figures are as good now +as they ever were, and his book can never become obsolete. But +listen to what John Bell says of the microscope: + +"Philosophers of the last age had been at infinite pains to find the +ultimate fibre of muscles, thinking to discover its properties in its +form; but they saw just in proportion to the glasses which they used, +or to their practice and skill in that art, which is now almost +forsaken." + +Dr. Bostock's work, neglected as it is, is one which I value very +highly as a really learned compilation, full of original references. +But Dr. Bostock says: "Much as the naturalist has been indebted to +the microscope, by bringing into view many beings of which he could +not otherwise have ascertained the existence, the physiologist has +not yet derived any great benefit from the instrument." + +These are only specimens of the manner in which the microscope and +its results were generally regarded by the generation just preceding +our own. + +I have referred you to the proper authorities for the account of +those improvements which about the year 1830 rendered the compound +microscope an efficient and trustworthy instrument. It was now for +the first time that a true general anatomy became possible. As early +as 1816 Treviranus had attempted to resolve the tissues, of which +Bichat had admitted no less than twenty-one, into their simple +microscopic elements. How could such an attempt succeed, Henle well +asks, at a time when the most extensively diffused of all the +tissues, the areolar, was not at all understood? All that method +could do had been accomplished by Bichat and his followers. It was +for the optician to take the next step. The future of anatomy and +physiology, as an enthusiastic micrologist of the time said, was in +the hands of Messrs. Schieck and Pistor, famous opticians of Berlin. + +In those earlier days of which I am speaking, all the points of +minute anatomy were involved in obscurity. Some found globules +everywhere, some fibres. Students disputed whether the conjunctiva +extended over the cornea or not, and worried themselves over Gaultier +de Claubry's stratified layers of the skin, or Breschet's +blennogenous and chromatogenous organs. The dartos was a puzzle, the +central spinal canal a myth, the decidua clothed in fable as much as +the golden fleece. The structure of bone, now so beautifully made +out,--even that of the teeth, in which old Leeuwenhoek, peeping with +his octogenarian eyes through the minute lenses wrought with his own +hands, had long ago seen the "pipes," as he called them,--was hardly +known at all. The minute structure of the viscera lay in the mists +of an uncertain microscopic vision. The intimate recesses of the +animal system were to the students of anatomy what the anterior of +Africa long was to geographers, and the stories of microscopic +explorers were as much sneered at as those of Bruce or Du Chailly, +and with better reason. + +Now what have we come to in our own day? In the first place, the +minute structure of all the organs has been made out in the most +satisfactory way. The special arrangements of the vessels and the +ducts of all the glands, of the air-tubes and vesicles of the lungs, +of the parts which make up the skin and other membranes, all the +details of those complex parenchymatous organs which had confounded +investigation so long, have been lifted out of the invisible into the +sight of all observers. It is fair to mention here, that we owe a +great deal to the art of minute injection, by which we are enabled to +trace the smallest vessels in the midst of the tissues where they are +distributed. This is an old artifice of anatomists. The famous +Ruysch, who died a hundred and thirty years ago, showed that each of +the viscera has its terminal vessels arranged in its own peculiar +way; the same fact which you may see illustrated in Gerber's figures +after the minute injections of Berres. I hope to show you many +specimens of this kind in the microscope, the work of English and +American hands. Professor Agassiz allows me also to make use of a +very rich collection of injected preparations sent him by Professor +Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition +of which I had a number of microscopes made expressly, by Mr. Grunow, +during the past season. All this illustrates what has been done for +the elucidation of the intimate details of formation of the organs. + +But the great triumph of the microscope as applied to anatomy has +been in the resolution of the organs and the tissues into their +simple constituent anatomical elements. It has taken up general +anatomy where Bichat left it. He had succeeded in reducing the +structural language of nature to syllables, if you will permit me to +use so bold an image. The microscopic observers who have come after +him have analyzed these into letters, as we may call them,--the +simple elements by the combination of which Nature spells out +successively tissues, which are her syllables, organs which are her +words, systems which are her chapters, and so goes on from the simple +to the complex, until she binds up in one living whole that wondrous +volume of power and wisdom which we call the human body. + +The alphabet of the organization is so short and simple, that I will +risk fatiguing your attention by repeating it, according to the plan +I have long adopted. + +A. Cells, either floating, as in the blood, or fixed, like those in +the cancellated structure of bone, already referred to. Very +commonly they have undergone a change of figure, most frequently a +flattening which reduces them to scales, as in the epidermis and the +epithelium. + +B. Simple, translucent, homogeneous solid, such as is found at the +back of the cornea, or forming the intercellular substance of +cartilage. + +C. The white fibrous element, consisting of very delicate, tenacious +threads. This is the long staple textile substance of the body. It +is to the organism what cotton is pretended to be to our Southern +States. It pervades the whole animal fabric as areolar tissue, which +is the universal packing and wrapping material. It forms the +ligaments which bind the whole frame-work together. It furnishes the +sinews, which are the channels of power. It enfolds every muscle. +It wraps the brain in its hard, insensible folds, and the heart +itself beats in a purse that is made of it. + +D. The yellow elastic, fibrous element, the caoutchouc of the animal +mechanism, which pulls things back into place, as the India-rubber +band shuts the door we have opened. + +E. The striped muscular fibre,--the red flesh, which shortens itself +in obedience to the will, and thus produces all voluntary active +motion. + +F. The unstriped muscular fibre, more properly the fusiform-cell +fibre, which carries on the involuntary internal movements. + +G. The nerve-cylinder, a glassy tube, with a pith of some firmness, +which conveys sensation to the brain and the principle which induces +motion from it. + +H. The nerve-corpuscle, the centre of nervous power. + +I. The mucous tissue, as Virchow calls it, common in embryonic +structures, seen in the vitreous humor of the adult. + +To these add X, granules, of indeterminate shape and size, Y, for +inorganic matters, such as the salts of bone and teeth, and Z, to +stand as a symbol of the fluids, and you have the letters of what I +have ventured to call the alphabet of the body. + +But just as in language certain diphthongs and syllables are +frequently recurring, so we have in the body certain secondary and +tertiary combinations, which we meet more frequently than the +solitary elements of which they are composed. + +Thus A B, or a collection of cells united by simple structureless +solid, is seen to be extensively employed in the body under the name +of cartilage. Out of this the surfaces of the articulations and the +springs of the breathing apparatus are formed. But when Nature came +to the buffers of the spinal column (intervertebral disks) and the +washers of the joints (semilunar fibrocartilages of the knee, etc.), +she required more tenacity than common cartilage possessed. What did +she do? What does man do in a similar case of need? I need hardly +tell you. The mason lays his bricks in simple mortar. But the +plasterer works some hair into the mortar which he is going to lay in +large sheets on the walls. The children of Israel complained that +they had no straw to make their bricks with, though portions of it +may still be seen in the crumbling pyramid of Darshour, which they +are said to have built. I visited the old house on Witch Hill in +Salem a year or two ago, and there I found the walls coated with clay +in which straw was abundantly mingled;--the old Judaizing witch- +hangers copied the Israelites in a good many things. The Chinese and +the Corsicans blend the fibres of amianthus in their pottery to give +it tenacity. Now to return to Nature. To make her buffers and +washers hold together in the shocks to which they would be subjected, +she took common cartilage and mingled the white fibrous tissue with +it, to serve the same purpose as the hair in the mortar, the straw in +the bricks and in the plaster of the old wall, and the amianthus in +the earthen vessels. Thus we have the combination A B C, or fibro- +cartilage. Again, the bones were once only gristle or cartilage, A +B. To give them solidity they were infiltrated with stone, in the +form of salts of lime, an inorganic element, so that bone would be +spelt out by the letters A, B, and Y. + +If from these organic syllables we proceed to form organic words, we +shall find that Nature employs three principal forms; namely, +Vessels, Membranes, and Parenchyma, or visceral tissue. The most +complex of them can be resolved into a combination of these few +simple anatomical constituents. + + +Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find +the same elements in morbid growths that we have met with in normal +structures. The pus-corpuscle and the white blood-corpuscle can only +be distinguished by tracing them to their origin. A frequent form of +so-called malignant disease proves to be only a collection of altered +epithelium-cells. Even cancer itself has no specific anatomical +element, and the diagnosis of a cancerous tumor by the microscope, +though tolerably sure under the eye of an expert, is based upon +accidental, and not essential points,--the crowding together of the +elements, the size of the cell-nuclei, and similar variable +characters. + +Let us turn to PHYSIOLOGY. The microscope, which has made a new +science of the intimate structure of the organs, has at the same time +cleared up many uncertainties concerning the mechanism of the special +functions. Up to the time of the living generation of observers, +Nature had kept over all her inner workshops the forbidding +inscription, No Admittance! If any prying observer ventured to spy +through his magnifying tubes into the mysteries of her glands and +canals and fluids, she covered up her work in blinding mists and +bewildering halos, as the deities of old concealed their favored +heroes in the moment of danger. + +Science has at length sifted the turbid light of her lenses, and +blanched their delusive rainbows. + +Anatomy studies the organism in space. Physiology studies it also in +time. After the study of form and composition follows close that of +action, and this leads us along back to the first moment of the germ, +and forward to the resolution of the living frame into its lifeless +elements. In this way Anatomy, or rather that branch of it which we +call Histology, has become inseparably blended with the study of +function. The connection between the science of life and that of +intimate structure on the one hand, and composition on the other, is +illustrated in the titles of two recent works of remarkable +excellence,--"the Physiological Anatomy" of Todd and Bowman, and the +"Physiological Chemistry" of Lehmann. + +Let me briefly recapitulate a few of our acquisitions in Physiology, +due in large measure to our new instruments and methods of research, +and at the same time indicate the limits which form the permanent or +the temporary boundaries of our knowledge. I will begin with the +largest fact and with the most absolute and universally encountered +limitation. + +The "largest truth in Physiology" Mr. Paget considers to be "the +development of ova through multiplication and division of their +cells." I would state it more broadly as the agency of the cell in +all living processes. It seems at present necessary to abandon the +original idea of Schwann, that we can observe the building up of a +cell from the simple granules of a blastema, or formative fluid. The +evidence points rather towards the axiom, Omnis cellula a cellula; +that is, the germ of a new cell is always derived from a preexisting +cell. The doctrine of Schwann, as I remarked long ago (1844), runs +parallel with the nebular theory in astronomy, and they may yet stand +or fall together. + +As we have seen Nature anticipating the plasterer in fibro-cartilage, +so we see her beforehand with the glassblower in her dealings with +the cell. The artisan blows his vitreous bubbles, large or small, to +be used afterwards as may be wanted. So Nature shapes her hyaline +vesicles and modifies them to serve the needs of the part where they +are found. The artisan whirls his rod, and his glass bubble becomes +a flattened disk, with its bull's-eye for a nucleus. These lips of +ours are all glazed with microscopic tiles formed of flattened cells, +each one of them with its nucleus still as plain and relatively as +prominent, to the eye of the microscopist, as the bull's-eye in the +old-fashioned windowpane. Everywhere we find cells, modified or +unchanged. They roll in inconceivable multitudes (five millions and +more to the cubic millimetre, according to Vierordt) as blood-disks +through our vessels. A close-fitting mail of flattened cells coats +our surface with a panoply of imbricated scales (more than twelve +thousand millions), as Harting has computed, as true a defence against +our enemies as the buckler of the armadillo or the carapace of the +tortoise against theirs. The same little protecting organs pave all +the great highways of the interior system. Cells, again, preside +over the chemical processes which elaborate the living fluids; they +change their form to become the agents of voluntary and involuntary +motion; the soul itself sits on a throne of nucleated cells, and +flashes its mandates through skeins of glassy filaments which once +were simple chains of vesicles. And, as if to reduce the problem of +living force to its simplest expression, we see the yolk of a +transparent egg dividing itself in whole or in part, and again +dividing and subdividing, until it becomes a mass of cells, out of +which the harmonious diversity of the organs arranges itself, worm or +man, as God has willed from the beginning. + +This differentiation having been effected, each several part assumes +its special office, having a life of its own adjusted to that of +other parts and the whole. "Just as a tree constitutes a mass +arranged in a definite manner, in which, in every single part, in the +leaves as in the root, in the trunk as in the blossom, cells are +discovered to be the ultimate elements, so is it also with the forms +of animal life. Every animal presents itself as a sum of vital +unities, every one of which manifests all the characteristics of +life." + +The mechanism is as clear, as unquestionable, as absolutely settled +and universally accepted, as the order of movement of the heavenly +bodies, which we compute backward to the days of the observatories on +the plains of Shinar, and on the faith of which we regulate the +movements of war and trade by the predictions of our ephemeris. + +The mechanism, and that is all. We see the workman and the tools, +but the skill that guides the work and the power that performs it are +as invisible as ever. I fear that not every listener took the +significance of those pregnant words in the passage I quoted from +John Bell,--"thinking to discover its properties in its form." We +have discovered the working bee in this great hive of organization. +We have detected the cell in the very act of forming itself from a +nucleus, of transforming itself into various tissues, of selecting +the elements of various secretions. But why one cell becomes nerve +and another muscle, why one selects bile and another fat, we can no +more pretend to tell, than why one grape sucks out of the soil the +generous juice which princes hoard in their cellars, and another the +wine which it takes three men to drink,--one to pour it down, another +to swallow it, and a third to hold him while it is going down. +Certain analogies between this selecting power and the phenomena of +endosmosis in the elective affinities of chemistry we can find, but +the problem of force remains here, as everywhere, unsolved and +insolvable. + +Do we gain anything by attempting to get rid of the idea of a special +vital force because we find certain mutually convertible relations +between forces in the body and out of it? I think not, any more than +we should gain by getting rid of the idea and expression Magnetism +because of its correlation with electricity. We may concede the +unity of all forms of force, but we cannot overlook the fixed +differences of its manifestations according to the conditions under +which it acts. It is a mistake, however, to think the mystery is +greater in an organized body than in any other. We see a stone fall +or a crystal form, and there is nothing stranger left to wonder at, +for we have seen the Infinite in action. + +Just so far as we can recognize the ordinary modes of operation of +the common forces of nature,--gravity, cohesion, elasticity, +transudation, chemical action, and the rest,--we see the so-called +vital acts in the light of a larger range of known facts and familiar +analogies. Matteuecci's well-remembered lectures contain many and +striking examples of the working of physical forces in physiological +processes. Wherever rigid experiment carries us, we are safe in +following this lead; but the moment we begin to theorize beyond our +strict observation, we are in danger of falling into those mechanical +follies which true science has long outgrown. + +Recognizing the fact, then, that we have learned nothing but the +machinery of life, and are no nearer to its essence, what is it that +we have gained by this great discovery of the cell formation and +function? + +It would have been reward enough to learn the method Nature pursues +for its own sake. If the sovereign Artificer lets us into his own +laboratories and workshops, we need not ask more than the privilege +of looking on at his work. We do not know where we now stand in the +hierarchy of created intelligences. We were made a little lower than +the angels. I speak it not irreverently; as the lower animals +surpass man in some of their attributes, so it may be that not every +angel's eye can see as broadly and as deeply into the material works +of God as man himself, looking at the firmament through an equatorial +of fifteen inches' aperture, and searching into the tissues with a +twelfth of an inch objective. + +But there are other positive gains of a more practical character. +Thus we are no longer permitted to place the seat of the living +actions in the extreme vessels, which are only the carriers from +which each part takes what it wants by the divine right of the +omnipotent nucleated cell. The organism has become, in the words +already borrowed from Virchow, "a sum of vital unities." The +strictum and laxum, the increased and diminished action of the +vessels, out of which medical theories and methods of treatment have +grown up, have yielded to the doctrine of local cell-communities, +belonging to this or that vascular district, from which they help +themselves, as contractors are wont to do from the national treasury. + +I cannot promise to do more than to select a few of the points of +contact between our ignorance and our knowledge which present +particular interest in the existing state of our physiological +acquisitions. Some of them involve the microscopic discoveries of +which I have been speaking, some belong to the domain of chemistry, +and some have relations with other departments of physical science. + +If we should begin with the digestive function, we should find that +the long-agitated question of the nature of the acid of the gastric +juice is becoming settled in favor of the lactic. But the whole +solvent agency of the digestive fluid enters into the category of +that exceptional mode of action already familiar to us in chemistry +as catalysis. It is therefore doubly difficult of explanation; +first, as being, like all reactions, a fact not to be accounted for +except by the imaginative appeal to "affinity," and secondly, as +being one of those peculiar reactions provoked by an element which +stands outside and looks on without compromising itself. + +The doctrine of Mulder, so widely diffused in popular and scientific +belief, of the existence of a common base of all albuminous +substances, the so-called protein, has not stood the test of rigorous +analysis. The division of food into azotized and non-azotized is no +doubt important, but the attempt to show that the first only is +plastic or nutritive, while the second is simply calorifacient, or +heat-producing, fails entirely in the face of the facts revealed by +the study of man in different climates, and of numerous experiments +in the feeding of animals. I must return to this subject in +connection with the respiratory function. + +The sugar-making faculty of the liver is another "catalytic" mystery, +as great as the rest of them, and no greater. Liver-tissue brings +sugar out of the blood, or out of its own substance;--why? + + Quia est in eo + Virtus saccharitiva. + +Just what becomes of the sugar beyond the fact of its disappearance +before it can get into the general circulation and sweeten our +tempers, it is hard to say. + +The pancreatic fluid makes an emulsion of the fat contained in our +food, but just how the fatty particles get into the villi we must +leave Brucke and Kolliker to settle if they can. + +No one has shown satisfactorily the process by which the blood- +corpuscles are formed out of the lymph-corpuscles, nor what becomes +of them. These two questions are like those famous household +puzzles,--Where do the flies come from? and, Where do the pins go +to? + +There is a series of organs in the body which has long puzzled +physiologists,--organs of glandular aspect, but having no ducts,--the +spleen, the thyroid and thymus bodies, and the suprarenal capsules. +We call them vascular glands, and we believe that they elaborate +colored and uncolored blood-cells; but just what changes they effect, +and just how they effect them, it has proved a very difficult matter +to determine. So of the noted glandules which form Peyer's patches, +their precise office, though seemingly like those of the lymphatic +glands, cannot be positively assigned, so far as I know, at the +present time. It is of obvious interest to learn it with reference +to the pathology of typhoid fever. It will be remarked that the +coincidence of their changes in this disease with enlargement of the +spleen suggests the idea of a similarity of function in these two +organs. + +The theories of the production of animal heat, from the times of +Black, Lavoisier, and Crawford to those of Liebig, are familiar to +all who have paid any attention to physiological studies. The +simplicity of Liebig's views, and the popular form in which they have +been presented, have given them wide currency, and incorporated them +in the common belief and language of our text-books. Direct +oxidation or combustion of the carbon and hydrogen contained in the +food, or in the tissues themselves; the division of alimentary +substances into respiratory, or non-azotized, and azotized,--these +doctrines are familiar even to the classes in our high-schools. But +this simple statement is boldly questioned. Nothing proves that +oxygen combines (in the system) with hydrogen and carbon in +particular, rather than with sulphur and azote. Such is the well- +grounded statement of Robin and Verdeil. "It is very probable that +animal heat is entirely produced by the chemical actions which take +place in the organism, but the phenomenon is too complex to admit of +our calculating it according to the quality of oxygen consumed." +These last are the words of Regnault, as cited by Mr. Lewes, whose +intelligent discussion of this and many of the most interesting +physiological problems I strongly recommend to your attention. + +This single illustration covers a wider ground than the special +function to which it belongs. We are learning that the chemistry of +the body must be studied, not simply by its ingesta and egesta, but +that there is a long intermediate series of changes which must be +investigated in their own light, under their own special conditions. +The expression "sum of vital unities" applies to the chemical +actions, as well as to other actions localized in special parts; and +when the distinguished chemists whom I have just cited entitle their +work a treatise on the immediate principles of the body, they only +indicate the nature of that profound and subtile analysis which must +take the place of all hasty generalizations founded on a comparison +of the food with residual products. + +I will only call your attention to the fact, that the exceptional +phenomenon of the laboratory is the prevailing law of the organism. +Nutrition itself is but one great catalytic process. As the blood +travels its rounds, each part selects its appropriate element and +transforms it to its own likeness. Whether the appropriating agent +be cell or nucleus, or a structureless solid like the intercellular +substance of cartilage, the fact of its presence determines the +separation of its proper constituents from the circulating fluid, so +that even when we are wounded bone is replaced by bone, skin by skin, +and nerve by nerve. + +It is hardly without a smile that we resuscitate the old question of +the 'vis insita' of the muscular fibre, so famous in the discussions of +Haller and his contemporaries. Speaking generally, I think we may +say that Haller's doctrine is the one now commonly received; namely, +that the muscles contract in virtue of their own inherent endowments. +It is true that Kolliker says no perfectly decisive fact has been +brought forward to prove that the striated muscles contract with. +out having been acted on by nerves. Yet Mr. Bowman's observations on +the contraction of isolated fibres appear decisive enough (unless we +consider them invalidated by Dr. Lionel Beale's recent researches), +tending to show that each elementary fibre is supplied with nerves; +and as to the smooth muscular fibres, we have Virchow's statement +respecting the contractility of those of the umbilical cord, where +there is not a trace of any nerves. + +In the investigation of the nervous system, anatomy and physiology +have gone hand in hand. It is very singular that so important, and +seemingly simple, a fact as the connection of the nerve-tubes, at +their origin or in their course, with the nerve-cells, should have so +long remained open to doubt, as you may see that it did by referring +to the very complete work of Sharpey and Quain (edition of 1849), the +histological portion of which is cordially approved by Kolliker +himself. + +Several most interesting points of the minute anatomy of the nervous +centres have been laboriously and skilfully worked out by a recent +graduate of this Medical School, in a monograph worthy to stand in +line with those of Lockhart Clarke, Stilling, and Schroder van der +Kolk. I have had the privilege of examining and of showing some of +you a number of Dr. Dean's skilful preparations. I have no space to +give even an abstract of his conclusions. I can only refer to his +proof of the fact, that a single cell may send its processes into +several different bundles of nerve-roots, and to his demonstration of +the curved ascending and descending fibres from the posterior +nerveroots, to reach what he has called the longitudinal columns of +the cornea. I must also mention Dr. Dean's exquisite microscopic +photographs from sections of the medulla oblongata, which appear to +me to promise a new development, if not a new epoch, in anatomical +art. + +It having been settled that the nerve-tubes can very commonly be +traced directly to the nerve-cells, the object of all the observers +in this department of anatomy is to follow these tubes to their +origin. We have an infinite snarl of telegraph wires, and we may be +reasonably sure, that, if we can follow them up, we shall find each +of them ends in a battery somewhere. One of the most interesting +problems is to find the ganglionic origin of the great nerves of the +medulla oblongata, and this is the end to which, by the aid of the +most delicate sections, colored so as to bring out their details, +mounted so as to be imperishable, magnified by the best instruments, +and now self-recorded in the light of the truth-telling sunbeam, our +fellow-student is making a steady progress in a labor which I think +bids fair to rank with the most valuable contributions to histology +that we have had from this side of the Atlantic. + +It is interesting to see how old questions are incidentally settled +in the course of these new investigations. Thus, Mr. Clarke's +dissections, confirmed by preparations of Mr. Dean's which I have +myself examined, placed the fact of the decussation of the pyramids-- +denied by Haller, by Morgagni, and even by Stilling--beyond doubt. +So the spinal canal, the existence of which, at least in the adult, +has been so often disputed, appears as a coarse and unequivocal +anatomical fact in many of the preparations referred to. + +While these studies of the structure of the cord have been going on, +the ingenious and indefatigable Brown-Sequard has been investigating +the functions of its different parts with equal diligence. The +microscopic anatomists had shown that the ganglionic corpuscles of +the gray matter of the cord are connected with each other by their +processes, as well as with the nerve-roots. M. Brown-Sequard has +proved by numerous experiments that the gray substance transmits +sensitive impressions and muscular stimulation. The oblique +ascending and descending fibres from the posterior nerve-roots, +joining the "longitudinal columns of the cornua," account for the +results of Brown-Sequard's sections of the posterior columns. The +physiological experimenter has also made it evident that the +decussation of the conductors of sensitive impressions has its seat +in the spinal core, and not in the encephalon, as had been supposed. +Not less remarkable than these results are the facts, which I with +others of my audience have had the opportunity of observing, as shown +by M. Brown-Sequard, of the artificial production of epilepsy in +animals by injuring the spinal cord, and the induction of the +paroxysm by pinching a certain portion of the skin. I would also +call the student's attention to his account of the relations of the +nervous centres to nutrition and secretion, the last of which +relations has been made the subject of an extended essay by our +fellow countryman, Dr. H. F. Campbell of Georgia. + +The physiology of the spinal cord seems a simple matter as you study +it in Longet. The experiments of Brown-Sequard have shown the +problem to be a complex one, and raised almost as many doubts as they +have solved questions; at any rate, I believe all lecturers on +physiology agree that there is no part of their task they dread so +much as the analysis of the evidence relating to the special offices +of the different portions of the medulla spinalis. In the brain we +are sure that we do not know how to localize functions; in the spinal +cord, we think we do know something; but there are so many anomalies, +and seeming contradictions, and sources of fallacy, that beyond the +facts of crossed paralysis of sensation, and the conducting agency of +the gray substance, I am afraid we retain no cardinal principles +discovered since the development of the reflex function took its +place by Sir Charles Bell's great discovery. + +By the manner in which I spoke of the brain, you will see that I am +obliged to leave phrenology sub Jove,--out in the cold,--as not one +of the household of science. I am not one of its haters; on the +contrary, I am grateful for the incidental good it has done. I love +to amuse myself in its plaster Golgothas, and listen to the glib +professor, as he discovers by his manipulations + + "All that disgraced my betters met in me." + +I loved of old to see square-headed, heavy-jawed Spurzheim make a +brain flower out into a corolla of marrowy filaments, as Vieussens +had done before him, and to hear the dry-fibred but human-hearted +George Combe teach good sense under the disguise of his equivocal +system. But the pseudo-sciences, phrenology and the rest, seem to me +only appeals to weak minds and the weak points of strong ones. There +is a pica or false appetite in many intelligences; they take to odd +fancies in place of wholesome truth, as girls gnaw at chalk and +charcoal. Phrenology juggles with nature. It is so adjusted as to +soak up all evidence that helps it, and shed all that harms it. It +crawls forward in all weathers, like Richard Edgeworth's hygrometer. +It does not stand at the boundary of our ignorance, it seems to me, +but is one of the will-o'-the-wisps of its undisputed central domain +of bog and quicksand. Yet I should not have devoted so many words to +it, did I not recognize the light it has thrown on human actions by +its study of congenital organic tendencies. Its maps of the. +surface of the head are, I feel sure, founded on a delusion, but its +studies of individual character are always interesting and +instructive. + +The "snapping-turtle" strikes after its natural fashion when it first +comes out of the egg. Children betray their tendencies in their way +of dealing with the breasts that nourish them; nay, lean venture to +affirm, that long before they are born they teach their mothers +something of their turbulent or quiet tempers. + + "Castor gaudet equis, ovo proanatus eodem + Pugnis." + +Strike out the false pretensions of phrenology; call it anthropology; +let it study man the individual in distinction from man the +abstraction, the metaphysical or theological lay-figure; and it +becomes "the proper study of mankind," one of the noblest and most +interesting of pursuits. + +The whole physiology of the nervous system, from the simplest +manifestation of its power in an insect up to the supreme act of the +human intelligence working through the brain, is full of the most +difficult yet profoundly interesting questions. The singular +relations between electricity and nerve-force, relations which it has +been attempted to interpret as meaning identity, in the face of +palpable differences, require still more extended studies. You may +be interested by Professor Faraday's statement of his opinion on the +matter. "Though I am not satisfied that the nervous fluid is only +electricity, still I think that the agent in the nervous system maybe +an inorganic force; and if there be reason for supposing that +magnetism is a higher relation of force than electricity, so it may +well be imagined that the nervous power may be of a still more +exalted character, and yet within the reach of experiment." + +In connection with this statement, it is interesting to refer to the +experiments of Helmholtz on the rapidity of transmission of the +nervous actions. The rate is given differently in Valentin's report +of these experiments and in that found in the "Scientific Annual" for +1858. One hundred and eighty to three hundred feet per second is the +rate of movement assigned for sensation, but all such results must be +very vaguely approximative. Boxers, fencers, players at the Italian +game of morn, "prestidigitators," and all who depend for their +success on rapidity of motion, know what differences there are in the +personal equation of movement. + +Reflex action, the mechanical sympathy, if I may so call it, of +distant parts; Instinct, which is crystallized intelligence,--an +absolute law with its invariable planes and angles introduced into +the sphere of consciousness, as raphides are inclosed in the living +cells of plants; Intellect,--the operation of the thinking principle +through material organs, with an appreciable waste of tissue in every +act of thought, so that our clergymen's blood has more phosphates to +get rid of on Monday than on any other day of the week; Will,-- +theoretically the absolute determining power, practically limited in +different degrees by the varying organization of races and +individuals, annulled or perverted by different ill-understood +organic changes; on all these subjects our knowledge is in its +infancy, and from the study of some of them the interdict of the +Vatican is hardly yet removed. + +I must allude to one or two points in the histology and physiology of +the organs of sense. The anterior continuation of the retina beyond +the ora serrata has been a subject of much discussion. If H. Muller +and Kolliker can be relied upon, this question is settled by +recognizing that a layer of cells, continued from the retina, passes +over the surface of the zonula Zinnii, but that no proper nervous +element is so prolonged forward. + +I observe that Kolliker calls the true nervous elements of the retina +"the layer of gray cerebral substance." In fact, the ganglionic +corpuscles of each eye may be considered as constituting a little +brain, connected with the masses behind by the commissure, commonly +called the optic nerve. We are prepared, therefore, to find these +two little brains in the most intimate relations with each other, as +we find the cerebral hemispheres. We know that they are directly +connected by fibres that arch round through the chiasma. + +I mention these anatomical facts to introduce a physiological +observation of my own, first announced in one of the lectures before +the Medical Class, subsequently communicated to the American Academy +of Arts and Sciences, and printed in its "Transactions" for February +14, 1860. I refer to the apparent transfer of impressions from one +retina to the other, to which I have given the name reflex vision. +The idea was suggested to me in consequence of certain effects +noticed in employing the stereoscope. Professor William B. Rodgers +has since called the attention of the American Scientific Association +to some facts bearing on the subject, and to a very curious +experiment of Leonardo da Vinci's, which enables the observer to look +through the palm of his hand (or seem to), as if it had a hole bored +through it. As he and others hesitated to accept my explanation, I +was not sorry to find recently the following words in the +"Observations on Man" of that acute observer and thinker, David +Hartley. "An impression made on the right eye alone by a single +object may propagate itself into the left, and there raise up an +image almost equal in vividness to itself; and consequently when we +see with one eye only, we may, however, have pictures in both eyes." +Hartley, in 1784, had anticipated many of the doctrines which have +since been systematized into the theory of reflex actions, and with +which I have attempted to associate this act of reflex vision. My +sixth experiment, however, in the communication referred to, appears +to me to be a crucial one, proving the correctness of my explanation, +and I am not aware that it has been before instituted. + +Another point of great interest connected with the physiology of +vision, and involved for a long time in great obscurity, is that of +the adjustment of the eye to different distances. Dr. Clay Wallace +of New York, who published a very ingenious little book on the eye +about twenty years ago, with vignettes reminding one of Bewick, was +among the first, if not the first, to describe the ciliary muscle, to +which the power of adjustment is generally ascribed. It is +ascertained, by exact experiment with the phacueidoscope, that +accommodation depends on change of form of the crystalline lens. +Where the crystalline is wanting, as Mr. Ware long ago taught, no +power of accommodation remains. The ciliary muscle is generally +thought to effect the change of form of the crystalline. The power +of accommodation is lost after the application of atropine, in +consequence, as is supposed, of the paralysis of this muscle. This, +I believe, is the nearest approach to a demonstration we have on this +point. + +I have only time briefly to refer to Professor Draper's most +ingenious theory as to the photographic nature of vision, for an +account of which I must refer to his original and interesting +Treatise on Physiology. + +It were to be wished that the elaborate and very interesting +researches of the Marquis Corti, which have revealed such singular +complexity of structure in the cochlea of the ear, had done more to +clear up its doubtful physiology; but I am afraid we have nothing but +hypotheses for the special part it plays in the act of hearing, and +that we must say the same respecting the office of the semicircular +canals. + +The microscope has achieved some of its greatest triumphs in teaching +us the changes which occur in the development of the embryo. No more +interesting discovery stands recorded in the voluminous literature of +this subject than the one originally announced by Martin Barry, +afterwards discredited, and still later confirmed by Mr. Newport and +others; namely the fact that the fertilizing filament reaches the +interior of the ovum in various animals;--a striking parallel to the +action of the pollen-tube in the vegetable. But beyond the +mechanical facts all is mystery in the movements of organization, as +profound as in the fall of a stone or the formation of a crystal. + +To the chemist and the microscopist the living body presents the same +difficulties, arising from the fact that everything is in perpetual +change in the organism. The fibrine of the blood puzzles the one as +much as its globules puzzle the other. The difference between the +branches of science which deal with space only, and those which deal +with space and time, is this: we have no glasses that can magnify +time. The figure I here show you a was photographed from an object +(pleurosigma angulatum) magnified a thousand diameters, or presenting +a million times its natural surface. This other figure of the same +object, enlarged from the one just shown, is magnified seven thousand +diameters, or forty-nine million times in surface. When we can make +the forty-nine millionth of a second as long as its integer, +physiology and chemistry will approach nearer the completeness of +anatomy. + +Our reverence becomes more worthy, or, if you will, less unworthy of +its Infinite Object in proportion as our intelligence is lifted and +expanded to a higher and broader understanding of the Divine methods +of action. If Galen called his heathen readers to admire, the power, +the wisdom, the providence, the goodness of the "Framer of the animal +body,"--if Mr. Boyle, the student of nature, as Addison and that +friend of his who had known him for forty years tell us, never +uttered the name of the Supreme Being without making a distinct pause +in his speech, in token of his devout recognition of its awful +meaning,--surely we, who inherit the accumulated wisdom of nearly two +hundred years since the time of the British philosopher, and of +almost two thousand since the Greek physician, may well lift our +thoughts from the works we study to their great Artificer. These +wonderful discoveries which we owe to that mighty little instrument, +the telescope of the inner firmament with all its included worlds; +these simple formulae by which we condense the observations of a +generation in a single axiom; these logical analyses by which we +fence out the ignorance we cannot reclaim, and fix the limits of our +knowledge,--all lead us up to the inspiration of the Almighty, which +gives understanding to the world's great teachers. To fear science +or knowledge, lest it disturb our old beliefs, is to fear the influx +of the Divine wisdom into the souls of our fellow-men; for what is +science but the piecemeal revelation,--uncovering,--of the plan of +creation, by the agency of those chosen prophets of nature whom God +has illuminated from the central light of truth for that single +purpose? + +The studies which we have glanced at are preliminary in your +education to the practical arts which make use of them,--the arts of +healing,--surgery and medicine. The more you examine the structure +of the organs and the laws of life, the more you will find how +resolutely each of the cell-republics which make up the E pluribus +unum of the body maintains its independence. Guard it, feed it, air +it, warm it, exercise or rest it properly, and the working elements +will do their best to keep well or to get well. What do we do with +ailing vegetables? Dr. Warren, my honored predecessor in this chair, +bought a country-place, including half of an old orchard. A few +years afterwards I saw the trees on his side of the fence looking in +good health, while those on the other side were scraggy and +miserable. How do you suppose this change was brought about? By +watering them with Fowler's solution? By digging in calomel freely +about their roots? Not at all; but by loosening the soil round them, +and supplying them with the right kind of food in fitting quantities. + +Now a man is not a plant, or, at least, he is a very curious one, for +he carries his soil in his stomach, which is a kind--of portable +flower-pot, and he grows round it, instead of out of it. He has, +besides, a singularly complex nutritive apparatus and a nervous +system. But recollect the doctrine already enunciated in the +language of Virchow, that an animal, like a tree, is a sum of vital +unities, of which the cell is the ultimate element. Every healthy +cell, whether in a vegetable or an animal, necessarily performs its +function properly so long as it is supplied with its proper materials +and stimuli. A cell may, it is true, be congenitally defective, in +which case disease is, so to speak, its normal state. But if +originally sound and subsequently diseased, there has certainly been +some excess, deficiency, or wrong quality in the materials or stimuli +applied to it. You remove this injurious influence and substitute a +normal one; remove the baked coal-ashes, for instance, from the roots +of a tree, and replace them with loam; take away the salt meat from +the patient's table, and replace it with fresh meat and vegetables, +and the cells of the tree or the man return to their duty. + +I do not know that we ever apply to a plant any element which is not +a natural constituent of the vegetable structure, except perhaps +externally, for the accidental purpose of killing parasites. The +whole art of cultivation consists in learning the proper food and +conditions of plants, and supplying them. We give them water, +earths, salts of various kinds such as they are made of, with a +chance to help themselves to air and light. The farmer would be +laughed at who undertook to manure his fields or his trees with a +salt of lead or of arsenic. These elements are not constituents of +healthy plants. The gardener uses the waste of the arsenic furnaces +to kill the weeds in his walks. + +If the law of the animal cell, and of the animal organism, which is +built up of such cells, is like that of the vegetable, we might +expect that we should treat all morbid conditions of any of the vital +unities belonging to an animal in the same way, by increasing, +diminishing, or changing its natural food or stimuli. + +That is an aliment which nourishes; whatever we find in the +organism, as a constant and integral element, either forming part of +its structure, or one of the conditions of vital processes, that and +that only deserves the name of aliment. I see no reason, +therefore, why iron, phosphate of lime, sulphur, should not be +considered food for man, as much as guano or poudrette for +vegetables. Whether one or another of them is best in any given +case,--whether they shall be taken alone or in combination, in large +or small quantities, are separate questions. But they are elements +belonging to the body, and even in moderate excess will produce +little disturbance. There is no presumption against any of this +class of substances, any more than against water or salt, provided +they are used in fitting combinations, proportions, and forms. + +But when it comes to substances alien to the healthy system, which +never belong to it as normal constituents, the case is very +different. There is a presumption against putting lead or arsenic +into the human body, as against putting them into plants, because +they do not belong there, any more than pounded glass, which, it is +said, used to be given as a poison. The same thing is true of +mercury and silver. What becomes of these alien substances after +they get into the system we cannot always tell. But in the case of +silver, from the accident of its changing color under the influence +of light, we do know what happens. It is thrown out, in part at +least, under the epidermis, and there it remains to the patient's +dying day. This is a striking illustration of the difficulty which +the system finds in dealing with non-assimilable elements, and +justifies in some measure the vulgar prejudice against mineral +poisons. + +I trust the youngest student on these benches will not commit the +childish error of confounding a presumption against a particular +class of agents with a condemnation of them. Mercury, for instance, +is alien to the system, and eminently disturbing in its influence. +Yet its efficacy in certain forms of specific disease is acknowledged +by all but the most sceptical theorists. Even the esprit moqueur of +Ricord, the Voltaire of pelvic literature, submits to the time- +honored constitutional authority of this great panacea in the class +of cases to which he has devoted his brilliant intelligence. Still, +there is no telling what evils have arisen from the abuse of this +mineral. Dr. Armstrong long ago pointed out some of them, and they +have become matters of common notoriety. I am pleased, therefore, +when I find so able and experienced a practitioner as Dr. Williams of +this city proving that iritis is best treated without mercury, and +Dr. Vanderpoel showing the same thing to be true for pericarditis. + +Whatever elements nature does not introduce into vegetables, the +natural food of all animal life,--directly of herbivorous, indirectly +of carnivorous animals,--are to be regarded with suspicion. Arsenic- +eating may seem to improve the condition of horses for a time,--and +even of human beings, if Tschudi's stories can be trusted,--but it +soon appears that its alien qualities are at war with the animal +organization. So of copper, antimony, and other non-alimentary +simple substances; everyone of them is an intruder in the living +system, as much as a constable would be, quartered in our household. +This does not mean that they may not, any of them, be called in for a +special need, as we send for the constable when we have good reason +to think we have a thief under our roof; but a man's body is his +castle, as well as his house, and the presumption is that we are to +keep our alimentary doors bolted against these perturbing agents. + +Now the feeling is very apt to be just contrary to this. The habit +has been very general with well-taught practitioners, to have +recourse to the introduction of these alien elements into the system +on the occasion of any slight disturbance. The tongue was a little +coated, and mercury must be given; the skin was a little dry, and the +patient must take antimony. It was like sending for the constable +and the posse comitatus when there is only a carpet to shake or a +refuse-barrel to empty. [Dr. James Johnson advises persons not ailing +to take five grains of blue pill with one or two of aloes twice a +week for three or four months in the year, with half a pint of +compound decoction of sarsaparilla every day for the same period, to +preserve health and prolong life. Pract. Treatise on Dis. of +Liver, etc. p. 272.] The constitution bears slow poisoning a great +deal better than might be expected; yet the most intelligent men in +the profession have gradually got out of the habit of prescribing +these powerful alien substances in the old routine way. Mr. Metcalf +will tell you how much more sparingly they are given by our +practitioners at the present time, than when he first inaugurated the +new era of pharmacy among us. Still, the presumption in favor of +poisoning out every spontaneous reaction of outraged nature is not +extinct in those who are trusted with the lives of their fellow- +citizens. "On examining the file of prescriptions at the hospital, I +discovered that they were rudely written, and indicated a treatment, +as they consisted chiefly of tartar emetic, ipecacuanha, and epsom +salts, hardly favorable to the cure of the prevailing diarrhoea and +dysenteries." In a report of a poisoning case now on trial, where +we are told that arsenic enough was found in the stomach to produce +death in twenty-four hours, the patient is said to have been treated +by arsenic, phosphorus, bryonia, aconite, nux vomica, and muriatic +acid,--by a practitioner of what school it may be imagined. + +The traditional idea of always poisoning out disease, as we smoke out +vermin, is now seeking its last refuge behind the wooden cannon and +painted port-holes of that unblushing system of false scientific +pretences which I do not care to name in a discourse addressed to an +audience devoted to the study of the laws of nature in the light of +the laws of evidence. It is extraordinary to observe that the system +which, by its reducing medicine to a name and a farce, has accustomed +all who have sense enough to see through its thin artifices to the +idea that diseases get well without being "cured," should now be the +main support of the tottering poison-cure doctrine. It has +unquestionably helped to teach wise people that nature heals most +diseases without help from pharmaceutic art, but it continues to +persuade fools that art can arrest them all with its specifics. + +It is worse than useless to attempt in any way to check the freest +expression of opinion as to the efficacy of any or all of the +"heroic" means of treatment employed by practitioners of different +schools and periods. Medical experience is a great thing, but we +must not forget that there is a higher experience, which tries its +results in a court of a still larger jurisdiction; that, namely, in +which the laws of human belief are summoned to the witness-box, and +obliged to testify to the sources of error which beset the medical +practitioner. The verdict is as old as the father of medicine, who +announces it in the words, "judgment is difficult." Physicians +differed so in his time, that some denied that there was any such +thing as an art of medicine. + +One man's best remedies were held as mischievous by another. The art +of healing was like soothsaying, so the common people said; "the same +bird was lucky or unlucky, according as he flew to the right or +left." + +The practice of medicine has undergone great changes within the +period of my own observation. Venesection, for instance, has so far +gone out of fashion, that, as I am told by residents of the New York +Bellevue and the Massachusetts General Hospitals, it is almost +obsolete in these institutions, at least in medical practice. The +old Brunonian stimulating treatment has come into vogue again in the +practice of Dr. Todd and his followers. The compounds of mercury +have yielded their place as drugs of all work, and specifics for that +very frequent subjective complaint, nescio quid faciam,--to compounds +of iodine. [Sir Astley Cooper has the boldness,--or honesty,--to +speak of medicines which "are given as much to assist the medical man +as his patient." Lectures (London, 1832), p. 14.] Opium is believed +in, and quinine, and "rum," using that expressive monosyllable to +mean all alcoholic cordials. If Moliere were writing now, instead of +saignare, purgare, and the other, he would be more like to say, +Stimulare, opium dare et potassio-iodizare. + +I have been in relation successively with the English and American +evacuant and alterative practice, in which calomel and antimony +figured so largely that, as you may see in Dr. Jackson's last +"Letter," Dr. Holyoke, a good representative of sterling old- +fashioned medical art, counted them with opium and Peruvian bark as +his chief remedies; with the moderately expectant practice of Louis; +the blood-letting "coup sur coup" of Bouillaud; the contra-stimulant +method of Rasori and his followers; the anti-irritant system of +Broussais, with its leeching and gum-water; I have heard from our own +students of the simple opium practice of the renowned German teacher, +Oppolzer; and now I find the medical community brought round by the +revolving cycle of opinion to that same old plan of treatment which +John Brown taught in Edinburgh in the last quarter of the last +century, and Miner and Tully fiercely advocated among ourselves in +the early years of the present. The worthy physicians last +mentioned, and their antagonist Dr. Gallup, used stronger language +than we of these degenerate days permit ourselves. "The lancet is a +weapon which annually slays more than the sword," says Dr. Tully. +"It is probable that, for forty years past, opium and its +preparations have done seven times the injury they have rendered +benefit, on the great scale of the world," says Dr. Gallup. + +What is the meaning of these perpetual changes and conflicts of +medical opinion and practice, from an early antiquity to our own +time? Simply this: all "methods" of treatment end in disappointment +of those extravagant expectations which men are wont to entertain of +medical art. The bills of mortality are more obviously affected by +drainage, than by this or that method of practice. The insurance +companies do not commonly charge a different percentage on the lives +of the patients of this or that physician. In the course of a +generation, more or less, physicians themselves are liable to get +tired of a practice which has so little effect upon the average +movement of vital decomposition. Then they are ready for a change, +even if it were back again to a method which has already been tried, +and found wanting. + +Our practitioners, or many of them, have got back to the ways of old +Dr. Samuel Danforth, who, as it is well known, had strong objections +to the use of the lancet. By and by a new reputation will be made by +some discontented practitioner, who, tired of seeing patients die +with their skins full of whiskey and their brains muddy with opium, +returns to a bold antiphlogistic treatment, and has the luck to see a +few patients of note get well under it. So of the remedies which +have gone out of fashion and been superseded by others. It can +hardly be doubted that they will come into vogue again, more or less +extensively, under the influence of that irresistible demand for +change just referred to. + +Then will come the usual talk about a change in the character of +disease, which has about as much meaning as that concerning +"old-fashioned snow-storms." "Epidemic constitutions" of disease +mean something, no doubt; a great deal as applied to malarious +affections; but that the whole type of diseases undergoes such +changes that the practice must be reversed from depleting to +stimulating, and vice versa, is much less likely than that methods of +treatment go out of fashion and come in again. If there is any +disease which claims its percentage with reasonable uniformity, it is +phthisis. Yet I remember that the reverend and venerable Dr. Prince +of Salem told me one Commencement day, as I was jogging along towards +Cambridge with him, that he recollected the time when that disease +was hardly hardly known; and in confirmation of his statement +mentioned a case in which it was told as a great event, that somebody +down on "the Cape" had died of "a consumption." This story does not +sound probable to myself, as I repeat it, yet I assure you it is +true, and it shows how cautiously we must receive all popular stories +of great changes in the habits of disease. + +Is there no progress, then, but do we return to the same beliefs and +practices which our forefathers wore out and threw away? I trust and +believe that there is a real progress. We may, for instance, return +in a measure to the Brunonian stimulating system, but it must be in a +modified way, for we cannot go back to the simple Brunonian +pathology, since we have learned too much of diseased action to +accept its convenient dualism. So of other doctrines, each new +Avatar strips them of some of their old pretensions, until they take +their fitting place at last, if they have any truth in them, or +disappear, if they were mere phantasms of the imagination. + +In the mean time, while medical theories are coming in and going out, +there is a set of sensible men who are never run away with by them, +but practise their art sagaciously and faithfully in much the same +way from generation to generation. From the time of Hippocrates to +that of our own medical patriarch, there has been an apostolic +succession of wise and good practitioners. If you will look at the +first aphorism of the ancient Master you will see that before all +remedies he places the proper conduct of the patient and his +attendants, and the fit ordering of all the conditions surrounding +him. The class of practitioners I have referred to have always been +the most faithful in attending to these points. No doubt they have +sometimes prescribed unwisely, in compliance with the prejudices of +their time, but they have grown wiser as they have grown older, and +learned to trust more in nature and less in their plans of +interference. I believe common opinion confirms Sir James Clark's +observation to this effect. + +The experience of the profession must, I think, run parallel with +that of the wisest of its individual members. Each time a plan of +treatment or a particular remedy comes up for trial, it is submitted +to a sharper scrutiny. When Cullen wrote his Materia Medica, he had +seriously to assail the practice of giving burnt toad, which was +still countenanced by at least one medical authority of note. I have +read recently in some medical journal, that an American practitioner, +whose name is known to the country, is prescribing the hoof of a +horse for epilepsy. It was doubtless suggested by that old fancy of +wearing a portion of elk's hoof hung round the neck or in a ring, for +this disease. But it is hard to persuade reasonable people to +swallow the abominations of a former period. The evidence which +satisfied Fernelius will not serve one of our hospital physicians. + +In this way those articles of the Materia Medica which had nothing +but loathsomeness to recommend them have been gradually dropped, and +are not like to obtain any general favor again with civilized +communities. The next culprits to be tried are the poisons. I have +never been in the least sceptical as to the utility of some of them, +when properly employed. Though I believe that at present, taking the +world at large, and leaving out a few powerful agents of such immense +value that they rank next to food in importance, the poisons +prescribed for disease do more hurt than good, I have no doubt, and +never professed to have any, that they do much good in prudent and +instructed hands. But I am very willing to confess a great jealousy +of many agents, and I could almost wish to see the Materia Medica so +classed as to call suspicion upon certain ones among them. + +Thus the alien elements, those which do not properly enter into the +composition of any living tissue, are the most to be suspected,-- +mercury, lead, antimony, silver, and the rest, for the reasons I have +before mentioned. Even iodine, which, as it is found in certain +plants, seems less remote from the animal tissues, gives unequivocal +proofs from time to time that it is hostile to some portions of the +glandular system. + +There is, of course, less prima facie objection to those agents which +consist of assimilable elements, such as are found making a part of +healthy tissues. These are divisible into three classes,--foods, +poisons, and inert, mostly because insoluble, substances. The food +of one animal or of one human being is sometimes poison to another, +and vice versa; inert substances may act mechanically, so as to +produce the effect of poisons; but this division holds exactly enough +for our purpose. + +Strictly speaking, every poison consisting of assimilable elements +may be considered as unwholesome food. It is rejected by the +stomach, or it produces diarrhoea, or it causes vertigo or +disturbance of the heart's action, or some other symptom for which +the subject of it would consult the physician, if it came on from any +other cause than taking it under the name of medicine. Yet portions +of this unwholesome food which we call medicine, we have reason to +believe, are assimilated; thus, castor-oil appears to be partially +digested by infants, so that they require large doses to affect them +medicinally. Even that deadliest of poisons, hydrocyanic acid, is +probably assimilated, and helps to make living tissue, if it do not +kill the patient, for the assimilable elements which it contains, +given in the separate forms of amygdalin and emulsin, produce no +disturbance, unless, as in Bernard's experiments, they are suffered +to meet in the digestive organs. A medicine consisting of +assimilable substances being then simply unwholesome food, we +understand what is meant by those cumulative effects of such remedies +often observed, as in the case of digitalis and strychnia. They are +precisely similar to the cumulative effects of a salt diet in +producing scurvy, or of spurred rye in producing dry gangrene. As +the effects of such substances are a violence to the organs, we +should exercise the same caution with regard to their use that we +would exercise about any other kind of poisonous food,--partridges at +certain seasons, for instance. Even where these poisonous kinds of +food seem to be useful, we should still regard them with great +jealousy. Digitalis lowers the pulse in febrile conditions. +Veratrum viride does the same thing. How do we know that a rapid +pulse is not a normal adjustment of nature to the condition it +accompanies? Digitalis has gone out of favor; how sure are we that +Veratrum viride will not be found to do more harm than good in a case +of internal inflammation, taking the whole course of the disease into +consideration? Think of the change of opinion with regard to the use +of opium in delirium tremens (which you remember is sometimes called +delirium vigilans), where it seemed so obviously indicated, since the +publication of Dr. Ware's admirable essay. I respect the evidence of +my contemporaries, but I cannot forget the sayings of the Father of +medicine,--Ars longa, judicium diffcile. + +I am not presuming to express an opinion concerning Veratrum viride, +which was little heard of when I was still practising medicine. I am +only appealing to that higher court of experience which sits in +judgment on all decisions of the lower medical tribunals, and which +requires more than one generation for its final verdict. + +Once change the habit of mind so long prevalent among practitioners +of medicine; once let it be everywhere understood that the +presumption is in favor of food, and not of alien substances, of +innocuous, and not of unwholesome food, for the sick; that this +presumption requires very strong evidence in each particular case to +overcome it; but that, when such evidence is afforded, the alien +substance or the unwholesome food should be given boldly, in +sufficient quantities, in the same spirit as that with which the +surgeon lifts his knife against a patient,--that is, with the same +reluctance and the same determination,--and I think we shall have and +hear much less of charlatanism in and out of the profession. The +disgrace of medicine has been that colossal system of self-deception, +in obedience to which mines have been emptied of their cankering +minerals, the vegetable kingdom robbed of all its noxious growths, +the entrails of animals taxed for their impurities, the poison-bags +of reptiles drained of their venom, and all the inconceivable +abominations thus obtained thrust down the throats of human beings +suffering from some fault of organization, nourishment, or vital +stimulation. + +Much as we have gained, we have not yet thoroughly shaken off the +notion that poison is the natural food of disease, as wholesome +aliment is the support of health. Cowper's lines, in "The Task," +show the matter-of-course practice of his time: + + "He does not scorn it, who has long endured + A fever's agonies, and fed on drugs." + +Dr. Kimball of Lowell, who has been in the habit of seeing a great +deal more of typhoid fever than most practitioners, and whose +surgical exploits show him not to be wanting in boldness or +enterprise, can tell you whether he finds it necessary to feed his +patients on drugs or not. His experience is, I believe, that of the +most enlightened and advanced portion of the profession; yet I think +that even in typhoid fever, and certainly in many other complaints, +the effects of ancient habits and prejudices may still be seen in the +practice of some educated physicians. + +To you, young men, it belongs to judge all that has gone before you. +You come nearer to the great fathers of modern medicine than some of +you imagine. Three of my own instructors attended Dr. Rush's +Lectures. The illustrious Haller mentions Rush's inaugural thesis in +his "Bibliotheca Anatomica;" and this same Haller, brought so close +to us, tells us he remembers Ruysch, then an old man, and used to +carry letters between him and Boerhaave. Look through the history of +medicine from Boerhaave to this present day. You will see at once +that medical doctrine and practice have undergone a long series of +changes. You will see that the doctrine and practice of our own time +must probably change in their turn, and that, if we can trust at all +to the indications of their course, it will be in the direction of an +improved hygiene and a simplified treatment. Especially will the old +habit of violating the instincts of the sick give place to a +judicious study of these same instincts. It will be found that +bodily, like mental insanity, is best managed, for the most part, by +natural soothing agencies. Two centuries ago there was a +prescription for scurvy containing "stercoris taurini et anserini +par, quantitas trium magnarum nucum," of the hell-broth containing +which "guoties-cumque sitit oeger, large bibit." When I have +recalled the humane common-sense of Captain Cook in the matter of +preventing this disease; when I have heard my friend, Mr. Dana, +describing the avidity with which the scurvy-stricken sailors snuffed +up the earthy fragrance of fresh raw potatoes, the food which was to +supply the elements wanting to their spongy tissues, I have +recognized that the perfection of art is often a return to nature, +and seen in this single instance the germ of innumerable beneficent +future medical reforms. + +I cannot help believing that medical curative treatment will by and +by resolve itself in great measure into modifications of the food, +swallowed and breathed, and of the natural stimuli, and that less +will be expected from specifics and noxious disturbing agents, either +alien or assimilable. The noted mineral-waters containing iron, +sulphur, carbonic acid, supply nutritious or stimulating materials to +the body as much as phosphate of lime and ammoniacal compounds do to +the cereal plants. The effects of a milk and vegetable diet, of +gluten bread in diabetes, of cod-liver oil in phthisis, even of such +audacious innovations as the water-cure and the grape-cure, are only +hints of what will be accomplished when we have learned to discover +what organic elements are deficient or in excess in a case of chronic +disease, and the best way of correcting the abnormal condition, just +as an agriculturist ascertains the wants of his crops and modifies +the composition of his soil. In acute febrile diseases we have long +ago discovered that far above all drug-medication is the use of mild +liquid diet in the period of excitement, and of stimulant and +nutritious food in that of exhaustion. Hippocrates himself was as +particular about his barley-ptisan as any Florence Nightingale of our +time could be. + +The generation to which you, who are just entering the profession, +belong, will make a vast stride forward, as I believe, in the +direction of treatment by natural rather than violent agencies. What +is it that makes the reputation of Sydenham, as the chief of English +physicians? His prescriptions consisted principally of simples. An +aperient or an opiate, a "cardiac" or a tonic, may be commonly found +in the midst of a somewhat fantastic miscellany of garden herbs. It +was not by his pharmaceutic prescriptions that he gained his great +name. It was by daring to order fresh air for small-pox patients, +and riding on horseback for consumptives, in place of the smothering +system, and the noxious and often loathsome rubbish of the +established schools. Of course Sydenham was much abused by his +contemporaries, as he frequently takes occasion to remind his reader. +"I must needs conclude," he says, "either that I am void of merit, or +that the candid and ingenuous part of mankind, who are formed with so +excellent a temper of mind as to be no strangers to gratitude, make a +very small part of the whole." If in the fearless pursuit of truth +you should find the world as ungracious in the nineteenth century as +he found it in the seventeenth, you may learn a lesson of self- +reliance from another utterance of the same illustrious physician: +"'T is none of my business to inquire what other persons think, but +to establish my own observations; in order to which, I ask no favor +of the reader but to peruse my writings with temper." + +The physician has learned a great deal from the surgeon, who is +naturally in advance of him, because he has a better opportunity of +seeing the effects of his remedies. Let me shorten one of Ambroise +Pare's stories for you. There had been a great victory at the pass +of Susa, and they were riding into the city. The wounded cried out +as the horses trampled them under their hoofs, which caused good +Ambroise great pity, and made him wish himself back in Paris. Going +into a stable he saw four dead soldiers, and three desperately +wounded, placed with their backs against the wall. An old campaigner +came up.--"Can these fellows get well?" he said. "No!" answered the +surgeon. Thereupon, the old soldier walked up to them and cut all +their throats, sweetly, and without wrath (doulcement et sans +cholere). Ambroise told him he was a bad man to do such a thing. +"I hope to God;" he said, "somebody will do as much for me if I ever +get into such a scrape" (accoustre de telle facon). "I was not much +salted in those days" (bien doux de sel), says Ambroise, "and little +acquainted with the treatment of wounds." However, as he tells us, +he proceeded to apply boiling oil of Sambuc (elder) after the +approved fashion of the time,--with what torture to the patient may +be guessed. At last his precious oil gave out, and he used instead +an insignificant mixture of his own contrivance. He could not sleep +that night for fear his patients who had not been scalded with the +boiling oil would be poisoned by the gunpowder conveyed into their +wounds by the balls. To his surprise, he found them much better than +the others the next morning, and resolved never again to burn his +patients with hot oil for gun-shot wounds. + +This was the beginning, as nearly as we can fix it, of that reform +which has introduced plain water-dressings in the place of the +farrago of external applications which had been a source of profit to +apothecaries and disgrace to art from, and before, the time when +Pliny complained of them. A young surgeon who was at Sudley Church, +laboring among the wounded of Bull Run, tells me they had nothing but +water for dressing, and he (being also doux de sel) was astonished to +see how well the wounds did under that simple treatment. + +Let me here mention a fact or two which may be of use to some of you +who mean to enter the public service. You will, as it seems, have +gun-shot wounds almost exclusively to deal with. Three different +surgeons, the one just mentioned and two who saw the wounded of Big +Bethel, assured me that they found no sabre-cuts or bayonet wounds. +It is the rifle-bullet from a safe distance which pierces the breasts +of our soldiers, and not the gallant charge of broad platoons and +sweeping squadrons, such as we have been in the habit of considering +the chosen mode of warfare of ancient and modern chivalry. [Sir +Charles James Napier had the same experience in Virginia in 1813. +"Potomac. We have nasty sort of fighting here, amongst creeks and +bushes, and lose men without show." "Yankee never shows himself, he +keeps in the thickest wood, fires and runs off."--These five +thousand in the open field might be attacked, but behind works it +would be throwing away lives." He calls it "an inglorious warfare," +--says one of the leaders is "a little deficient in gumption,"--but +--still my opinion is, that if we tuck up our sleeves and lay our +ears back we might thrash them; that is, if we caught them out of +their trees, so as to slap at them with the bayonet."--Life, etc. +vol. i. p. 218 et seq.] + +Another fact parallels the story of the old campaigner, and may teach +some of you caution in selecting your assistants. A chaplain told it +to two of our officers personally known to myself. He overheard the +examination of a man who wished to drive one of the "avalanche" +wagons, as they call them. The man was asked if he knew how to deal +with wounded men. "Oh yes," he answered; "if they're hit here," +pointing to the abdomen, "knock 'em on the head,--they can't get +well." + +In art and outside of it you will meet the same barbarisms that +Ambroise Pare met with,--for men differ less from century to century +than we are apt to suppose; you will encounter the same opposition, +if you attack any prevailing opinion, that Sydenham complained of. +So far as possible, let not such experiences breed in you a contempt +for those who are the subjects of folly or prejudice, or foster any +love of dispute for its own sake. Should you become authors, express +your opinions freely; defend them rarely. It is not often that an +opinion is worth expressing, which cannot take care of itself. +Opposition is the best mordant to fix the color of your thought in +the general belief. + +It is time to bring these crowded remarks to a close. The day has +been when at the beginning of a course of Lectures I should have +thought it fitting to exhort you to diligence and entire devotion to +your tasks as students. It is not so now. The young man who has not +heard the clarion-voices of honor and of duty now sounding throughout +the land, will heed no word of mine. In the camp or the city, in the +field or the hospital, under sheltering roof, or half-protecting +canvas, or open sky, shedding our own blood or stanching that of our +wounded defenders, students or teachers, whatever our calling and our +ability, we belong, not to ourselves, but to our imperilled country, +whose danger is our calamity, whose ruin would be our enslavement, +whose rescue shall be our earthly salvation! + + + + + + +SCHOLASTIC AND BEDSIDE TEACHING. + +An Introductory Lecture delivered before the Medical Class of Harvard +University, November 6, 1867. + +The idea is entertained by some of our most sincere professional +brethren, that to lengthen and multiply our Winter Lectures will be +of necessity to advance the cause of medical education. It is a fair +subject for consideration whether they do not overrate the relative +importance of that particular mode of instruction which forms the +larger part of these courses. + +As this School could only lengthen its lecture term at the expense of +its "Summer Session," in which more direct, personal, and familiar +teaching takes the place of our academic discourses, and in which +more time can be given to hospitals, infirmaries, and practical +instruction in various important specialties, whatever might be +gained, a good deal would certainly be lost in our case by the +exchange. + +The most essential part of a student's instruction is obtained, as I +believe, not in the lecture-room, but at the bedside. Nothing seen +there is lost; the rhythms of disease are learned by frequent +repetition; its unforeseen occurrences stamp themselves indelibly in +the memory. Before the student is aware of what he has acquired, he +has learned the aspects and course and probable issue of the diseases +he has seen with his teacher, and the proper mode of dealing with +them, so far as his master knows it. On the other hand, our ex +cathedra prelections have a strong tendency to run into details +which, however interesting they may be to ourselves and a few of our +more curious listeners, have nothing in them which will ever be of +use to the student as a practitioner. It is a perfectly fair +question whether I and some other American Professors do not teach +quite enough that is useless already. Is it not well to remind the +student from time to time that a physician's business is to avert +disease, to heal the sick, to prolong life, and to diminish +suffering? Is it not true that the young man of average ability will +find it as much as he can do to fit himself for these simple duties? +Is it not best to begin, at any rate, by making sure of such +knowledge as he will require in his daily walk, by no means +discouraging him from any study for which his genius fits him when he +once feels that he has become master of his chosen art. + +I know that many branches of science are of the greatest value as +feeders of our medical reservoirs. But the practising physician's +office is to draw the healing waters, and while he gives his time to +this labor he can hardly be expected to explore all the sources that +spread themselves over the wide domain of science. The traveller who +would not drink of the Nile until he had tracked it to its parent +lakes, would be like to die of thirst; and the medical practitioner +who would not use the results of many laborers in other departments +without sharing their special toils, would find life far too short +and art immeasurably too long. + +We owe much to Chemistry, one of the most captivating as well as +important of studies; but the medical man must as a general rule +content himself with a clear view of its principles and a limited +acquaintance with its facts; such especially as are pertinent to his +pursuits. I am in little danger of underrating Anatomy or +Physiology; but as each of these branches splits up into specialties, +any one of which may take up a scientific life-time, I would have +them taught with a certain judgment and reserve, so that they shall +not crowd the more immediately practical branches. So of all the +other ancillary and auxiliary kinds of knowledge, I would have them +strictly subordinated to that particular kind of knowledge for which +the community looks to its medical advisers. + +A medical school is not a scientific school, except just so far as +medicine itself is a science. On the natural history side, medicine +is a science; on the curative side, chiefly an art. This is implied +in Hufeland's aphorism: "The physician must generalize the disease +and individualize the patient." + +The coordinated and classified results of empirical observation, in +distinction from scientific experiment, have furnished almost all we +know about food, the medicine of health, and medicine, the food of +sickness. We eat the root of the Solanum tuberosum and throw away +its fruit; we eat the fruit of the Solanum Lycopersicum and throw +away its root. Nothing but vulgar experience has taught us to reject +the potato ball and cook the tomato. So of most of our remedies. +The subchloride of mercury, calomel, is the great British specific; +the protochloride of mercury, corrosive sublimate, kills like +arsenic, but no chemist could have told us it would be so. + +From observations like these we can obtain certain principles from +which we can argue deductively to facts of a like nature, but the +process is limited, and we are suspicious of all reasoning in that +direction applied to the processes of healthy and diseased life. We +are continually appealing to special facts. We are willing to give +Liebig's artificial milk when we cannot do better, but we watch the +child anxiously whose wet-nurse is a chemist's pipkin. A pair of +substantial mammary glands has the advantage over the two hemispheres +of the most learned Professor's brain, in the art of compounding a +nutritious fluid for infants. + +The bedside is always the true centre of medical teaching. Certain +branches must be taught in the lecture-room, and will necessarily +involve a good deal that is not directly useful to the future +practitioner. But the over ambitious and active student must not be +led away by the seduction of knowledge for its own sake from his +principal pursuit. The humble beginner, who is alarmed at the vast +fields of knowledge opened to him, may be encouraged by the assurance +that with a very slender provision of science, in distinction from +practical skill, he may be a useful and acceptable member of the +profession to which the health of the community is intrusted. + +To those who are not to engage in practice, the various pursuits of +science hardly require to be commended. Only they must not be +disappointed if they find many subjects treated in our courses as a +medical class requires, rather than as a scientific class would +expect, that is, with special limitations and constant reference to +practical ends. Fortunately they are within easy reach of the +highest scientific instruction. The business of a school like this +is to make useful working physicians, and to succeed in this it is +almost as important not to overcrowd the mind of the pupil with +merely curious knowledge as it is to store it with useful +information. + +In this direction I have written my lecture, not to undervalue any +form of scientific labor in its place, an unworthy thought from which +I hope I need not defend myself,--but to discourage any undue +inflation of the scholastic programme, which even now asks more of +the student than the teacher is able to obtain from the great +majority of those who present themselves for examination. I wish to +take a hint in education from the Secretary of the Massachusetts +Board of Agriculture, who regards the cultivation of too much land as +a great defect in our New England farming. I hope that our Medical +Institutions may never lay themselves open to the kind of accusation +Mr. Lowe brings against the English Universities, when he says that +their education is made up "of words that few understand and most +will shortly forget; of arts that can never be used, if indeed they +can even be learnt; of histories inapplicable to our times; of +languages dead and even mouldy; of grammatical rules that never had +living use and are only post mortem examinations; and of statements +fagoted with utter disregard of their comparative value." + +This general thought will be kept in view throughout my somewhat +discursive address, which will begin with an imaginary clinical +lesson from the lips of an historical personage, and close with the +portrait from real life of one who, both as teacher and practitioner, +was long loved and honored among us. If I somewhat overrun my hour, +you must pardon me, for I can say with Pascal that I have not had the +time to make my lecture shorter. + + +In the year 1647, that good man John Eliot, commonly called the +Apostle Eliot, writing to Mr. Thomas Shepherd, the pious minister of +Cambridge, referring to the great need of medical instruction for the +Indians, used these words: + +"I have thought in my heart that it were a singular good work, if the +Lord would stirre up the hearts of some or other of his people in +England to give some maintenance toward some Schoole or Collegiate +exercise this way, wherein there should be Anatomies and other +instructions that way, and where there might be some recompence given +to any that should bring in any vegetable or other thing that is +vertuous in the way of Physick. + +"There is another reason which moves my thought and desires this way, +namely that our young students in Physick may be trained up better +then they yet bee, who have onely theoreticall knowledge, and are +forced to fall to practise before ever they saw an Anatomy made, or +duely trained up in making experiments, for we never had but one +Anatomy in the countrey, which Mr. Giles Firman [Firmin] now in +England, did make and read upon very well, but no more of that now." + +Since the time of the Apostle Eliot the Lord has stirred up the +hearts of our people to the building of many Schools and Colleges +where medicine is taught in all its branches. Mr. Giles Firmin's +"Anatomy" may be considered the first ancestor of a long line of +skeletons which have been dangling and rattling in our lecture-rooms +for more than a century. + +Teaching in New England in 1647 was a grave but simple matter. A +single person, combining in many cases, as in that of Mr. Giles +Firmin, the offices of physician and preacher, taught what he knew to +a few disciples whom he gathered about him. Of the making of that +"Anatomy" on which my first predecessor in the branch I teach" did +read very well" we can know nothing. The body of some poor wretch +who had swung upon the gallows, was probably conveyed by night to +some lonely dwelling at the outskirts of the village, and there by +the light of flaring torches hastily dissected by hands that trembled +over the unwonted task. And ever and anon the master turned to his +book, as he laid bare the mysteries of the hidden organs; to his +precious Vesalius, it might be, or his figures repeated in the +multifarious volume of Ambroise Pare; to the Aldine octavo in which +Fallopius recorded his fresh observations; or that giant folio of +Spigelius just issued from the press of Amsterdam, in which lovely +ladies display their viscera with a coquettish grace implying that it +is rather a pleasure than otherwise to show the lace-like omentum, +and hold up their appendices epiploicae as if they were saying "these +are our jewels." + +His teaching of medicine was no doubt chiefly clinical, and received +with the same kind of faith as that which accepted his words from the +pulpit. His notions of disease were based on what he had observed, +seen always in the light of the traditional doctrines in which he was +bred. His discourse savored of the weighty doctrines of Hippocrates, +diluted by the subtle speculations of Galen, reinforced by the +curious comments of the Arabian schoolmen as they were conveyed in +the mellifluous language of Fernelius, blended, it may be, with +something of the lofty mysticism of Van Helmont, and perhaps stealing +a flavor of that earlier form of Homoeopathy which had lately come to +light in Sir Kenelm Digby's "Discourse concerning the Cure of Wounds +by the Sympathetic Powder." + +His Pathology was mythology. A malformed foetus, as the readers of +Winthrop's Journal may remember, was enough to scare the colonists +from their propriety, and suggest the gravest fears of portended +disaster. The student of the seventeenth century opened his Licetus +and saw figures of a lion with the head of a woman, and a man with +the head of an elephant. He had offered to his gaze, as born of a +human mother, the effigy of a winged cherub, a pterocephalous +specimen, which our Professor of Pathological Anatomy would hardly +know whether to treat with the reverence due to its celestial aspect, +or to imprison in one of his immortalizing jars of alcohol. + +His pharmacopoeia consisted mainly of simples, such as the venerable +"Herball" of Gerard describes and figures in abounding affluence. +St. John's wort and Clown's All-heal, with Spurge and Fennel, Saffron +and Parsley, Elder and Snake-root, with opium in some form, and +roasted rhubarb and the Four Great Cold Seeds, and the two Resins, of +which it used to be said that whatever the Tacamahaca has not cured, +the Caranna will, with the more familiar Scammony and Jalap and Black +Hellebore, made up a good part of his probable list of remedies. He +would have ordered Iron now and then, and possibly an occasional dose +of Antimony. He would perhaps have had a rheumatic patient wrapped +in the skin of a wolf or a wild cat, and in case of a malignant fever +with "purples" or petechiae, or of an obstinate king's evil, he might +have prescribed a certain black powder, which had been made by +calcining toads in an earthen pot; a choice remedy, taken internally, +or applied to any outward grief. + +Except for the toad-powder and the peremptory drastics, one might +have borne up against this herb doctoring as well as against some +more modern styles of medication. Barbeyrac and his scholar Sydenham +had not yet cleansed the Pharmacopoeia of its perilous stuff, but +there is no doubt that the more sensible physicians of that day knew +well enough that a good honest herb-tea which amused the patient and +his nurses was all that was required to carry him through all common +disorders. + +The student soon learned the physiognomy of disease by going about +with his master; fevers, pleurisies, asthmas, dropsies, fluxes, +small-pox, sore-throats, measles, consumptions. He saw what was done +for them. He put up the medicines, gathered the herbs, and so +learned something of materia medico and botany. He learned these few +things easily and well, for he could give his whole attention to +them. Chirurgery was a separate specialty. Women in child-birth +were cared for by midwives. There was no chemistry deserving the +name to require his study. He did not learn a great deal, perhaps, +but what he did learn was his business, namely, how to take care of +sick people. + +Let me give you a picture of the old=fashioned way of instruction, by +carrying you with me in imagination in the company of worthy Master +Giles Firmin as he makes his round of visits among the good folk of +Ipswich, followed by his one student, who shall answer to the +scriptural name of Luke. It will not be for entertainment chiefly, +but to illustrate the one mode of teaching which can never be +superseded, and which, I venture to say, is more important than all +the rest put together. The student is a green hand, as you will +perceive. + +In the first dwelling they come to, a stout fellow is bellowing with +colic. + +"He will die, Master, of a surety, methinks," says the timid youth in +a whisper. + +"Nay, Luke," the Master answers, "'t is but a dry belly-ache. Didst +thou not mark that he stayed his roaring when I did press hard over +the lesser bowels? Note that he hath not the pulse of them with +fevers, and by what Dorcas telleth me there hath been no long +shutting up of the vice naturales. We will steep certain comforting +herbs which I will shew thee, and put them in a bag and lay them on +his belly. Likewise he shall have my cordial julep with a portion of +this confection which we do call Theriaca Andromachi, which hath +juice of poppy in it, and is a great stayer of anguish. This fellow +is at his prayers to-day, but I warrant thee he shall be swearing +with the best of them to-morrow." + +They jog along the bridle-path on their horses until they come to +another lowly dwelling. They sit a while with a delicate looking +girl in whom the ingenuous youth naturally takes a special interest. +The good physician talks cheerfully with her, asks her a few +questions. Then to her mother: "Good-wife, Margaret hath somewhat +profited, as she telleth, by the goat's milk she hath taken night and +morning. Do thou pluck a maniple--that is an handful--of the plant +called Maidenhair, and make a syrup therewith as I have shewed thee. +Let her take a cup full of the same, fasting, before she sleepeth, +also before she riseth from her bed." And so they leave the house. + +"What thinkest thou, Luke, of the maid we have been visiting?" "She +seemeth not much ailing, Master, according to my poor judgment. For +she did say she was better. And she had a red cheek and a bright +eye, and she spake of being soon able to walk unto the meeting, and +did seem greatly hopeful, but spare of flesh, methought, and her +voice something hoarse, as of one that hath a defluxion, with some +small coughing from a cold, as she did say. Speak I not truly, +Master, that she will be well speedily?" + +"Yea, Luke, I do think she shall be well, and mayhap speedily. But +it is not here with us she shall be well. For that redness of the +cheek is but the sign of the fever which, after the Grecians, we do +call the hectical; and that shining of the eyes is but a sickly +glazing, and they which do every day get better and likewise thinner +and weaker shall find that way leadeth to the church-yard gate. This +is the malady which the ancients did call tubes, or the wasting +disease, and some do name the consumption. A disease whereof most +that fall ailing do perish. This Margaret is not long for earth--but +she knoweth it not, and still hopeth." + +"Why, then, Master, didst thou give her of thy medicine, seeing that +her ail is unto death?" + +"Thou shalt learn, boy, that they which are sick must have somewhat +wherewith to busy their thoughts. There be some who do give these +tabid or consumptives a certain posset made with lime-water and anise +and liquorice and raisins of the sun, and there be other some who do +give the juice of craw-fishes boiled in barley-water with chicken- +broth, but these be toys, as I do think, and ye shall find as good +virtue, nay better, in this syrup of the simple called Maidenhair." + +Something after this manner might Master Giles Firmin have delivered +his clinical instructions. Somewhat in this way, a century and a +half later, another New England physician, Dr. Edward Augustus +Holyoke, taught a young man who came to study with him, a very +diligent and intelligent youth, James Jackson by name, the same whose +portrait in his advanced years hangs upon this wall, long the honored +Professor of Theory and Practice in this Institution, of whom I shall +say something in this Lecture. Our venerated Teacher studied +assiduously afterwards in the great London Hospitals, but I think he +used to quote his "old Master" ten times where he quoted Mr. Cline or +Dr. Woodville once. + +When I compare this direct transfer of the practical experience of a +wise man into the mind of a student,--every fact one that he can use +in the battle of life and death,--with the far off, unserviceable +"scientific" truths that I and some others are in the habit of +teaching, I cannot help asking myself whether, if we concede that our +forefathers taught too little, there is not--a possibility that we +may sometimes attempt to teach too much. I almost blush when I think +of myself as describing the eight several facets on two slender +processes of the palate bone, or the seven little twigs that branch +off from the minute tympanic nerve, and I wonder whether my excellent +colleague feels in the same way when he pictures himself as giving +the constitution of neurin, which as he and I know very well is that +of the hydrate of trimethyle-oxethyle-ammonium, or the formula for +the production of alloxan, which, though none but the Professors and +older students can be expected to remember it, is C10 H4 N4 O6+ 2HO, +NO5}=C8 H4 N2 O10+2CO2+N2+NH4 O, NO5. + +I can bear the voice of some rough iconoclast addressing the +Anatomist and the Chemist in tones of contemptuous indignation: "What +is this stuff with which you are cramming the brains of young men who +are to hold the lives of the community in their hands? Here is a man +fallen in a fit; you can tell me all about the eight surfaces of the +two processes of the palate bone, but you have not had the sense to +loosen that man's neck-cloth, and the old women are all calling you a +fool? Here is a fellow that has just swallowed poison. I want +something to turn his stomach inside out at the shortest notice. Oh, +you have forgotten the dose of the sulphate of zinc, but you remember +the formula for the production of alloxan!" + +"Look you, Master Doctor,--if I go to a carpenter to come and stop a +leak in my roof that is flooding the house, do you suppose I care +whether he is a botanist or not? Cannot a man work in wood without +knowing all about endogens and exogens, or must he attend Professor +Gray's Lectures before he can be trusted to make a box-trap? If my +horse casts a shoe, do you think I will not trust a blacksmith to +shoe him until I have made sure that he is sound on the distinction +between the sesquioxide and the protosesquioxide of iron?" + +--But my scientific labor is to lead to useful results by and by, in +the next generation, or in some possible remote future.-- + +"Diavolo!" as your Dr. Rabelais has it,--answers the iconoclast,-- +"what is that to me and my colic, to me and my strangury? I pay the +Captain of the Cunard steamship to carry me quickly and safely to +Liverpool, not to make a chart of the Atlantic for after voyagers! +If Professor Peirce undertakes to pilot me into Boston Harbor and +runs me on Cohasset rocks, what answer is it to tell me that he is +Superintendent of the Coast Survey? No, Sir! I want a plain man in +a pea-jacket and a sou'wester, who knows the channel of Boston +Harbor, and the rocks of Boston Harbor, and the distinguished +Professor is quite of my mind as to the matter, for I took the pains +to ask him before I ventured to use his name in the way of +illustration." + + +I do not know how the remarks of the image-breaker may strike others, +but I feel that they put me on my defence with regard to much of my +teaching. Some years ago I ventured to show in an introductory +Lecture how very small a proportion of the anatomical facts taught in +a regular course, as delivered by myself and others, had any +practical bearing whatever on the treatment of disease. How can I, +how can any medical teacher justify himself in teaching anything that +is not like to be of practical use to a class of young men who are to +hold in their hands the balance in which life and death, ease and +anguish, happiness and wretchedness are to be daily weighed? + +I hope we are not all wrong. Oftentimes in finding how sadly +ignorant of really essential and vital facts and rules were some of +those whom we had been larding with the choicest scraps of science, I +have doubted whether the old one-man system of teaching, when the one +man was of the right sort, did not turn out better working physicians +than our more elaborate method. The best practitioner I ever knew +was mainly shaped to excellence in that way. I can understand +perfectly the regrets of my friend Dr. John Brown of Edinburgh, for +the good that was lost with the old apprenticeship system. I +understand as well Dr. Latham's fear "that many men of the best +abilities and good education will be deterred from prosecuting physic +as a profession, in consequence of the necessity indiscriminately +laid upon all for impossible attainments." + +I feel therefore impelled to say a very few words in defence of that +system of teaching adopted in our Colleges, by which we wish to +supplement and complete the instruction given by private individuals +or by what are often called Summer Schools. + +The reason why we teach so much that is not practical and in itself +useful, is because we find that the easiest way of teaching what is +practical and useful. If we could in any way eliminate all that +would help a man to deal successfully with disease, and teach it by +itself so that it should be as tenaciously rooted in the memory, as +easily summoned when wanted, as fertile in suggestion of related +facts, as satisfactory to the peremptory demands of the intelligence +as if taught in its scientific connections, I think it would be our +duty so to teach the momentous truths of medicine, and to regard all +useless additions as an intrusion on the time which should be +otherwise occupied. + +But we cannot successfully eliminate and teach by itself that which +is purely practical. The easiest and surest why of acquiring facts +is to learn them in groups, in systems, and systematized knowledge is +science. You can very often carry two facts fastened together more +easily than one by itself, as a housemaid can carry two pails of +water with a hoop more easily than one without it. You can remember +a man's face, made up of many features, better than you can his nose +or his mouth or his eye-brow. Scores of proverbs show you that you +can remember two lines that rhyme better than one without the jingle. +The ancients, who knew the laws of memory, grouped the seven cities +that contended for the honor of being Homer's birthplace in a line +thus given by Aulus Gellius: + +Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai. + +I remember, in the earlier political days of Martin Van Buren, that +Colonel Stone, of the "New York Commercial," or one of his +correspondents, said that six towns of New York would claim in the +same way to have been the birth-place of the "Little Magician," as he +was then called; and thus he gave their names, any one of which I +should long ago have forgotten, but which as a group have stuck tight +in my memory from that day to this; + +Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac. + +If the memory gains so much by mere rhythmical association, how much +more will it gain when isolated facts are brought together under laws +and principles, when organs are examined in their natural +connections, when structure is coupled with function, and healthy and +diseased action are studied as they pass one into the other! +Systematic, or scientific study is invaluable as supplying a natural +kind of mnemonics, if for nothing else. You cannot properly learn +the facts you want from Anatomy and Chemistry in any way so easily as +by taking them in their regular order, with other allied facts, only +there must be common sense exercised in leaving out a great deal +which belongs to each of the two branches as pure science. The +dullest of teachers is the one who does not know what to omit. + +The larger aim of scientific training is to furnish you with +principles to which you will be able to refer isolated facts, and so +bring these within the range of recorded experience. See what the +"London Times" said about the three Germans who cracked open John +Bull Chatwood's strong-box at the Fair the other day, while the three +Englishmen hammered away in vain at Brother Jonathan Herring's. The +Englishmen represented brute force. The Germans had been trained to +appreciate principle. The Englishman "knows his business by rote and +rule of thumb"--science, which would "teach him to do in an hour what +has hitherto occupied him two hours," "is in a manner forbidden to +him." To this cause the "Times" attributes the falling off of +English workmen in comparison with those of the Continent. + +Granting all this, we must not expect too much from "science" as +distinguished from common experience. There are ten thousand +experimenters without special apparatus for every one in the +laboratory. Accident is the great chemist and toxicologist. Battle +is the great vivisector. Hunger has instituted researches on food +such as no Liebig, no Academic Commission has ever recorded. + +Medicine, sometimes impertinently, often ignorantly, often carelessly +called "allopathy," appropriates everything from every source that +can be of the slightest use to anybody who is ailing in any way, or +like to be ailing from any cause. It learned from a monk how to use +antimony, from a Jesuit how to cure agues, from a friar how to cut +for stone, from a soldier how to treat gout, from a sailor how to +keep off scurvy, from a postmaster how to sound the Eustachian tube, +from a dairy-maid how to prevent small-pox, and from an old market- +woman how to catch the itch-insect. It borrowed acupuncture and the +moxa from the Japanese heathen, and was taught the use of lobelia by +the American savage. It stands ready to-day to accept anything from +any theorist, from any empiric who can make out a good case for his +discovery or his remedy. "Science" is one of its benefactors, but +only one, out of many. Ask the wisest practising physician you know, +what branches of science help him habitually, and what amount of +knowledge relating to each branch he requires for his professional +duties. He will tell you that scientific training has a value +independent of all the special knowledge acquired. He will tell you +that many facts are explained by studying them in the wider range of +related facts to which they belong. He will gratefully recognize +that the anatomist has furnished him with indispensable data, that +the physiologist has sometimes put him on the track of new modes of +treatment, that the chemist has isolated the active principles of his +medicines, has taught him how to combine them, has from time to time +offered him new remedial agencies, and so of others of his allies. +But he will also tell you, if I am not mistaken, that his own branch +of knowledge is so extensive and so perplexing that he must accept +most of his facts ready made at their hands. He will own to you that +in the struggle for life which goes on day and night in our thoughts +as in the outside world of nature, much that he learned under the +name of science has died out, and that simple homely experience has +largely taken the place of that scholastic knowledge to which he and +perhaps some of his instructors once attached a paremount importance. + +This, then, is my view of scientific training as conducted in courses +such as you are entering on. Up to a certain point I believe in set +Lectures as excellent adjuncts to what is far more important, +practical instruction at the bedside, in the operating room, and +under the eye of the Demonstrator. But I am so far from wishing +these courses extended, that I think some of them--suppose I say my +own--would almost bear curtailing. Do you want me to describe more +branches of the sciatic and crural nerves? I can take Fischer's +plates, and lecturing on that scale fill up my whole course and not +finish the nerves alone. We must stop somewhere, and for my own part +I think the scholastic exercises of our colleges have already claimed +their full share of the student's time without our seeking to extend +them. + +I trust I have vindicated the apparent inconsequence of teaching +young students a good deal that seems at first sight profitless, but +which helps them to learn and retain what is profitable. But this is +an inquisitive age, and if we insist on piling up beyond a certain +height knowledge which is in itself mere trash and lumber to a man +whose life is to be one long fight with death and disease, there will +be some sharp questions asked by and by, and our quick-witted people +will perhaps find they can get along as well without the professor's +cap as without the bishop's mitre and the monarch's crown. + +I myself have nothing to do with clinical teaching. Yet I do not +hesitate to say it is more essential than all the rest put together, +so far as the ordinary practice of medicine is concerned; and this is +by far the most important thing to be learned, because it deals with +so many more lives than any other branch of the profession. So of +personal instruction, such as we give and others give in the interval +of lectures, much of it at the bedside, some of it in the laboratory, +some in the microscope-room, some in the recitation-room, I think it +has many advantages of its own over the winter course, and I do not +wish to see it shortened for the sake of prolonging what seems to me +long enough already. + +If I am jealous of the tendency to expand the time given to the +acquisition of curious knowledge, at the expense of the plain old- +fashioned bedside teachings, I only share the feeling which Sydenham +expressed two hundred years ago, using an image I have already +borrowed. "He would be no honest and successful pilot who was to +apply himself with less industry to avoid rocks and sands and bring +his vessel safely home, than to search into the causes of the ebbing +and flowing of the sea, which, though very well for a philosopher, is +foreign to him whose business it is to secure the ship. So neither +will a physician, whose province it is to cure diseases, be able to +do so, though he be a person of great genius, who bestows less time +on the hidden and intricate method of nature, and adapting his means +thereto, than on curious and subtle speculation." + +"Medicine is my wife and Science is my mistress," said Dr. Rush. I +do not think that the breach of the seventh commandment can be shown +to have been of advantage to the legitimate owner of his affections. +Read what Dr. Elisha Bartlett says of him as a practitioner, or ask +one of our own honored ex-professors, who studied under him, whether +Dr. Rush had ever learned the meaning of that saying of Lord Bacon, +that man is the minister and interpreter of Nature, or whether he did +not speak habitually of Nature as an intruder in the sick room, from +which his art was to expel her as an incompetent and a meddler. + +All a man's powers are not too much for such a profession as +Medicine. "He is a learned man," said old Parson Emmons of Franklin, +"who understands one subject, and he is a very learned man who +understands two subjects." Schonbein says he has been studying +oxygen for thirty years. Mitscherlich said it took fourteen years to +establish a new fact in chemistry. Aubrey says of Harvey, the +discoverer of the circulation, that "though all his profession would +allow him to be an excellent anatomist, I have never heard of any who +admired his therapeutic way." My learned and excellent friend before +referred to, Dr. Brown of Edinburgh, from whose very lively and +sensible Essay, "Locke and Sydenham," I have borrowed several of my +citations, contrasts Sir Charles Bell, the discoverer, the man of +science, with Dr. Abercrombie, the master in the diagnosis and +treatment of disease. It is through one of the rarest of +combinations that we have in our Faculty a teacher on whom the +scientific mantle of Bell has fallen, and who yet stands preeminent +in the practical treatment of the class of diseases which his +inventive and ardent experimental genius has illustrated. M. Brown- +Sequard's example is as, eloquent as his teaching in proof of the +advantages of well directed scientific investigation. But those who +emulate his success at once as a discoverer and a practitioner must +be content like him to limit their field of practice. The highest +genius cannot afford in our time to forget the ancient precept, +Divide et impera. + +"I suppose I must go and earn this guinea," said a medical man who +was sent for while he was dissecting an animal. I should not have +cared to be his patient. His dissection would do me no good, and his +thoughts would be too much upon it. I want a whole man for my +doctor, not a half one. I would have sent for a humbler +practitioner, who would have given himself entirely to me, and told +the other--who was no less a man than John Hunter--to go on and +finish the dissection of his tiger. + +Sydenham's "Read Don Quixote" should be addressed not to the student, +but to the Professor of today. Aimed at him it means, "Do not be too +learned." + +Do not think you are going to lecture to picked young men who are +training themselves to be scientific discoverers. They are of fair +average capacity, and they are going to be working doctors. + +These young men are to have some very serious vital facts to deal +with. I will mention a few of them. + +Every other resident adult you meet in these streets is or will be +more or less tuberculous. This is not an extravagant estimate, as +very nearly one third of the deaths of adults in Boston last year +were from phthisis. If the relative number is less in our other +northern cities, it is probably in a great measure because they are +more unhealthy; that is, they have as much, or nearly as much, +consumption, but they have more fevers or other fatal diseases. + +These heavy-eyed men with the alcoholized brains, these pallid youths +with the nicotized optic ganglia and thinking-marrows brown as their +own meerschaums, of whom you meet too many,--will ask all your wisdom +to deal with their poisoned nerves and their enfeebled wills. + +Nearly seventeen hundred children under five years of age died last +year in this city. A poor human article, no doubt, in many cases, +still, worth an attempt to save them, especially when we remember the +effect of Dr. Clarke's suggestion at the Dublin Hospital, by which +some twenty-five or thirty thousand children's lives have probably +been saved in a single city. + +Again, the complaint is often heard that the native population is not +increasing so rapidly as in former generations. The breeding and +nursing period of American women is one of peculiar delicacy and +frequent infirmity. Many of them must require a considerable +interval between the reproductive efforts, to repair damages arid +regain strength. This matter is not to be decided by an appeal to +unschooled nature. It is the same question as that of the deformed +pelvis,--one of degree. The facts of mal-vitalization are as much to +be attended to as those of mal-formation. If the woman with a +twisted pelvis is to be considered an exempt, the woman with a +defective organization should be recognized as belonging to the +invalid corps. We shudder to hear what is alleged as to the +prevalence of criminal practices; if back of these there can be shown +organic incapacity or overtaxing of too limited powers, the facts +belong to the province of the practical physician, as well as of the +moralist and the legislator, and require his gravest consideration. + +Take the important question of bleeding. Is venesection done with +forever? Six years ago it was said here in an introductory Lecture +that it would doubtless come back again sooner or later. A fortnight +ago I found myself in the cars with one of the most sensible and +esteemed practitioners in New England. He took out his wallet and +showed me two lancets, which he carried with him; he had never given +up their use. This is a point you will have to consider. + +Or, to mention one out of many questionable remedies, shall you give +Veratrum Viride in fevers and inflammations? It makes the pulse +slower in these affections. Then the presumption would naturally be +that it does harm. The caution with reference to it on this ground +was long ago recorded in the Lecture above referred to. See what Dr. +John Hughes Bennett says of it in the recent edition of his work on +Medicine. Nothing but the most careful clinical experience can +settle this and such points of treatment. + +These are all practical questions--questions of life and death, and +every day will be full of just such questions. Take the problem of +climate. A patient comes to you with asthma and wants to know where +he can breathe; another comes to you with phthisis and wants to know +where he can live. What boy's play is nine tenths of all that is +taught in many a pretentious course of lectures, compared with what +an accurate and extensive knowledge of the advantages and +disadvantages of different residences in these and other complaints +would be to a practising physician + +I saw the other day a gentleman living in Canada, who had spent seven +successive winters in Egypt, with the entire relief of certain +obscure thoracic symptoms which troubled him while at home. I saw, +two months ago, another gentleman from Minnesota, an observer and a +man of sense, who considered that State as the great sanatorium for +all pulmonary complaints. If half our grown population are or will +be more or less tuberculous, the question of colonizing Florida +assumes a new aspect. Even within the borders of our own State, the +very interesting researches of Dr. Bowditch show that there is a +great variation in the amount of tuberculous disease in different +towns, apparently connected with local conditions. The hygienic map +of a State is quite as valuable as its geological map, and it is the +business of every practising physician to know it thoroughly. They +understand this in England, and send a patient with a dry irritating +cough to Torquay or Penzance, while they send another with relaxed +bronchial membranes to Clifton or Brighton. Here is another great +field for practical study. + +So as to the all-important question of diet. "Of all the means of +cure at our command," says Dr. Bennett, "a regulation of the quantity +and quality of the diet is by far the most powerful." Dr. MacCormac +would perhaps except the air we breathe, for he thinks that impure +air, especially in sleeping rooms, is the great cause of tubercle. +It is sufficiently proved that the American,--the New Englander,--the +Bostonian, can breed strong and sound children, generation after +generation,--nay, I have shown by the record of a particular family +that vital losses may be retrieved, and a feeble race grow to lusty +vigor in this very climate and locality. Is not the question why our +young men and women so often break down, and how they can be kept +from breaking down, far more important for physicians to settle than +whether there is one cranial vertebra, or whether there are four, or +none? + +--But I have a taste for the homologies, I want to go deeply into the +subject of embryology, I want to analyze the protonihilates +precipitated from pigeon's milk by the action of the lunar spectrum,- +shall I not follow my star,--shall I not obey my instinct,--shall I +not give myself to the lofty pursuits of science for its own sake? + +Certainly you may, if you like. But take down your sign, or never +put it up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and +Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the +difficulty. We all admire the achievements of this band of +distinguished doctors who do not practise. But we say of their work +and of all pure science, as the French officer said of the charge of +the six hundred at Balaclava, "C'est magnifique, mais ce n'est pas la +guerre,"--it is very splendid, but it is not a practising doctor's +business. His patient has a right to the cream of his life and not +merely to the thin milk that is left after "science" has skimmed it +off. The best a physician can give is never too good for the +patient. + +It is often a disadvantage to a young practitioner to be known for +any accomplishment outside of his profession. Haller lost his +election as Physician to the Hospital in his native city of Berne, +principally on the ground that he was a poet. In his later years the +physician may venture more boldly. Astruc was sixty-nine years old +when he published his "Conjectures," the first attempt, we are told, +to decide the authorship of the Pentateuch showing anything like a +discerning criticism. Sir Benjamin Brodie was seventy years old +before he left his physiological and surgical studies to indulge in +psychological speculations. The period of pupilage will be busy +enough in acquiring the knowledge needed, and the season of active +practice will leave little leisure for any but professional studies. + +Dr. Graves of Dublin, one of the first clinical teachers of our time, +always insisted on his students' beginning at once to visit the +hospital. At the bedside the student must learn to treat disease, +and just as certainly as we spin out and multiply our academic +prelections we shall work in more and more stuffing, more and more +rubbish, more and more irrelevant, useless detail which the student +will get rid of just as soon as he leaves us. Then the next thing +will be a new organization, with an examining board of first-rate +practical men, who will ask the candidate questions that mean +business,--who will make him operate if he is to be a surgeon, and +try him at the bedside if he is to be a physician,--and not puzzle +him with scientific conundrums which not more than one of the +questioners could answer himself or ever heard of since he graduated. + +Or these women who are hammering at the gates on which is written "No +admittance for the mothers of mankind," will by and by organize an +institution, which starting from that skilful kind of nursing which +Florence Nightingale taught so well, will work backwards through +anodynes, palliatives, curatives, preventives, until with little show +of science it imparts most of what is most valuable in those branches +of the healing art it professes to teach. When that time comes, the +fitness of women for certain medical duties, which Hecquet advocated +in 1708, which Douglas maintained in 1736, which Dr. John Ware, long +the honored Professor of Theory and Practice in this Institution, +upheld within our own recollection in the face of his own recorded +opinion to the contrary, will very possibly be recognized. + +My advice to every teacher less experienced than myself would be, +therefore: Do not fret over the details you have to omit; you +probably teach altogether too many as it is. Individuals may learn a +thing with once hearing it, but the only way of teaching a whole +class is by enormous repetition, representation, and illustration in +all possible forms. Now and then you will have a young man on your +benches like the late Waldo Burnett,--not very often, if you lecture +half a century. You cannot pretend to lecture chiefly for men like +that,--a Mississippi raft might as well take an ocean-steamer in tow. +To meet his wants you would have to leave the rest of your class +behind and that you must not do. President Allen of Jefferson +College says that his instruction has been successful in proportion +as it has been elementary. It may be a humiliating statement, but it +is one which I have found true in my own experience. + +To the student I would say, that however plain and simple may be our +teaching, he must expect to forget much which he follows +intelligently in the lecture-room. But it is not the same as if he +had never learned it. A man must get a thing before he can forget +it. There is a great world of ideas we cannot voluntarily recall,-- +they are outside the limits of the will. But they sway our conscious +thought as the unseen planets influence the movements of those within +the sphere of vision. No man knows how much he knows,--how many +ideas he has,--any more than he knows how many blood-globules roll in +his veins. Sometimes accident brings back here and there one, but +the mind is full of irrevocable remembrances and unthinkable +thoughts, which take a part in all its judgments as indestructible +forces. Some of you must feel your scientific deficiencies painfully +after your best efforts. But every one can acquire what is most +essential. A man of very moderate ability may be a good physician, +if he devotes himself faithfully to the work. More than this, a +positively dull man, in the ordinary acceptation of the term, +sometimes makes a safer practitioner than one who has, we will say, +five per cent. more brains than his average neighbor, but who thinks +it is fifty per cent. more. Skulls belonging to this last variety of +the human race are more common, I may remark, than specimens like the +Neanderthal cranium, a cast of which you will find on the table in +the Museum. + +Whether the average talent be high or low, the Colleges of the land +must make the best commodity they can out of such material as the +country and the cities furnish them. The community must have Doctors +as it must have bread. It uses up its Doctors just as it wears out +its shoes, and requires new ones. All the bread need not be French +rolls, all the shoes need not be patent leather ones; but the bread +must be something that can be eaten, and the shoes must be something +that can be worn. Life must somehow find food for the two forces +that rub everything to pieces, or burn it to ashes,--friction and +oxygen. Doctors are oxydable products, and the schools must keep +furnishing new ones as the old ones turn into oxyds; some of first- +rate quality that burn with a great light, some of a lower grade of +brilliancy, some honestly, unmistakably, by the grace of God, of +moderate gifts, or in simpler phrase, dull. + +The public will give every honest and reasonably competent worker in +the healing art a hearty welcome. It is on the whole very loyal to +the Medical Profession. Three successive years have borne witness to +the feeling with which this Institution, representing it in its +educational aspect, is regarded by those who are themselves most +honored and esteemed. The great Master of Natural Science bade the +last year's class farewell in our behalf, in those accents which +delight every audience. The Head of our ancient University honored +us in the same way in the preceding season. And how can we forget +that other occasion when the Chief Magistrate of the Commonwealth, +that noble citizen whom we have just lost, large-souled, sweet- +natured, always ready for every kind office, came among us at our +bidding, and talked to us of our duties in words as full of wisdom as +his heart was of goodness? + +You have not much to fear, I think, from the fancy practitioners. +The vulgar quackeries drop off, atrophied, one after another. +Homoeopathy has long been encysted, and is carried on the body +medical as quietly as an old wen. Every year gives you a more +reasoning and reasonable people to deal with. See how it is in +Literature. The dynasty of British dogmatists, after lasting a +hundred years and more, is on its last legs. Thomas Carlyle, third +in the line of descent, finds an audience very different from those +which listened to the silver speech of Samuel Taylor Coleridge and +the sonorous phrases of Samuel Johnson. We read him, we smile at his +clotted English, his "swarmery" and other picturesque expressions, +but we lay down his tirade as we do one of Dr. Cumming's +interpretations of prophecy, which tells us that the world is coming +to an end next week or next month, if the weather permits,--not +otherwise,--feeling very sure that the weather will be unfavorable. + +It is the same common-sense public you will appeal to. The less +pretension you make, the better they will like you in the long run. +I hope we shall make everything as plain and as simple to you as we +can. I would never use a long word, even, where a short one would +answer the purpose. I know there are professors in this country who +"ligate" arteries. Other surgeons only tie them, and it stops the +bleeding just as well. It is the familiarity and simplicity of +bedside instruction which makes it so pleasant as well as so +profitable. A good clinical teacher is himself a Medical School. We +need not wonder that our young men are beginning to announce +themselves not only as graduates of this or that College, but also as +pupils of some one distinguished master. + +I wish to close this Lecture, if you will allow me a few moments +longer, with a brief sketch of an instructor and practitioner whose +character was as nearly a model one in both capacities as I can find +anywhere recorded. + +Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine +in this University from 1812 to 1846, and whose name has been since +retained on our rolls as Professor Emeritus, died on the 27th of +August last, in the ninetieth year of his age. He studied his +profession, as I have already mentioned, with Dr. Holyoke of Salem, +one of the few physicians who have borne witness to their knowledge +of the laws of life by living to complete their hundredth year. I +think the student took his Old Master, as he always loved to call +him, as his model; each was worthy of the other, and both were bright +examples to all who come after them. + +I remember that in the sermon preached by Dr. Grazer after Dr. +Holyoke's death, one of the points most insisted upon as +characteristic of that wise and good old man was the perfect balance +of all his faculties. The same harmonious adjustment of powers, the +same symmetrical arrangement of life, the same complete fulfilment of +every day's duties, without haste and without needless delay, which +characterized the master, equally distinguished the scholar. A +glance at the life of our own Old Master, if I can do any justice at +all to his excellences, will give you something to carry away from +this hour's meeting not unworthy to be remembered. + +From December, 1797, to October, 1799, he remained with Dr. Holyoke +as a student, a period which he has spoken of as a most interesting +and most gratifying part of his life. After this he passed eight +months in London, and on his return, in October, 1800, he began +business in Boston. + +He had followed Mr. Cline, as I have mentioned, and was competent to +practise Surgery. But he found Dr. John Collins Warren had already +occupied the ground which at that day hardly called for more than one +leading practitioner, and wisely chose the Medical branch of the +profession. He had only himself to rely upon, but he had confidence +in his prospects, conscious, doubtless, of his own powers, knowing +his own industry and determination, and being of an eminently +cheerful and hopeful disposition. No better proof of his spirit can +be given than that, just a year from the time when he began to +practise as a physician, he took that eventful step which in such a +man implies that he sees his way clear to a position; he married a +lady blessed with many gifts, but not bringing him a fortune to +paralyze his industry. + +He had not miscalculated his chances in life. He very soon rose into +a good practice, and began the founding of that reputation which grew +with his years, until he stood by general consent at the head of his +chosen branch of the profession, to say the least, in this city and +in all this region of country. His skill and wisdom were the last +tribunal to which the sick and suffering could appeal. The community +trusted and loved him, the profession recognized him as the noblest +type of the physician. The young men whom he had taught wandered +through foreign hospitals; where they learned many things that were +valuable, and many that were curious; but as they grew older and +began to think more of their ability to help the sick than their +power of talking about phenomena, they began to look back to the +teaching of Dr. Jackson, as he, after his London experience, looked +back to that of Dr. Holyoke. And so it came to be at last that the +bare mention of his name in any of our medical assemblies would call +forth such a tribute of affectionate regard as is only yielded to age +when it brings with it the record of a life spent in well doing. + +No accident ever carries a man to eminence such as his in the medical +profession. He who looks for it must want it earnestly and work for +it vigorously; Nature must have qualified him in many ways, and +education must have equipped him with various knowledge, or his +reputation will evaporate before it reaches the noon-day blaze of +fame. How did Dr. Jackson gain the position which all conceded to +him? In the answer to this question some among you may find a key +that shall unlock the gate opening on that fair field of the future +of which all dream but which not all will ever reach. + +First of all, he truly loved his profession. He had no intellectual +ambitions outside of it, literary, scientific or political. To him +it was occupation enough to apply at the bedside the best of all that +he knew for the good of his patient; to protect the community against +the inroads of pestilence; to teach the young all that he himself had +been taught, with all that his own experience had added; to leave on +record some of the most important results of his long observation. + +With his patients he was so perfect at all points that it is hard to +overpraise him. I have seen many noted British and French and +American practitioners, but I never saw the man so altogether +admirable at the bedside of the sick as Dr. James Jackson. His smile +was itself a remedy better than the potable gold and the dissolved +pearls that comforted the praecordia of mediaeval monarchs. Did a +patient, alarmed without cause, need encouragement, it carried the +sunshine of hope into his heart and put all his whims to flight, as +David's harp cleared the haunted chamber of the sullen king. Had the +hour come, not for encouragement, but for sympathy, his face, his +voice, his manner all showed it, because his heart felt it. So +gentle was he, so thoughtful, so calm, so absorbed in the case before +him, not to turn round and look for a tribute to his sagacity, not to +bolster himself in a favorite theory, but to find out all he could, +and to weigh gravely and cautiously all that he found, that to follow +him in his morning visit was not only to take a lesson in the healing +art, it was learning how to learn, how to move, how to look, how to +feel, if that can be learned. To visit with Dr. Jackson was a +medical education. + +He was very firm, with all his kindness. He would have the truth +about his patients. The nurses found it out; and the shrewder ones +never ventured to tell him anything but a straight story. A clinical +dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse +in the Massachusetts General Hospital, a mistress in her calling, was +as good questioning and answering as one would be like to hear +outside of the court-room. + +Of his practice you can form an opinion from his book called "Letters +to a Young Physician." Like all sensible men from the days of +Hippocrates to the present, he knew that diet and regimen were more +important than any drug or than all drugs put together. Witness his +treatment of phthisis and of epilepsy. He retained, however, more +confidence in some remedial agents than most of the younger +generation would concede to them. Yet his materia medica was a +simple one. + +"When I first went to live with Dr. Holyoke," he says, "in 1797, +showing me his shop, he said, 'There seems to you to be a great +variety of medicines here, and that it will take you long to get +acquainted with them, but most of them are unimportant. There are +four which are equal to all the rest, namely, Mercury, Antimony, Bark +and Opium.'" And Dr. Jackson adds, "I can only say of his practice, +the longer I have lived, I have thought better and better of it." +When he thought it necessary to give medicine, he gave it in earnest. +He hated half-practice--giving a little of this or that, so as to be +able to say that one had done something, in case a consultation was +held, or a still more ominous event occurred. He would give opium, +for instance, as boldly as the late Dr. Fisher of Beverly, but he +followed the aphorism of the Father of Medicine, and kept extreme +remedies for extreme cases. + +When it came to the "non-naturals," as he would sometimes call them, +after the old physicians,--namely, air, meat and drink, sleep and +watching, motion and rest, the retentions and excretions, and the +affections of the mind,--he was, as I have said, of the school of +sensible practitioners, in distinction from that vast community of +quacks, with or without the diploma, who think the chief end of man +is to support apothecaries, and are never easy until they can get +every patient upon a regular course of something nasty or noxious. +Nobody was so precise in his directions about diet, air, and +exercise, as Dr. Jackson. He had the same dislike to the a peu pres, +the about so much, about so often, about so long, which I afterwards +found among the punctilious adherents of the numerical system at La +Pitie. + +He used to insist on one small point with a certain philological +precision, namely, the true meaning of the word "cure." He would +have it that to cure a patient was simply to care for him. I refer +to it as showing what his idea was of the relation of the physician +to the patient. It was indeed to care for him, as if his life were +bound up in him, to watch his incomings and outgoings, to stand guard +at every avenue that disease might enter, to leave nothing to chance; +not merely to throw a few pills and powders into one pan of the +scales of Fate, while Death the skeleton was seated in the other, but +to lean with his whole weight on the side of life, and shift the +balance in its favor if it lay in human power to do it. Such +devotion as this is only to be looked for in the man who gives +himself wholly up to the business of healing, who considers Medicine +itself a Science, or if not a science, is willing to follow it as an +art,--the noblest of arts, which the gods and demigods of ancient +religions did not disdain to practise and to teach. + +The same zeal made him always ready to listen to any new suggestion +which promised to be useful, at a period of life when many men find +it hard to learn new methods and accept new doctrines. Few of his +generation became so accomplished as he in the arts of direct +exploration; coming straight from the Parisian experts, I have +examined many patients with him, and have had frequent opportunities +of observing his skill in percussion and auscultation. + +One element in his success, a trivial one compared with others, but +not to be despised, was his punctuality. He always carried two +watches,--I doubt if he told why, any more than Dr. Johnson told what +he did with the orange-peel,--but probably with reference to this +virtue. He was as much to be depended upon at the appointed time as +the solstice or the equinox. There was another point I have heard +him speak of as an important rule with him; to come at the hour when +he was expected; if he had made his visit for several days +successively at ten o'clock, for instance, not to put it off, if be +could possibly help it, until eleven, and so keep a nervous patient +and an anxious family waiting for him through a long, weary hour. + +If I should attempt to characterize his teaching, I should say that +while it conveyed the best results of his sagacious and extended +observation, it was singularly modest, cautious, simple, sincere. +Nothing was for show, for self-love; there was no rhetoric, no +declamation, no triumphant "I told you so," but the plain statement +of a clear-headed honest man, who knows that he is handling one of +the gravest subjects that interest humanity. His positive +instructions were full of value, but the spirit in which he taught +inspired that loyal love of truth which lies at the bottom of all +real excellence. + +I will not say that, during his long career, Dr. Jackson never made +an enemy. I have heard him tell how, in his very early days, old Dr. +Danforth got into a towering passion with him about some professional +consultation, and exploded a monosyllable or two of the more +energetic kind on the occasion. I remember that that somewhat +peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson +succeeded to his place as Professor of Theory and Practice. A young +man of Dr. Jackson's talent and energy could hardly take the position +that belonged to him without crowding somebody in a profession where +three in a bed is the common rule of the household. But he was a +peaceful man and a peace-maker all his days. No man ever did more, +if so much, to produce and maintain the spirit of harmony for which +we consider our medical community as somewhat exceptionally +distinguished. + +If this harmony should ever be threatened, I could wish that every +impatient and irritable member of the profession would read that +beautiful, that noble Preface to the "Letters," addressed to John +Collins Warren. I know nothing finer in the medical literature of +all time than this Prefatory Introduction. It is a golden prelude, +fit to go with the three great Prefaces which challenge the +admiration of scholars,--Calvin's to his Institutes, De Thou's to his +History, and Casaubon's to his Polybius,--not because of any learning +or rhetoric, though it is charmingly written, but for a spirit +flowing through it to which learning and rhetoric are but as the +breath that is wasted on the air to the Mood that warms the heart. + +Of a similar character is this short extract which I am permitted to +make from a private letter of his to a dear young friend. He was +eighty-three years old at the time of writing it. + +"I have not loved everybody whom I have known, but I have striven to +see the good points in the characters of all men and women. At first +I must have done this from something in my own nature, for I was not +aware of it, and yet was doing it without any plan, when one day, +sixty years ago, a friend whom I loved and respected said this to me, +'Ah, James, I see that you are destined to succeed in the world, and +to make friends, because you are so ready to see the good point in +the characters of those you meet.'" + +I close this imperfect notice of some features in the character of +this most honored and beloved of physicians by applying to him the +words which were written of William Heberden, whose career was not +unlike his own, and who lived to the same patriarchal age. + +"From his early youth he had always entertained a deep sense of +religion, a consummate love of virtue, an ardent thirst after +knowledge, and an earnest desire to promote the welfare and happiness +of all mankind. By these qualities, accompanied with great sweetness +of manners, he acquired the love and esteem of all good men, in a +degree which perhaps very few have experienced; and after passing an +active life with the uniform testimony of a good conscience, he +became an eminent example of its influence, in the cheerfulness and +serenity of his latest age." + +Such was the man whom I offer to you as a model, young gentlemen, at +the outset of your medical career. I hope that many of you will +recognize some traits of your own special teachers scattered through +various parts of the land in the picture I have drawn. Let me assure +you that whatever you may learn in this or any other course of public +lectures,--and I trust you will learn a great deal,--the daily +guidance, counsel, example, of your medical father, for such the Oath +of Hippocrates tells you to consider your preceptor, will, if he is +in any degree like him of whom I have spoken, be the foundation on +which all that we teach is reared, and perhaps outlive most of our +teachings, as in Dr. Jackson's memory the last lessons that remained +with him were those of his Old Master. + + + + + + +THE MEDICAL PROFESSION IN MASSACHUSETTS. + +A Lecture of a Course by members of the Massachusetts Historical +Society, delivered before the Lowell Institute, January 29, 1869. + +The medical history of eight generations, told in an hour, must be in +many parts a mere outline. The details I shall give will relate +chiefly to the first century. I shall only indicate the leading +occurrences, with the more prominent names of the two centuries which +follow, and add some considerations suggested by the facts which have +been passed in review. + +A geographer who was asked to describe the tides of Massachusetts +Bay, would have to recognize the circumstance that they are a limited +manifestation of a great oceanic movement. To consider them apart +from this, would be to localize a planetary phenomenon, and to +provincialize a law of the universe. The art of healing in +Massachusetts has shared more or less fully and readily the movement +which, with its periods of ebb and flow, has been raising its level +from age to age throughout the better part of Christendom. Its +practitioners brought with them much of the knowledge and many of the +errors of the Old World; they have always been in communication with +its wisdom and its folly; it is not without interest to see how far +the new conditions in which they found themselves have been favorable +or unfavorable to the growth of sound medical knowledge and practice. + +The state of medicine is an index of the civilization of an age and +country,--one of the best, perhaps, by which it can be judged. +Surgery invokes the aid of all the mechanical arts. From the rude +violences of the age of stone,--a relic of which we may find in the +practice of Zipporah, the wife of Moses,--to the delicate operations +of to-day upon patients lulled into temporary insensibility, is a +progress which presupposes a skill in metallurgy and in the labors of +the workshop and the laboratory it has taken uncounted generations to +accumulate. Before the morphia which deadens the pain of neuralgia, +or the quinine which arrests the fit of an ague, can find their place +in our pharmacies, commerce must have perfected its machinery, and +science must have refined its processes, through periods only to be +counted by the life of nations. Before the means which nature and +art have put in the hands of the medical practitioner can be fairly +brought into use, the prejudices of the vulgar must be overcome, the +intrusions of false philosophy must be fenced out, and the +partnership with the priesthood dissolved. All this implies that +freedom and activity of thought which belong only to the most +advanced conditions of society; and the progress towards this is by +gradations as significant of wide-spread changes, as are the varying +states of the barometer of far-extended conditions of the atmosphere. + +Apart, then, from its special and technical interest, my subject has +a meaning which gives a certain importance, and even dignity, to +details in themselves trivial and almost unworthy of record. A +medical entry in Governor Winthrop's journal may seem at first sight +a mere curiosity; but, rightly interpreted, it is a key to his whole +system of belief as to the order of the universe and the relations +between man and his Maker. Nothing sheds such light on the +superstitions of an age as the prevailing interpretation and +treatment of disease. When the touch of a profligate monarch was a +cure for one of the most inveterate of maladies, when the common +symptoms of hysteria were prayed over as marks of demoniacal +possession, we might well expect the spiritual realms of thought to +be peopled with still stranger delusions. + +Let us go before the Pilgrims of the Mayflower, and look at the +shores on which they were soon to land. A wasting pestilence had so +thinned the savage tribes that it was sometimes piously interpreted +as having providentially prepared the way for the feeble band of +exiles. Cotton Mather, who, next to the witches, hated the +"tawnies," "wild beasts," "blood-hounds," "rattlesnakes," +"infidels," as in different places he calls the unhappy Aborigines, +describes the condition of things in his lively way, thus: +"The Indians in these Parts had newly, even about a Year or Two +before, been visited with such a prodigious Pestilence; as carried +away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of +Twenty) among them so that the Woods were almost cleared of those +pernicious Creatures to make Room for a better Growth." + +What this pestilence was has been much discussed. It is variously +mentioned by different early writers as "the plague," "a great and +grievous plague," "a sore consumption," as attended with spots which +left unhealed places on those who recovered, as making the "whole +surface yellow as with a garment." Perhaps no disease answers all +these conditions so well as smallpox. We know from different sources +what frightful havoc it made among the Indians in after years,--in +1631, for instance, when it swept away the aboriginal inhabitants of +"whole towns," and in 1633. We have seen a whole tribe, the Mandans, +extirpated by it in our own day. The word "plague" was used very +vaguely, as in the description of the "great sickness" found among +the Indians by the expedition of 1622. This same great sickness +could hardly have been yellow fever, as it occurred in the month of +November. I cannot think, therefore, that either the scourge of the +East or our Southern malarial pestilence was the disease that wasted +the Indians. As for the yellowness like a garment, that is too +familiar to the eyes of all who have ever looked on the hideous mask +of confluent variola. + +Without the presence or the fear of these exotic maladies, the +forlorn voyagers of the Mayflower had sickness enough to contend +with. At their first landing at Cape Cod, gaunt and hungry and +longing for fresh food, they found upon the sandy shore "great +mussel's, and very fat and full of sea-pearl." Sailors and +passengers indulged in the treacherous delicacy; which seems to have +been the sea-clam; and found that these mollusks, like the shell the +poet tells of, remembered their august abode, and treated the way- +worn adventurers to a gastric reminiscence of the heaving billows. +In the mean time it blew and snowed and froze. The water turned to +ice on their clothes, and made them many times like coats of iron. +Edward Tilley had like to have "sounded" with cold. The gunner, too, +was sick unto death, but "hope of trucking" kept him on his feet,--a +Yankee, it should seem, when he first touched the shore of New +England. Most, if not all, got colds and coughs, which afterwards +turned to scurvy, whereof many died. + +How can we wonder that the crowded and tempest-tossed voyagers, many +of them already suffering, should have fallen before the trials of +the first winter in Plymouth? Their imperfect shelter, their +insufficient supply of bread, their salted food, now in unwholesome +condition, account too well for the diseases and the mortality that +marked this first dreadful season; weakness, swelling of the limbs, +and other signs of scurvy, betrayed the want of proper nourishment +and protection from the elements. In December six of their number +died, in January eight, in February, seventeen, in March thirteen. +With the advance of spring the mortality diminished, the sick and +lame began to recover, and the colonists, saddened but not +disheartened, applied themselves to the labors of the opening year. + +One of the most pressing needs of the early colonists must have been +that of physicians and surgeons. In Mr. Savage's remarkable +Genealogical Dictionary of the first settlers who came over before +1692 and their descendants to the third generation, I find scattered +through the four crowded volumes the names of one hundred and thirty- +four medical practitioners. Of these, twelve, and probably many +more, practised surgery; three were barber-surgeons. A little +incident throws a glimmer from the dark lantern of memory upon +William Direly, one of these practitioners with the razor and the +lancet. He was lost between Boston and Roxbury in a violent tempest +of wind and snow; ten days afterwards a son was born to his widow, +and with a touch of homely sentiment, I had almost said poetry, they +called the little creature "Fathergone" Direly. Six or seven, +probably a larger number, were ministers as well as physicians, one +of whom, I am sorry to say, took to drink and tumbled into the +Connecticut River, and so ended. One was not only doctor, but also +schoolmaster and poet. One practised medicine and kept a tavern. +One was a butcher, but calls himself a surgeon in his will, a union +of callings which suggests an obvious pleasantry. One female +practitioner, employed by her own sex,--Ann Moore,--was the precursor +of that intrepid sisterhood whose cause it has long been my pleasure +and privilege to advocate on all fitting occasions. + +Outside of this list I must place the name of Thomas Wilkinson, who +was complained of, is 1676, for practising contrary to law. + +Many names in the catalogue of these early physicians have been +associated, in later periods, with the practice of the profession,-- +among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge, +Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams, +Woodward. Touton was a Huguenot, Burchsted a German from Silesia, +Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the +honor of the profession, was only Peacock disguised under this alias, +which would not, I fear, prove very attractive to patients. + +What doctrines and practice were these colonists likely to bring, +with them? + +Two principal schools of medical practice prevailed in the Old World +during the greater part of the seventeenth century. The first held +to the old methods of Galen: its theory was that the body, the +microcosm, like the macrocosm, was made up of the four elements-- +fire, air, water, earth; having respectively the qualities hot, dry, +moist, cold. The body was to be preserved in health by keeping each +of these qualities in its natural proportion; heat, by the proper +temperature; moisture, by the due amount of fluid; and so as to the +rest. Diseases which arose from excess of heat were to be attacked +by cooling remedies; those from excess of cold, by heating ones; and +so of the other derangements of balance. This was truly the +principle of contraries contrariis, which ill-informed persons have +attempted to make out to be the general doctrine of medicine, whereas +there is no general dogma other than this: disease is to be treated +by anything that is proved to cure it. The means the Galenist +employed were chiefly diet and vegetable remedies, with the use of +the lancet and other depleting agents. He attributed the four +fundamental qualities to different vegetables, in four different +degrees; thus chicory was cold in the fourth degree, pepper was hot +in the fourth, endive was cold and dry in the second, and bitter +almonds were hot in the first and dry in the second degree. When we +say "cool as a cucumber," we are talking Galenism. The seeds of that +vegetable ranked as one of "the four greater cold seeds" of this +system. + +Galenism prevailed mostly in the south of Europe and France. The +readers of Moliere will have no difficulty in recalling some of its +favorite modes of treatment, and the abundant mirth he extracted from +them. + +These Galenists were what we should call "herb-doctors" to-day. +Their insignificant infusions lost credit after a time; their +absurdly complicated mixtures excited contempt, and their nauseous +prescriptions provoked loathing and disgust. A simpler and bolder +practice found welcome in Germany, depending chiefly on mineral +remedies, mercury, antimony, sulphur, arsenic, and the use, sometimes +the secret use, of opium. Whatever we think of Paracelsus, the chief +agent in the introduction of these remedies, and whatever limits we +may assign to the use of these long-trusted mineral drugs, there can +be no doubt that the chemical school, as it was called, did a great +deal towards the expurgation of the old, overloaded, and repulsive +pharmacopoeia. We shall find evidence in the practice of our New- +England physicians of the first century, that they often employed +chemical remedies, and that, by the early part of the following +century, their chief trust was in the few simple, potent drugs of +Paracelsus. + +We have seen that many of the practitioners of medicine, during the +first century of New England, were clergymen. This relation between +medicine and theology has existed from a very early period; from the +Egyptian priest to the Indian medicine-man, the alliance has been +maintained in one form or another. The partnership was very common +among our British ancestors. Mr. Ward, the Vicar of Stratford-on- +Avon, himself a notable example of the union of the two characters, +writing about 1660, says, + +"The Saxons had their blood-letters, but under the Normans physicke, +begunne in England; 300 years agoe itt was not a distinct profession +by itself, but practised by men in orders, witness Nicholas de +Ternham, the chief English physician and Bishop of Durham; Hugh of +Evesham, a physician and cardinal; Grysant, physician and pope; John +Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul +Bush, a bachelor of divinitie in Oxford, was a man well read in +physick as well as divinitie, he was the first bishop of Bristol." + +"Again in King Richard the Second's time physicians and divines were +not distinct professions; for one Tydeman, Bishop of Landaph and +Worcester, was physician to King Richard the Second." + +This alliance may have had its share in creating and keeping up the +many superstitions which have figured so largely in the history of +medicine. It is curious to see that a medical work left in +manuscript by the Rev. Cotton Mather and hereafter to be referred to, +is running over with follies and superstitious fancies; while his +contemporary and fellow-townsman, William Douglass, relied on the +same few simple remedies which, through Dr. Edward Holyoke and Dr. +James Jackson, have come down to our own time, as the most important +articles of the materia medica. + +Let us now take a general glance at some of the conditions of the +early settlers; and first, as to the healthfulness of the climate. +The mortality of the season that followed the landing of the Pilgrims +at Plymouth has been sufficiently accounted for. After this, the +colonists seem to have found the new country agreeing very well with +their English constitutions. Its clear air is the subject of eulogy. +Its dainty springs of sweet water are praised not only by Higginson +and Wood, but even the mischievous Morton says, that for its delicate +waters Canaan came not near this country." There is a tendency to +dilate on these simple blessings, which reminds one a little of the +Marchioness in Dickens's story, with her orange-peel-and-water +beverage. Still more does one feel the warmth of coloring,--such as +we expect from converts to a new faith, and settlers who want to +entice others over to their clearings, when Winslow speaks, in 1621, +of "abundance of roses, white, red, and damask; single, but very +sweet indeed;" a most of all, however, when, in the same connection, +he says, "Here are grapes white and red, and very sweet and strong +also." This of our wild grape, a little vegetable Indian, which +scalps a civilized man's mouth, as his animal representative scalps +his cranium. But there is something quite charming in Winslow's +picture of the luxury in which they are living. Lobsters, oysters, +eels, mussels, fish and fowl, delicious fruit, including the grapes +aforesaid,--if they only had "kine, horses, and sheep," he makes no +question but men would live as contented here as in any part of the +world. We cannot help admiring the way in which they took their +trials, and made the most of their blessings. + +"And how Content they were," says Cotton Mather, "when an Honest Man, +as I have heard, inviting his Friends to a Dish of Clams, at the +Table gave Thanks to Heaven, who had given them to suck the abundance +of the Seas, and of the Treasures Aid in the Sands!" + +Strangely enough, as it would seem, except for this buoyant +determination to make the best of everything, they hardly appear to +recognize the difference of the climate from that which they had +left. After almost three years' experience, Winslow says, he can +scarce distinguish New England from Old England, in respect of heat +and cold, frost, snow, rain, winds, etc. The winter, he thinks (if +there is a difference), is sharper and longer; but yet he may be +deceived by the want of the comforts he enjoyed at home. He cannot +conceive any climate to agree better with the constitution of the +English, not being oppressed with extremity of heats, nor nipped by +biting cold: + +"By which means, blessed be God, we enjoy our health, notwithstanding +those difficulties we have undergone, in such a measure as would have +been admired, if we had lived in England with the like means." + +Edward Johnson, after mentioning the shifts to which they were put +for food, says,-- + +"And yet, methinks, our children are as cheerful, fat, and lusty, +with feeding upon those mussels, clams, and other fish, as they were +in England with their fill of bread." + +Higginson, himself a dyspeptic, "continually in physic," as he says, +and accustomed to dress in thick clothing, and to comfort his stomach +with drink that was "both strong and stale,"--the "jolly good ale and +old," I suppose, of free and easy Bishop Still's song,--found that he +both could and did oftentimes drink New England water very well, +--which he seems to look upon as a remarkable feat. He could go as +lightclad as any, too, with only a light stuff cassock upon his +shirt, and stuff breeches without linings. Two of his children were +sickly: one,--little misshapen Mary,--died on the passage, and, in +her father's words, "was the first in our ship that was buried in the +bowels of the great Atlantic sea;" the other, who had been "most +lamentably handled" by disease, recovered almost entirely "by the +very wholesomeness of the air, altering, digesting, and drying up the +cold and crude humors of the body." Wherefore, he thinks it a wise +course for all cold complexions to come to take physic in New +England, and ends with those often quoted words, that "a sup of New +England's air is better than a whole draught of Old England's ale." +Mr. Higginson died, however, "of a hectic fever," a little more than +a year after his arrival. + +The medical records which I shall cite show that the colonists were +not exempt from the complaints of the Old World. Besides the common +diseases to which their descendants are subject, there were two +others, to say nothing of the dreaded small-pox, which later medical +science has disarmed,--little known among us at the present day, but +frequent among the first settlers. The first of these was the +scurvy, already mentioned, of which Winthrop speaks in 1630, saying, +that it proved fatal to those who fell into discontent, and lingered +after their former conditions in England; the poor homesick creatures +in fact, whom we so forget in our florid pictures of the early times +of the little band in the wilderness. Many who were suffering from +scurvy got well when the Lyon arrived from England, bringing store of +juice of lemons. The Governor speaks of another case in 1644; and it +seems probable that the disease was not of rare occurrence. + +The other complaint from which they suffered, but which has nearly +disappeared from among us, was intermittent fever, or fever and ague. +I investigated the question as to the prevalence of this disease in +New England, in a dissertation, which was published in a volume with +other papers, in the year 1838. I can add little to the facts there +recorded. One which escaped me was, that Joshua Scottow, in "Old +Men's Tears," dated 1691, speaks of "shaking agues," as among the +trials to which they had been subjected. The outline map of New +England, accompanying the dissertation above referred to, indicates +all the places where I had evidence that the disease had originated. +It was plain enough that it used to be known in many localities where +it has long ceased to be feared. Still it was and is remarkable to +see what a clean bill of health in this particular respect our barren +soil inherited with its sterility. There are some malarious spots on +the edge of Lake Champlain, arid there have been some temporary +centres of malaria, within the memory of man, on one or more of our +Massachusetts rivers, but these are harmless enough, for the most +part, unless the millers dam them, when they are apt to retaliate +with a whiff from their meadows, that sets the whole neighborhood +shaking with fever and ague. + + +The Pilgrims of the Mayflower had with them a good physician, a man +of standing, a deacon of their church, one whom they loved and +trusted, Dr. Samuel Fuller. But no medical skill could keep cold and +hunger and bad food, and, probably enough, desperate homesickness in +some of the feebler sort, from doing their work. No detailed record +remains of what they suffered or what was attempted for their relief +during the first sad winter. The graves of those who died were +levelled and sowed with grain that the losses of the little band +might not be suspected by the savage tenants of the wilderness, and +their story remains untold. + +Of Dr. Fuller's practice, at a later period, we have an account in a +letter of his to Governor Bradford, dated June, 1630. "I have been +to Matapan" (now Dorchester), he says, "and let some twenty of those +people blood." Such wholesale depletion as this, except with avowed +homicidal intent, is quite unknown in these days; though I once saw +the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy, +order some ten or fifteen patients, taken almost indiscriminately, to +be bled in a single morning. + +Dr. Fuller's two visits to Salem, at the request of Governor +Endicott, seem to have been very satisfactory to that gentleman. +Morton, the wild fellow of Merry Mount, gives a rather questionable +reason for the Governor's being so well pleased with the physician's +doings. The names under which he mentions the two personages, it +will be seen, are not intended to be complimentary. "Dr. Noddy did a +great cure for Captain Littleworth. He cured him of a disease called +a wife." William Gager, who came out with Winthrop, is spoken of as +"a right godly man and skilful chyrurgeon, but died of a malignant +fever not very long after his arrival." + +Two practitioners of the ancient town of Newbury are entitled to +special notice, for different reasons. The first is Dr. John Clark, +who is said by tradition to have been the first regularly educated +physician who resided in New England. His portrait, in close-fitting +skull-cap, with long locks and venerable flowing beard, is familiar +to our eyes on the wall of our Society's antechamber. His left hand +rests upon a skull, his right hand holds an instrument which deserves +a passing comment. It is a trephine, a surgical implement for +cutting round pieces out of broken skulls, so as to get at the +fragments which have been driven in, and lift them up. It has a +handle like that of a gimlet, with a claw like a hammer, to lift +with, I suppose, which last contrivance I do not see figured in my +books. But the point I refer to is this: the old instrument, the +trepan, had a handle like a wimble, what we call a brace or bit- +stock. The trephine is not mentioned at all in Peter Lowe's book, +London, 1634; nor in Wiseman's great work on Surgery, London, 1676; +nor in the translation of Dionis, published by Jacob Tonson, in 1710. +In fact it was only brought into more general use by Cheselden and +Sharpe so late as the beginning of the last century. As John Clark +died in 1661, it is remarkable to see the last fashion in the way of +skull-sawing contrivances in his hands,--to say nothing of the claw +on the handle, and a Hey's saw, so called in England, lying on the +table by him, and painted there more than a hundred years before Hey +was born. This saw is an old invention, perhaps as old as +Hippocrates, and may be seen figured in the "Armamentarium +Chirurgicum" of Scultetus, or in the Works of Ambroise Pare. + +Dr. Clark is said to have received a diploma before be came, for +skill in lithotomy. He loved horses, as a good many doctors do, and +left a good property, as they all ought to do. His grave and noble +presence, with the few facts concerning him, told with more or less +traditional authority, give us the feeling that the people of +Newbury, and afterwards of Boston, had a wise and skilful medical +adviser and surgeon in Dr. John Clark. + +The venerable town of Newbury had another physician who was less +fortunate. The following is a court record of 1652: + +"This is to certify whom it may concern, that we the subscribers, +being called upon to testify against doctor William Snelling for +words by him uttered, affirm that being in way of merry discourse, a +health being drank to all friends, he answered, + + "I'll pledge my friends, + And for my foes + A plague for their heels + And,'--- + +[a similar malediction on the other extremity of their feet.] + +"Since when he hath affirmed that he only intended the proverb used +in the west country, nor do we believe he intended otherwise. + +"[Signed] +"WILLIAM THOMAS. +"THOMAS MILWARD. + +"March 12th 1651, All which I acknowledge, and am sorry I did not +expresse my intent, or that I was so weak as to use so foolish a +proverb. + +"[Signed] +"GULIELMUS SNELLING." + + +Notwithstanding this confession and apology, the record tells us that +"William Snelling in his presentment for cursing is fined ten +shillings and the fees of court." + +I will mention one other name among those of the Fathers of the +medical profession in New England. The "apostle" Eliot says, writing +in 1647, "We never had but one anatomy in the country, which Mr. +Giles Firman, now in England, did make and read upon very well." + +Giles Firmin, as the name is commonly spelled, practised physic in +this country for a time. He seems to have found it a poor business; +for, in a letter to Governor Winthrop, he says, "I am strongly sett +upon to studye divinitie: my studyes else must be lost, for physick +is but a meene helpe." + +Giles Firmin's Lectures on Anatomy were the first scientific +teachings of the New World. While the Fathers were enlightened +enough to permit such instructions, they were severe in dealing with +quackery; for, in 1631, our court records show that one Nicholas +Knopp, or Knapp, was sentenced to be fined or whipped "for taking +upon him to cure the scurvey by a water of noe worth nor value, which +he solde att a very deare rate." Empty purses or sore backs would be +common with us to-day if such a rule were enforced. + +Besides the few worthies spoken of, and others whose names I have not +space to record, we must remember that there were many clergymen who +took charge of the bodies as well as the souls of their patients, +among them two Presidents of Harvard College, Charles Chauncy and +Leonard Hoar,--and Thomas Thacher, first minister of the "Old South," +author of the earliest medical treatises printed in the country,[A +Brief Rule to Guide the Common People in Small pox and +Measles. 1674.] whose epitaph in Latin and Greek, said to have been +written by Eleazer, an "Indian Youth" and a member of the Senior +Class of Harvard College, may be found in the "Magnalia." I miss +this noble savage's name in our triennial catalogue; and as there is +many a slip between the cup and lip, one is tempted to guess that he +may have lost his degree by some display of his native instinct,-- +possibly a flourish of the tomahawk or scalping-knife. However this +may have been, the good man he celebrated was a notable instance of +the Angelical Conjunction, as the author of the "Magnalia" calls it, +of the offices of clergyman and medical practitioner. + +Michael Wigglesworth, author of the "Day of Doom," attended the sick, +"not only as a Pastor, but as a Physician too, and this, not only in +his own town, but also in all those of the vicinity." Mather says of +the sons of Charles Chauncy, "All of these did, while they had +Opportunity, Preach the Gospel; and most, if not all of them, like +their excellent Father before them, had an eminent skill in physick +added unto their other accomplishments," etc. Roger Williams is said +to have saved many in a kind of pestilence which swept away many +Indians. + +To these names must be added, as sustaining a certain relation to the +healing art, that of the first Governor Winthrop, who is said by John +Cotton to have been "Help for our Bodies by Physick [and] for our +Estates by Law," and that of his son, the Governor of Connecticut, +who, as we shall see, was as much physician as magistrate. + +I had submitted to me for examination, in 1862, a manuscript found +among the Winthrop Papers, marked with the superscription, "For my +worthy friend Mr. Wintrop," dated in 1643, London, signed Edward +Stafford, and containing medical directions and prescriptions. It +may be remembered by some present that I wrote a report on this +paper, which was published in the "Proceedings" of this Society. +Whether the paper was written for Governor John Winthrop of +Massachusetts, or for his son, Governor John of Connecticut, there is +no positive evidence that I have been able to obtain. It is very +interesting, however, as giving short and simple practical +directions, such as would be most like to be wanted and most useful, +in the opinion of a physician in repute of that day. + +The diseases prescribed for are plague, small-pox, fevers, king's +evil, insanity, falling-sickness, and the like; with such injuries as +broken bones, dislocations, and burning with gunpowder. The remedies +are of three kinds: simples, such as St. John's wort, Clown's all- +heal, elder, parsley, maidenhair, mineral drugs, such as lime, +saltpetre, Armenian bole, crocus metallorum, or sulphuret of +antimony; and thaumaturgic or mystical, of which the chief is, "My +black powder against the plague, small-pox; purples, all sorts of +feavers; Poyson; either, by Way of Prevention or after Infection." +This marvellous remedy was made by putting live toads into an earthen +pot so as to half fill it, and baking and burning them "in the open +ayre, not in an house,"--concerning which latter possibility I +suspect Madam Winthrop would have had something to say,--until they +could be reduced by pounding, first into a brown, and then into a +black, powder. Blood-letting in some inflammations, fasting in the +early stage of fevers, and some of those peremptory drugs with which +most of us have been well acquainted in our time, the infragrant +memories of which I will not pursue beyond this slight allusion, are +among his remedies. + +The Winthrops, to one of whom Dr. Stafford's directions were +addressed, were the medical as well as the political advisers of +their fellow-citizens for three or four successive generations. One +of them, Governor John of Connecticut, practised so extensively, +that, but for his more distinguished title in the State, he would +have been remembered as the Doctor. The fact that he practised in +another colony, for the most part, makes little difference in the +value of the records we have of his medical experience, which have +fortunately been preserved, and give a very fair idea, in all +probability, of the way in which patients were treated in +Massachusetts, when they fell into intelligent and somewhat educated +hands, a little after the middle of the seventeenth century: + +I have before me, while writing, a manuscript collection of the +medical cases treated by him, and recorded at the time in his own +hand, which has been intrusted to me by our President, his +descendant. + +They are generally marked Hartford, and extend from the year 1657 to +1669. From these, manuscripts, and from the letters printed in the +Winthrop Papers published by our Society, I have endeavored to obtain +some idea of the practice of Governor John Winthrop, Junior. The +learned eye of Mr. Pulsifer would have helped me, no doubt, as it has +done in other cases; but I have ventured this time to attempt finding +my own way among the hieroglyphics of these old pages. By careful +comparison of many prescriptions, and by the aid of Schroder, Salmon, +Culpeper, and other old compilers, I have deciphered many of his +difficult paragraphs with their mysterious recipes. + +The Governor employed a number of the simples dear to ancient women, +--elecampane and elder and wormwood and anise and the rest; but he +also employed certain mineral remedies, which he almost always +indicates by their ancient symbols, or by a name which should leave +them a mystery to the vulgar. I am now prepared to reveal the mystic +secrets of the Governor's beneficent art, which rendered so many good +and great as well as so many poor and dependent people his debtors,- +at least, in their simple belief,--for their health and their lives. + +His great remedy, which he gave oftener than any other, was nitre; +which he ordered in doses of twenty or thirty grains to adults, and +of three grains to infants. Measles, colics, sciatica, headache, +giddiness, and many other ailments, all found themselves treated, and +I trust bettered, by nitre; a pretty safe medicine in moderate doses, +and one not likely to keep the good Governor awake at night, thinking +whether it might not kill, if it did not cure. We may say as much +for spermaceti, which he seems to have considered "the sovereign'st +thing on earth" for inward bruises, and often prescribes after falls +and similar injuries. + +One of the next remedies, in point of frequency, which he was in the +habit of giving, was (probably diaphoretic) antimony; a mild form of +that very active metal, and which, mild as it was, left his patients +very commonly with a pretty strong conviction that they had been +taking something that did not exactly agree with them. Now and then +he gave a little iron or sulphur or calomel, but very rarely; +occasionally, a good, honest dose of rhubarb or jalap; a taste of +stinging horseradish, oftener of warming guiacum; sometimes an +anodyne, in the shape of mithridate,--the famous old farrago, which +owed its virtue to poppy juice; [This is the remedy which a Boston +divine tried to simplify. See Electuarium Novum Alexipharmacum, by +Rev. Thomas Harward, lecturer at the Royal Chappell. Boston, 1732. +This tract is in our Society's library.] very often, a harmless +powder of coral; less frequently, an inert prescription of pleasing +amber; and (let me say it softly within possible hearing of his +honored descendant), twice or oftener,--let us hope as a last +resort,--an electuary of millipedes,--sowbugs, if we must give them +their homely English name. One or two other prescriptions, of the +many unmentionable ones which disgraced the pharmacopoeia of the +seventeenth century, are to be found, but only in very rare +instances, in the faded characters of the manuscript. + +The excellent Governor's accounts of diseases are so brief, that we +get only a very general notion of the complaints for which he +prescribed. Measles and their consequences are at first more +prominent than any other one affection, but the common infirmities of +both sexes and of all ages seem to have come under his healing hand. +Fever and ague appears to have been of frequent occurrence. + +His published correspondence shows that many noted people were in +communication with him as his patients. Roger Williams wants a +little of his medicine for Mrs. Weekes's daughter; worshipful John +Haynes is in receipt of his powders; troublesome Captain Underhill +wants "a little white vitterall" for his wife, and something to cure +his wife's friend's neuralgia, (I think his wife's friend's husband +had a little rather have had it sent by the hands of Mrs. Underhill, +than by those of the gallant and discursive captain); and pious John +Davenport says, his wife "tooke but one halfe of one of the papers" +(which probably contained the medicine he called rubila), "but could +not beare the taste of it, and is discouraged from taking any more;" +and honored William Leete asks for more powders for his "poore little +daughter Graciana," though he found it "hard to make her take it," +delicate, and of course sensitive, child as she was, languishing and +dying before her time, in spite of all the bitter things she +swallowed,--God help all little children in the hands of dosing +doctors and howling dervishes! Restless Samuel Gorton, now tamed by +the burden of fourscore and two years, writes so touching an account +of his infirmities, and expresses such overflowing gratitude for the +relief he has obtained from the Governor's prescriptions, wondering +how "a thing so little in quantity, so little in sent, so little in +taste, and so little to sence in operation, should beget and bring +forth such efects," that we repent our hasty exclamation, and bless +the memory of the good Governor, who gave relief to the worn-out +frame of our long-departed brother, the sturdy old heretic of Rhode +Island. + +What was that medicine which so frequently occurs in the printed +letters under the name of "rubila"? It is evidently a secret remedy, +and, so far as I know, has not yet been made out. I had almost given +it up in despair, when I found what appears to be a key to the +mystery. In the vast multitude of prescriptions contained in the +manuscripts, most of them written in symbols, I find one which I thus +interpret: + +"Four grains of (diaphoretic) antimony, with twenty grains of nitre, +with a little salt of tin, making rubila." Perhaps something was +added to redden the powder, as he constantly speaks of "rubifying" +or "viridating" his prescriptions; a very common practice of +prescribers, when their powders look a little too much like plain +salt or sugar. + + +Waitstill Winthrop, the Governor's son, "was a skilful physician," +says Mr. Sewall, in his funeral sermon; "and generously gave, not +only his advice, but also his Medicines, for the healing of the Sick, +which, by the Blessing of God, were made successful for the recovery +of many." "His son John, a member of the Royal Society, speaks of +himself as 'Dr. Winthrop,' and mentions one of his own prescriptions +in a letter to Cotton Mather." Our President tells me that there was +an heirloom of the ancient skill in his family, within his own +remembrance, in the form of a certain precious eye-water, to which +the late President John Quincy Adams ascribed rare virtue, and which +he used to obtain from the possessor of the ancient recipe. + +These inherited prescriptions are often treasured in families, I do +not doubt, for many generations. When I was yet of trivial age, and +suffering occasionally, as many children do, from what one of my +Cambridgeport schoolmates used to call the "ager,"--meaning thereby +toothache or face-ache,--I used to get relief from a certain plaster +which never went by any other name in the family than "Dr. Oliver." + +Dr. James Oliver was my great-great-grandfather, graduated in 1680, +and died in 1703. This was, no doubt, one of his nostrums; for +nostrum, as is well known, means nothing more than our own or my own +particular medicine, or other possession or secret, and physicians in +old times used to keep their choice recipes to themselves a good +deal, as we have had occasion to see. + +Some years ago I found among my old books a small manuscript marked +"James Oliver. This Book Begun Aug. 12, 1685." It is a rough sort +of account-book, containing among other things prescriptions for +patients, and charges for the same, with counter-charges for the +purchase of medicines and other matters. Dr. Oliver practised in +Cambridge, where may be seen his tomb with inscriptions, and with +sculptured figures that look more like Diana of the Ephesians, as +given in Calmet's Dictionary, than like any angels admitted into good +society here or elsewhere. + +I do not find any particular record of what his patients suffered +from, but I have carefully copied out the remedies he mentions, and +find that they form a very respectable catalogue. Besides the usual +simples, elder, parsley, fennel, saffron, snake-root, wormwood, I +find the Elixir Proprietatis, with other elixire and cordials, as if +he rather fancied warming medicines; but he called in the aid of some +of the more energetic remedies, including iron, and probably mercury, +as he bought two pounds of it at one time. + +The most interesting item is his bill against the estate of Samuel +Pason of Roxbury, for services during his last illness. He attended +this gentleman,--for such he must have been, by the amount of physic +which he took, and which his heirs paid for,--from June 4th, 1696, to +September 3d of the same year, three months. I observe he charges +for visits as well as for medicines, which is not the case in most of +his bills. He opens the attack with a carminative appeal to the +visceral conscience, and follows it up with good hard-hitting +remedies for dropsy,--as I suppose the disease would have been +called,--and finishes off with a rallying dose of hartshorn and iron. + +It is a source of honest pride to his descendant that his bill, which +was honestly paid, as it seems to have been honorably earned, +amounted to the handsome total of seven pounds and two shillings. +Let me add that he repeatedly prescribes plaster, one of which was +very probably the "Dr. Oliver" that soothed my infant griefs, and for +which I blush to say that my venerated ancestor received from Goodman +Hancock the painfully exiguous sum of no pounds, no shillings, and +sixpence. + +I have illustrated the practice of the first century, from the two +manuscripts I have examined, as giving an impartial idea of its +every-day methods. The Governor, Johannes Secundus, it is fair to +remember, was an amateur practitioner, while my ancestor was a +professed physician. Comparing their modes of treatment with the +many scientific follies still prevailing in the Old World, and still +more with the extraordinary theological superstitions of the +community in which they lived, we shall find reason, I think, to +consider the art of healing as in a comparatively creditable state +during the first century of New England. + +In addition to the evidence as to methods of treatment furnished by +the manuscripts I have cited, I subjoin the following document, to +which my attention was called by Dr. Shurtleff, our present Mayor. +This is a letter of which the original is to be found in vol. lxix. +page 10 of the "Archives" preserved at the State House in Boston. It +will be seen that what the surgeon wanted consisted chiefly of +opiates, stimulants, cathartics, plasters, and materials for +bandages. The complex and varied formulae have given place to +simpler and often more effective forms of the same remedies; but the +list and the manner in which it is made out are proofs of the good +sense and schooling of the surgeon, who, it may be noted, was in such +haste that he neglected all his stops. He might well be in a hurry, +as on the very day upon which he wrote, a great body of Indians-- +supposed to be six or seven hundred--appeared before Hatfield; and +twenty-five resolute young men of Hadley, from which town he wrote, +crossed the river and drove them away. + + +HADLY May 30: 76 + +Mr RAWSON Sr + +What we have recd by Tho: Houey the past month is not the cheifest of +our wants as you have love for poor wounded I pray let us not want +for these following medicines if you have not a speedy conveyance of +them I pray send on purpose they are those things mentioned in my +former letter but to prevent future mistakes I have wrote them att +large wee have great want with the greatest halt and speed let +us be supplyed. +Sr +Yr Sert +WILL LOCHS + + +(Endorsed) + +Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye +Council with it but could not obtaine any thing to be sent in answer +thereto 13 June 1676 + + +I have given some idea of the chief remedies used by our earlier +physicians, which were both Galenic and chemical; that is, vegetable +and mineral. They, of course, employed the usual perturbing +medicines which Montaigne says are the chief reliance of their craft. +There were, doubtless, individual practitioners who employed special +remedies with exceptional boldness and perhaps success. Mr. Eliot is +spoken of, in a letter of William Leete to Winthrop, Junior, as being +under Mr. Greenland's mercurial administrations. The latter was +probably enough one of these specialists. + +There is another class of remedies which appears to have been +employed occasionally, but, on the whole, is so little prominent as +to imply a good deal of common sense among the medical practitioners, +as compared with the superstitions prevailing around them. I have +said that I have caught the good Governor, now and then, prescribing +the electuary of millipedes; but he is entirely excused by the almost +incredible fact that they were retained in the materia medica so late +as when Rees's Cyclopaedia was published, and we there find the +directions formerly given by the College of Edinburgh for their +preparation. Once or twice we have found him admitting still more +objectionable articles into his materia medica; in doing which, I am +sorry to say that he could plead grave and learned authority. But +these instances are very rare exceptions in a medical practice of +many years, which is, on the whole, very respectable, considering the +time and circumstances. + +Some remedies of questionable though not odious character appear +occasionally to have been employed by the early practitioners, but +they were such as still had the support of the medical profession. +Governor John Winthrop, the first, sends for East Indian bezoar, with +other commodities he is writing for. Governor Endicott sends him one +he had of Mr. Humfrey. I hope it was genuine, for they cheated +infamously in the matter of this concretion, which ought to come out +of an animal's stomach, but the real history of which resembles what +is sometimes told of modern sausages. + +There is a famous law-case of James the First's time, in which a +goldsmith sold a hundred pounds' worth of what he called bezoar, +which was proved to be false, and the purchaser got a verdict against +him. Governor Endicott also sends Winthrop a unicorn's horn, which +was the property of a certain Mrs. Beggarly, who, in spite of her +name, seems to have been rich in medical knowledge and possessions. +The famous Thomas Bartholinus wrote a treatise on the virtues of this +fabulous-sounding remedy, which was published in 1641, and +republished in 1678. + +The "antimonial cup," a drinking vessel made of that metal, which, +like our quassia-wood cups, might be filled and emptied in saecula +saeculorum without exhausting its virtues, is mentioned by Matthew +Cradock, in a letter to the elder Winthrop, but in a doubtful way, as +it was thought, he says, to have shortened the days of Sir Nathaniel +Riche; and Winthrop himself, as I think, refers to its use, calling +it simply "the cup." An antimonial cup is included in the inventory +of Samuel Seabury, who died 1680, and is valued at five shillings. +There is a treatise entitled "The Universall Remedy, or the Vertues +of the Antimoniall Cup, By John Evans, Minister and Preacher of God's +Word, London, 1634," in our own Society's library. + +One other special remedy deserves notice, because of native growth. +I do not know when Culver's root, Leptandra Virginica of our National +Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to +John Winthrop of New London, speaks of it as famous for the cure of +consumptions, and wishes to get some of it, through his mediation, +for Katharine, his eldest daughter. He gets it, and gives it to the +"poor damsel," who is languishing, as he says, and who dies the next +month,--all the sooner, I have little doubt, for this uncertain and +violent drug, with which the meddlesome pedant tormented her in that +spirit of well-meant but restless quackery, which could touch nothing +without making mischief, not even a quotation, and yet proved at +length the means of bringing a great blessing to our community, as we +shall see by and by; so does Providence use our very vanities and +infirmities for its wise purposes. + +Externally, I find the practitioners on whom I have chiefly relied +used the plasters of Paracelsus, of melilot, diachylon, and probably +diaphoenicon, all well known to the old pharmacopoeias, and some of +them to the modern ones,--to say nothing of "my yellow salve," of +Governor John, the second, for the composition of which we must apply +to his respected descendant. + +The authors I find quoted are Barbette's Surgery, Camerarius on Gout, +and Wecherus, of all whom notices may be found in the pages of Haller +and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's +Practice of Physic and Anatomy, the last as belonging to Samuel +Seabury, chirurgeon, before mentioned. Nicholas Culpeper was a +shrewd charlatan, and as impudent a varlet as ever prescribed for a +colic; but knew very well what he was about, and badgers the College +with great vigor. A copy of Spigelius's famous Anatomy, in the +Boston Athenaeum, has the names of Increase and Samuel Mather written +in it, and was doubtless early overhauled by the youthful Cotton, who +refers to the great anatomist's singular death, among his curious +stories in the "Magnalia," and quotes him among nearly a hundred +authors whom he cites in his manuscript "The Angel of Bethesda." Dr. +John Clark's "books and instruments, with several chirurgery +materials in the closet," a were valued in his inventory at sixty +pounds; Dr. Matthew Fuller, who died in 1678, left a library valued +at ten pounds; and a surgeon's chest and drugs valued at sixteen +pounds.' + + +Here we leave the first century and all attempts at any further +detailed accounts of medicine and its practitioners. It is necessary +to show in a brief glance what had been going on in Europe during the +latter part of that century, the first quarter of which had been made +illustrious in the history of medical science by the discovery of the +circulation. + +Charles Barbeyrac, a Protestant in his religion, was a practitioner +and teacher of medicine at Montpellier. His creed was in the way of +his obtaining office; but the young men followed his instructions +with enthusiasm. Religious and scientific freedom breed in and in, +until it becomes hard to tell the family of one from that of the +other. Barbeyrac threw overboard the old complex medical farragos of +the pharmacopoeias, as his church had disburdened itself of the +popish ceremonies. + +Among the students who followed his instructions were two Englishmen: +one of them, John Locke, afterwards author of an "Essay on the Human +Understanding," three years younger than his teacher; the other, +Thomas Sydenham, five years older. Both returned to England. Locke, +whose medical knowledge is borne witness to by Sydenham, had the good +fortune to form a correct opinion on a disease from which the Earl of +Shaftesbury was suffering, which led to an operation that saved his +life. Less felicitous was his experience with a certain ancilla +culinaria virgo,--which I am afraid would in those days have been +translated kitchen-wench, instead of lady of the culinary +department,--who turned him off after she had got tired of him, and +called in another practitioner. [Locke and Sydenham, p. 124. By John +Brown, M. D. Edinburgh, 1866.] This helped, perhaps, to spoil a +promising doctor, and make an immortal metaphysician. At any rate, +Locke laid down the professional wig and cane, and took to other +studies. + +The name of Thomas Sydenham is as distinguished in the history of +medicine as that of John Locke in philosophy. As Barbeyrac was found +in opposition to the established religion, as Locke took the rational +side against orthodox Bishop Stillingfleet, so Sydenham went with +Parliament against Charles, and was never admitted a Fellow by the +College of Physicians, which, after he was dead, placed his bust in +their hall by the side of that of Harvey. + +What Sydenham did for medicine was briefly this he studied the course +of diseases carefully, and especially as affected by the particular +season; to patients with fever he gave air and cooling drinks, +instead of smothering and heating them, with the idea of sweating out +their disease; he ordered horseback exercise to consumptives; he, +like his teacher, used few and comparatively simple remedies; he did +not give any drug at all, if he thought none was needed, but let well +enough alone. He was a sensible man, in short, who applied his +common sense to diseases which he had studied with the best light of +science that he could obtain. + +The influence of the reform he introduced must have been more or less +felt in this country, but not much before the beginning of the +eighteenth century, as his great work was not published until 1675, +and then in Latin. I very strongly suspect that there was not so +much to reform in the simple practice of the physicians of the new +community, as there was in that of the learned big-wigs of the +"College," who valued their remedies too much in proportion to their +complexity, and the extravagant and fantastic ingredients which went +to their making. + +During the memorable century which bred and bore the Revolution, the +medical profession gave great names to our history. But John Brooks +belonged to the State, and Joseph Warren belongs to the country and +mankind, and to speak of them would lead me beyond my limited-- +subject. There would be little pleasure in dwelling on the name of +Benjamin Church; and as for the medical politicians, like Elisha +Cooke in the early part of the century, or Charles Jarvis, the bald +eagle of Boston, in its later years, whether their practice was +heroic or not, their patients were, for he is a bold man who trusts +one that is making speeches and coaxing voters, to meddle with the +internal politics of his corporeal republic. + +One great event stands out in the medical history of this eighteenth +century; namely, the introduction of the practice of inoculation for +small-pox. Six epidemics of this complaint had visited Boston in the +course of a hundred years. Prayers had been asked in the churches +for more than a hundred sick in a single day, and this many times. +About a thousand persons had died in a twelvemonth, we are told, and, +as we may infer, chiefly from this cause. + +In 1721, this disease, after a respite of nineteen years, again +appeared as an epidemic. In that year it was that Cotton Mather, +browsing, as was his wont, on all the printed fodder that came within +reach of his ever-grinding mandibles, came upon an account of +inoculation as practised in Turkey, contained in the "Philosophical +Transactions." He spoke of it to several physicians, who paid little +heed to his story; for they knew his medical whims, and had probably +been bored, as we say now-a-days, many of them, with listening to his +"Angel of Bethesda," and satiated with his speculations on the +Nishmath Chajim. + +The Reverend Mather,--I use a mode of expression he often employed +when speaking of his honored brethren,--the Reverend Mather was right +this time, and the irreverent doctors who laughed at him were wrong. +One only of their number disputes his claim to giving the first +impulse to the practice, in Boston. This is what that person says: +"The Small-Pox spread in Boston, New England, A.1721, and the +Reverend Dr. Cotton Mather, having had the use of these +Communications from Dr. William Douglass (that is, the writer of +these words); surreptitiously, without the knowledge of his Informer, +that he might have the honour of a New fangled notion, sets an +Undaunted Operator to work, and in this Country about 290 were +inoculated." + +All this has not deprived Cotton Mather of the credit of suggesting, +and a bold and intelligent physician of the honor of carrying out, +the new practice. On the twenty-seventh day of June, 1721, Zabdiel +Boylston of Boston inoculated his only son for smallpox,--the first +person ever submitted to the operation in the New World. The story +of the fierce resistance to the introduction of the practice; of how +Boylston was mobbed, and Mather had a hand-grenade thrown in at his +window; of how William Douglass, the Scotchman, "always positive, and +sometimes accurate," as was neatly said of him, at once depreciated +the practice and tried to get the credit of suggesting it, and how +Lawrence Dalhonde, the Frenchman, testified to its destructive +consequences; of how Edmund Massey, lecturer at St. Albans, preached +against sinfully endeavoring to alter the course of nature by +presumptuous interposition, which he would leave to the atheist and +the scoffer, the heathen and unbeliever, while in the face of his +sermon, afterwards reprinted in Boston, many of our New England +clergy stood up boldly in defence of the practice,--all this has been +told so well and so often that I spare you its details. Set this +good hint of Cotton Mather against that letter of his to John +Richards, recommending the search after witch-marks, and the +application of the water-ordeal, which means throw your grandmother +into the water, if she has a mole on her arm;--if she swims, she is a +witch and must be hanged; if she sinks, the Lord have mercy on her +soul! + +Thus did America receive this great discovery, destined to save +thousands of lives, via Boston, from the hands of one of our own +Massachusetts physicians. + +The year 1735 was rendered sadly memorable by the epidemic of the +terrible disease known as "throat distemper," and regarded by many as +the same as our "diphtheria." Dr. Holyoke thinks the more general +use of mercurials in inflammatory complaints dates from the time of +their employment in this disease, in which they were thought to have +proved specially useful. + +At some time in the course of this century medical practice had +settled down on four remedies as its chief reliance. I must repeat +an incident which I have related in another of these Essays. When +Dr. Holyoke, nearly seventy years ago, received young Mr. James +Jackson as his student, he showed him the formidable array of +bottles, jars, and drawers around his office, and then named the four +remedies referred to as being of more importance than all the rest +put together. These were "Mercury, Antimony, Opium, and Peruvian +Bark." I doubt if either of them remembered that, nearly seventy +years before, in 1730, Dr. William Douglass, the disputatious +Scotchman, mentioned those same four remedies, in the dedication of +his quarrelsome essay on inoculation, as the most important ones in +the hands of the physicians of his time. + +In the "Proceedings" of this Society for the year 1863 is a very +pleasant paper by the late Dr. Ephraim Eliot, giving an account of +the leading physicians of Boston during the last quarter of the last +century. The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch, +Danforth, John Warren, Jeffries, are all famous in local history, and +are commemorated in our medical biographies. One of them, at least, +appears to have been more widely known, not only as one of the first +aerial voyagers, but as an explorer in the almost equally hazardous +realm of medical theory. Dr. John Jeffries, the first of that name, +is considered by Broussais as a leader of medical opinion in America, +and so referred to in his famous "Examen des Doctrines Medicales." + +Two great movements took place in this eighteenth century, the effect +of which has been chiefly felt in our own time; namely, the +establishment of the Massachusetts Medical Society, and the founding +of the Medical School of Harvard University. + + +The third century of our medical history began with the introduction +of the second great medical discovery of modern times,--of all time +up to that date, I may say,--once more via Boston, if we count the +University village as its suburb, and once more by one of our +Massachusetts physicians. In the month of July, 1800, Dr. Benjamin +Waterhouse of Cambridge submitted four of his own children to the new +process of vaccination,--the first persons vaccinated, as Dr. Zabdiel +Boylston's son had been the first person inoculated in the New World. + +A little before the first half of this century was completed, in the +autumn of 1846, the great discovery went forth from the Massachusetts +General Hospital, which repaid the debt of America to the science of +the Old World, and gave immortality to the place of its origin in the +memory and the heart of mankind. The production of temporary +insensibility at will--tuto, cito, jucunde, safely, quickly, +pleasantly--is one of those triumphs over the infirmities of our +mortal condition which change the aspect of life ever afterwards. +Rhetoric can add nothing to its glory; gratitude, and the pride +permitted to human weakness, that our Bethlehem should have been +chosen as the birthplace of this new embodiment of the divine mercy, +are all we can yet find room for. + +The present century has seen the establishment of all those great +charitable institutions for the cure of diseases of the body and of +the mind, which our State and our city have a right to consider as +among the chief ornaments of their civilization. + +The last century had very little to show, in our State, in the way of +medical literature. The worthies who took care of our grandfathers +and great-grandfathers, like the Revolutionary heroes, fought (with +disease) and bled (their patients) and died (in spite of their own +remedies); but their names, once familiar, are heard only at rare +intervals. Honored in their day, not unremembered by a few solitary +students of the past, their memories are going sweetly to sleep in +the arms of the patient old dry-nurse, whose "blackdrop" is the +never-failing anodyne of the restless generations of men. Except the +lively controversy on inoculation, and floating papers in journals, +we have not much of value for that long period, in the shape of +medical records. + +But while the trouble with the last century is to find authors to +mention, the trouble of this would be to name all that we find. Of +these, a very few claim unquestioned preeminence. + +Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical +School of our University, did a great work for the advancement of +medicine and surgery in New England, by his labors as teacher and +author, greater, it is claimed by some, than was ever done by any +other man. The two Warrens, of our time, each left a large and +permanent record of a most extended surgical practice. James Jackson +not only educated a whole generation by his lessons of wisdom, but +bequeathed some of the most valuable results of his experience to +those who came after him, in a series of letters singularly pleasant +and kindly as well as instructive. John Ware, keen and cautious, +earnest and deliberate, wrote the two remarkable essays which have +identified his name, for all time, with two important diseases, on +which he has shed new light by his original observations. + +I must do violence to the modesty of the living by referring to the +many important contributions to medical science by Dr. Jacob Bigelow, +and especially to his discourse on "Self-limited Diseases," an +address which can be read in a single hour, but the influence of +which will be felt for a century. + +Nor would the profession forgive me if I forgot to mention the +admirable museum of pathological anatomy, created almost entirely by +the hands of Dr. John Barnard Swett Jackson, and illustrated by his +own printed descriptive catalogue, justly spoken of by a +distinguished professor in the University of Pennsylvania as the most +important contribution which had ever been made in this country to +the branch to which it relates. + +When we look at the literature of mental disease, as seen in hospital +reports and special treatises, we can mention the names of Wyman, +Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts +or placed at the head of her institutions for the treatment of the +insane. + +We have a right to claim also one who is known all over the civilized +world as a philanthropist, to us as a townsman and a graduate of our +own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor +of a great multitude who were born to a world of inward or of outward +darkness. + +I cannot pass over in silence the part taken by our own physicians in +those sanitary movements which are assuming every year greater +importance. Two diseases especially have attracted attention, above +all others, with reference to their causes and prevention; cholera, +the "black death" of the nineteenth century, and consumption, the +white plague of the North, both of which have been faithfully studied +and reported on by physicians of our own State and city. The +cultivation of medical and surgical specialties, which is fast +becoming prevalent, is beginning to show its effects in the +literature of the profession, which is every year growing richer in +original observations and investigations. + +To these benefactors who have labored for us in their peaceful +vocation, we must add the noble army of surgeons, who went with the +soldiers who fought the battles of their country, sharing many of +their dangers, not rarely falling victims to fatigue, disease, or the +deadly volleys to which they often exposed themselves in the +discharge of their duties. + +The pleasant biographies of the venerable Dr. Thacher, and the worthy +and kind-hearted gleaner, Dr. Stephen W. Williams, who came after +him, are filled with the names of men who served their generation +well, and rest from their labors, followed by the blessing of those +for whom they endured the toils and fatigues inseparable from their +calling. The hardworking, intelligent country physician more +especially deserves the gratitude of his own generation, for he +rarely leaves any permanent record in the literature of his +profession. Books are hard to obtain; hospitals, which are always +centres of intelligence, are remote; thoroughly educated and superior +men are separated by wide intervals; and long rides, though favorable +to reflection, take up much of the time which might otherwise be +given to the labors of the study. So it is that men of ability and +vast experience, like the late Dr. Twitchell, for instance, make a +great and deserved reputation, become the oracles of large districts, +and yet leave nothing, or next to nothing, by which their names shall +be preserved from blank oblivion. + +One or two other facts deserve mention, as showing the readiness of +our medical community to receive and adopt any important idea or +discovery. The new science of Histology, as it is now called, was +first brought fully before the profession of this country by the +translation of Bichat's great work, "Anatomie Generale," by the late +Dr. George Hayward. + +The first work printed in this country on Auscultation,--that +wonderful art of discovering disease, which, as it were, puts a +window in the breast, through which the vital organs can be seen, to +all intents and purposes, was the manual published anonymously by +"A Member of the Massachusetts Medical Society." + + +We are now in some slight measure prepared to weigh the record of the +medical profession in Massachusetts, and pass our judgment upon it. +But in-order to do justice to the first generation of practitioners, +we must compare what we know of their treatment of disease with the +state of the art in England, and the superstitions which they saw all +around them in other departments of knowledge or belief. + +English medical literature must have been at a pretty low ebb when +Sydenham recommended Don Quixote to Sir Richard Blackmore for +professional reading. The College Pharmacopoeia was loaded with the +most absurd compound mixtures, one of the most complex of which (the +same which the Reverend Mr. Harward, "Lecturer at the Royal Chappel +in Boston," tried to simplify), was not dropped until the year 1801. +Sir Kenelm Digby was playing his fantastic tricks with the +Sympathetic powder, and teaching Governor Winthrop, the second, how +to cure fever and ague, which some may like to know. "Pare the +patient's nails; put the parings in a little bag, and hang the bag +round the neck of a live eel, and put him in a tub of water. The eel +will die, and the patient will recover." + +Wiseman, the great surgeon, was discoursing eloquently on the +efficacy of the royal touch in scrofula. The founder of the +Ashmolean Museum at Oxford, consorting with alchemists and +astrologers, was treasuring the manuscripts of the late pious Dr. +Richard Napier, in which certain letters (Rx Ris) were understood to +mean Responsum Raphaelis,--the answer of the angel Raphael to the +good man's medical questions. The illustrious Robert Boyle was +making his collection of choice and safe remedies, including the sole +of an old shoe, the thigh bone of a hanged man, and things far worse +than these, as articles of his materia medica. Dr. Stafford, whose +paper of directions to his "friend, Mr. Wintrop," I cited, was +probably a man of standing in London; yet toad-powder was his +sovereign remedy. + +See what was the state of belief in other matters among the most +intelligent persons of the colonies, magistrates and clergymen. +Jonathan Brewster, son of the church-elder, writes the wildest +letters to John Winthrop about alchemy,--"mad for making gold as the +Lynn rock-borers are for finding it." + +Remember the theology and the diabology of the time. Mr. Cotton's +Theocracy was a royal government, with the King of kings as its +nominal head, but with an upper chamber of saints, and a tremendous +opposition in the lower house; the leader of which may have been +equalled, but cannot have been surpassed by any of our earth-born +politicians. The demons were prowling round the houses every night, +as the foxes were sneaking about the hen-roosts. The men of +Gloucester fired whole flasks of gunpowder at devils disguised as +Indians and Frenchmen. + +How deeply the notion of miraculous interference with the course of +nature was rooted, is shown by the tenacity of the superstition about +earthquakes. We can hardly believe that our Professor Winthrop, +father of the old judge and the "squire," whom many of us Cambridge +people remember so well, had to defend himself against the learned +and excellent Dr. Prince, of the Old South Church, for discussing +their phenomena as if they belonged to the province of natural +science: + +Not for the sake of degrading the aspect of the noble men who founded +our State, do I refer to their idle beliefs and painful delusions, +but to show against what influences the common sense of the medical +profession had to assert itself. + +Think, then, of the blazing stars, that shook their horrid hair in +the sky; the phantom ship, that brought its message direct from the +other world; the story of the mouse and the snake at Watertown; of +the mice and the prayer-book; of the snake in church; of the calf +with two heads; and of the cabbage in the perfect form of a cutlash, +--all which innocent occurrences were accepted or feared as alarming +portents. + +We can smile at these: but we cannot smile at the account of unhappy +Mary Dyer's malformed offspring; or of Mrs. Hutchinson's domestic +misfortune of similar character, in the story of which the physician, +Dr. John Clark of Rhode Island, alone appears to advantage; or as we +read the Rev. Samuel Willard's fifteen alarming pages about an +unfortunate young woman suffering with hysteria. Or go a little +deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia, +first admonished, then whipped; at last, taking her own little +daughter's life; put on trial, and standing mute, threatened to be +pressed to death, confessing, sentenced, praying to be beheaded; and +none the less pitilessly swung from the fatal ladder. + +The cooper's crazy wife--crazy in the belief that she has committed +the unpardonable sin--tries to drown her child, to save it from +misery; and the poor lunatic, who would be tenderly cared for to-day +in a quiet asylum, is judged to be acting under the instigation of +Satan himself. Yet, after all, what can we say, who put Bunyan's +"Pilgrim's Progress," full of nightmare dreams of horror, into all +our children's hands; a story in which the awful image of the man in +the cage might well turn the nursery where it is read into a +madhouse? + +The miserable delusion of witchcraft illustrates, in a still more +impressive way, the false ideas which governed the supposed relation +of men with the spiritual world. I have no doubt many physicians +shared in these superstitions. Mr. Upham says they--that is, some of +them--were in the habit of attributing their want of success to the +fact, that an "evil hand" was on their patient. The temptation was +strong, no doubt, when magistrates and ministers and all that +followed their lead were contented with such an explanation. But how +was it in Salem, according to Mr. Upham's own statement? Dr. John +Swinnerton was, he says, for many years the principal physician of +Salem. And he says, also, "The Swinnerton family were all along +opposed to Mr. Parris, and kept remarkably clear from the witchcraft +delusion." Dr. John Swinnerton--the same, by the way, whose memory +is illuminated by a ray from the genius of Hawthorne--died the very +year before the great witchcraft explosion took place. But who can +doubt that it was from him that the family had learned to despise and +to resist the base superstition; or that Bridget Bishop, whose house +he rented, as Mr. Upham tells me, the first person hanged in the time +of the delusion, would have found an efficient protector in her +tenant, had he been living, to head the opposition of his family to +the misguided clergymen and magistrates? + +I cannot doubt that our early physicians brought with them many Old- +World medical superstitions, and I have no question that they were +more or less involved in the prevailing errors of the community in +which they lived. But, on the whole, their record is a clean one, so +far as we can get at it; and where it is questionable we must +remember that there must have been many little-educated persons among +them; and that all must have felt, to some extent, the influence of +those sincere and devoted but unsafe men, the physic-practising +clergymen, who often used spiritual means as a substitute for +temporal ones, who looked upon a hysteric patient as possessed by the +devil, and treated a fractured skull by prayers and plasters, +following the advice of a ruling elder in opposition to the "unanimous +opinion of seven surgeons." + +To what results the union of the two professions was liable to lead, +may be seen by the example of a learned and famous person, who has +left on record the product of his labors in the double capacity of +clergyman and physician. + +I have had the privilege of examining a manuscript of Cotton Mather's +relating to medicine, by the kindness of the librarian of the +American Antiquarian Society, to which society it belongs. A brief +notice of this curious document may prove not uninteresting. + +It is entitled "The Angel of Bethesda: an Essay upon the Common +Maladies of Mankind, offering, first, the sentiments of Piety," etc., +etc., and "a collection of plain but potent and Approved REMEDIES for +the Maladies." There are sixty-six "Capsula's," as he calls them, or +chapters, in his table of contents; of which, five--from the +fifteenth to the nineteenth, inclusive--are missing. This is a most +unfortunate loss, as the eighteenth capsula treated of agues, and we +could have learned from it something of their degree of frequency in +this part of New England. There is no date to the manuscript; which, +however, refers to a case observed Nov. 14, 1724. + +The divine takes precedence of the physician in this extraordinary +production. He begins by preaching a sermon at his unfortunate +patient. Having thrown him into a cold sweat by his spiritual +sudorific, he attacks him with his material remedies, which are often +quite as unpalatable. The simple and cleanly practice of Sydenham, +with whose works he was acquainted, seems to have been thrown away +upon him. Everything he could find mentioned in the seventy or +eighty authors he cites, all that the old women of both sexes had +ever told him of, gets into his text, or squeezes itself into his +margin. + +Evolving disease out of sin, he hates it, one would say, as he hates +its cause, and would drive it out of the body with all noisome +appliances. "Sickness is in Fact Flagellum Dei pro peccatis mundi." +So saying, he encourages the young mother whose babe is wasting away +upon her breast with these reflections: + +"Think; oh the grievous Effects of Sin! This wretched Infant has not +arrived unto years of sense enough, to sin after the similitude of +the transgression committed by Adam. Nevertheless the Transgression +of Adam, who had all mankind Foederally, yea, Naturally, in him, has +involved this Infant in the guilt of it. And the poison of the old +serpent, which infected Adam when he fell into his Transgression, by +hearkening to the Tempter, has corrupted all mankind, and is a seed +unto such diseases as this Infant is now laboring under. Lord, what +are we, and what are our children, but a Generation of Vipers?" + +Many of his remedies are at least harmless, but his pedantry and +utter want of judgment betray themselves everywhere. He piles his +prescriptions one upon another, without the least discrimination. He +is run away with by all sorts of fancies and superstitions. He +prescribes euphrasia, eye-bright, for disease of the eyes; appealing +confidently to the strange old doctrine of signatures, which inferred +its use from the resemblance of its flower to the organ of vision. +For the scattering of wens, the efficacy of a Dead Hand has been out +of measure wonderful. But when he once comes to the odious class of +remedies, he revels in them like a scarabeus. This allusion will +bring us quite near enough to the inconceivable abominations with +which he proposed to outrage the sinful stomachs of the unhappy +confederates and accomplices of Adam. + +It is well that the treatise was never printed, yet there are +passages in it worth preserving. He speaks of some remedies which +have since become more universally known: + +"Among the plants of our soyl, Sir William Temple singles out Five +[Six] as being of the greatest virtue and most friendly to health: +and his favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and +Elder." + +"But these Five [Six] plants may admitt of some competitors. The +QUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!" + +Of Ipecacuanha, he says,-- +"This is now in its reign; the most fashionable vomit." + +"I am not sorry that antimonial emetics begin to be disused." + +He quotes "Mr. Lock" as recommending red poppy-water and abstinence +from flesh as often useful in children's diseases. + +One of his "Capsula's" is devoted to the animalcular origin of +diseases, at the end of which he says, speaking of remedies for this +supposed source of our distempers: + +"Mercury we know thee: But we are afraid thou wilt kill us too, if we +employ thee to kill them that kill us. + +"And yett, for the cleansing of the small Blood Vessels, and making +way for the free circulation of the Blood and Lymph--there is nothing +like Mercurial Deobstruents." + +From this we learn that mercury was already in common use, and the +subject of the same popular prejudice as in our own time. + +His poetical turn shows itself here and there: + +"O Nightingale, with a Thorn at thy Breast; Under the trouble of a +Cough, what can be more proper than such thoughts as these?"... + +If there is pathos in this, there is bathos in his apostrophe to the +millipede, beginning "Poor sowbug!" and eulogizing the healing +virtues of that odious little beast; of which he tells us to take +"half a pound, putt 'em alive into a quart or two of wine," with +saffron and other drugs, and take two ounces twice a day. + +The "Capsula" entitled "Nishmath Chajim" was printed in 1722, at +New London, and is in the possession of our own Society. He means, +by these words, something like the Archxus of Van Helmont, of which +he discourses in a style wonderfully resembling that of Mr. Jenkinson +in the "Vicar of Wakefield." "Many of the Ancients thought there was +much of a Real History in the Parable, and their Opinion was that +there is, DIAPHORA KATA TAS MORPHAS, A Distinction (and so a +Resemblance) of men as to their Shapes after Death." And so on, with +Ireaeus, Tertullian, Thespesius, and "the TA TONE PSEUCONE CROMATA," +in the place of "Sanconiathon, Manetho, Berosus," and "Anarchon ara +kai ateleutaion to pan." + +One other passage deserves notice, as it relates to the single +medical suggestion which does honor to Cotton Mather's memory. It +does not appear that he availed himself of the information which he +says, he obtained from his slave, for such I suppose he was. + +In his appendix to "Variolae Triumphatae," he says,-- + +"There has been a wonderful practice lately used in several parts of +the world, which indeed is not yet become common in our nation. + +"I was first informed of it by a Garamantee servant of my own, long +before I knew that any Europeans or Asiaticks had the least +acquaintance with it, and some years before I was enriched with the +communications of the learned Foreigners, whose accounts I found +agreeing with what I received of my servant, when he shewed me the +Scar of the Wound made for the operation; and said, That no person +ever died of the smallpox, in their countrey, that had the courage to +use it. + +"I have since met with a considerable Number of these Africans, who +all agree in one story; That in their countrey grandy-many dy of the +small-pox: But now they learn this way: people take juice of smallpox +and cutty-skin and put in a Drop; then by'nd by a little sicky, +sicky: then very few little things like small-pox; and nobody dy of +it; and nobody have small-pox any more. Thus, in Africa, where the +poor creatures dy of the smallpox like Rotten Sheep, a merciful God +has taught them an Infallible preservative. 'T is a common practice, +and is attended with a constant success." + +What has come down to us of the first century of medical practice, in +the hands of Winthrop and Oliver, is comparatively simple and +reasonable. I suspect that the conditions of rude, stern life, in +which the colonists found themselves in the wilderness, took the +nonsense out of them, as the exigencies of a campaign did out of our +physicians and surgeons in the late war. Good food and enough of it, +pure air and water, cleanliness, good attendance, an anaesthetic, an +opiate, a stimulant, quinine, and two or three common drugs, proved +to be the marrow of medical treatment; and the fopperies of the +pharmacopoeia went the way of embroidered shirts and white kid gloves +and malacca joints, in their time of need. "Good wine is the best +cordiall for her," said Governor John Winthrop, Junior, to Samuel +Symonds, speaking of that gentleman's wife,--just as Sydenham, +instead of physic, once ordered a roast chicken and a pint of canary +for his patient in male hysterics. + +But the profession of medicine never could reach its full development +until it became entirely separated from that of divinity. The +spiritual guide, the consoler in afliction, the confessor who is +admitted into the secrets of our souls, has his own noble sphere of +duties; but the healer of men must confine himself solely to the +revelations of God in nature, as he sees their miracles with his own +eyes. No doctrine of prayer or special providence is to be his +excuse for not looking straight at secondary causes, and acting, +exactly so far as experience justifies him, as if he were himself the +divine agent which antiquity fabled him to be. While pious men were +praying--humbly, sincerely, rightly, according to their knowledge-- +over the endless succession of little children dying of spasms in the +great Dublin Hospital, a sagacious physician knocked some holes in +the walls of the ward, let God's blessed air in on the little +creatures, and so had already saved in that single hospital, as it +was soberly calculated thirty years ago, more than sixteen thousand +lives of these infant heirs of immortality. [Collins's Midwifery, p. +312. Published by order of the Massachusetts Medical Society. +Boston, 1841.] + +Let it be, if you will, that the wise inspiration of the physician +was granted in virtue of the clergyman's supplications. Still, the +habit of dealing with things seen generates another kind of +knowledge, and another way of thought, from that of dealing with +things unseen; which knowledge and way of thought are special means +granted by Providence, and to be thankfully accepted. + +The mediaeval ecclesiastics expressed a great truth in that saying, +so often quoted, as carrying a reproach with it: "Ubi tres medici, +duo athei,"--"Where there are three physicians, there are two +atheists." + +It was true then, it is true to-day, that the physician very +commonly, if not very generally, denies and repudiates the deity of +ecclesiastical commerce. The Being whom Ambroise Pare meant when he +spoke those memorable words, which you may read over the professor's +chair in the French School of Medicine, "Te le pensay, et Dieu le +guarit," "I dressed his wound, and God healed it,"--is a different +being from the God that scholastic theologians have projected from +their consciousness, or shaped even from the sacred pages which have +proved so plastic in their hands. He is a God who never leaves +himself without witness, who repenteth him of the evil, who never +allows a disease or an injury, compatible with the enjoyment of life, +to take its course without establishing an effort, limited by certain +fixed conditions, it is true, but an effort, always, to restore the +broken body or the shattered mind. In the perpetual presence of this +great Healing Agent, who stays the bleeding of wounds, who knits the +fractured bone, who expels the splinter by a gentle natural process, +who walls in the inflammation that might involve the vital organs, +who draws a cordon to separate the dead part from the living, who +sends his three natural anaesthetics to the over-tasked frame in due +order, according to its need,--sleep, fainting, death; in this +perpetual presence, it is doubtless hard for the physician to realize +the theological fact of a vast and permanent sphere of the universe, +where no organ finds itself in its natural medium, where no wound +heals kindly, where the executive has abrogated the pardoning power, +and mercy forgets its errand; where the omnipotent is unfelt save in +malignant agencies, and the omnipresent is unseen and unrepresented; +hard to accept the God of Dante's "Inferno," and of Bunyan's caged +lunatic. If this is atheism, call three, instead of two of the trio, +atheists, and it will probably come nearer the truth. + +I am not disposed to deny the occasional injurious effect of the +materializing influences to which the physician is subjected. +A spiritual guild is absolutely necessary to keep him, to keep us +all, from becoming the "fingering slaves" that Wordsworth treats with +such shrivelling scorn. But it is well that the two callings have +been separated, and it is fitting that they remain apart. In +settling the affairs of the late concern, I am afraid our good +friends remain a little in our debt. We lent them our physician +Michael Servetus in fair condition, and they returned him so damaged +by fire as to be quite useless for our purposes. Their Reverend +Samuel Willard wrote us a not over-wise report of a case of hysteria; +and our Jean Astruc gave them (if we may trust Dr. Smith's Dictionary +of the Bible) the first discerning criticism on the authorship of the +Pentateuch. Our John Locke enlightened them with his letters +concerning toleration; and their Cotton Mather obscured our twilight +with his "Nishmath Chajim." + +Yet we must remember that the name of Basil Valentine, the monk, is +associated with whatever good and harm we can ascribe to antimony; +and that the most remarkable of our specifics long bore the name of +"Jesuit's Bark," from an old legend connected with its introduction. +"Frere Jacques," who taught the lithotomists of Paris, owes his +ecclesiastical title to courtesy, as he did not belong to a religious +order. + +Medical science, and especially the study of mental disease, is +destined, I believe, to react to much greater advantage on the +theology of the future than theology has acted on medicine in the +past. The liberal spirit very generally prevailing in both +professions, and the good understanding between their most +enlightened members, promise well for the future of both in a +community which holds every point of human belief, every institution +in human hands, and every word written in a human dialect, open to +free discussion today, to-morrow, and to the end of time. Whether +the world at large will ever be cured of trusting to specifics as a +substitute for observing the laws of health, and to mechanical or +intellectual formula as a substitute for character, may admit of +question. Quackery and idolatry are all but immortal. + +We can find most of the old beliefs alive amongst us to-day, only +having changed their dresses and the social spheres in which they +thrive. We think the quarrels of Galenists and chemists belong to +the past, forgetting that Thomsonism has its numerous apostles in our +community; that it is common to see remedies vaunted as purely +vegetable, and that the prejudice against "mineral poisons," +especially mercury, is as strong in many quarters now as it was at +the beginning of the seventeenth century. Names are only air, and +blow away with a change of wind; but beliefs are rooted in human +wants and weakness, and die hard. The oaks of Dodona are prostrate, +and the shrine of Delphi is desolate; but the Pythoness and the Sibyl +may be consulted in Lowell Street for a very moderate compensation. +Nostradamus and Lilly seem impossible in our time; but we have seen +the advertisements of an astrologer in our Boston papers year after +year, which seems to imply that he found believers and patrons. You +smiled when I related Sir Kenelm Digby's prescription with the live +eel in it; but if each of you were to empty his or her pockets, would +there not roll out, from more than one of them, a horse-chestnut, +carried about as a cure for rheumatism? The brazen head of Roger +Bacon is mute; but is not "Planchette" uttering her responses in a +hundred houses of this city? We think of palmistry or chiromancy as +belonging to the days of Albertus Magnus, or, if existing in our +time, as given over to the gypsies; but a very distinguished person +has recently shown me the line of life, and the line of fortune, on +the palm of his hand, with a seeming confidence in the sanguine +predictions of his career which had been drawn from them. What shall +we say of the plausible and well-dressed charlatans of our own time, +who trade in false pretences, like Nicholas Knapp of old, but without +any fear of being fined or whipped; or of the many follies and +inanities, imposing on the credulous part of the community, each of +them gaping with eager, open mouth for a gratuitous advertisement by +the mention of its foolish name in any respectable connection? + +I turn from this less pleasing aspect of the common intelligence +which renders such follies possible, to close the honorable record of +the medical profession in this, our ancient Commonwealth. + +We have seen it in the first century divided among clergymen, +magistrates, and regular practitioners; yet, on the whole, for the +time, and under the circumstances, respectable, except where it +invoked supernatural agencies to account for natural phenomena. + +In the second century it simplified its practice, educated many +intelligent practitioners, and began the work of organizing for +concerted action, and for medical teaching. + +In this, our own century, it has built hospitals, perfected and +multiplied its associations and educational institutions, enlarged +and created museums, and challenged a place in the world of science +by its literature. + +In reviewing the whole course of its history we read a long list of +honored names, and a precious record written in private memories, in +public charities, in permanent contributions to medical science, in +generous sacrifices for the country. We can point to our capital as +the port of entry for the New World of the great medical discoveries +of two successive centuries, and we can claim for it the triumph over +the most dreaded foe that assails the human body,--a triumph which +the annals of the race can hardly match in three thousand years of +medical history. + + + + + + +THE YOUNG PRACTITIONER + +[A Valedictory Address delivered to the Graduating Class of the +Bellevue Hospital College, March 2, 1871.] + + +The occasion which calls us together reminds us not a little of that +other ceremony which unites a man and woman for life. The banns have +already been pronounced which have wedded our young friends to the +profession of their choice. It remains only to address to them some +friendly words of cheering counsel, and to bestow upon them the +parting benediction. + +This is not the time for rhetorical display or ambitious eloquence. +We must forget ourselves, and think only of them. To us it is an +occasion; to them it is an epoch. The spectators at the wedding look +curiously at the bride and bridegroom; at the bridal veil, the +orange-flower garland, the giving and receiving of the ring; they +listen for the tremulous "I will," and wonder what are the mysterious +syllables the clergyman whispers in the ear of the married maiden. +But to the newly-wedded pair what meaning in those words, "for +better, for worse," "in sickness and in health," "till death us do +part!" To the father, to the mother, who know too well how often the +deadly nightshade is interwoven with the wreath of orange-blossoms, +how empty the pageant, how momentous the reality! + +You will not wonder that I address myself chiefly to those who are +just leaving academic life for the sterner struggle and the larger +tasks of matured and instructed manhood. The hour belongs to them; +if others find patience to listen, they will kindly remember that, +after all, they are but as the spectators at the wedding, and that +the priest is thinking less of them than of their friends who are +kneeling at the altar. + +I speak more directly to you, then, gentlemen of the graduating +class. The days of your education, as pupils of trained instructors, +are over. Your first harvest is all garnered. Henceforth you are to +be sowers as well as reapers, and your field is the world. How does +your knowledge stand to-day? What have you gained as a permanent +possession? What must you expect to forget? What remains for you +yet to learn? These are questions which it may interest you to +consider. + +There is another question which must force itself on the thoughts of +many among you: "How am I to obtain patients and to keep their +confidence? "You have chosen a laborious calling, and made many +sacrifices to fit yourselves for its successful pursuit. You wish to +be employed that you may be useful, and that you may receive the +reward of your industry. I would take advantage of these most +receptive moments to give you some hints which may help you to +realize your hopes and expectations. Such is the outline of the +familiar talk I shall offer you. + +Your acquaintance with some of the accessory branches is probably +greater now than it will be in a year from now,--much greater than it +will by ten years from now. The progress of knowledge, it may be +feared, or hoped, will have outrun the text-books in which you +studied these branches. Chemistry, for instance, is very apt to +spoil on one's hands. "Nous avons change tout cela" might serve as +the standing motto of many of our manuals. Science is a great +traveller, and wears her shoes out pretty fast, as might be expected. + +You are now fresh from the lecture-room and the laboratory. You can +pass an examination in anatomy, physiology, chemistry, materia +medica, which the men in large practice all around you would find a +more potent sudorific than any in the Pharmacopceia. These masters +of the art of healing were once as ready with their answers as you +are now, but they have got rid of a great deal of the less +immediately practical part of their acquisitions, and you must +undergo the same depleting process. Hard work will train it off, as +sharp exercise trains off the fat of a prize-fighter. + +Yet, pause a moment before you infer that your teachers must have +been in fault when they furnished you with mental stores not directly +convertible to practical purposes, and likely in a few years to lose +their place in your memory. All systematic knowledge involves much +that is not practical, yet it is the only kind of knowledge which +satisfies the mind, and systematic study proves, in the long-run, the +easiest way of acquiring and retaining facts which are practical. +There are many things which we can afford to forget, which yet it was +well to learn. Your mental condition is not the same as if you had +never known what you now try in vain to recall. There is a perpetual +metempsychosis of thought, and the knowledge of to-day finds a soil +in the forgotten facts of yesterday. You cannot see anything in the +new season of the guano you placed last year about the roots of your +climbing plants, but it is blushing and breathing fragrance in your +trellised roses; it has scaled your porch in the bee-haunted honey- +suckle; it has found its way where the ivy is green; it is gone where +the woodbine expands its luxuriant foliage. + +Your diploma seems very broad to-day with your list of +accomplishments, but it begins to shrink from this hour like the Peau +de Chagrin of Balzac's story. Do not worry about it, for all the +while there will be making out for you an ampler and fairer +parchment, signed by old Father Time himself as President of that +great University in which experience is the one perpetual and all- +sufficient professor. + +Your present plethora of acquirements will soon cure itself. +Knowledge that is not wanted dies out like the eyes of the fishes of +the Mammoth Cave. When you come to handle life and death as your +daily business, your memory will of itself bid good-by to such +inmates as the well-known foramina of the sphenoid bone and the +familiar oxides of methyl-ethylamyl-phenyl-ammonium. Be thankful +that you have once known them, and remember that even the learned +ignorance of a nomenclature is something to have mastered, and may +furnish pegs to hang facts upon which would otherwise have strewed +the floor of memory in loose disorder. + +But your education has, after all, been very largely practical. You +have studied medicine and surgery, not chiefly in books, but at the +bedside and in the operating amphitheatre. It is the special +advantage of large cities that they afford the opportunity of seeing +a great deal of disease in a short space of time, and of seeing many +cases of the same kind of disease brought together. Let us not be +unjust to the claims of the schools remote from the larger centres of +population. Who among us has taught better than Nathan Smith, better +than Elisha Bartlett? who teaches better than some of our living +contemporaries who divide their time between city and country +schools? I am afraid we do not always do justice to our country +brethren, whose merits are less conspicuously exhibited than those of +the great city physicians and surgeons, such especially as have +charge of large hospitals. There are modest practitioners living in +remote rural districts who are gifted by nature with such sagacity +and wisdom, trained so well in what is most essential to the practice +of their art, taught so thoroughly by varied experience, forced to +such manly self-reliance by their comparative isolation, that, from +converse with them alone, from riding with them on their long rounds +as they pass from village to village, from talking over cases with +them, putting up their prescriptions, watching their expedients, +listening to their cautions, marking the event of their predictions, +hearing them tell of their mistakes, and now and then glory a little +in the detection of another's blunder, a young man would find himself +better fitted for his real work than many who have followed long +courses of lectures and passed a showy examination. But the young +man is exceptionally fortunate who enjoys the intimacy of such a +teacher. And it must be confessed that the great hospitals, +infirmaries, and dispensaries of large cities, where men of well- +sifted reputations are in constant attendance, are the true centres +of medical education. No students, I believe, are more thoroughly +aware of this than those who have graduated at this institution. +Here, as in all our larger city schools, the greatest pains are taken +to teach things as well as names. You have entered into the +inheritance of a vast amount of transmitted skill and wisdom, which +you have taken, warm, as it were, with the life of your well-schooled +instructors. You have not learned all that art has to teach you, but +you are safer practitioners to-day than were many of those whose +names we hardly mention without a genuflection. I had rather be +cared for in a fever by the best-taught among you than by the +renowned Fernelius or the illustrious Boerhaave, could they come back +to us from that better world where there are no physicians needed, +and, if the old adage can be trusted, not many within call. I had +rather have one of you exercise his surgical skill upon me than find +myself in the hands of a resuscitated Fabricius Hildanus, or even of +a wise Ambroise Pare, revisiting earth in the light of the nineteenth +century. + +You will not accuse me of underrating your accomplishments. You know +what to do for a child in a fit, for an alderman in an apoplexy, for +a girl that has fainted, for a woman in hysterics, for a leg that is +broken, for an arm that is out of joint, for fevers of every color, +for the sailor's rheumatism, and the tailor's cachexy. In fact you +do really know so much at this very hour, that nothing but the +searching test of time can fully teach you the limitations of your +knowledge. + +Of some of these you will permit me to remind you. You will never +have outgrown the possibility of new acquisitions, for Nature is +endless in her variety. But even the knowledge which you may be said +to possess will be a different thing after long habit has made it a +part of your existence. The tactus eruditus extends to the mind as +well as to the finger-ends. Experience means the knowledge gained by +habitual trial, and an expert is one who has been in the habit of +trying. This is the kind of knowledge that made Ulysses wise in the +ways of men. Many cities had he seen, and known the minds of those +who dwelt in them. This knowledge it was that Chaucer's Shipman +brought home with him from the sea a + + "In many a tempest had his berd be shake." + +This is the knowledge we place most confidence in, in the practical +affairs of life. + +Our training has two stages. The first stage deals with our +intelligence, which takes the idea of what is to be done with the +most charming ease and readiness. Let it be a game of billiards, for +instance, which the marker is going to teach us. We have nothing to +do but to make this ball glance from that ball and hit that other +ball, and to knock that ball with this ball into a certain caecal +sacculus or diverticulum which our professional friend calls a +pocket. Nothing can be clearer; it is as easy as "playing upon this +pipe," for which Hamlet gives Guildenstern such lucid directions. +But this intelligent Me, who steps forward as the senior partner in +our dual personality, turns out to be a terrible bungler. He misses +those glancing hits which the hard-featured young professional person +calls "carroms," and insists on pocketing his own ball instead of the +other one. + +It is the unintelligent Me, stupid as an idiot, that has to try a +thing a thousand times before he can do it, and then never knows how +he does it, that at last does it well. We have to educate ourselves +through the pretentious claims of intellect, into the humble accuracy +of instinct, and we end at last by acquiring the dexterity, the +perfection, the certainty, which those masters of arts, the bee and +the spider, inherit from Nature. + +Book-knowledge, lecture-knowledge, examination-knowledge, are all in +the brain. But work-knowledge is not only in the brain, it is in the +senses, in the muscles, in the ganglia of the sympathetic nerves,-- +all over the man, as one may say, as instinct seems diffused through +every part of those lower animals that have no such distinct organ as +a brain. See a skilful surgeon handle a broken limb; see a wise old +physician smile away a case that looks to a novice as if the sexton +would soon be sent for; mark what a large experience has done for +those who were fitted to profit by it, and you will feel convinced +that, much as you know, something is still left for you to learn. + +May I venture to contrast youth and experience in medical practice, +something in the way the man painted the lion, that is, the lion +under? + +The young man knows the rules, but the old man knows-the exceptions. +The young man knows his patient, but the old man knows also his +patient's family, dead and alive, up and down for generations. He +can tell beforehand what diseases their unborn children will be +subject to, what they will die of if they live long enough, and +whether they had better live at all, or remain unrealized +possibilities, as belonging to a stock not worth being perpetuated. +The young man feels uneasy if he is not continually doing something +to stir up his patient's internal arrangements. The old man takes +things more quietly, and is much more willing to let well enough +alone: All these superiorities, if such they are,'you must wait for +time to bring you. In the meanwhile (if we will let the lion be +uppermost for a moment), the young man's senses are quicker than +those of his older rival. His education in all the accessory +branches is more recent, and therefore nearer the existing condition +of knowledge. He finds it easier than his seniors to accept the +improvements which every year is bringing forward. New ideas build +their nests in young men's brains. "Revolutions are not made by men +in spectacles," as I once heard it remarked, and the first whispers +of a new truth are not caught by those who begin to feel the need of +an ear-trumpet. Granting all these advantages to the young man, he +ought, nevertheless, to go on improving, on the whole, as a medical +practitioner, with every year, until he has ripened into a well- +mellowed maturity. But, to improve, he must be good for something at +the start. If you ship a poor cask of wine to India and back, if you +keep it a half a century, it only grows thinner and sharper. + +You are soon to enter into relations with the public, to expend your +skill and knowledge for its benefit, and find your support in the +rewards of your labor. What kind of a constituency is this which is +to look to you as its authorized champions in the struggle of life +against its numerous enemies? + +In the first place, the persons who seek the aid of the physician are +very honest and sincere in their wish to get rid of their complaints, +and, generally speaking, to live as long as they can. However +attractively the future is painted to them, they are attached to the +planet with which they are already acquainted. They are addicted to +the daily use of this empirical and unchemical mixture which we call +air; and would hold on to it as a tippler does to his alcoholic +drinks. There is nothing men will not do, there is nothing they have +not done, to recover their health and save their lives. They have +submitted to be half-drowned in water, and half-choked with gases, to +be buried up to their chins in earth, to be seared with hot irons +like galley-slaves, to be crimped with knives, like cod-fish, to have +needles thrust into their flesh, and bonfires kindled on their skin, +to swallow all sorts of abominations, and to pay for all this, as if +to be singed and scalded were a costly privilege, as if blisters were +a blessing, and leeches were a luxury. What more can be asked to +prove their honesty and sincerity? + +This same community is very intelligent with respect to a great many +subjects-commerce, mechanics, manufactures, politics. But with +regard to medicine it is hopelessly ignorant and never finds it out. +I do not know that it is any worse in this country than in Great +Britain, where Mr. Huxley speaks very freely of "the utter ignorance +of the simplest laws of their own animal life, which prevails among +even the most highly educated persons." And Cullen said before him +"Neither the acutest genius nor the soundest judgment will avail in +judging of a particular science, in regard to which they have not +been exercised. I have been obliged to please my patients sometimes +with reasons, and I have found that any will pass, even with able +divines and acute lawyers; the same will pass with the husbands as +with the wives." If the community could only be made aware of its +own utter ignorance, and incompetence to form opinions on medical +subjects, difficult enough to those who give their lives to the study +of them, the practitioner would have an easier task. But it will +form opinions of its own, it cannot help it, and we cannot blame it, +even though we know how slight and deceptive are their foundations. + +This is the way it happens: Every grown-up person has either been ill +himself or had a friend suffer from illness, from which he has +recovered. Every sick person has done something or other by +somebody's advice, or of his own accord, a little before getting +better. There is an irresistible tendency to associate the thing +done, and the improvement which followed it, as cause and effect. +This is the great source of fallacy in medical practice. But the +physician has some chance of correcting his hasty inference. He +thinks his prescription cured a single case of a particular +complaint; he tries it in twenty similar cases without effect, and +sets down the first as probably nothing more than a coincidence. The +unprofessional experimenter or observer has no large experience to +correct his hasty generalization. He wants to believe that the means +he employed effected his cure. He feels grateful to the person who +advised it, he loves to praise the pill or potion which helped him, +and he has a kind of monumental pride in himself as a living +testimony to its efficacy. So it is that you will find the community +in which you live, be it in town or country, full of brands plucked +from the burning, as they believe, by some agency which, with your +better training, you feel reasonably confident had nothing to do with +it. Their disease went out of itself, and the stream from the +medical fire-annihilator had never even touched it. + +You cannot and need not expect to disturb the public in the +possession of its medical superstitions. A man's ignorance is as +much his private property, and as precious in his own eyes, as his +family Bible. You have only to open your own Bible at the ninth +chapter of St. John's Gospel, and you will find that the logic of a +restored patient was very simple then, as it is now, and very hard to +deal with. My clerical friends will forgive me for poaching on their +sacred territory, in return for an occasional raid upon the medical +domain of which they have now and then been accused. + +A blind man was said to have been restored to sight by a young person +whom the learned doctors of the Jewish law considered a sinner, and, +as such, very unlikely to have been endowed with a divine gift of +healing. They visited the patient repeatedly, and evidently teased +him with their questions about the treatment, and their insinuations +about the young man, until he lost his temper. At last he turned +sharply upon them: "Whether he be a sinner or no, I know not: one +thing I know, that, whereas I was blind, now I see." + +This is the answer that always has been and always will be given by +most persons when they find themselves getting well after doing +anything, no matter what,--recommended by anybody, no matter whom. +Lord Bacon, Robert Boyle, Bishop Berkeley, all put their faith in +panaceas which we should laugh to scorn. They had seen people get +well after using them. Are we any wiser than those great men? Two +years ago, in a lecture before the Massachusetts Historical Society, +I mentioned this recipe of Sir Kenelm Digby for fever and ague: Pare +the patient's nails; put the parings in a little bag, and hang the +bag round the neck of a live eel, and place him in a tub of water. +The eel will die, and the patient will recover. + +Referring to this prescription in the course of the same lecture, I +said: "You smiled when I related Sir Kenehn Digby's prescription, +with the live eel in it; but if each of you were to empty his or her +pockets, would there not roll out, from more than one of them, a +horse-chestnut, carried about as a cure for rheumatism?" Nobody saw +fit to empty his or her pockets, and my question brought no response. +But two months ago I was in a company of educated persons, college +graduates every one of them, when a gentleman, well known in our +community, a man of superior ability and strong common-sense, on the +occasion of some talk arising about rheumatism, took a couple of very +shiny horse-chestnuts from his breeches-pocket, and laid them on the +table, telling us how, having suffered from the complaint in +question, he had, by the advice of a friend, procured these two +horse-chestnuts on a certain time a year or more ago, and carried +them about him ever since; from which very day he had been entirely +free from rheumatism. + +This argument, from what looks like cause and effect, whether it be +so or not, is what you will have to meet wherever you go, and you +need not think you can answer it. In the natural course of things +some thousands of persons must be getting well or better of slight +attacks of colds, of rheumatic pains, every week, in this city alone. +Hundreds of them do something or other in the way of remedy, by +medical or other advice, or of their own motion, and the last thing +they do gets the credit of the recovery. Think what a crop of +remedies this must furnish, if it were all harvested! + +Experience has taught, or will teach you, that most of the wonderful +stories patients and others tell of sudden and signal cures are like +Owen Glendower's story of the portents that announced his birth. The +earth shook at your nativity, did it? Very likely, and + + "So it would have done, + At the same season, if your mother's cat + Had kittened, though yourself had ne'er been born." + +You must listen more meekly than Hotspur did to the babbling +Welshman, for ignorance is a solemn and sacred fact, and, like +infancy, which it resembles, should be respected. Once in a while +you will have a patient of sense, born with the gift of observation, +from whom you may learn something. When you find yourself in the +presence of one who is fertile of medical opinions, and affluent in +stories of marvellous cures,--of a member of Congress whose name +figures in certificates to the value of patent medicines, of a +voluble dame who discourses on the miracles she has wrought or seen +wrought with the little jokers of the sugar-of-milk globule-box, take +out your watch and count the pulse; also note the time of day, and +charge the price of a visit for every extra fifteen, or, if you are +not very busy, every twenty minutes. In this way you will turn what +seems a serious dispensation into a double blessing, for this class +of patients loves dearly to talk, and it does them a deal of good, +and you feel as if you had earned your money by the dose you have +taken, quite as honestly as by any dose you may have ordered. + +You must take the community just as it is, and make the best of it. +You wish to obtain its confidence; there is a short rule for doing +this which you will find useful,--deserve it. But, to deserve it in +full measure, you must unite many excellences, natural and acquired. + +As the basis of all the rest, you must have all those traits of +character which fit you to enter into the most intimate and +confidential relations with the families of which you are the +privileged friend and counsellor. Medical Christianity, if I may use +such a term, is of very early date. By the oath of Hippocrates, the +practitioner of ancient times bound himself to enter his patient's +house with the sole purpose of doing him good, and so to conduct +himself as to avoid the very appearance of evil. Let the physician +of to-day begin by coming up to this standard, and add to it all the +more recently discovered virtues and graces. + +A certain amount of natural ability is requisite to make you a good +physician, but by no means that disproportionate development of some +special faculty which goes by the name of genius. A just balance of +the mental powers is a great deal more likely to be useful than any +single talent, even were it the power of observation; in excess. For +a mere observer is liable to be too fond of facts for their own sake, +so that, if he told the real truth, he would confess that he takes +more pleasure in a post-mortem examination which shows him what was +the matter with a patient, than in a case which insists on getting +well and leaving him in the dark as to its nature. Far more likely +to interfere with the sound practical balance of the mind is that +speculative, theoretical tendency which has made so many men noted in +their day, whose fame has passed away with their dissolving theories. +Read Dr. Bartlett's comparison of the famous Benjamin Rush with his +modest fellow-townsman Dr. William Currie, and see the dangers into +which a passion for grandiose generalizations betrayed a man of many +admirable qualities. + +I warn you against all ambitious aspirations outside of your +profession. Medicine is the most difficult of sciences and the most +laborious of arts. It will task all your powers of body and mind if +you are faithful to it. Do not dabble in the muddy sewer of +politics, nor linger by the enchanted streams of literature, nor dig +in far-off fields for the hidden waters of alien sciences. The great +practitioners are generally those who concentrate all their powers on +their business. If there are here and there brilliant exceptions, it +is only in virtue of extraordinary gifts, and industry to which very +few are equal. + +To get business a man mast really want it; and do you suppose that +when you are in the middle of a heated caucus, or half-way through a +delicate analysis, or in the spasm of an unfinished ode, your eyes +rolling in the fine frenzy of poetical composition, you want to be +called to a teething infant, or an ancient person groaning under the +griefs of a lumbago? I think I have known more than one young man +whose doctor's sign proclaimed his readiness to serve mankind in that +capacity, but who hated the sound of a patient's knock, and as he sat +with his book or his microscope, felt exactly as the old party +expressed himself in my friend Mr. Brownell's poem + + "All I axes is, let me alone." + +The community soon finds out whether you are in earnest, and really +mean business, or whether you are one of those diplomaed dilettanti +who like the amusement of quasi medical studies, but have no idea of +wasting their precious time in putting their knowledge in practice +for the benefit of their suffering fellow-creatures. + +The public is a very incompetent judge of your skill and knowledge, +but it gives its confidence most readily to those who stand well with +their professional brethren, whom they call upon when they themselves +or their families are sick, whom they choose to honorable offices, +whose writings and teachings they hold in esteem. A man may be much +valued by the profession and yet have defects which prevent his +becoming a favorite practitioner, but no popularity can be depended +upon as permanent which is not sanctioned by the judgment of +professional experts, and with these you will always stand on your +substantial merits. + +What shall I say of the personal habits you must form if you wish for +success? Temperance is first upon the list. Intemperance in a +physician partakes of the guilt of homicide, for the muddled brain +may easily make a fatal blunder in a prescription and the unsteady +hand transfix an artery in an operation. Tippling doctors have been +too common in the history of medicine. Paracelsus was a sot, +Radcliffe was much too fond of his glass, and Dr. James Hurlbut of +Wethersfield, Connecticut, a famous man in his time, used to drink a +square bottle of rum a day, with a corresponding allowance of opium +to help steady his nerves. We commonly speak of a man as being the +worse for liquor, but I was asking an Irish laborer one day about his +doctor, who, as he said, was somewhat given to drink. "I like him +best when he's a little that way," he said; "then I can spake to +him." I pitied the poor patient who could not venture to allude to +his colic or his pleurisy until his physician was tipsy. + +There are personal habits of less gravity than the one I have +mentioned which it is well to guard against, or, if they are formed, +to relinquish. A man who may be called at a moment's warning into +the fragrant boudoir of suffering loveliness should not unsweeten its +atmosphere with reminiscences of extinguished meerschaums. He should +remember that the sick are sensitive and fastidious, that they love +the sweet odors and the pure tints of flowers, and if his presence is +not like the breath of the rose, if his hands are not like the leaf +of the lily, his visit may be unwelcome, and if he looks behind him +he may see a window thrown open after he has left the sick-chamber. +I remember too well the old doctor who sometimes came to help me +through those inward griefs to which childhood is liable. "Far off +his coming "--shall I say "shone," and finish the Miltonic phrase, or +leave the verb to the happy conjectures of my audience? Before him +came a soul-subduing whiff of ipecacuanha, and after him lingered a +shuddering consciousness of rhubarb. He had lived so much among his +medicaments that he had at last become himself a drug, and to have +him pass through a sick-chamber was a stronger dose than a +conscientious disciple of Hahnemann would think it safe to +administer. + +Need I remind yon of the importance of punctuality in your +engagements, and of the worry and distress to patients and their +friends which the want of it occasions? One of my old teachers +always carried two watches, to make quite sure of being exact, and +not only kept his appointments with the regularity of a chronometer, +but took great pains to be at his patient's house at the time when he +had reason to believe he was expected, even if no express appointment +was made. It is a good rule; if you call too early, my lady's hair +may not be so smooth as could be wished, and, if you keep her waiting +too long, her hair may be smooth, but her temper otherwise. + +You will remember, of course, always to get the weather-gage of your +patient. I mean, to place him so that the light falls on his face +and not on yours. It is a kind of, ocular duel that is about to take +place between you; you are going to look through his features into +his pulmonary and hepatic and other internal machinery, and he is +going to look into yours quite as sharply to see what you think about +his probabilities for time or eternity. + +No matter how hard he stares at your countenance, he should never be +able to read his fate in it. It should be cheerful as long as there +is hope, and serene in its gravity when nothing is left but +resignation. The face of a physician, like that of a diplomatist, +should be impenetrable. Nature is a benevolent old hypocrite; she +cheats the sick and the dying with illusions better than any +anodynes. If there are cogent reasons why a patient should be +undeceived, do it deliberately and advisedly, but do not betray your +apprehensions through your tell-tale features. + +We had a physician in our city whose smile was commonly reckoned as +being worth five thousand dollars a year to him, in the days, too, of +moderate incomes. You cannot put on such a smile as that any more +than you can get sunshine without sun; there was a tranquil and +kindly nature under it that irradiated the pleasant face it made one +happier to meet on his daily rounds. But you can cultivate the +disposition, and it will work its way through to the surface, nay, +more,--you can try to wear a quiet and encouraging look, and it will +react on your disposition and make you like what you seem to be, or +at least bring you nearer to its own likeness. + +Your patient has no more right to all the truth you know than he has +to all the medicine in your saddlebags, if you carry that kind of +cartridge-box for the ammunition that slays disease. He should get +only just so much as is good for him. I have seen a physician +examining a patient's chest stop all at once, as he brought out a +particular sound with a tap on the collarbone, in the attitude of a +pointer who has just come on the scent or sight of a woodcock. You +remember the Spartan boy, who, with unmoved countenance, hid the fox +that was tearing his vitals beneath his mantle. What he could do in +his own suffering you must learn to do for others on whose vital +organs disease has fastened its devouring teeth. It is a terrible +thing to take away hope, even earthly hope, from a fellow-creature. +Be very careful what names you let fall before your patient. He +knows what it means when you tell him he has tubercles or Bright's +disease, and, if he hears the word carcinoma, he will certainly look +it out in a medical dictionary, if he does not interpret its dread +significance on the instant. Tell him he has asthmatic symptoms, or +a tendency to the gouty diathesis, and he will at once think of all +the asthmatic and gouty old patriarchs he has ever heard of, and be +comforted. You need not be so cautious in speaking of the health of +rich and remote relatives, if he is in the line of succession. + +Some shrewd old doctors have a few phrases always on hand for +patients that will insist on knowing the pathology of their +complaints without the slightest capacity of understanding the +scientific explanation. I have known the term "spinal irritation" +serve well on such occasions, but I think nothing on the whole has +covered so much ground, and meant so little, and given such profound +satisfaction to all parties, as the magnificent phrase "congestion of +the portal system." + +Once more, let me recommend you, as far as possible, to keep your +doubts to yourself, and give the patient the benefit of your +decision. Firmness, gentle firmness, is absolutely necessary in this +and certain other relations. Mr. Rarey with Cruiser, Richard with +Lady Ann, Pinel with his crazy people, show what steady nerves can do +with the most intractable of animals, the most irresistible of +despots, and the most unmanageable of invalids. + +If you cannot acquire and keep the confidence of your patient, it is +time for you to give place to some other practitioner who can. If +you are wise and diligent, you can establish relations with the best +of them which they will find it very hard to break. But, if they +wish to employ another person, who, as they think, knows more than +you do, do not take it as a personal wrong. A patient believes +another man can save his life, can restore him to health, which, as +he thinks, you have not the skill to do. No matter whether the +patient is right or wrong, it is a great impertinence to think you +have any property in him. Your estimate of your own ability is not +the question, it is what the patient thinks of it. All your wisdom +is to him like the lady's virtue in Raleigh's song: + + "If she seem not chaste to me, + What care I how chaste she be?" + +What I call a good patient is one who, having found a good physician, +sticks to him till he dies. But there are many very good people who +are not what I call good patients. I was once requested to call on a +lady suffering from nervous and other symptoms. It came out in the +preliminary conversational skirmish, half medical, half social, that +I was the twenty-sixth member of the faculty into whose arms, +professionally speaking, she had successively thrown herself. Not +being a believer in such a rapid rotation of scientific crops, I +gently deposited the burden, commending it to the care of number +twenty-seven, and, him, whoever he might be, to the care of Heaven. + +If there happened to be among my audience any person who wished to +know on what principles the patient should choose his physician, I +should give him these few precepts to think over: + +Choose a man who is personally agreeable, for a daily visit from an +intelligent, amiable, pleasant, sympathetic person will cost you no +more than one from a sloven or a boor, and his presence will do more +for you than any prescription the other will order. + +Let him be a man of recognized good sense in other matters, and the +chance is that he will be sensible as a practitioner. + +Let him be a man who stands well with his professional brethren, whom +they approve as honest, able, courteous. + +Let him be one whose patients are willing to die in his hands, not +one whom they go to for trifles, and leave as soon as they are in +danger, and who can say, therefore, that he never loses a patient. + +Do not leave the ranks of what is called the regular profession, +unless you wish to go farther and fare worse, for you may be assured +that its members recognize no principle which hinders their accepting +any remedial agent proved to be useful, no matter from what quarter +it comes. The difficulty is that the stragglers, organized under +fantastic names in pretentious associations, or lurking in solitary +dens behind doors left ajar, make no real contributions to the art of +healing. When they bring forward a remedial agent like chloral, like +the bromide of potassium, like ether, used as an anesthetic, they +will find no difficulty in procuring its recognition. + +Some of you will probably be more or less troubled by the pretensions +of that parody of mediaeval theology which finds its dogma of +hereditary depravity in the doctrine of psora, its miracle of +transubstantiation in the mystery of its triturations and dilutions, +its church in the people who have mistaken their century, and its +priests in those who have mistaken their calling. You can do little +with persons who are disposed to accept these curious medical +superstitions. The saturation-point of individual minds with +reference to evidence, and especially medical evidence, differs, and +must always continue to differ, very widely. There are those whose +minds are satisfied with the decillionth dilution of a scientific +proof. No wonder they believe in the efficacy of a similar +attenuation of bryony or pulsatilla. You have no fulcrum you can +rest upon to lift an error out of such minds as these, often highly +endowed with knowledge and talent, sometimes with genius, but +commonly richer in the imaginative than the observing and reasoning +faculties. + +Let me return once more to the young graduate. Your relations to +your professional brethren may be a source of lifelong happiness and +growth in knowledge and character, or they may make you wretched and +end by leaving you isolated from those who should be your friends and +counsellors. The life of a physician becomes ignoble when he suffers +himself to feed on petty jealousies and sours his temper in perpetual +quarrels. You will be liable to meet an uncomfortable man here and +there in the profession,--one who is so fond of being in hot water +that it is a wonder all the albumen in his body is not coagulated. +There are common barrators among doctors as there are among lawyers, +--stirrers up of strife under one pretext and another, but in reality +because they like it. They are their own worst enemies, and do +themselves a mischief each time they assail their neighbors. In my +student days I remember a good deal of this Donnybrook-Fair style of +quarrelling, more especially in Paris, where some of the noted +surgeons were always at loggerheads, and in one of our lively Western +cities. Soon after I had set up an office, I had a trifling +experience which may serve to point a moral in this direction. I had +placed a lamp behind the glass in the entry to indicate to the +passer-by where relief from all curable infirmities was to be sought +and found. Its brilliancy attracted the attention of a devious +youth, who dashed his fist through the glass and upset my modest +luminary. All he got by his vivacious assault was that he left +portions of integument from his knuckles upon the glass, had a lame +hand, was very easily identified, and had to pay the glazier's bill. +The moral is that, if the brilliancy of another's reputation excites +your belligerent instincts, it is not worth your while to strike at +it, without calculating which of you is likely to suffer most, if you +do. + +You may be assured that when an ill-conditioned neighbor is always +complaining of a bad taste in his mouth and an evil atmosphere about +him, there is something wrong about his own secretions. In such +cases there is an alterative regimen of remarkable efficacy: it is a +starvation-diet of letting alone. The great majority of the +profession are peacefully inclined. Their pursuits are eminently +humanizing, and they look with disgust on the personalities which +intrude themselves into the placid domain of an art whose province it +is to heal and not to wound. + +The intercourse of teacher and student in a large school is +necessarily limited, but it should be, and, so far as my experience +goes, it is, eminently cordial and kindly. You will leave with +regret, and hold in tender remembrance, those who have taken you by +the hand at your entrance on your chosen path, and led you patiently +and faithfully, until the great gates at its end have swung upon +their hinges, and the world lies open before you. That venerable +oath to which I have before referred bound the student to regard his +instructor in the light of a parent, to treat his children like +brothers, to succor him in his day of need. I trust the spirit of +the oath of Hippocrates is not dead in the hearts of the students of +to-day. They will remember with gratitude every earnest effort, +every encouraging word, which has helped them in their difficult and +laborious career of study. The names they read on their diplomas +will recall faces that are like family-portraits in their memory, and +the echo of voices they have listened to so long will linger in their +memories far into the still evening of their lives. + +One voice will be heard no more which has been familiar to many among +you. It is not for me, a stranger to these scenes, to speak his +eulogy. I have no right to sadden this hour by dwelling on the deep +regrets of friendship, or to bid the bitter tears of sorrow flow +afresh. Yet I cannot help remembering what a void the death of such +a practitioner as your late instructor must leave in the wide circle +of those who leaned upon his counsel and assistance in their hour of +need, in a community where he was so widely known and esteemed, in a +school where he bore so important a part. There is no exemption from +the common doom for him who holds the shield to protect others. The +student is called from his bench, the professor from his chair, the +practitioner in his busiest period hears a knock more peremptory than +any patient's midnight summons, and goes on that unreturning visit +which admits of no excuse, and suffers no delay. The call of such a +man away from us is the bereavement of a great family. Nor can we +help regretting the loss for him of a bright and cheerful earthly +future; for the old age of a physician is one of the happiest periods +of his life. He is loved and cherished for what he has been, and +even in the decline of his faculties there are occasions when his +experience is still appealed to, and his trembling hands are looked +to with renewing hope and trust, as being yet able to stay the arm of +the destroyer. + +But if there is so much left for age, how beautiful, how inspiring is +the hope of youth! I see among those whom I count as listeners one +by whose side I have sat as a fellow-teacher, and by whose +instructions I have felt myself not too old to profit. As we +borrowed him from your city, I must take this opportunity of telling +you that his zeal, intelligence, and admirable faculty as an +instructor were heartily and universally recognized among us. We +return him, as we trust, uninjured, to the fellow-citizens who have +the privilege of claiming him as their own. + +And now, gentlemen of the graduating class, nothing remains but for +me to bid you, in the name of those for whom I am commissioned and +privileged to speak, farewell as students, and welcome as +practitioners. I pronounce the two benedictions in the same breath, +as the late king's demise and the new king's accession are proclaimed +by the same voice at the same moment. You would hardly excuse me if +I stooped to any meaner dialect than the classical and familiar +language of your prescriptions, the same in which your title to the +name of physician is, if, like our own institution, you follow the +ancient usage, engraved upon your diplomas. + +Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete, +filii! + +Salvete, VIRI, artis medicae magister; Salvete amici; salvete +fratres! + + + + + + +MEDICAL LIBRARIES. + +[Dedicatory Address at the opening of the Medical Library in Boston, +December 3, 1878.] + +It is my appointed task, my honorable privilege, this evening, to +speak of what has been done by others. No one can bring his tribute +of words into the presence of great deeds, or try with them to +embellish the memory of any inspiring achievement, without feeling +and leaving with others a sense of their insufficiency. So felt +Alexander when he compared even his adored Homer with the hero the +poet had sung. So felt Webster when he contrasted the phrases of +rhetoric with the eloquence of patriotism and of self-devotion. So +felt Lincoln when on the field of Gettysburg he spoke those immortal +words which Pericles could not nave bettered, which Aristotle could +not have criticised. So felt he who wrote the epitaph of the builder +of the dome which looks down on the crosses and weathercocks that +glitter over London. + +We are not met upon a battle-field, except so far as every laborious +achievement means a victory over opposition, indifference, +selfishness, faintheartedness, and that great property of mind as +well as matter,--inertia. We are not met in a cathedral, except so +far as every building whose walls are lined with the products of +useful and ennobling thought is a temple of the Almighty, whose +inspiration has given us understanding. But we have gathered within +walls which bear testimony to the self-sacrificing, persevering +efforts of a few young men, to whom we owe the origin and development +of all that excites our admiration in this completed enterprise; and +I might consider my task as finished if I contented myself with +borrowing the last word of the architect's epitaph and only saying, +Look around you! + +The reports of the librarian have told or will tell you, in some +detail, what has been accomplished since the 21st of December, 1874, +when six gentlemen met at the house of Dr. Henry Ingersoll Bowditch +to discuss different projects for a medical library. In less than +four years from that time, by the liberality of associations and of +individuals, this collection of nearly ten thousand volumes, of five +thousand pamphlets, and of one hundred and twenty-five journals, +regularly received,--all worthily sheltered beneath this lofty roof, +--has come into being under our eyes. It has sprung up, as it were; +in the night like a mushroom; it stands before us in full daylight as +lusty as an oak, and promising to grow and flourish in the perennial +freshness of an evergreen. + +To whom does our profession owe this already large collection of +books, exceeded in numbers only by four or five of the most extensive +medical libraries in the country, and lodged in a building so well +adapted to its present needs? We will not point out individually all +those younger members of the profession who have accomplished what +their fathers and elder brethren had attempted and partially +achieved. We need not write their names on these walls, after the +fashion of those civic dignitaries who immortalize themselves on +tablets of marble and gates of iron. But their contemporaries know +them well, and their descendants will not forget them,--the men who +first met together, the men who have given their time and their +money, the faithful workers, worthy associates of the strenuous +agitator who gave no sleep to his eyes, no slumber to his eyelids, +until he had gained his ends; the untiring, imperturbable, tenacious, +irrepressible, all-subduing agitator who neither rested nor let +others rest until the success of the project was assured. If, +against his injunctions, I name Dr. James Read Chadwick, it is only +my revenge for his having kept me awake so often and so long while he +was urging on the undertaking in which he has been preeminently +active and triumphantly successful. + +We must not forget the various medical libraries which preceded this: +that of an earlier period, when Boston contained about seventy +regular practitioners, the collection afterwards transferred to the +Boston Athenaeum; the two collections belonging to the University; +the Treadwell Library at the Massachusetts General Hospital; the +collections of the two societies, that for Medical Improvement and +that for Medical Observation; and more especially the ten thousand +volumes relating to medicine belonging to our noble public city +library,--too many blossoms on the tree of knowledge, perhaps, for +the best fruit to ripen. But the Massachusetts Medical Society now +numbers nearly four hundred members in the city of Boston. The time +had arrived for a new and larger movement. There was needed a place +to which every respectable member of the medical profession could +obtain easy access; where, under one roof, all might find the special +information they were seeking; where the latest medical intelligence +should be spread out daily as the shipping news is posted on the +bulletins of the exchange; where men engaged in a common pursuit +could meet, surrounded by the mute oracles of science and art; where +the whole atmosphere should be as full of professional knowledge as +the apothecary's shop is of the odor of his medicaments. This was +what the old men longed for,--the prophets and kings of the +profession, who + + "Desired it long, + But died without the sight." + +This is what the young men and those who worked under their guidance +undertook to give us. And now such a library, such a reading-room, +such an exchange, such an intellectual and social meeting place, we +be hold a fact, plain before us. The medical profession of our city, +and, let us add, of all those neighboring places which it can reach +with its iron arms, is united as never before by the commune +vinculum, the common bond of a large, enduring, ennobling, unselfish +interest. It breathes a new air of awakened intelligence. It +marches abreast of the other learned professions, which have long had +their extensive and valuable centralized libraries; abreast of them, +but not promising to be content with that position. What glorifies a +town like a cathedral? What dignifies a province like a university? +What illuminates a country like its scholarship, and what is the nest +that hatches scholars but a library? + +The physician, some may say, is a practical man and has little use +for all this book-learning. Every student has heard Sydenham's reply +to Sir Richard Blackmore's question as to what books he should read, +--meaning medical books. "Read Don Quixote," was his famous answer. +But Sydenham himself made medical books and may be presumed to have +thought those at least worth reading. Descartes was asked where was +his library, and in reply held up the dissected body of an animal. +But Descartes made books, great books, and a great many of them. A +physician of common sense without erudition is better than a learned +one without common sense, but the thorough master of his profession +must have learning added to his natural gifts. + +It is not necessary to maintain the direct practical utility of all +kinds of learning. Our shelves contain many books which only a +certain class of medical scholars will be likely to consult. There +is a dead medical literature, and there is a live one. The dead is +not all ancient, the live is not all modern. There is none, modern +or ancient, which, if it has no living value for the student, will +not teach him something by its autopsy. But it is with the live +literature of his profession that the medical practitioner is first +of all concerned. + +Now there has come a great change in our time over the form in which +living thought presents itself. The first printed books,--the +incunabula,--were inclosed in boards of solid oak, with brazen clasps +and corners; the boards by and by were replaced by pasteboard covered +with calf or sheepskin; then cloth came in and took the place of +leather; then the pasteboard was covered with paper instead of cloth; +and at this day the quarterly, the monthly, the weekly periodical in +its flimsy unsupported dress of paper, and the daily journal, naked +as it came from the womb of the press, hold the larger part of the +fresh reading we live upon. We must have the latest thought in its +latest expression; the page must be newly turned like the morning +bannock; the pamphlet must be newly opened like the ante-prandial +oyster. + +Thus a library, to meet the need of our time, must take, and must +spread out in a convenient form, a great array of periodicals. Our +active practitioners read these by preference over almost everything +else. Our specialists, more particularly, depend on the month's +product, on the yearly crop of new facts, new suggestions, new +contrivances, as much as the farmer on the annual yield of his acres. +One of the first wants, then, of the profession is supplied by our +library in its great array of periodicals from many lands, in many +languages. Such a number of medical periodicals no private library +would have room for, no private person would pay for, or flood his +tables with if they were sent him for nothing. These, I think, with +the reports of medical societies and the papers contributed to them, +will form the most attractive part of our accumulated medical +treasures. They will be also one of our chief expenses, for these +journals must be bound in volumes and they require a great amount of +shelf-room; all this, in addition to the cost of subscription for +those which are not furnished us gratuitously. + +It is true that the value of old scientific periodicals is, other +things being equal, in the inverse ratio of their age, for the +obvious reason that what is most valuable in the earlier volumes of a +series is drained off into the standard works with which the +intelligent practitioner is supposed to be familiar. But no extended +record of facts grows too old to be useful, provided only that we +have a ready and sure way of getting at the particular fact or facts +we are in search of. + +And this leads me to speak of what I conceive to be one of the +principal tasks to be performed by the present and the coming +generation of scholars, not only in the medical, but in every +department of knowledge. I mean the formation of indexes, and more +especially of indexes to periodical literature. + +This idea has long been working in the minds of scholars, and all who +have had occasion to follow out any special subject. I have a right +to speak of it, for I long ago attempted to supply the want of +indexes in some small measure for my own need. I had a very complete +set of the "American Journal of the Medical Sciences;" an entire set +of the "North American Review," and many volumes of the reprints of +the three leading British quarterlies. Of what use were they to me +without general indexes? I looked them all through carefully and +made classified lists of all the articles I thought I should most +care to read. But they soon outgrew my lists. The "North American +Review" kept filling up shelf after shelf, rich in articles which I +often wanted to consult, but what a labor to find them, until the +index of Mr. Gushing, published a few months since, made the contents +of these hundred and twenty volumes as easily accessible as the words +in a dictionary! I had a, copy of good Dr. Abraham Rees's +Cyclopaedia, a treasure-house to my boyhood which has not lost its +value for me in later years. But where to look for what I wanted? I +wished to know, for instance, what Dr. Burney had to say about +singing. Who would have looked for it under the Italian word +cantare? I was curious to learn something of the etchings of +Rembrandt, and where should I find it but under the head "Low +Countries, Engravers of the,"--an elaborate and most valuable article +of a hundred double-columned close-printed quarto pages, to which no +reference, even, is made under the title Rembrandt. + +There was nothing to be done, if I wanted to know where that which I +specially cared for was to be found in my Rees's Cyclopaedia, but to +look over every page of its forty-one quarto volumes and make out a +brief list of matters of interest which I could not find by their +titles, and this I did, at no small expense of time and trouble. + +Nothing, therefore, could be more pleasing to me than to see the +attention which has been given of late years to the great work of +indexing. It is a quarter of a century since Mr. Poole published his +"Index to Periodical Literature," which it is much to be hoped is +soon to appear in a new edition, grown as it must be to formidable +dimensions by the additions of so long a period. The "British and +Foreign Medical Review," edited by the late Sir John Forties, +contributed to by Huxley, Carpenter, Laycock, and others of the most +distinguished scientific men of Great Britain, has an index to its +twenty-four volumes, and by its aid I find this valuable series as +manageable as a lexicon. The last edition of the "Encyclopaedia +Britannica" had a complete index in a separate volume, and the +publishers of Appletons' "American Cyclopaedia" have recently issued +an index to their useful work, which must greatly add to its value. +I have already referred to the index to the "North American Review," +which to an American, and especially to a New Englander, is the most +interesting and most valuable addition of its kind to our literary +apparatus since the publication of Mr. Allibone's "Dictionary of +Authors." I might almost dare to parody Mr. Webster's words in +speaking of Hamilton, to describe what Mr. Gushing did for the solemn +rows of back volumes of our honored old Review which had been long +fossilizing on our shelves: "He touched the dead corpse of the 'North +American,' and it sprang to its feet." A library of the best +thought of the best American scholars during the greater portion of +the century was brought to light by the work of the indexmaker as +truly as were the Assyrian tablets by the labors of Layard. + +A great portion of the best writing and reading literary, scientific, +professional, miscellaneous--comes to us now, at stated intervals, in +paper covers. The writer appears, as it were, in his shirt-sleeves. +As soon as he has delivered his message the book-binder puts a coat +on his back, and he joins the forlorn brotherhood of "back volumes," +than which, so long as they are unindexed, nothing can be more +exasperating. Who wants a lock without a key, a ship without a +rudder, a binnacle without a compass, a check without a signature, a +greenback without a goldback behind it? + +I have referred chiefly to the medical journals, but I would include +with these the reports of medical associations, and those separate +publications which, coming in the form of pamphlets, heap themselves +into chaotic piles and bundles which are worse than useless, taking +up a great deal of room, and frightening everything away but mice and +mousing antiquarians, or possibly at long intervals some terebrating +specialist. + +Arranged, bound, indexed, all these at once become accessible and +valuable. I will take the first instance which happens to suggest +itself. How many who know all about osteoblasts and the experiments +of Ollier, and all that has grown out of them, know where to go for a +paper by the late Dr. A. L. Peirson of Salem, published in the year +1840, under the modest title, Remarks on Fractures? And if any +practitioner who has to deal with broken bones does not know that +most excellent and practical essay, it is a great pity, for it +answers very numerous questions which will be sure to suggest +themselves to the surgeon and the patient as no one of the recent +treatises, on my own shelves, at least, can do. + +But if indexing is the special need of our time in medical +literature, as in every department of knowledge, it must be +remembered that it is not only an immense labor, but one that never +ends. It requires, therefore, the cooperation of a large number of +individuals to do the work, and a large amount of money to pay for +making its results public through the press. When it is remembered +that the catalogue of the library of the British Museum is contained +in nearly three thousand large folios of manuscript, and not all its +books are yet included, the task of indexing any considerable branch +of science or literature looks as if it were well nigh impossible. +But many hands make light work. An "Index Society" has been formed +in England, already numbering about one hundred and seventy members. +It aims at "supplying thorough indexes to valuable works and +collections which have hitherto lacked them; at issuing indexes to +the literature of special subjects; and at gathering materials for a +general reference index." This society has published a little +treatise setting forth the history and the art of indexing, which I +trust is in the hands of some of our members, if not upon our +shelves. + +Something has been done in the same direction by individuals in our +own country, as we have already seen. The need of it in the +department of medicine is beginning to be clearly felt. Our library +has already an admirable catalogue with cross references, the work of +a number of its younger members cooperating in the task. A very +intelligent medical student, Mr. William D. Chapin, whose excellent +project is indorsed by well-known New York physicians and professors, +proposes to publish a yearly index to original communications in the +medical journals of the United States, classified by authors and +subjects. But it is from the National Medical Library at Washington +that we have the best promise and the largest expectations. That +great and growing collection of fifty thousand volumes is under the +eye and hand of a librarian who knows books and how to manage them. +For libraries are the standing armies of civilization, and an army is +but a mob without a general who can organize and marshal it so as to +make it effective. The "Specimen Fasciculus of a Catalogue of the +National Medical Library," prepared under the direction of Dr. +Billings, the librarian, would have excited the admiration of Haller, +the master scholar in medical science of the last century, or rather +of the profession in all centuries, and if carried out as it is begun +will be to the nineteenth all and more than all that the three +Bibliothecae--Anatomica, Chirurgica, and Medicinae-Practicae--were to +the eighteenth century. I cannot forget the story that Agassiz was +so fond of telling of the king of Prussia and Fichte. It was after +the humiliation and spoliation of the kingdom by Napoleon that the +monarch asked the philosopher what could be done to regain the lost +position of the nation. "Found a great university, Sire," was the +answer, and so it was that in the year 1810 the world-renowned +University of Berlin came into being. I believe that we in this +country can do better than found a national university, whose +professors shall be nominated in caucuses, go in and out, perhaps, +like postmasters, with every change of administration, and deal with +science in the face of their constituency as the courtier did with +time when his sovereign asked him what o'clock it was: "Whatever hour +your majesty pleases." But when we have a noble library like that at +Washington, and a librarian of exceptional qualifications like the +gentleman who now holds that office, I believe that a liberal +appropriation by Congress to carry out a conscientious work for the +advancement of sound knowledge and the bettering of human conditions, +like this which Dr. Billings has so well begun, would redound greatly +to the honor of the nation. It ought to be willing to be at some +charge to make its treasures useful to its citizens, and, for its own +sake, especially to that class which has charge of health, public and +private. This country abounds in what are called "self-made men," +and is justly proud of many whom it thus designates. In one sense no +man is self-made who breathes the air of a civilized community. In +another sense every man who is anything other than a phonograph on +legs is self-made. But if we award his just praise to the man who +has attained any kind of excellence without having had the same +advantages as others whom, nevertheless, he has equalled or +surpassed, let us not be betrayed into undervaluing the mechanic's +careful training to his business, the thorough and laborious +education of the scholar and the professional man. + +Our American atmosphere is vocal with the flippant loquacity of half +knowledge. We must accept whatever good can be got out of it, and +keep it under as we do sorrel and mullein and witchgrass, by +enriching the soil, and sowing good seed in plenty; by good teaching +and good books, rather than by wasting our time in talking against +it. Half knowledge dreads nothing but whole knowledge. + +I have spoken of the importance and the predominance of periodical +literature, and have attempted to do justice to its value. But the +almost exclusive reading of it is not without its dangers. The +journals contain much that is crude and unsound; the presumption; it +might be maintained, is against their novelties, unless they come +from observers of established credit. Yet I have known a +practitioner,--perhaps more than one,--who was as much under the +dominant influence of the last article he had read in his favorite +medical journal as a milliner under the sway of the last fashion- +plate. The difference between green and seasoned knowledge is very +great, and such practitioners never hold long enough to any of their +knowledge to have it get seasoned. + +It is needless to say, then, that all the substantial and permanent +literature of the profession should be represented upon our shelves. +Much of it is there already, and as one private library after another +falls into this by the natural law of gravitation, it will gradually +acquire all that is most valuable almost without effort. A scholar +should not be in a hurry to part with his books. They are probably +more valuable to him than they can be to any other individual. What +Swedenborg called "correspondence" has established itself between his +intelligence and the volumes which wall him within their sacred +inclosure. Napoleon said that his mind was as if furnished with +drawers,--he drew out each as he wanted its contents, and closed it +at will when done with them. The scholar's mind, to use a similar +comparison, is furnished with shelves, like his library. Each book +knows its place in the brain as well as against the wall or in the +alcove. His consciousness is doubled by the books which encircle +him, as the trees that surround a lake repeat themselves in its +unruffled waters. Men talk of the nerve that runs to the pocket, but +one who loves his books, and has lived long with them, has a nervous +filament which runs from his sensorium to every one of them. Or, if +I may still let my fancy draw its pictures, a scholar's library is to +him what a temple is to the worshipper who frequents it. There is +the altar sacred to his holiest experiences. There is the font where +his new-born thought was baptized and first had a name in his +consciousness. There is the monumental tablet of a dead belief, +sacred still in the memory of what it was while yet alive. No +visitor can read all this on the lettered backs of the books that +have gathered around the scholar, but for him, from the Aldus on the +lowest shelf to the Elzevir on the highest, every volume has a +language which none but be can interpret. Be patient with the book- +collector who loves his companions too well to let them go. Books +are not buried with their owners, and the veriest book-miser that +ever lived was probably doing far more for his successors than his +more liberal neighbor who despised his learned or unlearned avarice. +Let the fruit fall with the leaves still clinging round it. Who +would have stripped Southey's walls of the books that filled them, +when, his mind no longer capable of taking in their meaning, he would +still pat and fondle them with the vague loving sense of what they +had once been to him,--to him, the great scholar, now like a little +child among his playthings? + +We need in this country not only the scholar, but the virtuoso, who +hoards the treasures which he loves, it may be chiefly for their +rarity and because others who know more than he does of their value +set a high price upon them. As the wine of old vintages is gently +decanted out of its cobwebbed bottles with their rotten corks into +clean new receptacles, so the wealth of the New World is quietly +emptying many of the libraries and galleries of the Old World into +its newly formed collections and newly raised edifices. And this +process must go on in an accelerating ratio. No Englishman will be +offended if I say that before the New Zealander takes his stand on a +broken arch of London Bridge to sketch the ruins of St. Paul's in the +midst of a vast solitude, the treasures of the British Museum will +have found a new shelter in the halls of New York or Boston. No +Catholic will think hardly of my saying that before the Coliseum +falls, and with it the imperial city, whose doom prophecy has linked +with that of the almost eternal amphitheatre, the marbles, the +bronzes, the paintings, the manuscripts of the Vatican will have left +the shores of the Tiber for those of the Potomac, the Hudson, the +Mississippi, or the Sacramento. And what a delight in the pursuit of +the rarities which the eager book-hunter follows with the scent of a +beagle! + +Shall I ever forget that rainy day in Lyons, that dingy bookshop, +where I found the Aetius, long missing from my Artis bledicae +Principes, and where I bought for a small pecuniary consideration, +though it was marked rare, and was really tres rare, the Aphorisms of +Hippocrates, edited by and with a preface from the hand of Francis +Rabelais? And the vellum-bound Tulpius, which I came upon in Venice, +afterwards my only reading when imprisoned in quarantine at +Marseilles, so that the two hundred and twenty-eight cases he has +recorded are, many of them, to this day still fresh in my memory. +And the Schenckius,--the folio filled with casus rariores, which had +strayed in among the rubbish of the bookstall on the boulevard,--and +the noble old Vesalius with its grand frontispiece not unworthy of +Titian, and the fine old Ambroise Pare, long waited for even in Paris +and long ago, and the colossal Spigelius with his eviscerated +beauties, and Dutch Bidloo with its miracles of fine engraving and +bad dissection, and Italian Mascagni, the despair of all would-be +imitators, and pre-Adamite John de Ketam, and antediluvian +Berengarius Carpensis,--but why multiply names, every one of which +brings back the accession of a book which was an event almost like +the birth of an infant? + +A library like ours must exercise the largest hospitality. A great +many books may be found in every large collection which remind us of +those apostolic looking old men who figure on the platform at our +political and other assemblages. Some of them have spoken words of +wisdom in their day, but they have ceased to be oracles; some of them +never had any particularly important message for humanity, but they +add dignity to the meeting by their presence; they look wise, whether +they are so or not, and no one grudges them their places of honor. +Venerable figure-heads, what would our platforms be without you? + +Just so with our libraries. Without their rows of folios in creamy +vellum, or showing their black backs with antique lettering of +tarnished gold, our shelves would look as insufficient and unbalanced +as a column without its base, as a statue without its pedestal. And +do not think they are kept only to be spanked and dusted during that +dreadful period when their owner is but too thankful to become an +exile and a wanderer from the scene of single combats between dead +authors and living housemaids. Men were not all cowards before +Agamemnon or all fools before the days of Virchow and Billroth. And +apart from any practical use to be derived from the older medical +authors, is there not a true pleasure in reading the accounts of +great discoverers in their own words? I do not pretend to hoist up +the Bibliotheca Anatomica of Mangetus and spread it on my table every +day. I do not get out my great Albinus before every lecture on the +muscles, nor disturb the majestic repose of Vesalius every time I +speak of the bones he has so admirably described and figured. But it +does please me to read the first descriptions of parts to which the +names of their discoverers or those who have first described them +have become so joined that not even modern science can part them; to +listen to the talk of my old volume as Willis describes his circle +and Fallopius his aqueduct and Varolius his bridge and Eustachius his +tube and Monro his foramen,--all so well known to us in the human +body; it does please me to know the very words in which Winslow +described the opening which bears his name, and Glisson his capsule +and De Graaf his vesicle; I am not content until I know in what +language Harvey announced his discovery of the circulation, and how +Spigelius made the liver his perpetual memorial, and Malpighi found a +monument more enduring than brass in the corpuscles of the spleen and +the kidney. + +But after all, the readers who care most for the early records of +medical science and art are the specialists who are dividing up the +practice of medicine and surgery as they were parcelled out, +according to Herodotus, by the Egyptians. For them nothing is too +old, nothing is too new, for to their books of ail others is +applicable the saying of D'Alembert that the author kills himself in +lengthening out what the reader kills himself in trying to shorten. + +There are practical books among these ancient volumes which can never +grow old. Would you know how to recognize "male hysteria" and to +treat it, take down your Sydenham; would you read the experience of a +physician who was himself the subject of asthma, and who, +notwithstanding that, in the words of Dr. Johnson, "panted on till +ninety," you will find it in the venerable treatise of Sir John +Floyer; would you listen to the story of the King's Evil cured by the +royal touch, as told by a famous chirurgeon who fully believed in it, +go to Wiseman; would you get at first hand the description of the +spinal disease which long bore his name, do not be startled if I tell +you to go to Pott,--to Percival Pott, the great surgeon of the last +century. + +There comes a time for every book in a library when it is wanted by +somebody. It is but a few weeks since one of the most celebrated +physicians in the country wrote to me from a great centre of medical +education to know if I had the works of Sanctorius, which he had +tried in vain to find. I could have lent him the "Medicina Statica," +with its frontispiece showing Sanctorius with his dinner on the table +before him, in his balanced chair which sunk with him below the level +of his banquet-board when he had swallowed a certain number of +ounces,--an early foreshadowing of Pettenkofer's chamber and +quantitative physiology,--but the "Opera Omnia" of Sanctorius I had +never met with, and I fear he had to do without it. + +I would extend the hospitality of these shelves to a class of works +which we are in the habit of considering as being outside of the pale +of medical science, properly so called, and sometimes of coupling +with a disrespectful name. Such has always been my own practice. I +have welcomed Culpeper and Salmon to my bookcase as willingly as +Dioscorides or Quincy, or Paris or Wood and Bache. I have found a +place for St. John Long, and read the story of his trial for +manslaughter with as much interest as the laurel-water case in which +John Hunter figured as a witness. I would give Samuel Hahnemann a +place by the side of Samuel Thomson. Am I not afraid that some +student of imaginative turn and not provided with the needful +cerebral strainers without which all the refuse of gimcrack +intelligences gets into the mental drains and chokes them up,--am I +not afraid that some such student will get hold of the "Organon" or +the "Maladies Chroniques" and be won over by their delusions, and so +be lost to those that love him as a man of common sense and a brother +in their high calling? Not in the least. If he showed any symptoms +of infection I would for once have recourse to the principle of +similia similibus. To cure him of Hahnemann I would prescribe my +favorite homoeopathic antidote, Okie's Bonninghausen. If that +failed, I would order Grauvogl as a heroic remedy, and if he survived +that uncured, I would give him my blessing, if I thought him honest, +and bid him depart in peace. For me he is no longer an individual. +He belongs to a class of minds which we are bound to be patient with +if their Maker sees fit to indulge them with existence. We must +accept the conjuring ultra-ritualist, the dreamy second adventist, +the erratic spiritualist, the fantastic homoeopathist, as not +unworthy of philosophic study; not more unworthy of it than the +squarers of the circle and the inventors of perpetual motion, and the +other whimsical visionaries to whom De Morgan has devoted his most +instructive and entertaining "Budget of Paradoxes." I hope, +therefore, that our library will admit the works of the so-called +Eclectics, of the Thomsonians, if any are in existence, of the +Clairvoyants, if they have a literature, and especially of the +Homoeopathists. This country seems to be the place for such a +collection, which will by and by be curious and of more value than at +present, for Homoeopathy seems to be following the pathological law +of erysipelas, fading out where it originated as it spreads to new +regions. At least I judge so by the following translated extract +from a criticism of an American work in the "Homoeopatische +Rundschau" of Leipzig for October, 1878, which I find in the +"Homoeopathic Bulletin" for the month of November just passed: +"While we feel proud of the spread and rise of Homoeopathy across the +ocean, and while the Homoeopathic works reaching us from there, and +published in a style such as is unknown in Germany, bear eloquent +testimony to the eminent activity of our transatlantic colleagues, we +are overcome by sorrowful regrets at the position Homoeopathy +occupies in Germany. Such a work [as the American one referred to] +with us would be impossible; it would lack the necessary support." + +By all means let our library secure a good representation of the +literature of Homoeopathy before it leaves us its "sorrowful regrets" +and migrates with its sugar of milk pellets, which have taken the +place of the old pilulae micae panis, to Alaska, to "Nova Zembla, or +the Lord knows where." + +What shall I say in this presence of the duties of a Librarian? +Where have they ever been better performed than in our own public +city library, where the late Mr. Jewett and the living Mr. Winsor +have shown us what a librarian ought to be,--the organizing head, the +vigilant guardian, the seeker's index, the scholar's counsellor? His +work is not merely that of administration, manifold and laborious as +its duties are. He must have a quick intelligence and a retentive +memory. He is a public carrier of knowledge in its germs. His +office is like that which naturalists attribute to the bumble-bee,-- +he lays up little honey for himself, but he conveys the fertilizing +pollen from flower to flower. + +Our undertaking, just completed,--and just begun--has come at the +right time, not a day too soon. Our practitioners need a library +like this, for with all their skill and devotion there is too little +genuine erudition, such as a liberal profession ought to be able to +claim for many of its members. In reading the recent obituary +notices of the late Dr. Geddings of South Carolina, I recalled what +our lamented friend Dr. Coale used to tell me of his learning and +accomplishments, and I could not help reflecting how few such medical +scholars we had to show in Boston or New England. We must clear up +this unilluminated atmosphere, and here,--here is the true electric +light which will irradiate its darkness. + +The public will catch the rays reflected from the same source of +light, and it needs instruction on the great subjects of health and +disease,--needs it sadly. It is preyed upon by every kind of +imposition almost without hindrance. Its ignorance and prejudices +react upon the profession to the great injury of both. The jealous +feeling, for instance, with regard to such provisions for the study +of anatomy as are sanctioned by the laws in this State and carried +out with strict regard to those laws, threatens the welfare, if not +the existence of institutions for medical instruction wherever it is +not held in check by enlightened intelligence. And on the other hand +the profession has just been startled by a verdict against a +physician, ruinous in its amount,--enough to drive many a hard- +working young practitioner out of house and home,--a verdict which +leads to the fear that suits for malpractice may take the place of +the panel game and child-stealing as a means of extorting money. If +the profession in this State, which claims a high standard of +civilization, is to be crushed and ground beneath the upper millstone +of the dearth of educational advantages and the lower millstone of +ruinous penalties for what the ignorant ignorantly shall decide to be +ignorance, all I can say is + +God save the Commonhealth of Massachusetts! + +Once more, we cannot fail to see that just as astrology has given +place to astronomy, so theology, the science of Him whom by searching +no man can find out, is fast being replaced by what we may not +improperly call theonomy, or the science of the laws according to +which the Creator acts. And since these laws find their fullest +manifestations for us, at least, in rational human natures, the study +of anthropology is largely replacing that of scholastic divinity. We +must contemplate our Maker indirectly in human attributes as we talk +of Him in human parts of speech. And this gives a sacredness to the +study of man in his physical, mental, moral, social, and religious +nature which elevates the faithful students of anthropology to the +dignity of a priesthood, and sheds a holy light on the recorded +results of their labors, brought together as they are in such a +collection as this which is now spread out before us. + +Thus, then, our library is a temple as truly as the dome-crowned +cathedral hallowed by the breath of prayer and praise, where the dead +repose and the living worship. May it, with all its treasures, be +consecrated like that to the glory of God, through the contributions +it shall make to the advancement of sound knowledge, to the relief of +human suffering, to the promotion of harmonious relations between the +members of the two noble professions which deal with the diseases of +the soul and with those of the body, and to the common cause in which +all good men are working, the furtherance of the well-being of their +fellow-creatures! + +NOTE.--As an illustration of the statement in the last paragraph but +one, I take the following notice from the "Boston Daily Advertiser," +of December 4th, the day after the delivery of the address: +"Prince Lucien Bonaparte is now living in London, and is devoting +himself to the work of collecting the creeds of all religions and +sects, with a view to their classification,--his object being simply +scientific or anthropological." + +Since delivering the address, also, I find a leading article in the +"Cincinnati Lancet and Clinic" of November 30th, headed "The +Decadence of Homoeopathy," abundantly illustrated by extracts from +the "Homoeopathic Times," the leading American organ of that sect. + +In the New York "Medical Record" of the same date, which I had not +seen before the delivery of my address, is an account of the action +of the Homoeopathic Medical Society of Northern New York, in which +Hahnemann's theory of "dynamization" is characterized in a formal +resolve as "unworthy the confidence of the Homoeopathic profession." + +It will be a disappointment to the German Homoeopathists to read in +the "Homoeopathic Times" such a statement as the following: +"Whatever the influences have been which have checked the outward +development of Homoeopathy, it is plainly evident that the +Homoeopathic school, as regards the number of its openly avowed +representatives, has attained its majority, and has begun to decline +both in this country and in England." + +All which is an additional reason for making a collection of the +incredibly curious literature of Homoeopathy before that +pseudological inanity has faded out like so many other delusions. + + + + + + +SOME OF MY EARLY TEACHERS + +[A Farewell Address to the Medical School of Harvard University, +November 28, 1882.] + +I had intended that the recitation of Friday last should be followed +by a few parting words to my class and any friends who might happen +to be in the lecture-room. But I learned on the preceding evening +that there was an expectation, a desire, that my farewell should take +a somewhat different form; and not to disappoint the wishes of those +whom I was anxious to gratify, I made up my mind to appear before you +with such hasty preparation as the scanty time admitted. + +There are three occasions upon which a human being has a right to +consider himself as a centre of interest to those about him: when he +is christened, when he is married, and when he is buried. Every one +is the chief personage, the hero, of his own baptism, his own +wedding, and his own funeral. + +There are other occasions, less momentous, in which one may make more +of himself than under ordinary circumstances he would think it proper +to do; when he may talk about himself, and tell his own experiences, +in fact, indulge in a more or less egotistic monologue without fear +or reproach. + +I think I may claim that this is one of those occasions. I have +delivered my last anatomical lecture and heard my class recite for +the last time. They wish to hear from me again in a less scholastic +mood than that in which they have known me. Will you not indulge me +in telling you something of my own story? + +This is the thirty-sixth Course of Lectures in which I have taken my +place and performed my duties as Professor of Anatomy. For more than +half of my term of office I gave instruction in Physiology, after the +fashion of my predecessors and in the manner then generally prevalent +in our schools, where the physiological laboratory was not a +necessary part of the apparatus of instruction. It was with my +hearty approval that the teaching of Physiology was constituted a +separate department and made an independent Professorship. Before my +time, Dr. Warren had taught Anatomy, Physiology, and Surgery in the +same course of Lectures, lasting only three or four months. As the +boundaries of science are enlarged, new divisions and subdivisions of +its territories become necessary. In the place of six Professors in +1847, when I first became a member of the Faculty, I count twelve +upon the Catalogue before me, and I find the whole number engaged in +the work of instruction in the Medical School amounts to no less than +fifty. + +Since I began teaching in this school, the aspect of many branches of +science has undergone a very remarkable transformation. Chemistry +and Physiology are no longer what they were, as taught by the +instructors of that time. We are looking forward to the synthesis of +new organic compounds; our artificial madder is already in the +market, and the indigo-raisers are now fearing that their crop will +be supplanted by the manufactured article. In the living body we +talk of fuel supplied and work done, in movement, in heat, just as if +we were dealing with a machine of our own contrivance. + +A physiological laboratory of to-day is equipped with instruments of +research of such ingenious contrivance, such elaborate construction, +that one might suppose himself in a workshop where some exquisite +fabric was to be wrought, such as Queens love to wear, and Kings do +not always love to pay for. They are, indeed, weaving a charmed web, +for these are the looms from which comes the knowledge that clothes +the nakedness of the intellect. Here are the mills that grind food +for its hunger, and "is not the life more than meat, and the body +than raiment?" + +But while many of the sciences have so changed that the teachers of +the past would hardly know them, it has not been so with the branch I +teach, or, rather, with that division of it which is chiefly taught +in this amphitheatre. General anatomy, or histology, on the other +hand, is almost all new; it has grown up, mainly, since I began my +medical studies. I never saw a compound microscope during my years +of study in Paris. Individuals had begun to use the instrument, but +I never heard it alluded to by either Professors or students. In +descriptive anatomy I have found little to unlearn, and not a great +deal that was both new and important to learn. Trifling additions +are made from year to year, not to be despised and not to be +overvalued. Some of the older anatomical works are still admirable, +some of the newer ones very much the contrary. I have had recent +anatomical plates brought me for inspection, and I have actually +button-holed the book-agent, a being commonly as hard to get rid of +as the tar-baby in the negro legend, that I might put him to shame +with the imperial illustrations of the bones and muscles in the great +folio of Albinus, published in 1747, and the unapproached figures of +the lymphatic system of Mascagni, now within a very few years of a +century old, and still copied, or, rather, pretended to be copied, in +the most recent works on anatomy. + +I am afraid that it is a good plan to get rid of old Professors, and +I am thankful to hear that there is a movement for making provision +for those who are left in need when they lose their offices and their +salaries. I remember one of our ancient Cambridge Doctors once asked +me to get into his rickety chaise, and said to me, half humorously, +half sadly, that he was like an old horse,--they had taken off his +saddle and turned him out to pasture. I fear the grass was pretty +short where that old servant of the public found himself grazing. If +I myself needed an apology for holding my office so long, I should +find it in the fact that human anatomy is much the same study that it +was in the days of Vesalius and Fallopius, and that the greater part +of my teaching was of such a nature that it could never become +antiquated. + +Let me begin with my first experience as a medical student. I had +come from the lessons of Judge Story and Mr. Ashmun in the Law School +at Cambridge. I had been busy, more or less, with the pages of +Blackstone and Chitty, and other text-books of the first year of +legal study. More or less, I say, but I am afraid it was less rather +than more. For during that year I first tasted the intoxicating +pleasure of authorship. A college periodical, conducted by friends +of mine, still undergraduates, tempted me into print, and there is no +form of lead-poisoning which more rapidly and thoroughly pervades the +blood and bones and marrow than that which reaches the young author +through mental contact with type-metal. Qui a bu, boira,--he who has +once been a drinker will drink again, says the French proverb. So +the man or woman who has tasted type is sure to return to his old +indulgence sooner or later. In that fatal year I had my first attack +of authors' lead-poisoning, and I have never got quite rid of it from +that day to this. But for that I might have applied myself more +diligently to my legal studies, and carried a green bag in place of a +stethoscope and a thermometer up to the present day. + +What determined me to give up Law and apply myself to Medicine I can +hardly say, but I had from the first looked upon that year's study as +an experiment. At any rate, I made the change, and soon found myself +introduced to new scenes and new companionships. + +I can scarcely credit my memory when I recall the first impressions +produced upon me by sights afterwards become so familiar that they +could no more disturb a pulse-beat than the commonest of every-day +experiences. The skeleton, hung aloft like a gibbeted criminal, +looked grimly at me as I entered the room devoted to the students of +the school I had joined, just as the fleshless figure of Time, with +the hour-glass and scythe, used to glare upon me in my childhood from +the "New England Primer." The white faces in the beds at the +Hospital found their reflection in my own cheeks, which lost their +color as I looked upon them. All this had to pass away in a little +time; I had chosen my profession, and must meet its painful and +repulsive aspects until they lost their power over my sensibilities. + +The private medical school which I had joined was one established by +Dr. James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow +Lewis, and Dr. George W. Otis. Of the first three gentlemen I have +either spoken elsewhere or may find occasion to speak hereafter. The +two younger members of this association of teachers were both +graduates of our University, one of the year 1819, the other of 1818. + +Dr. Lewis was a great favorite with students. He was a man of very +lively temperament, fond of old books and young people, open-hearted, +free-spoken, an enthusiast in teaching, and especially at home in +that apartment of the temple of science where nature is seen in +undress, the anthropotomic laboratory, known to common speech as the +dissecting-room. He had that quality which is the special gift of +the man born for a teacher,--the power of exciting an interest in +that which he taught. While he was present the apartment I speak of +was the sunniest of studios in spite of its mortuary spectacles. Of +the students I met there I best remember James Jackson, Junior, full +of zeal and playful as a boy, a young man whose early death was a +calamity to the profession of which he promised to be a chief +ornament; the late Reverend J. S. C. Greene, who, as the prefix to +his name signifies, afterwards changed his profession, but one of +whose dissections I remember looking upon with admiration; and my +friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is +entitled to be called, then, as now and always, a favorite with all +about him. He had come to us from the schools of Germany, and +brought with him recollections of the teachings of Blumenbach and the +elder Langenbeck, father of him whose portrait hangs in our Museum. +Dr. Lewis was our companion as well as our teacher. A good +demonstrator is,--I will not say as important as a good Professor in +the teaching of Anatomy, because I am not sure that he is not more +important. He comes into direct personal relations with the +students,--he is one of them, in fact, as the Professor cannot be +from the nature of his duties. The Professor's chair is an +insulating stool, so to speak; his age, his knowledge, real or +supposed, his official station, are like the glass legs which support +the electrician's piece of furniture, and cut it off from the common +currents of the floor upon which it stands. Dr. Lewis enjoyed +teaching and made his students enjoy being taught. He delighted in +those anatomical conundrums to answer which keeps the student's eyes +open and his wits awake. He was happy as he dexterously performed +the tour de maitre of the old barber-surgeons, or applied the spica +bandage and taught his scholars to do it, so neatly and symmetrically +that the aesthetic missionary from the older centre of civilization +would bend over it in blissful contemplation, as if it were a +sunflower. Dr. Lewis had many other tastes, and was a favorite, not +only with students, but in a wide circle, professional, antiquarian, +masonic, and social. + +Dr. Otis was less widely known, but was a fluent and agreeable +lecturer, and esteemed as a good surgeon. + +I must content myself with this glimpse at myself and a few of my +fellow-students in Boston. After attending two courses of Lectures +in the school of the University, I went to Europe to continue my +studies. + +You may like to hear something of the famous Professors of Paris in +the days when I was a student in the Ecole de Medicine, and following +the great Hospital teachers. + +I can hardly believe my own memory when I recall the old +practitioners and Professors who were still going round the hospitals +when I mingled with the train of students that attended the morning +visits. See that bent old man who is groping his way through the +wards of La Charity. That is the famous Baron Boyer, author of the +great work on surgery in nine volumes, a writer whose clearness of +style commends his treatise to general admiration, and makes it a +kind of classic. He slashes away at a terrible rate, they say, when +he gets hold of the subject of fistula in its most frequent habitat, +--but I never saw him do more than look as if he wanted to cut a good +dollop out of a patient he was examining. The short, square, +substantial man with iron-gray hair, ruddy face, and white apron is +Baron Larrey, Napoleon's favorite surgeon, the most honest man he +ever saw,--it is reputed that he called him. To go round the Hotel +des Invalides with Larrey was to live over the campaigns of Napoleon, +to look on the sun of Austerlitz, to hear the cannons of Marengo, to +struggle through the icy waters of the Beresina, to shiver in the +snows of the Russian retreat, and to gaze through the battle smoke +upon the last charge of the red lancers on the redder field of +Waterloo. Larrey was still strong and sturdy as I saw him, and few +portraits remain printed in livelier colors on the tablet of my +memory. + +Leave the little group of students which gathers about Larrey beneath +the gilded dome of the Invalides and follow me to the Hotel Dieu, +where rules and reigns the master-surgeon of his day, at least so far +as Paris and France are concerned,--the illustrious Baron Dupuytren. +No man disputed his reign, some envied his supremacy. Lisfranc +shrugged his shoulders as he spoke of "ce grand homme de l'autre cots +de la riviere," that great man on the other side of the river, but +the great man he remained, until he bowed before the mandate which +none may disobey. "Three times," said Bouillaud, "did the apoplectic +thunderbolt fall on that robust brain,"--it yielded at last as the +old bald cliff that is riven and crashes down into the valley. I saw +him before the first thunderbolt had descended: a square, solid man, +with a high and full-domed head, oracular in his utterances, +indifferent to those around him, sometimes, it was said, very rough +with them. He spoke in low, even tones, with quiet fluency, and was +listened to with that hush of rapt attention which I have hardly seen +in any circle of listeners unless when such men as ex-President John +Quincy Adams or Daniel Webster were the speakers. I do not think +that Dupuytren has left a record which explains his influence, but in +point of fact he dominated those around him in a remarkable manner. +You must have all witnessed something of the same kind. The personal +presence of some men carries command with it, and their accents +silence the crowd around them, when the same words from other lips +might fall comparatively unheeded. + +As for Lisfranc, I can say little more of him than that he was a +great drawer of blood and hewer of members. I remember his ordering +a wholesale bleeding of his patients, right and left, whatever might +be the matter with them, one morning when a phlebotomizing fit was on +him. I recollect his regretting the splendid guardsmen of the old +Empire,--for what? because they had such magnificent thighs to +amputate. I got along about as far as that with him, when I ceased +to be a follower of M. Lisfranc. + +The name of Velpeau must have reached many of you, for he died in +1867, and his many works made his name widely known. Coming to Paris +in wooden shoes, starving, almost, at first, he raised himself to +great eminence as a surgeon and as an author, and at last obtained +the Professorship to which his talents and learning entitled him. +His example may be an encouragement to some of my younger hearers who +are born, not with the silver spoon in their mouths, but with the +two-tined iron fork in their hands. It is a poor thing to take up +their milk porridge with in their young days, but in after years it +will often transfix the solid dumplings that roll out of the silver +spoon. So Velpeau found it. He had not what is called genius, he +was far from prepossessing in aspect, looking as if he might have +wielded the sledge-hammer (as I think he had done in early life) +rather than the lancet, but he had industry, determination, +intelligence, character, and he made his way to distinction and +prosperity, as some of you sitting on these benches and wondering +anxiously what is to become of you in the struggle for life will have +done before the twentieth century has got halfway through its first +quarter. A good sound head over a pair of wooden shoes is a great +deal better than a wooden head belonging to an owner who cases his +feet in calf-skin, but a good brain is not enough without a stout +heart to fill the four great conduits which carry at once fuel and +fire to that mightiest of engines. + +How many of you who are before me are familiarly acquainted with the +name of Broussais, or even with that of Andral? Both were lecturing +at the Ecole de Medicine, and I often heard them. Broussais was in +those days like an old volcano, which has pretty nearly used up its +fire and brimstone, but is still boiling and bubbling in its +interior, and now and then sends up a spirt of lava and a volley of +pebbles. His theories of gastro-enteritis, of irritation and +inflammation as the cause of disease, and the practice which sprang +from them, ran over the fields of medicine for a time like flame over +the grass of the prairies. The way in which that knotty-featured, +savage old man would bring out the word irritation--with rattling and +rolling reduplication of the resonant letter r--might have taught a +lesson in articulation to Salvini. But Broussais's theory was +languishing and well-nigh become obsolete, and this, no doubt, added +vehemence to his defence of his cherished dogmas. + +Old theories, and old men who cling to them, must take themselves out +of the way as the new generation with its fresh thoughts and altered +habits of mind comes forward to take the place of that which is dying +out. This was a truth which the fiery old theorist found it very hard +to learn, and harder to bear, as it was forced upon him. For the +hour of his lecture was succeeded by that of a younger and far more +popular professor. As his lecture drew towards its close, the +benches, thinly sprinkled with students, began to fill up; the doors +creaked open and banged back oftener and oftener, until at last the +sound grew almost continuous, and the voice of the lecturer became a +leonine growl as he strove in vain to be heard over the noise of +doors and footsteps. + +Broussais was now sixty-two years old. The new generation had +outgrown his doctrines, and the Professor for whose hour the benches +had filled themselves belonged to that new generation. Gabriel +Andral was little more than half the age of Broussais, in the full +prime and vigor of manhood at thirty-seven years. He was a rapid, +fluent, fervid, and imaginative speaker, pleasing in aspect and +manner,--a strong contrast to the harsh, vituperative old man who had +just preceded him. His Clinique Medicale is still valuable as a +collection of cases, and his researches on the blood, conducted in +association with Gavarret, contributed new and valuable facts to +science. But I remember him chiefly as one of those instructors +whose natural eloquence made it delightful to listen to him. I doubt +if I or my fellow-students did full justice either to him or to the +famous physician of Hotel Dieu, Chomel. We had addicted ourselves +almost too closely to the words of another master, by whom we were +ready to swear as against all teachers that ever were or ever would +be. + +This object of our reverence, I might almost say idolatry, was one +whose name is well known to most of the young men before me, even to +those who may know comparatively little of his works and teachings. +Pierre Charles Alexandre Louis, at the age of forty-seven, as I +recall him, was a tall, rather spare, dignified personage, of serene +and grave aspect, but with a pleasant smile and kindly voice for the +student with whom he came into personal relations. If I summed up +the lessons of Louis in two expressions, they would be these; I do +not hold him answerable for the words, but I will condense them after +my own fashion in French, and then give them to you, expanded +somewhat, in English: + + Formez toujours des idees nettes. + Fuyez toujours les a peu pres. + +Always make sure that you form a distinct and clear idea of the +matter you are considering. + +Always avoid vague approximations where exact estimates are possible; +about so many,--about so much, instead of the precise number and +quantity. + +Now, if there is anything on which the biological sciences have +prided themselves in these latter years it is the substitution of +quantitative for qualitative formulae. The "numerical system," of +which Louis was the great advocate, if not the absolute originator, +was an attempt to substitute series of carefully recorded facts, +rigidly counted and closely compared, for those never-ending records +of vague, unverifiable conclusions with which the classics of the +healing art were overloaded. The history of practical medicine had +been like the story of the Danaides. "Experience" had been, from +time immemorial, pouring its flowing treasures into buckets full of +holes. At the existing rate of supply and leakage they would never +be filled; nothing would ever be settled in medicine. But cases +thoroughly recorded and mathematically analyzed would always be +available for future use, and when accumulated in sufficient number +would lead to results which would be trustworthy, and belong to +science. + +You young men who are following the hospitals hardly know how much +you are indebted to Louis. I say nothing of his Researches on +Phthisis or his great work on Typhoid Fever. But I consider his +modest and brief Essay on Bleeding in some Inflammatory Diseases, +based on cases carefully observed and numerically analyzed, one of +the most important written contributions to practical medicine, to +the treatment of internal disease, of this century, if not since the +days of Sydenham. The lancet was the magician's wand of the dark +ages of medicine. The old physicians not only believed in its +general efficacy as a wonder-worker in disease, but they believed +that each malady could be successfully attacked from some special +part of the body,--the strategic point which commanded the seat of +the morbid affection. On a figure given in the curious old work of +John de Ketam, no less than thirty-eight separate places are marked +as the proper ones to bleed from, in different diseases. Even Louis, +who had not wholly given up venesection, used now and then to order +that a patient suffering from headache should be bled in the foot, in +preference to any other part. + +But what Louis did was this: he showed by a strict analysis of +numerous cases that bleeding did not strangle,--jugulate was the word +then used,--acute diseases, more especially pneumonia. This was not +a reform,--it was a revolution. It was followed up in this country +by the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited +Diseases, which has, I believe, done more than any other work or +essay in our own language to rescue the practice of medicine from the +slavery to the drugging system which was a part of the inheritance of +the profession. + +Yes, I say, as I look back on the long hours of the many days I spent +in the wards and in the autopsy room of La Pitie, where Louis was one +of the attending physicians,--yes, Louis did a great work for +practical medicine. Modest in the presence of nature, fearless in +the face of authority, unwearying in the pursuit of truth, he was a +man whom any student might be happy and proud to claim as his teacher +and his friend, and yet, as I look back on the days when I followed +his teachings, I feel that I gave myself up too exclusively to his +methods of thought and study. + +There is one part of their business which certain medical +practitioners are too apt to forget; namely, that what they should +most of all try to do is to ward off disease, to alleviate suffering, +to preserve life, or at least to prolong it if possible. It is not +of the slightest interest to the patient to know whether three or +three and a quarter cubic inches of his lung are hepatized. His mind +is not occupied with thinking of the curious problems which are to be +solved by his own autopsy,--whether this or that strand of the spinal +marrow is the seat of this or that form of degeneration. He wants +something to relieve his pain, to mitigate the anguish of dyspnea, to +bring back motion and sensibility to the dead limb, to still the +tortures of neuralgia. What is it to him that you can localize and +name by some uncouth term the disease which you could not prevent and +which you cannot cure? An old woman who knows how to make a poultice +and how to put it on, and does it tuto, eito, jucunde, just when and +where it is wanted, is better,--a thousand times better in many +cases,--than a staring pathologist, who explores and thumps and +doubts and guesses, and tells his patient be will be better tomorrow, +and so goes home to tumble his books over and make out a diagnosis. + +But in those days, I, like most of my fellow students, was thinking +much more of "science" than of practical medicine, and I believe if +we had not clung so closely to the skirts of Louis and had followed +some of the courses of men like Trousseau,--therapeutists, who gave +special attention to curative methods, and not chiefly to diagnosis, +--it would have been better for me and others. One thing, at any +rate, we did learn in the wards of Louis. We learned that a very +large proportion of diseases get well of themselves, without any +special medication,--the great fact formulated, enforced, and +popularized by Dr. Jacob Bigelow in the Discourse referred to. We +unlearned the habit of drugging for its own sake. This detestable +practice, which I was almost proscribed for condemning somewhat too +epigrammatically a little more than twenty years ago, came to us, I +suspect, in a considerable measure from the English "general +practitioners," a sort of prescribing apothecaries. You remember +how, when the city was besieged, each artisan who was called upon in +council to suggest the best means of defence recommended the articles +he dealt in: the carpenter, wood; the blacksmith, iron; the mason, +brick; until it came to be a puzzle to know which to adopt. Then the +shoemaker said, "Hang your walls with new boots," and gave good +reasons why these should be the best of all possible defences. Now +the "general practitioner" charged, as I understand, for his +medicine, and in that way got paid for his visit. Wherever this is +the practice, medicine is sure to become a trade, and the people +learn to expect drugging, and to consider it necessary, because drugs +are so universally given to the patients of the man who gets his +living by them. + +It was something to have unlearned the pernicious habit of constantly +giving poisons to a patient, as if they were good in themselves, of +drawing off the blood which he would want in his struggle with +disease, of making him sore and wretched with needless blisters, of +turning his stomach with unnecessary nauseous draught and mixtures, +--only because he was sick and something must be done. But there +were positive as well as negative facts to be learned, and some of +us, I fear, came home rich in the negatives of the expectant +practice, poor in the resources which many a plain country +practitioner had ready in abundance for the relief and the cure of +disease. No one instructor can be expected to do all for a student +which he requires. Louis taught us who followed him the love of +truth, the habit of passionless listening to the teachings of nature, +the most careful and searching methods of observation, and the sure +means of getting at the results to be obtained from them in the +constant employment of accurate tabulation. He was not a showy, or +eloquent, or, I should say, a very generally popular man, though the +favorite, almost the idol, of many students, especially Genevese and +Bostonians. But he was a man of lofty and admirable scientific +character, and his work will endure in its influences long after his +name is lost sight of save to the faded eyes of the student of +medical literature. + +Many other names of men more or less famous in their day, and who +were teaching while I was in Paris, come up before me. They are but +empty sounds for the most part in the ears of persons of not more +than middle age. Who of you knows anything of Richerand, author of a +very popular work on Physiology, commonly put into the student's +hands when I first began to ask for medical text-books? I heard him +lecture once, and have had his image with me ever since as that of an +old, worn-out man,--a venerable but dilapidated relic of an effete +antiquity. To verify this impression I have just looked out the +dates of his birth and death, and find that he was eighteen years +younger than the speaker who is now addressing you. There is a +terrible parallax between the period before thirty and that after +threescore and ten, as two men of those ages look, one with naked +eyes, one through his spectacles, at the man of fifty and thereabout. +Magendie, I doubt not you have all heard of. I attended but one of +his lectures. I question if one here, unless some contemporary of my +own has strayed into the amphitheatre,--knows anything about +Marjolin. I remember two things about his lectures on surgery, the +deep tones of his voice as he referred to his oracle,--the earlier +writer, Jean Louis Petit,--and his formidable snuffbox. What he +taught me lies far down, I doubt not, among the roots of my +knowledge, but it does not flower out in any noticeable blossoms, or +offer me any very obvious fruits. Where now is the fame of +Bouillaud, Professor and Deputy, the Sangrado of his time? Where is +the renown of Piorry, percussionist and poet, expert alike in the +resonances of the thoracic cavity and those of the rhyming +vocabulary?--I think life has not yet done with the vivacious +Ricord, whom I remember calling the Voltaire of pelvic literature,--a +sceptic as to the morality of the race in general, who would have +submitted Diana to treatment with his mineral specifics, and ordered +a course of blue pills for the vestal virgins. + +Ricord was born at the beginning of the century, and Piorry some +years earlier. Cruveilhier, who died in 1874, is still remembered by +his great work on pathological anatomy; his work on descriptive +anatomy has some things which I look in vain for elsewhere. But +where is Civiale,--where are Orfila, Gendrin, Rostan, Biett, Alibert, +--jolly old Baron Alibert, whom I remember so well in his broad- +brimmed hat, worn a little jauntily on one side, calling out to the +students in the court-yard of the Hospital St. Louis, "Enfans de la +methode naturelle, etes-vous tous ici?" "Children of the natural +method [his own method of classification of skin diseases,] are you +all here? "All here, then, perhaps; all where, now? + +My show of ghosts is over. It is always the same story that old men +tell to younger ones, some few of whom will in their turn repeat the +tale, only with altered names, to their children's children. + + Like phantoms painted on the magic slide, + Forth from the darkness of the past we glide, + As living shadows for a moment seen + In airy pageant on the eternal screen, + Traced by a ray from one unchanging flame, + Then seek the dust and stillness whence we came. + +Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden, +where he had written his Latin graduating thesis, talking of the +learned Gaubius and the late illustrious Boerhaave and other dead +Dutchmen, of whom you know as much, most of you, as you do of Noah's +apothecary and the family physician of Methuselah, whose +prescriptions seem to have been lost to posterity. Dr. Lloyd came +back to Boston full of the teachings of Cheselden and Sharpe, William +Hunter, Smellie, and Warner; Dr. James Jackson loved to tell of Mr. +Cline and to talk of Mr. John Hunter; Dr. Reynolds would give you his +recollections of Sir Astley Cooper and Mr. Abernethy; I have named +the famous Frenchmen of my student days; Leyden, Edinburgh, London, +Paris, were each in turn the Mecca of medical students, just as at +the present day Vienna and Berlin are the centres where our young men +crowd for instruction. These also must sooner or later yield their +precedence and pass the torch they hold to other hands. Where shall +it next flame at the head of the long procession? Shall it find its +old place on the shores of the Gulf of Salerno, or shall it mingle +its rays with the northern aurora up among the fiords of Norway,--or +shall it be borne across the Atlantic and reach the banks of the +Charles, where Agassiz and Wyman have taught, where Hagen still +teaches, glowing like his own Lampyris splendidula, with enthusiasm, +where the first of American botanists and the ablest of American +surgeons are still counted in the roll of honor of our great +University? + +Let me add a few words which shall not be other than cheerful, as I +bid farewell to this edifice which I have known so long. I am +grateful to the roof which has sheltered me, to the floors which have +sustained me, though I have thought it safest always to abstain from +anything like eloquence, lest a burst of too emphatic applause might +land my class and myself in the cellar of the collapsing structure, +and bury us in the fate of Korah, Dathan, and Abiram. I have helped +to wear these stairs into hollows,--stairs which I trod when they +were smooth and level, fresh from the plane. There are just thirty- +two of them, as there were five and thirty years ago, but they are +steeper and harder to climb, it seems to me, than they were then. I +remember that in the early youth of this building, the late Dr. John +K. Mitchell, father of our famous Dr. Weir Mitchell, said to me as +we came out of the Demonstrator's room, that some day or other a +whole class would go heels over head down this graded precipice, like +the herd told of in Scripture story. This has never happened as yet; +I trust it never will. I have never been proud of the apartment +beneath the seats, in which my preparations for lecture were made. +But I chose it because I could have it to myself, and I resign it, +with a wish that it were more worthy of regret, into the hands of my +successor, with my parting benediction. Within its twilight +precincts I have often prayed for light, like Ajax, for the daylight +found scanty entrance, and the gaslight never illuminated its dark +recesses. May it prove to him who comes after me like the cave of +the Sibyl, out of the gloomy depths of which came the oracles which +shone with the rays of truth and wisdom! + +This temple of learning is not surrounded by the mansions of the +great and the wealthy. No stately avenues lead up to its facades and +porticoes. I have sometimes felt, when convoying a distinguished +stranger through its precincts to its door, that he might question +whether star-eyed Science had not missed her way when she found +herself in this not too attractive locality. I cannot regret that +we--you, I should say--are soon to migrate to a more favored region, +and carry on your work as teachers and as learners in ampler halls +and under far more favorable conditions. + +I hope that I may have the privilege of meeting you there, possibly +may be allowed to add my words of welcome to those of my former +colleagues, and in that pleasing anticipation I bid good-by to this +scene of my long labors, and, for the present at least, to the +friends with whom I have been associated. + + + + + + +APPENDUM + +NOTES TO THE ADDRESS ON CURRENTS AND COUNTER +CURRENTS IN MEDICAL SCIENCE. + +Some passages contained in the original manuscript of the Address, +and omitted in the delivery on account of its length, are restored in +the text or incorporated with these Notes. + +NOTE A.-- + +There is good reason to doubt whether the nitrate of silver has any +real efficacy in epilepsy. It has seemed to cure many cases, but +epilepsy is a very uncertain disease, and there is hardly anything +which has not been supposed to cure it. Dr. Copland cites many +authorities in its favor, most especially Lombard's cases. But De la +Berge and Monneret (Comp. de Med. Paris), 1839, analyze these same +cases, eleven in number, and can only draw the inference of a very +questionable value in the supposed remedy. Dr. James Jackson says +that relief of epilepsy is not to be attained by any medicine with +which he is acquainted, but by diet. (Letters to a Young Physician, +p. 67.) Guy Patin, Dean of the Faculty of Paris, Professor at the +Royal College, Author of the Antimonial Martyrology, a wit and a man +of sense and learning, who died almost two hundred years ago, had +come to the same conclusion, though the chemists of his time boasted +of their remedies. "Did, you ever see a case of epilepsy cured by +nitrate of silver?" I said to one of the oldest and most experienced +surgeons in this country. "Never," was his instant reply. Dr. +Twitchell's experience was very similar. How, then, did nitrate of +silver come to be given for epilepsy? Because, as Dr. Martin has so +well reminded us, lunatics were considered formerly to be under the +special influence of Luna, the moon (which Esquirol, be it observed, +utterly denies), and lunar caustic, or nitrate of silver, is a salt +of that metal which was called luna from its whiteness, and of course +must be in the closest relations with the moon. It follows beyond +all reasonable question that the moon's metal, silver, and its +preparations, must be the specific remedy for moonblasted maniacs and +epileptics! + +Yet the practitioner who prescribes the nitrate of silver supposes he +is guided by the solemn experience of the past, instead of by its +idle fancies. He laughs at those old physicians who placed such +confidence in the right hind hoof of an elk as a remedy for the same +disease, and leaves the record of his own belief in a treatment quite +as fanciful and far more objectionable, written in indelible ink upon +a living tablet where he who runs may read it for a whole generation, +if nature spares his walking advertisement so long. + + + +NOTE B.-- + +The presumption that a man is innocent until he is proved guilty, +does not mean that there are no rogues, but lays the onus probandi on +the party to which it properly belongs. So with this proposition. +A noxious agent should never be employed in sickness unless there is +ample evidence in the particular case to overcome the general +presumption against all such agents, and the evidence is very apt to +be defective. + +The miserable delusion of Homoeopathy builds itself upon an axiom +directly the opposite of this; namely, that the sick are to be cured +by poisons. Similia similibus curantur means exactly this. It is +simply a theory of universal poisoning, nullified in practice by the +infinitesimal contrivance. The only way to kill it and all similar +fancies, and to throw every quack nostrum into discredit, is to root +out completely the suckers of the old rotten superstition that +whatever is odious or noxious is likely to be good for disease. The +current of sound practice with ourselves is, I believe, setting fast +in the direction I have indicated in the above proposition. To +uphold the exhibition of noxious agents in disease, as the rule, +instead of admitting them cautiously and reluctantly as the +exception, is, as I think, an eddy of opinion in the direction of the +barbarism out of which we believe our art is escaping. It is only +through the enlightened sentiment and action of the Medical +Profession that the community can be brought to acknowledge that +drugs should always be regarded as evils. + +It is true that some suppose, and our scientific and thoughtful +associate, Dr. Gould, has half countenanced the opinion, that there +may yet be discovered a specific for every disease. Let us not +despair of the future, but let us be moderate in our expectations. +When an oil is discovered that will make a bad watch keep good time; +when a recipe is given which will turn an acephalous foetus into a +promising child; when a man can enter the second time into his +mother's womb and give her back the infirmities which twenty +generations have stirred into her blood, and infused into his own +through hers, we may be prepared to enlarge the National +Pharmacopoeia with a list of specifies for everything but old age, +--and possibly for that also. + + + +NOTE C.-- + +The term specific is used here in its ordinary sense, without raising +the question of the propriety of its application to these or other +remedies. + +The credit of introducing Cinchona rests between the Jesuits, the +Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor, +who employed it as a secret remedy. (Pereira.) Mercury as an +internal specific remedy was brought into use by that impudent and +presumptuous quack, as he was considered, Paracelsus. (Encyc. Brit. +art. "Paracelsus.") Arsenic was introduced into England as a remedy +for intermittents by Dr. Fowler, in consequence of the success of a +patent medicine, the Tasteless Ague Drops, which were supposed, +"probably with reason," to be a preparation of that mineral. (Rees's +Cyc. art. "Arsenic.") Colchicum came into notice in a similar way, +from the success of the Eau Medicinale of M. Husson, a French +military officer. (Pereira.) Iodine was discovered by a saltpetre +manufacturer, but applied by a physician in place of the old remedy, +burnt sponge, which seems to owe its efficacy to it. (Dunglison, New +Remedies.) As for Sulphur, "the common people have long used it as an +ointment" for scabies. (Rees's Cyc. art. "Scabies.") The modern +cantiscorbutic regimen is credited to Captain Cook. "To his sagacity +we are indebted for the first impulse to those regulations by which +scorbutus is so successfully prevented in our navy." (Lond. Cyc. +Prac. Med. art. "Scorbutus.") Iron and various salts which enter +into the normal composition of the human body do not belong to the +materia medica by our definition, but to the materia alimentaria. + +For the first introduction of iron as a remedy, see Pereira, who +gives a very curious old story. + +The statement in the text concerning a portion of the materia medica +stands exactly as delivered, and is meant exactly as it stands. No +denunciation of drugs, as sparingly employed by a wise physician, was +or is intended. If, however, as Dr. Gould stated in his "valuable +and practical discourse" to which the Massachusetts Medical Society +"listened with profit as well as interest," "Drugs, in themselves +considered, may always be regarded as evils,"--any one who chooses +may question whether the evils from their abuse are, on the whole, +greater or less than the undoubted benefits obtained from their +proper use. The large exception of opium, wine, specifics, and +anaesthetics, made in the text, takes off enough from the useful +side, as I fully believe, to turn the balance; so that a vessel +containing none of these, but loaded with antimony, strychnine, +acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus +diaboli, tormentilla, and other approved, and, in skilful hands, +really useful remedies, brings, on the whole, more harm than good to +the port it enters. + +It is a very narrow and unjust view of the practice of medicine, to +suppose it to consist altogether in the use of powerful drugs, or of +drugs of any kind. Far from it. "The physician may do very much for +the welfare of the sick, more than others can do, although he does +not, even in the major part of cases, undertake to control and +overcome the disease by art. It was with these views that I never +reported any patient cured at our hospital. Those who recovered +their health were reported as well; not implying that they were made +so by the active treatment they had received there. But it was to be +understood that all patients received in that house were to be cured, +that is, taken care of." (Letters to a Young Physician, by James +Jackson, M. D., Boston, 1855.) + +"Hygienic rules, properly enforced, fresh air, change of air, travel, +attention to diet, good and appropriate food judiciously regulated, +together with the administration of our tonics, porter, ale, wine, +iron, etc., supply the diseased or impoverished system with what Mr. +Gull, of St. Bartholomew's Hospital, aptly calls the 'raw material of +the blood;' and we believe that if any real improvement has taken +place in medical practice, independently of those truly valuable +contributions we have before described, it is in the substitution of +tonics, stimulants, and general management, for drastic cathartics, +for bleeding, depressing agents, including mercury, tartar emetics, +etc., so much in vogue during the early part even of this century." +(F. P. Porcher, in Charleston Med. Journal and Review for January, +1860.) + + + + + +End of Project Gutenberg Etext Medical Essays, by Oliver Wendell Holmes + diff --git a/old/medic11.zip b/old/medic11.zip Binary files differnew file mode 100644 index 0000000..86dae60 --- /dev/null +++ b/old/medic11.zip |