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Title: Medical Essays
Author: Oliver Wendell Holmes, Sr. (The Physician and Poet)
(Not the Jurist O. W. Holmes, Jr.)
Release Date: July, 2001 [Etext #2700]
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MEDICAL ESSAYS
By Oliver Wendell Holmes
1842-1882
CONTENTS:
I. HOMEOPATHY AND ITS KINDRED DELUSIONS
II. THE CONTAGIOUSNESS OF PUERPERAL FEVER
III. CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
IV. BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE
V. SCHOLASTIC AND BEDSIDE TEACHING
VI. THE MEDICAL PROFESSION IN MASSACHUSETTS
VII. THE YOUNG PRACTITIONER
VIII. MEDICAL LIBRARIES
IX. SOME OF MY EARLY TEACHERS
PREFACE.
The character of the opposition which some of these papers have met
with suggests the inference that they contain really important, but
unwelcome truths. Negatives multiplied into each other change their
sign and become positives. Hostile criticisms meeting together are
often equivalent to praise, and the square of fault-finding turns out
to be the same thing as eulogy.
But a writer has rarely so many enemies as it pleases him to believe.
Self-love leads us to overrate the numbers of our negative
constituency. The larger portion of my limited circle of readers
must be quite indifferent to, if not ignorant of, the adverse
opinions which have been expressed or recorded concerning any of
these Addresses or Essays now submitted to their own judgment. It is
proper, however, to inform them, that some of the positions
maintained in these pages have been unsparingly attacked, with
various degrees of ability, scholarship, and good-breeding. The tone
of criticism naturally changes with local conditions in different
parts of a country extended like our own, so that it is one of the
most convenient gauges of the partial movements in the direction of
civilization. It is satisfactory to add, that the views assailed
have also been unflinchingly defended by unsought champions, among
the ablest of whom it is pleasant to mention, at this moment of
political alienation, the Editor of the Charleston Medical Journal.
"Currents and Counter-Currents" was written and delivered as an
Oration, a florid rhetorical composition, expressly intended to
secure the attention of an audience not easy to hold as listeners.
It succeeded in doing this, and also in being as curiously
misunderstood and misrepresented as if it had been a political
harangue. This gave it more local notoriety than it might otherwise
have attained, so that, as I learn, one ingenious person made use of
its title as an advertisement to a production of his own.
The commonest mode of misrepresentation was this: qualified
propositions, the whole meaning of which depended on the
qualifications, were stripped of these and taken as absolute. Thus,
the attempt to establish a presumption against giving poisons to sick
persons was considered as equivalent to condemning the use of these
substances. The only important inference the writer has been able to
draw from the greater number of the refutations of his opinions which
have been kindly sent him, is that the preliminary education of the
Medical Profession is not always what it ought to be.
One concession he is willing to make, whatever sacrifice of pride it
may involve. The story of Massasoit, which has furnished a coral, as
it were, for some teething critics, when subjected to a powerful
logical analysis, though correct in its essentials, proves to have
been told with exceptionable breadth of statement, and therefore (to
resume the metaphor) has been slightly rounded off at its edges, so
as to be smoother for any who may wish to bite upon it hereafter. In
other respects the Discourse has hardly been touched. It is only an
individual's expression, in his own way, of opinions entertained by
hundreds of the Medical Profession in every civilized country, and
has nothing in it which on revision the writer sees cause to retract
or modify. The superstitions it attacks lie at the very foundation
of Homoeopathy, and of almost every form of medical charlatanism.
Still the mere routinists and unthinking artisans in most callings
dislike whatever shakes the dust out of their traditions, and it may
be unreasonable to expect that Medicine will always prove an
exception to the rule. One half the opposition which the numerical
system of Louis has met with, as applied to the results of treatment,
has been owing to the fact that it showed the movements of disease to
be far more independent of the kind of practice pursued than was
agreeable to the pride of those whose self-confidence it abated.
The statement, that medicines are more sparingly used in physicians'
families than in most others, admits of a very natural explanation,
without putting a harsh construction upon it, which it was not
intended to admit. Outside pressure is less felt in the physician's
own household; that is all. If this does not sometimes influence him
to give medicine, or what seems to be medicine, when among those who
have more confidence in drugging than his own family commonly has,
the learned Professor Dunglison is hereby requested to apologize for
his definition of the word Placebo, or to expunge it from his Medical
Dictionary.
One thing is certain. A loud outcry on a slight touch reveals the
weak spot in a profession, as well as in a patient. It is a doubtful
policy to oppose the freest speech in those of our own number who are
trying to show us where they honestly believe our weakness lies.
Vast as are the advances of our Science and Art, may it not possibly
prove on examination that we retain other old barbarisms beside the
use of the astrological sign of Jupiter, with which we endeavor to
insure good luck to our prescriptions? Is it the act of a friend or
a foe to try to point them out to our brethren when asked to address
them, and is the speaker to subdue the constitutional habit of his
style to a given standard, under penalty of giving offence to a grave
assembly?
"Homoeopathy and its Kindred Delusions" was published nearly twenty
years ago, and has been long out of print, so that the author tried
in vain to procure a copy until the kindness of a friend supplied him
with the only one he has had for years. A foolish story reached his
ears that he was attempting to buy up stray copies for the sake of
suppressing it. This edition was in the press at that very time.
Many of the arguments contained in the Lectures have lost whatever
novelty they may have possessed. All its predictions have been
submitted to the formidable test of time. They appear to have stood
it, so far, about as well as most uninspired prophecies; indeed, some
of them require much less accommodation than certain grave
commentators employ in their readings of the ancient Prophets.
If some statistics recently published are correct, Homoeopathy has
made very slow progress in Europe.
In all England, as it appears, there are hardly a fifth more
Homoeopathic practitioners than there are students attending Lectures
at the Massachusetts Medical College at the present time. In America
it has undoubtedly proved more popular and lucrative, yet how loose a
hold it has on the public confidence is shown by the fact that, when
a specially valued life, which has been played with by one of its
agents, is seriously threatened, the first thing we expect to hear is
that a regular practitioner is by the patient's bed, and the
Homoeopathic counsellor overruled or discarded. Again, how many of
the ardent and capricious persons who embraced Homoeopathy have run
the whole round of pretentious novelties;--have been boarded at
water-cure establishments, closeted with uterine and other
specialists, and finally wandered over seas to put themselves in
charge of foreign celebrities, who dosed them as lustily as they were
ever dosed before they took to globules! It will surprise many to
learn to what a shadow of a shade Homoeopathy has dwindled in the
hands of many of its noted practitioners. The itch-doctrine is
treated with contempt. Infinitesimal doses are replaced by full ones
whenever the fancy-practitioner chooses. Good Homoeopathic reasons
can be found for employing anything that anybody wants to employ.
Homoeopathy is now merely a name, an unproved theory, and a box of
pellets pretending to be specifics, which, as all of us know, fail
ignominiously in those cases where we would thankfully sacrifice all
our prejudices and give the world to have them true to their
promises.
Homoeopathy has not died out so rapidly as Tractoration. Perhaps it
was well that it should not, for it has taught us a lesson of the
healing faculty of Nature which was needed, and for which many of us
have made proper acknowledgments. But it probably does more harm
than good to medical science at the present time, by keeping up the
delusion of treating everything by specifics,--the old barbarous
notion that sick people should feed on poisons [Lachesis, arrow-
poison, obtained from a serpent (Pulte). Crotalus horridus,
rattlesnake's venom (Neidhard). The less dangerous Pediculus capitis
is the favorite remedy of Dr. Mure, the English "Apostle of
Homoeopathy." These are examples of the retrograde current setting
towards barbarism] against which a part of the Discourse at the
beginning of this volume is directed.
The infinitesimal globules have not become a curiosity as yet, like
Perkins's Tractors. But time is a very elastic element in Geology
and Prophecy. If Daniel's seventy weeks mean four hundred and ninety
years, as the learned Prideaux and others have settled it that they
do, the "not many years" of my prediction may be stretched out a
generation or two beyond our time, if necessary, when the prophecy
will no doubt prove true.
It might be fitting to add a few words with regard to the Essay on
the Contagiousness of Puerperal Fever. But the whole question I
consider to be now transferred from the domain of medical inquiry to
the consideration of Life Insurance agencies and Grand Juries. For
the justification of this somewhat sharply accented language I must
refer the reader to the paper itself for details which I regret to
have been forced to place on permanent record.
BOSTON, January, 1861.
A SECOND PREFACE.
These Lectures and Essays are arranged in the order corresponding to
the date of their delivery or publication. They must, of course, be
read with a constant reference to these dates, by such as care to
read them. I have not attempted to modernize their aspect or
character in presenting them, in this somewhat altered connection, to
the public. Several of them were contained in a former volume which
received its name from the Address called "Currents and Counter-
Currents." Some of those contained in the former volume have been
replaced by others. The Essay called "Mechanism of Vital Actions"
has been transferred to a distinct collection of Miscellaneous
essays, forming a separate volume.
I had some intention of including with these papers an Essay on
Intermittent Fever in New England, which received one of the Boylston
prizes in 1837, and was published in the following year. But as this
was upon a subject of local interest, chiefly, and would have taken
up a good deal of room, I thought it best to leave it out, trusting
that the stray copies to be met with in musty book-shops would
sufficiently supply the not very extensive or urgent demand for a
paper almost half a century old.
Some of these papers created a little stir when they first fell from
the press into the pool of public consciousness. They will slide in
very quietly now in this new edition, and find out for themselves
whether the waters are those of Lethe, or whether they are to live
for a time as not wholly unvalued reminiscences.
March 21, 1883.
PREFACE TO THE NEW EDITION.
These Essays are old enough now to go alone without staff or crutch
in the shape of Prefaces. A very few words may be a convenience to
the reader who takes up the book and wishes to know what he is likely
to find in it.
HOMOEOPATHY AND ITS KINDRED DELUSIONS.
Homoeopathy has proved lucrative, and so long as it continues to be
so will surely exist,--as surely as astrology, palmistry, and other
methods of getting a living out of the weakness and credulity of
mankind and womankind. Though it has no pretensions to be considered
as belonging among the sciences, it may be looked upon by a
scientific man as a curious object of study among the vagaries of the
human mind. Its influence for good or the contrary may be made a
matter of calm investigation. I have studied it in the Essay before
the reader, under the aspect of an extravagant and purely imaginative
creation of its founder. Since that first essay was written, nearly
half a century ago, we have all had a chance to witness its practical
working. Two opposite inferences may be drawn from its doctrines and
practice. The first is that which is accepted by its disciples.
This is that all diseases are "cured" by drugs. The opposite
conclusion is drawn by a much larger number of persons. As they see
that patients are very commonly getting well under treatment by
infinitesimal drugging, which they consider equivalent to no
medication at all, they come to disbelieve in every form of drugging
and put their whole trust in "nature." Thus experience,
"From seeming evil still educing good,"
has shown that the dealers in this preposterous system of pseudo-
therapeutics have cooperated with the wiser class of practitioners in
breaking up the system of over-dosing and over-drugging which has
been one of the standing reproaches of medical practice. While.
keeping up the miserable delusion that diseases were all to be
"cured" by drugging, Homoeopathy has been unintentionally showing
that they would very generally get well without any drugging at all.
In the mean time the newer doctrines of the "mind cure," the "faith
cure," and the rest are encroaching on the territory so long
monopolized by that most ingenious of the pseudo-sciences. It would
not be surprising if its whole ground should be taken possession of
by these new claimants with their flattering appeals to the
imaginative class of persons open to such attacks. Similia similabus
may prove fatally true for once, if Homoeopathy is killed out by its
new-born rivals.
It takes a very moderate amount of erudition to unearth a charlatan
like the supposed father of the infinitesimal dosing system. The
real inventor of that specious trickery was an Irishman by the name
of Butler. The whole story is to be found in the "Ortus Medicinm" of
Van Helmont. I have given some account of his chapter "Butler" in
different articles, but I would refer the students of our
Homoeopathic educational institutions to the original, which they
will find very interesting and curious.
CURRENTS AND COUNTER-CURRENTS
My attack on over-drugging brought out some hostile comments and
treatment. Thirty years ago I expressed myself with more vivacity
than I should show if I were writing on the same subjects today.
Some of my more lively remarks called out very sharp animadversion.
Thus my illustration of prevention as often better than treatment in
the mother's words to her child which had got a poisonous berry in
its mouth,--"Spit it out!" gave mortal offence to a well-known New
York practitioner and writer, who advised the Massachusetts Medical
Society to spit out the offending speaker. Worse than this was my
statement of my belief that if a ship-load of miscellaneous drugs,
with certain very important exceptions,--drugs, many of which were
then often given needlessly and in excess, as then used "could be
sunk to the bottom of the sea, it would be all the better for mankind
and all the worse for the fishes." This was too bad. The sentence
was misquoted, quoted without its qualifying conditions, and
frightened some of my worthy professional brethren as much as if I
had told them to throw all physic to the dogs. But for the
epigrammatic sting the sentiment would have been unnoticed as a
harmless overstatement at the very worst.
Since this lecture was delivered a great and, as I think, beneficial
change has taken place in the practice of medicine. The habit of the
English "general practitioner" of making his profit out of the pills
and potions he administered was ruinous to professional advancement
and the dignity of the physician. When a half-starving medical man
felt that he must give his patient draught and boluses for which he
could charge him, he was in a pitiable position and too likely to
persuade himself that his drugs were useful to his patient because
they were profitable to him. This practice has prevailed a good deal
in America, and was doubtless the source in some measure of the
errors I combated.
THE CONTAGIOUSNESS OF PUERPERAL FEVER.
This Essay was read before a small Association called "The Society
for Medical Improvement," and published in a Medical Journal which
lasted but a single year. It naturally attracted less attention than
it would have done if published in such a periodical as the "American
Journal of Medical Sciences." Still it had its effect, as I have
every reason to believe. I cannot doubt that it has saved the lives
of many young mothers by calling attention to the existence and
propagation of "Puerperal Fever as a Private Pestilence," and laying
down rules for taking the necessary precautions against it. The case
has long been decided in favor of the views I advocated, but, at the
time when I wrote two of the most celebrated professors of Obstetrics
in this country opposed my conclusions with all the weight of their
experience and position.
This paper was written in a great heat and with passionate
indignation. If I touched it at all I might trim its rhetorical
exuberance, but I prefer to leave it all its original strength of
expression. I could not, if I had tried, have disguised the feelings
with which I regarded the attempt to put out of sight the frightful
facts which I brought forward and the necessary conclusions to which
they led. Of course the whole matter has been looked at in a new
point of view since the microbe as a vehicle of contagion has been
brought into light, and explained the mechanism of that which was
plain enough as a fact to all who were not blind or who did not shut
their eyes.
O. W. H.
BEVERLY Farms, Mass., August 3, 1891
HOMOEOPATHY AND ITS KINDRED DELUSIONS
[Two lectures delivered before the Boston Society for the Diffusion
of Useful Knowledge. 1842.]
[When a physician attempts to convince a person, who has fallen into
the Homoeopathic delusion, of the emptiness of its pretensions, he is
often answered by a statement of cases in which its practitioners are
thought to have effected wonderful cures. The main object of the
first of these Lectures is to show, by abundant facts, that such
statements, made by persons unacquainted with the fluctuations of
disease and the fallacies of observation, are to be considered in
general as of little or no value in establishing the truth of a
medical doctrine or the utility of a method of practice.
Those kind friends who suggest to a person suffering from a tedious
complaint, that he "Had better try Homoeopathy," are apt to enforce
their suggestion by adding, that "at any rate it can do no harm."
This may or may not be true as regards the individual. But it always
does very great harm to the community to encourage ignorance, error,
or deception in a profession which deals with the life and health of
our fellow-creatures. Whether or not those who countenance
Homoeopathy are guilty of this injustice towards others, the second
of these Lectures may afford them some means of determining.
To deny that good effects may happen from the observance of diet and
regimen when prescribed by Homoeopathists as well as by others, would
be very unfair to them. But to suppose that men with minds so
constituted as to accept such statements and embrace such doctrines
as make up the so-called science of Homoeopathy are more competent
than others to regulate the circumstances which influence the human
body in health and disease, would be judging very harshly the average
capacity of ordinary practitioners.
To deny that some patients may have been actually benefited through
the influence exerted upon their imaginations, would be to refuse to
Homoeopathy what all are willing to concede to every one of those
numerous modes of practice known to all intelligent persons by an
opprobrious title.
So long as the body is affected through the mind, no audacious
device, even of the most manifestly dishonest character, can fail of
producing occasional good to those who yield it an implicit or even a
partial faith. The argument founded on this occasional good would be
as applicable in justifying the counterfeiter and giving circulation
to his base coin, on the ground that a spurious dollar had often
relieved a poor man's necessities.
Homoeopathy has come before our public at a period when the growing
spirit of eclecticism has prepared many ingenious and honest minds to
listen to all new doctrines with a candor liable to degenerate into
weakness. It is not impossible that the pretended evolution of great
and mysterious virtues from infinitely attenuated atoms may have
enticed a few over-refining philosophers, who have slid into a vague
belief that matter subdivided grows less material, and approaches
nearer to a spiritual nature as it requires a more powerful
microscope for its detection.
However this may be, some persons seem disposed to take the ground of
Menzel that the Laity must pass formal judgment between the Physician
and the Homoeopathist, as it once did between Luther and the
Romanists. The practitioner and the scholar must not, therefore,
smile at the amount of time and labor expended in these Lectures upon
this shadowy system; which, in the calm and serious judgment of many
of the wisest members of the medical profession, is not entitled by
anything it has ever said or done to the notoriety of a public
rebuke, still less to the honors of critical martyrdom.]
I
I have selected four topics for this lecture, the first three of
which I shall touch but slightly, the last more fully. They are
1. The Royal cure of the King's Evil, or Scrofula.
2. The Weapon Ointment, and its twin absurdity, the Sympathetic
Powder.
3. The Tar-water mania of Bishop Berkeley.
4. The History of the Metallic Tractors, or Perkinism.
The first two illustrate the ease with which numerous facts are
accumulated to prove the most fanciful and senseless extravagances.
The third exhibits the entire insufficiency of exalted wisdom,
immaculate honesty, and vast general acquirements to make a good
physician of a great bishop.
The fourth shows us the intimate machinery of an extinct delusion,
which flourished only forty years ago; drawn in all its details, as
being a rich and comparatively recent illustration of the
pretensions, the arguments, the patronage, by means of which windy
errors have long been, and will long continue to be, swollen into
transient consequence. All display in superfluous abundance the
boundless credulity and excitability of mankind upon subjects
connected with medicine.
From the time of Edward the Confessor to Queen Anne, the monarchs of
England were in the habit of touching those who were brought to them
suffering with the scrofula, for the cure of that distemper. William
the Third had good sense enough to discontinue the practice, but Anne
resumed it, and, among her other patients, performed the royal
operation upon a child, who, in spite of his, disease, grew up at
last into Samuel Johnson. After laying his hand upon the sufferers,
it was customary for the monarch to hang a gold piece around the neck
of each patient. Very strict precautions were adopted to prevent
those who thought more of the golden angel hung round the neck by a
white ribbon, than of relief of their bodily infirmities, from making
too many calls, as they sometimes attempted to do. According to the
statement of the advocates and contemporaries of this remedy, none
ever failed of receiving benefit unless their little faith and
credulity starved their merits. Some are said to have been cured
immediately on the very touch, others did not so easily get rid of
their swellings, until they were touched a second time. Several
cases are related, of persons who had been blind for several weeks,
and months, and obliged even to be led to Whitehall, yet recovered
their sight immediately upon being touched, so as to walk away
without any guide." So widely, at one period, was the belief
diffused, that, in the course of twelve years, nearly a hundred
thousand persons were touched by Charles the Second. Catholic
divines; in disputes upon the orthodoxy of their church, did not deny
that the power had descended to protestant princes;--Dr. Harpsfield,
in his "Ecclesiastical History of England," admitted it, and in
Wiseman's words, "when Bishop Tooker would make use of this Argument
to prove the Truth of our Church, Smitheus doth not thereupon go
about to deny the Matter of fact; nay, both he and Cope acknowledge
it." "I myself," says Wiseman, the best English surgical writer of
his day,[Edinburgh Medical and Surgical Journal, vol. iii. p. 103.]
--"I my self have been a frequent Eye-witness of many hundred of
Cures performed by his Majesties Touch alone, without any assistance
of Chirurgery; and those, many of them such as had tired out the
endeavours of able Chirurgeons before they came hither. It were
endless to recite what I myself have seen, and what I have received
acknowledgments of by Letter, not only from the severall parts of
this Nation, but also from Ireland, Scotland, Jersey, Garnsey. It is
needless also to remember what Miracles of this nature were performed
by the very Bloud of his late Majesty of Blessed memory, after whose
decollation by the inhuman Barbarity of the Regicides, the reliques
of that were gathered on Chips and in Handkerchieffs by the pious
Devotes, who could not but think so great a suffering in so
honourable and pious a Cause, would be attended by an extraordinary
assistance of God, and some more then ordinary a miracle: nor did
their Faith deceive them in this there point, being so many hundred
that found the benefit of it." [Severall Chirurgicall Treatises.
London.1676. p. 246.]
Obstinate and incredulous men, as he tells us, accounted for these
cures in three ways: by the journey and change of air the patients
obtained in coming to London; by the influence of imagination; and
the wearing of gold.
To these objections he answers, 1st. That many of those cured were
inhabitants of the city. 2d. That the subjects of treatment were
frequently infants. 3d. That sometimes silver was given, and
sometimes nothing, yet the patients were cured.
A superstition resembling this probably exists at the present time in
some ignorant districts of England and this country. A writer in a
Medical Journal in the year 1807, speaks of a farmer in Devonshire,
who, being a ninth son of a ninth son, is thought endowed with
healing powers like those of ancient royalty, and who is accustomed
one day in every week to strike for the evil.
I remember that one of my schoolmates told me, when a boy, of a
seventh son of a seventh son, somewhere in Essex County, who touched
for the scrofula, and who used to hang a silver fourpence halfpenny
about the neck of those who came to him, which fourpence halfpenny it
was solemnly affirmed became of a remarkably black color after having
been some time worn, and that his own brother had been subjected to
this extraordinary treatment; but I must add that my schoolmate drew
a bow of remarkable length, strength, and toughness for his tender
years.
One of the most curious examples of the fallacy of popular belief and
the uncertainty of asserted facts in medical experience is to be
found in the history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT.
Fabricius Hildanus, whose name is familiar to every surgical
scholar, and Lord Bacon, who frequently dipped a little into
medicine, are my principal authorities for the few circumstances I
shall mention regarding it. The Weapon Ointment was a preparation
used for the healing of wounds, but instead of its being applied to
them, the injured part was washed and bandaged, and the weapon with
which the wound was inflicted was carefully anointed with the
unguent. Empirics, ignorant barbers, and men of that sort, are said
to have especially employed it. Still there were not wanting some
among the more respectable members of the medical profession who
supported its claims. The composition of this ointment was
complicated, in the different formulae given by different
authorities; but some substances addressed to the imagination, rather
than the wound or weapon, entered into all. Such were portions of
mummy, of human blood, and of moss from the skull of a thief hung in
chains.
Hildanus was a wise and learned man, one of the best surgeons of his
time. He was fully aware that a part of the real secret of the
Unguentum Armarium consisted in the washing and bandaging the wound
and then letting it alone. But he could not resist the solemn
assertions respecting its efficacy; he gave way before the outcry of
facts, and therefore, instead of denying all their pretensions, he
admitted and tried to account for them upon supernatural grounds. As
the virtue of those applications, he says, which are made to the
weapon cannot reach the wound, and as they can produce no effect
without contact, it follows, of necessity, that the Devil must have a
hand in the business; and as he is by far the most long headed and
experienced of practitioners, he cannot find this a matter of any
great difficulty. Hildanus himself reports, in detail, the case of a
lady who had received a moderate wound, for which the Unguentum
Armarium was employed without the slightest use. Yet instead of
receiving this flat case of failure as any evidence against the
remedy, he accounts for its not succeeding by the devout character of
the lady, and her freedom from that superstitious and over-
imaginative tendency which the Devil requires in those who are to be
benefited by his devices.
Lord Bacon speaks of the Weapon Ointment, in his Natural History, as
having in its favor the testimony of men of credit, though, in his
own language, he himself "as yet is not fully inclined to believe
it." His remarks upon the asserted facts respecting it show a
mixture of wise suspicion and partial belief. He does not like the
precise directions given as to the circumstances under which the
animals from which some of the materials were obtained were to be
killed; for he thought it looked like a provision for an excuse in
case of failure, by laying the fault to the omission of some of these
circumstances. But he likes well that "they do not observe the
confecting of the Ointment under any certain constellation; which is
commonly the excuse of magical medicines, when they fail, that they
were not made under a fit figure of heaven." [This was a mistake,
however, since the two recipes given by Hildanus are both very
explicit as to the aspect of the heavens required for different
stages of the process.] "It was pretended that if the offending
weapon could not be had, it would serve the purpose to anoint a
wooden one made like it." "This," says Bacon, "I should doubt to be a
device to keep this strange form of cure in request and use; because
many times you cannot come by the weapon itself." And in closing his
remarks on the statements of the advocates of the ointment, he says,
"Lastly, it will cure a beast as well as a man, which I like best of
all the rest, because it subjecteth the matter to an easy trial." It
is worth remembering, that more than two hundred years ago, when an
absurd and fantastic remedy was asserted to possess wonderful power,
and when sensible persons ascribed its pretended influence to
imagination, it was boldly answered that the cure took place when the
wounded party did not know of the application made to the weapon, and
even when a brute animal was the subject of the experiment, and that
this assertion, as we all know it was, came in such a shape as to
shake the incredulity of the keenest thinker of his time. The very
same assertion has been since repeated in favor of Perkinism, and,
since that, of Homoeopathy.
The same essential idea as that of the Weapon Ointment reproduced
itself in the still more famous SYMPATHETIC POWDER. This Powder was
said to have the faculty, if applied to the blood-stained garments of
a wounded person, to cure his injuries, even though he were at a
great distance at the time. A friar, returning from the East,
brought the recipe to Europe somewhat before the middle of the
seventeenth century. The Grand Duke of Florence, in which city the
friar was residing, heard of his cures, and tried, but without
success, to obtain his secret. Sir Kenehn Digby, an Englishman well
known to fame, was fortunate enough to do him a favor, which wrought
upon his feelings and induced him to impart to his benefactor the
composition of his extraordinary Powder. This English knight was at
different periods of his life an admiral, a theologian, a critic, a
metaphysician, a politician, and a disciple of Alchemy. As is not
unfrequent with versatile and inflammable people, he caught fire at
the first spark of a new medical discovery, and no sooner got home to
England than he began to spread the conflagration.
An opportunity soon offered itself to try the powers of the famous
powder. Mr. J. Howell, having been wounded in endeavoring to part
two of his friends who were fighting a duel, submitted himself to a
trial of the Sympathetic Powder. Four days after he received his
wounds, Sir Kenehn dipped one of Mr. Howell's gaiters in a solution
of the Powder, and immediately, it is said, the wounds, which were
very painful, grew easy, although the patient, who was conversing in
a corner of the chamber, had not, the least idea of what was doing
with his garter. He then returned home, leaving his garter in the
hands of Sir Kenelm, who had hung it up to dry, when Mr. Howell sent
his servant in a great hurry to tell him that his wounds were paining
him horribly; the garter was therefore replaced in the solution of
the Powder, "and the patient got well after five or six days of its
continued immersion."
King James First, his son Charles the First, the Duke of Buckingham,
then prime minister, and all the principal personages of the time,
were cognizant of this fact; and James himself, being curious to know
the secret of this remedy, asked it of Sir Kenelm, who revealed it to
him, and his Majesty had the opportunity of making several trials of
its efficacy, "which all succeeded in a surprising manner." [Dict.
des Sciences Medieales.]
The king's physician, Dr. Mayerne, was made master of the secret,
which he carried to France and communicated to the Duke of Mayenne,
who performed many cures by means of it, and taught it to his
surgeon, who, after the Duke's death, sold it to many distinguished
persons, by whose agency it soon ceased to be a secret. What was
this wonderful substance which so astonished kings, princes, dukes,
knights, and doctors? Nothing but powdered blue vitriol. But it was
made to undergo several processes that conferred on it extraordinary
virtues. Twice or thrice it was to be dissolved, filtered, and
crystallized. The crystals were to be laid in the sun during the
months of June, July, and August, taking care to turn them carefully
that all should be exposed. Then they were to be powdered,
triturated, and again exposed to the sun, again reduced to a very
fine powder, and secured in a vessel, while hot, from the sunshine.
If there seem anything remarkable in the fact of such astonishing
properties being developed by this process, it must be from our
short-sightedness, for common salt and charcoal develop powers quite
as marvellous after a certain number of thumps, stirs, and shakes,
from the hands of modern workers of miracles. In fact the Unguentum
Armarium and Sympathetic Powder resemble some more recent
prescriptions; the latter consisting in an infinite dilution of the
common dose in which remedies are given, and the two former in an
infinite dilution of the common distance at which they are applied.
Whether philosophers, and more especially metaphysicians, have any
peculiar tendency to dabble in drugs and dose themselves with physic,
is a question which might suggest itself to the reader of their
biographies.
When Bishop Berkeley visited the illustrious Malebranche at Paris, he
found him in his cell, cooking in a small pipkin a medicine for an
inflammation of the lungs, from which he was suffering; and the
disease, being unfortunately aggravated by the vehemence of their
discussion, or the contents of the pipkin, carried him off in the
course of a few days. Berkeley himself afforded a remarkable
illustration of a truth which has long been known to the members of
one of the learned professions, namely, that no amount of talent, or
of acquirements in other departments, can rescue from lamentable
folly those who, without something of the requisite preparation,
undertake to experiment with nostrums upon themselves and their
neighbors. The exalted character of Berkeley is thus drawn by Sir
James Mackintosh: Ancient learning, exact science, polished society,
modern literature, and the fine arts, contributed to adorn and enrich
the mind of this accomplished man. All his contemporaries agreed
with the satirist in ascribing
"'To Berkeley every virtue under heaven.'
"Even the discerning, fastidious, and turbulent Atterbury said, after
an interview with him, 'So much understanding, so much knowledge, so
much innocence, and such humility, I did not think had been the
portion of any but angels, till I saw this gentleman.'"
But among the writings of this great and good man is an Essay of the
most curious character, illustrating his weakness upon the point in
question, and entitled, "Siris, a Chain of Philosophical Reflections
and Inquiries concerning the Virtues of TAR WATER, and divers other
Subjects,"--an essay which begins with a recipe for his favorite
fluid, and slides by gentle gradations into an examination of the
sublimest doctrines of Plato. To show how far a man of honesty and
benevolence, and with a mind of singular acuteness and depth, may be
run away with by a favorite notion on a subject which his habits and
education do not fit him to investigate, I shall give a short account
of this Essay, merely stating that as all the supposed virtues of Tar
Water, made public in successive editions of his treatise by so
illustrious an author, have not saved it from neglect and disgrace,
it may be fairly assumed that they were mainly imaginary.
The bishop, as is usual in such cases, speaks of himself as
indispensably obliged, by the duty he owes to mankind, to make his
experience public. Now this was by no means evident, nor does it
follow in general, that because a man has formed a favorable opinion
of a person or a thing he has not the proper means of thoroughly
understanding, he shall be bound to print it, and thus give currency
to his impressions, which may be erroneous, and therefore injurious.
He would have done much better to have laid his impressions before
some experienced physicians and surgeons, such as Dr. Mead and Mr.
Cheselden, to have asked them to try his experiment over again, and
have been guided by their answers. But the good bishop got excited;
he pleased himself with the thought that he had discovered a great
panacea; and having once tasted the bewitching cup of self-quackery,
like many before and since his time, he was so infatuated with the
draught that he would insist on pouring it down the throats of his
neighbors and all mankind.
The precious fluid was made by stirring a gallon of water with a
quart of tar, leaving it forty-eight hours, and pouring off the clear
water. Such was the specific which the great metaphysician
recommended for averting and curing all manner of diseases. It was,
if he might be believed, a preventive of the small-pox, and of great
use in the course of the disease. It was a cure for impurities of
the blood, coughs, pleurisy, peripneumony, erysipelas, asthma,
indigestion, carchexia, hysterics, dropsy, mortification, scurvy, and
hypochondria. It was of great use in gout and fevers, and was an
excellent preservative of the teeth and gums; answered all the
purpose of Elixir Proprietatis, Stoughton's drops, diet drinks, and
mineral waters; was particularly to be recommended to sea-faring
persons, ladies, and men of studious and sedentary lives; could never
be taken too long, but, on the contrary, produced advantages which
sometimes did not begin to show themselves for two or three months.
"From my representing Tar Water as good for so many things," says
Berkeley, "some perhaps may conclude it is good for nothing. But
charity obligeth me to say what I know, and what I think, however it
may be taken. Men may censure and object as they please, but I
appeal to time and experiment. Effects misimputed, cases wrong told,
circumstances overlooked, perhaps, too, prejudices and partialities
against truth, may for a time prevail and keep her at the bottom of
her well, from whence nevertheless she emergeth sooner or later, and
strikes the eyes of all who do not keep them shut." I cannot resist
the temptation of illustrating the bishop's belief in the wonderful
powers of his remedy, by a few sentences from different parts of his
essay. "The hardness of stubbed vulgar constitutions renders them
insensible of a thousand things that fret and gall those delicate
people, who, as if their skin was peeled off, feel to the quick
everything that touches them. The tender nerves and low spirits of
such poor creatures would be much relieved by the use of Tar Water,
which might prolong and cheer their lives." "It [the Tar Water] may
be made stronger for brute beasts, as horses, in whose disorders I
have found it very useful." "This same water will also give
charitable relief to the ladies, who often want it more than the
parish poor; being many of them never able to make a good meal, and
sitting pale, puny, and forbidden, like ghosts, at their own table,
victims of vapors and indigestion." It does not appear among the
virtues of Tar Water that "children cried for it," as for some of our
modern remedies, but the bishop says, "I have known children take it
for above six months together with great benefit, and without any
inconvenience; and after long and repeated experience I do esteem it
a most excellent diet drink, fitted to all seasons and ages." After
mentioning its usefulness in febrile complaints, he says: "I have had
all this confirmed by my own experience in the late sickly season of
the year one thousand seven hundred and forty-one, having had twenty-
five fevers in my own family cured by this medicinal water, drunk
copiously." And to finish these extracts with a most important
suggestion for the improvement of the British nation: "It is much to
be lamented that our Insulars who act and think so much for
themselves, should yet, from grossness of air and diet, grow stupid
or doat sooner than other people, who, by virtue of elastic air,
water-drinking, and light food, preserve their faculties to extreme
old age; an advantage which may perhaps be approached, if not
equaled, even in these regions, by Tar Water, temperance, and early
hours."
Berkeley died at the age of about seventy; he might have lived
longer, but his fatal illness was so sudden that there was not time
enough to stir up a quart of the panacea. He was an illustrious man,
but he held two very odd opinions; that tar water was everything, and
that the whole material universe was nothing.
---------------------------
Most of those present have at some time in their lives heard mention
made of the METALLIC TRACTORS, invented by one Dr. Perkins, an
American, and formerly enjoying great repute for the cure of various
diseases. Many have seen or heard of a satirical poem, written by
one of our own countrymen also, about forty years since, and called
"Terrible Tractoration." The Metallic Tractors are now so utterly
abandoned that I have only by good fortune fallen upon a single one
of a pair, to show for the sake of illustration. For more than
thirty years this great discovery, which was to banish at least half
the evils which afflict humanity, has been sleeping undisturbed in
the grave of oblivion. Not a voice has, for this long period, been
raised in its favor; its noble and learned patrons, its public
institutions, its eloquent advocates, its brilliant promises are all
covered with the dust of silent neglect; and of the generation which
has sprung up since the period when it flourished, very few know
anything of its history, and hardly even the title which in its palmy
days it bore of PERKINISM. Taking it as settled, then, as no one
appears to answer for it, that Perkinism is entirely dead and gone,
that both in public and private, officially and individually, its
former adherents even allow it to be absolutely defunct, I select it
for anatomical examination. If this pretended discovery was made
public; if it was long kept before the public; if it was addressed to
the people of different countries; if it was formally investigated by
scientific men, and systematically adopted by benevolent persons, who
did everything in their power to diffuse the knowledge and practice
of it; if various collateral motives, such as interest and vanity,
were embarked in its cause; if, notwithstanding all these things, it
gradually sickened and died, then the conclusion seems a fair one,
that it did not deserve to live. Contrasting its failure with its
high pretensions, it is fair to call it an imposition; whether an
expressly fraudulent contrivance or not, some might be ready to
question. Everything historically shown to have happened concerning
the mode of promulgation, the wide diffusion, the apparent success of
this delusion, the respectability and enthusiasm of its advocates, is
of great interest in showing to what extent and by what means a
considerable part of the community may be led into the belief of that
which is to be eventually considered' as an idle folly. If there is
any existing folly, fraudulent or innocent in its origin, which
appeals to certain arguments for its support; provided that the very
same arguments can be shown to have been used for Perkinism with as
good reason, they will at once fall to the ground. Still more, if it
shall appear that the general course of any existing delusion bears a
strong resemblance to that of Perkinism, that the former is most
frequently advocated by the same class of persons who were
conspicuous in behalf of the latter, and treated with contempt or
opposed by the same kind of persons who thus treated Perkinism; if
the facts in favor of both have a similar aspect; if the motives of
their originators and propagators may be presumed to have been
similar; then there is every reason to suppose that the existing
folly will follow in the footsteps of the past, and after displaying
a given amount of cunning and credulity in those deceiving and
deceived, will drop from the public view like a fruit which has
ripened into spontaneous rottenness, and be succeeded by the fresh
bloom of some other delusion required by the same excitable portion
of the community.
Dr. Elisha Perkins was born at Norwich, Connecticut, in the year
1740. He had practised his profession with a good local reputation
for many years, when he fell upon a course of experiments, as it is
related, which led to his great discovery. He conceived the idea
that metallic substances might have the effect of removing diseases,
if applied in a certain manner; a notion probably suggested by the
then recent experiments of Galvani, in which muscular contractions
were found to be produced by the contact of two metals with the
living fibre. It was in 1796 that his discovery was promulgated in
the shape of the Metallic Tractors, two pieces of metal, one
apparently iron and the other brass, about three inches long, blunt
at one end and pointed at the other. These instruments were applied
for the cure of different complaints, such as rheumatism, local
pains, inflammations, and even tumors, by drawing them over the
affected part very lightly for about twenty minutes. Dr. Perkins
took out a patent for his discovery, and travelled about the country
to diffuse the new practice. He soon found numerous advocates of his
discovery, many of them of high standing and influence. In the year
1798 the tractors had crossed the Atlantic, and were publicly
employed in the Royal Hospital at Copenhagen. About the same time
the son of the inventor, Mr. Benjamin Douglass Perkins, carried them
to London, where they soon attracted attention. The Danish
physicians published an account of their cases, containing numerous
instances of alleged success, in a respectable octavo volume. In the
year 1804 an establishment, honored with the name of the Perkinean
Institution, was founded in London. The transactions of this
institution were published in pamphlets, the Perkinean Society had
public dinners at the Crown and Anchor, and a poet celebrated their
medical triumph in strains like these:
"See, pointed metals, blest with power t' appease
The ruthless rage of merciless disease,
O'er the frail part a subtle fluid pour,
Drenched with invisible Galvanic shower,
Till the arthritic staff and crutch forego,
And leap exulting like the bounding roe!"
While all these things were going on, Mr. Benjamin Douglass Perkins
was calmly pocketing money, so that after some half a dozen years he
left the country with more than ten thousand pounds, which had been
paid him by the believers in Great Britain. But in spite of all this
success, and the number of those interested and committed in its
behalf, Perkinism soon began to decline, and in 1811 the Tractors are
spoken of by an intelligent writer as being almost forgotten. Such
was the origin and duration of this doctrine and practice, into the
history of which we will now look a little more narrowly.
Let us see, then, by whose agency this delusion was established and
kept up; whether it was principally by those who were accustomed to
medical pursuits, or those whose habits and modes of reasoning were
different; whether it was with the approbation of those learned
bodies usually supposed to take an interest in scientific
discoveries, or only of individuals whose claims to distinction were
founded upon their position in society, or political station, or
literary eminence; whether the judicious or excitable classes entered
most deeply into it; whether, in short, the scientific men of that
time were deceived, or only intruded upon, and shouted down for the
moment by persons who had no particular call to invade their
precincts.
Not much, perhaps, was to be expected of the Medical Profession in
the way of encouragement. One Dr. Fuller, who wrote in England,
himself a Perkinist, thus expressed his opinion: "It must be an
extraordinary exertion of virtue and humanity for a medical man,
whose livelihood depends either on the sale of drugs, or on receiving
a guinea for writing a prescription, which must relate to those
drugs, to say to his patient, 'You had better purchase a set of
Tractors to keep in your family; they will cure you without the
expense of my attendance, or the danger of the common medical
practice.' For very obvious reasons medical men must never be
expected to recommend the use of Perkinism. The Tractors must trust
for their patronage to the enlightened and philanthropic out of the
profession, or to medical men retired from practice, and who know of
no other interest than the luxury of relieving the distressed. And I
do not despair of seeing the day when but very few of this
description as well as private families will be without them."
Whether the motives assigned by this medical man to his professional
brethren existed or not, it is true that Dr. Perkins did not gain a
great deal at their hands. The Connecticut Medical Society expelled
him in 1797 for violating their law against the use of nostrums, or
secret remedies. The leading English physicians appear to have
looked on with singular apathy or contempt at the miracles which it
was pretended were enacting in the hands of the apostles of the new
practice. In looking over the reviews of the time, I have found
little beyond brief occasional notices of their pretensions; the
columns of these journals being occupied with subjects of more
permanent interest. The state of things in London is best learned,
however, from the satirical poem to which I have already alluded as
having been written at the period referred to. This was entitled,
"Terrible Tractoration!! A Poetical Petition against Galvanizing
Trumpery and the Perkinistic Institution. Most respectfully
addressed to the Royal College of Physicians, by Christopher Caustic,
M. D., LL. D., A. S. S., Fellow of the Royal College of Physicians,
Aberdeen, and Honorary Member of no less than nineteen very learned
Societies." Two editions of this work were published in London in
the years 1803 and 1804, and one or two have been published in this
country.
"Terrible Tractoration" is supposed, by those who never read it, to
be a satire upon the follies of Perkins and his followers. It is, on
the contrary, a most zealous defence of Perkinism, and a fierce
attack upon its opponents, most especially upon such of the medical
profession as treated the subject with neglect or ridicule. The
Royal College of Physicians was the more peculiar object of the
attack, but with this body, the editors of some of the leading
periodicals, and several physicians distinguished at that time, and
even now remembered for their services to science and humanity, were
involved in unsparing denunciations. The work is by no means of the
simply humorous character it might be supposed, but is overloaded
with notes of the most seriously polemical nature. Much of the
history of the subject, indeed, is to be looked for in this volume.
It appears from this work that the principal members of the medical
profession, so far from hailing Mr. Benjamin Douglass Perkins as
another Harvey or Jenner, looked very coldly upon him and his
Tractors; and it is now evident that, though they were much abused
for so doing, they knew very well what they had to deal with, and
were altogether in the right. The delusion at last attracted such an
amount of attention as to induce Dr. Haygarth and some others of
respectable standing to institute some experiments which I shall
mention in their proper place, the result of which might have seemed
sufficient to show the emptiness of the whole contrivance.
The Royal Society, that learned body which for ages has constituted
the best tribunal to which Britain can appeal in questions of
science, accepted Mr. Perkins's Tractors and the book written about
them, passed the customary vote of thanks, and never thought of
troubling itself further in the investigation of pretensions of such
an aspect. It is not to be denied that a considerable number of
physicians did avow themselves advocates of the new practice; but out
of the whole catalogue of those who were publicly proclaimed as such,
no one has ever been known, so far as I am aware, to the scientific
world, except in connection with the short-lived notoriety of
Perkinism. Who were the people, then, to whose activity, influence,
or standing with the community was owing all the temporary excitement
produced by the Metallic Tractors?
First, those persons who had been induced to purchase a pair of
Tractors. These little bits of brass and iron, the intrinsic value
of which might, perhaps, amount to ninepence, were sold at five
guineas a pair! A man who has paid twenty-five dollars for his
whistle is apt to blow it louder and longer than other people. So it
appeared that when the "Perkinean Society" applied to the possessors
of Tractors in the metropolis to concur in the establishment of a
public institution for the use of these instruments upon the poor,
"it was found that only five out of above a hundred objected to
subscribe, on account of their want of confidence in the efficacy of
the practice; and these," the committee observes, "there is reason to
believe, never gave them a fair trial, probably never used them in
more than one case, and that perhaps a case in which the Tractors had
never been recommended as serviceable." "Purchasers of the
Tractors," said one of their ardent advocates, "would be among the
last to approve of them if they had reason to suppose themselves
defrauded of five guineas." He forgot poor Moses, with his "gross of
green spectacles, with silver rims and shagreen cases." "Dear
mother," cried the boy, "why won't you listen to reason? I had them
a dead bargain, or I should not have bought them. The silver rims
alone will sell for double the money."
But it is an undeniable fact, that many persons of considerable
standing, and in some instances holding the most elevated positions
in society, openly patronized the new practice. In a translation of
a work entitled "Experiments with the Metallic Tractors," originally
published in Danish, thence rendered successively into German and
English, Mr. Benjamin Perkins, who edited the English edition, has
given a copious enumeration of the distinguished individuals, both in
America and Europe, whose patronage he enjoyed. He goes so far as to
signify that ROYALTY itself was to be included among the number.
When the Perkinean Institution was founded, no less a person than
Lord Rivers was elected President, and eleven other individuals of
distinction, among them Governor Franklin, son of Dr. Franklin,
figured as Vice-Presidents. Lord Henniker, a member of the Royal
Society, who is spoken of as a man of judgment and talents,
condescended to patronize the astonishing discovery, and at different
times bought three pairs of Tractors. When the Tractors were
introduced into Europe, a large number of testimonials accompanied
them from various distinguished characters in America, the list of
whom is given in the translation of the Danish work referred to as
follows:
"Those who have individually stated cases, or who have presented
their names to the public as men who approved of this remedy, and
acknowledged themselves instrumental in circulating the Tractors, are
fifty-six in number; thirty-four of whom are physicians and surgeons,
and many of them of the first eminence, thirteen clergymen, most of
whom are doctors of divinity, and connected with the literary
institutions of America; among the remainder are two members of
Congress, one professor of natural philosophy in a college, etc.,
etc." It seemed to be taken rather hardly by Mr. Perkins that the
translators of the work which he edited, in citing the names of the
advocates of the Metallic Practice, frequently omitted the honorary
titles which should have been annexed. The testimonials were
obtained by the Danish writer, from a pamphlet published in America,
in which these titles were given in full. Thus one of these
testimonials is from "John Tyler, Esq., a magistrate in the county
of New London, and late Brigadier-General of the militia in that
State." The "omission of the General's title" is the subject of
complaint, as if this title were sufficient evidence of the
commanding powers of one of the patrons of tractoration. A similar
complaint is made when "Calvin Goddard, Esq., of Plainfield, Attorney
at Law, and a member of the Legislature of the State of Connecticut,"
is mentioned without his titular honors, and even on account of the
omission of the proper official titles belonging to "Nathan Pierce,
Esq., Governor and Manager of the Almshouse of Newburyport." These
instances show the great importance to be attached to civil and
military dignities, in qualifying their holders to judge of
scientific subjects, a truth which has not been overlooked by the
legitimate successors of the Perkinists. In Great Britain, the
Tractors were not less honored than in America, by the learned and
the illustrious. The "Perkinistic Committee" made this statement in
their report: "Mr. Perkins has annually laid before the public a
large collection of new cases communicated to him for that purpose by
disinterested and intelligent characters, from almost every quarter
of Great Britain. In regard to the competency of these vouchers, it
will be sufficient simply to state that, amongst others whose names
have been attached to their communications, are eight professors, in
four different universities, twenty-one regular Physicians, nineteen
Surgeons, thirty Clergymen, twelve of whom are Doctors of Divinity,
and numerous other characters of equal respectability."
It cannot but excite our notice and surprise that the number of
clergymen both in America and Great Britain who thrust forward their
evidence on this medical topic was singularly large in proportion to
that of the members of the medical profession. Whole pages are
contributed by such worthies as the Rev. Dr. Trotter of Hans Place,
the Rear. Waring Willett, Chaplain to the Earl of Dunmore, the Rev.
Dr. Clarke, Chaplain to the Prince of Wales. The style of these
theologico-medical communications may be seen in the following from a
divine who was also professor in one of the colleges of New England.
"I have used the Tractors with success in several other cases in my
own family, and although, like Naaman the Syrian, I cannot tell why
the waters of Jordan should be better than Abana and Pharpar, rivers
of Damascus; yet since experience has proved them so, no reasoning
can change the opinion. Indeed, the causes of all common facts are,
we think, perfectly well known to us; and it is very probable, fifty
or a hundred years hence, we shall as well know why the Metallic
Tractors should in a few minutes remove violent pains, as we now know
why cantharides and opium will produce opposite effects, namely, we
shall know very little about either excepting facts." Fifty or a
hundred years hence! if he could have looked forward forty years, he
would have seen the descendants of the "Perkinistic" philosophers
swallowing infinitesimal globules, and knowing and caring as much
about the Tractors as the people at Saratoga Springs do about the
waters of Abana and Pharpar.
I trust it will not be thought in any degree disrespectful to a
profession which we all honor, that I have mentioned the great zeal
of many clergymen in the cause of Perkinism. I hope, too, that I may
without offence suggest the causes which have often led them out of
their own province into one to which their education has no special
reference. The members of that profession ought to be, and commonly
are, persons of benevolent character. Their duties carry them into
the midst of families, and particularly at times when the members of
them are suffering from bodily illness. It is natural enough that a
strong desire should be excited to alleviate sufferings which may
have defied the efforts of professional skill; as natural that any
remedy which recommends itself to the belief or the fancy of the
spiritual physician should be applied with the hope of benefit; and
perfectly certain that the weakness of human nature, from which no
profession is exempt, will lead him to take the most flattering view
of its effects upon the patient; his own sagacity and judgment being
staked upon the success of the trial. The inventor of the Tractors
was aware of these truths. He therefore sent the Tractors
gratuitously to many clergymen, accompanied with a formal certificate
that the holder had become entitled to their possession by the
payment of five guineas. This was practised in our own neighborhood,
and I remember finding one of these certificates, so presented, which
proved that amongst the risks of infancy I had to encounter Perkins's
Tractors. Two clergymen of Boston and the vicinity, both well known
to local fame, gave in their testimony to the value of the
instruments thus presented to them; an unusually moderate proportion,
when it is remembered that to the common motives of which I have
spoken was added the seduction of a gift for which the profane public
was expected to pay so largely.
It was remarkable, also, that Perkinism, which had so little success
with the medical and scientific part of the community, found great
favor in the eyes of its more lovely and less obstinate portion.
"The lady of Major Oxholin,"--I quote from Mr. Perkins's volume,--
"having been lately in America, had seen and heard much of the great
effects of Perkinism. Influenced by a most benevolent disposition,
she brought these Tractors and the pamphlet with her to Europe, with
a laudable desire of extending their utility to her suffering
countrymen." Such was the channel by which the Tractors were
conveyed to Denmark, where they soon became the ruling passion.
The workmen, says a French writer, could not manufacture them fast
enough. Women carried them about their persons, and delighted in
bringing them into general use. To what extent the Tractors were
favored with the patronage of English and American ladies, it is of
course not easy to say, except on general principles, as their names
were not brought before the public. But one of Dr. Haygarth's
stories may lead us to conjecture that there was a class of female
practitioners who went about doing good with the Tractors in England
as well as in Denmark. A certain lady had the misfortune to have a
spot as big as a silver penny at the corner of her eye, caused by a
bruise, or some such injury. Another lady, who was a friend of hers,
and a strong believer in Perkinism, was very anxious to try the
effects of tractoration upon this unfortunate blemish. The patient
consented; the lady "produced the instruments, and, after drawing
them four or five times over the spot, declared that it changed to a
paler color, and on repeating the use of them a few minutes longer,
that it had almost vanished, and was scarcely visible, and departed
in high triumph at her success." The lady who underwent the
operation assured the narrator "that she looked in the glass
immediately after, and that not the least visible alteration had
taken place."
It would be a very interesting question, what was the intellectual
character of those persons most conspicuous in behalf of the
Perkinistic delusion? Such an inquiry might bring to light some
principles which we could hereafter apply to the study of other
popular errors. But the obscurity into which nearly all these
enthusiasts have subsided renders the question easier to ask than to
answer. I believe it would have been found that most of these
persons were of ardent temperament and of considerable imagination,
and that their history would show that Perkinism was not the first
nor the last hobby-horse they rode furiously. Many of them may very
probably have been persons of more than common talent, of active and
ingenious minds, of versatile powers and various acquirements. Such,
for instance, was the estimable man to whom I have repeatedly
referred as a warm defender of tractoration, and a bitter assailant
of its enemies. The story tells itself in the biographical preface
to his poem. He went to London with the view of introducing a
hydraulic machine, which he and his Vermont friends regarded as a
very important invention. He found, however, that the machine was
already in common use in that metropolis. A brother Yankee, then in
London, had started the project of a mill, which was to be carried by
the water of the Thames. He was sanguine enough to purchase one
fifth of this concern, which also proved a failure. At about the
same period he wrote the work which proved the great excitement of
his mind upon the subject of the transient folly then before the
public. Originally a lawyer, he was in succession a mechanician, a
poet, and an editor, meeting with far less success in each of these
departments than usually attends men of less varied gifts, but of
more tranquil and phlegmatic composition. But who is ignorant that
there is a class of minds characterized by qualities like those I
have mentioned; minds with many bright and even beautiful traits; but
aimless and fickle as the butterfly; that settle upon every gayly-
colored illusion as it opens into flower, and flutter away to another
when the first has dropped its leaves, and stands naked in the icy
air of truth!
Let us now look at the general tenor of the arguments addressed by
believers to sceptics and opponents. Foremost of all, emblazoned at
the head of every column, loudest shouted by every triumphant
disputant, held up as paramount to all other considerations,
stretched like an impenetrable shield to protect the weakest advocate
of the great cause against the weapons of the adversary, was that
omnipotent monosyllable which has been the patrimony of cheats and
the currency of dupes from time immemorial,--Facts! Facts! Facts!
First came the published cases of the American clergymen, brigadier-
generals, almshouse governors, representatives, attorneys, and
esquires. Then came the published cases of the surgeons of
Copenhagen. Then followed reports of about one hundred and fifty
cases published in England, "demonstrating the efficacy of the
metallic practice in a variety of complaints both upon the human body
and on horses, etc." But the progress of facts in Great Britain did
not stop here. Let those who rely upon the numbers of their
testimonials, as being alone sufficient to prove the soundness and
stability of a medical novelty, digest the following from the report
of the Perkinistic Committee. "The cases published [in Great
Britain] amounted, in March last, the date of Mr. Perkins's last
publication, to about five thousand. Supposing that not more than
one cure in three hundred which the Tractors have performed has been
published, and the proportion is probably much greater, it will be
seen that the number, to March last, will have exceeded one million
five hundred thousand!"
Next in order after the appeal to what were called facts, came a
series of arguments, which have been so long bruised and battered
round in the cause of every doctrine or pretension, new, monstrous,
or deliriously impossible, that each of them is as odiously familiar
to the scientific scholar as the faces of so many old acquaintances,
among the less reputable classes, to the officers of police.
No doubt many of my hearers will recognize, in the following
passages, arguments they may have heard brought forward with
triumphant confidence in behalf of some doctrine not yet extinct. No
doubt some may have honestly thought they proved something; may have
used them with the purpose of convincing their friends, or of
silencing the opponents of their favorite doctrine, whatever that
might be. But any train of arguments which was contrived for
Perkinism, which was just as applicable to it as to any other new
doctrine in the same branch of science, and which was fully employed
against its adversaries forty years since, might, in common charity,
be suffered to slumber in the grave of Perkinism. Whether or not the
following sentences, taken literally from the work of Mr. Perkins,
were the originals of some of the idle propositions we hear bandied
about from time to time, let those who listen judge.
The following is the test assumed for the new practice: "If diseases
are really removed, as those persons who have practised extensively
with the Tractors declare, it should seem there would be but little
doubt of their being generally adopted; but if the numerous reports
of their efficacy which have been published are forgeries, or are
unfounded, the practice ought to be crushed." To this I merely add,
it has been crushed.
The following sentence applies to that a priori judging and uncandid
class of individuals who buy their dinners without tasting all the
food there is in the market. "On all discoveries there are persons
who, without descending to any inquiry into the truth, pretend to
know, as it were by intuition, that newly asserted facts are founded
in the grossest errors. These were those who knew that Harvey's
report of the circulation of the blood was a preposterous and
ridiculous suggestion, and in latter later days there were others who
knew that Franklin deserved reproach for declaring that points were
preferable to balls for protecting buildings from lightning."
Again: "This unwarrantable mode of offering assertion for proof, so
unauthorized and even unprecedented except in the condemnation of a
Galileo, the persecution of a Copernicus, and a few other acts of
inquisitorial authority, in the times of ignorance and superstition,
affords but a lamentable instance of one of his remarks, that this is
far from being the Age of Reason."
"The most valuable medicines in the Materia Medica act on principles
of which we are totally ignorant. None have ever yet been able to
explain how opium produces sleep, or how bark cures intermittent
fevers; and yet few, it is hoped, will be so absurd as to desist from
the use of these important articles because they know nothing of the
principle of their operations." Or if the argument is preferred, in
the eloquent language of the Perkinistic poet:
"What though the CAUSES may not be explained,
Since these EFFECTS are duly ascertained,
Let not self-interest, prejudice, or pride,
Induce mankind to set the means aside;
Means which, though simple, are by
Heaven designed to alleviate the woes of human kind."
This course of argument is so often employed, that it deserves to be
expanded a little, so that its length and breadth may be fairly seen.
A series of what are called facts is brought forward to prove some
very improbable doctrine. It is objected by judicious people, or
such as have devoted themselves to analogous subjects, that these
assumed facts are in direct opposition to all that is known of the
course of nature, that the universal experience of the past affords a
powerful presumption against their truth, and that in proportion to
the gravity of these objections, should be the number and competence
of the witnesses. The answer is a ready one. What do we know of the
mysteries of Nature? Do we understand the intricate machinery of the
Universe? When to this is added the never-failing quotation,
"There are more things in heaven and earth, Horatio,
Than are dreamt of in your philosophy,"--
the question is thought to be finally disposed of.
Take the case of astrology as an example. It is in itself strange
and incredible that the relations of the heavenly bodies to each
other at a given moment of time, perhaps half a century ago, should
have anything to do with my success or misfortune in any undertaking
of to-day. But what right have I to say it cannot be so? Can I bind
the sweet influences of Pleiades, or loose the bands of Orion? I do
not know by what mighty magic the planets roll in their fluid paths,
confined to circles as unchanging as if they were rings of steel, nor
why the great wave of ocean follows in a sleepless round upon the
skirts of moonlight; nor cam I say from any certain knowledge that
the phases of the heavenly bodies, or even the falling of the leaves
of the forest, or the manner in which the sands lie upon the sea-
shore, may not be knit up by invisible threads with the web of human
destiny. There is a class of minds much more ready to believe that
which is at first sight incredible, and because it is incredible,
than what is generally thought reasonable. Credo quia impossibile
est,--"I believe, because it is impossible,"--is an old paradoxical
expression which might be literally applied to this tribe of persons.
And they always succeed in finding something marvellous, to call out
the exercise of their robust faith. The old Cabalistic teachers
maintained that there was not a verse, line, word, or even letter in
the Bible which had not a special efficacy either to defend the
person who rightly employed it, or to injure his enemies; always
provided the original Hebrew was made use of. In the hands of modern
Cabalists every substance, no matter how inert, acquires wonderful
medicinal virtues, provided it be used in a proper state of purity
and subdivision.
I have already mentioned the motives attributed by the Perkinists to
the Medical Profession, as preventing its members from receiving the
new but unwelcome truths. This accusation is repeated in different
forms and places, as, for instance, in the following passage:
"Will the medical man who has spent much money and labor in the
pursuit of the arcana of Physic, and on the exercise of which depends
his support in life, proclaim the inefficacy of his art, and
recommend a remedy to his patient which the most unlettered in
society can employ as advantageously as himself? and a remedy, too,
which, unlike the drops, the pills, the powders, etc., of the Materia
Medica, is inconsumable, and ever in readiness to be employed in
successive diseases?"
As usual with these people, much indignation was expressed at any
parallel between their particular doctrine and practice and those of
their exploded predecessors. "The motives," says the disinterested
Mr. Perkins, "which must have impelled to this attempt at classing
the METALLIC PRACTICE with the most paltry of empyrical projects, are
but too thinly veiled to escape detection."
To all these arguments was added, as a matter of course, an appeal to
the feelings of the benevolent in behalf of suffering humanity, in
the shape of a notice that the poor would be treated gratis. It is
pretty well understood that this gratuitous treatment of the poor
does not necessarily imply an excess of benevolence, any more than
the gratuitous distribution of a trader's shop-bills is an evidence
of remarkable generosity; in short, that it is one of those things
which honest men often do from the best motives, but which rogues and
impostors never fail to announce as one of their special
recommendations. It is astonishing to see how these things brighten
up at the touch of Mr. Perkins's poet:
"Ye worthy, honored, philanthropic few,
The muse shall weave her brightest wreaths for you,
Who in Humanity's bland cause unite,
Nor heed the shaft by interest aimed or spite;
Like the great Pattern of Benevolence,
Hygeia's blessings to the poor dispense;
And though opposed by folly's servile brood,
ENJOY THE LUXURY OF DOING GOOD."
Having thus sketched the history of Perkinism in its days of
prosperity; having seen how it sprung into being, and by what means
it maintained its influence, it only remains to tell the brief story
of its discomfiture and final downfall. The vast majority of the
sensible part of the medical profession were contented, so far as we
can judge, to let it die out of itself. It was in vain that the
advocates of this invaluable discovery exclaimed over their perverse
and interested obstinacy,--in vain that they called up the injured
ghosts of Harvey, Galileo, and Copernicus to shame that unbelieving
generation; the Baillies and the Heberdens,--men whose names have
come down to us as synonymous with honor and wisdom,--bore their
reproaches in meek silence, and left them unanswered to their fate.
There were some others, however, who, believing the public to labor
under a delusion, thought it worth while to see whether the charm
would be broken by an open trial of its virtue, as compared with that
of some less hallowed formula. It must be remembered that a peculiar
value was attached to the Metallic Tractors, as made and patented by
Mr. Perkins. Dr. Haygarth, of Bath, performed various experiments
upon patients afflicted with different complaints,--the patients
supposing that the real five-guinea Tractors were employed. Strange
to relate, he obtained equally wonderful effects with Tractors of
lead and of wood; with nails, pieces of bone, slate pencil, and
tobacco-pipe. Dr. Alderson employed sham Tractors made of wood, and
produced such effects upon five patients that they returned solemn
thanks in church for their cures. A single specimen of these cases
may stand for all of them. Ann Hill had suffered for some months
from pain in the right arm and shoulder. The Tractors (wooden ones)
were applied, and in the space of five minutes she expressed herself
relieved in the following apostrophe: "Bless me! why, who could have
thought it, that them little things could pull the pain from one.
Well, to be sure, the longer one lives, the more one sees; ah, dear!"
These experiments did not result in the immediate extinction of
Perkinism. Doubtless they were a great comfort to many obstinate
unbelievers, and helped to settle some sceptical minds; but for the
real Perkinistic enthusiasts, it may be questioned whether they would
at that time have changed their opinion though one had risen from the
dead to assure them that it was an error. It perished without
violence, by an easy and natural process. Like the famous toy of
Mongolfier, it rose by means of heated air,--the fevered breath of
enthusiastic ignorance,--and when this grew cool, as it always does
in a little while, it collapsed and fell.
And now, on reviewing the whole subject, how shall we account for the
extraordinary prevalence of the belief in Perkinism among a portion
of what is supposed to be the thinking part of the community?
Could the cures have been real ones, produced by the principle of
ANIMAL MAGNETISM? To this it may be answered that the Perkinists
ridiculed the idea of approximating Mesmer and the founder of their
own doctrine, that nothing like the somnambulic condition seems to
have followed the use of the Tractors, and that neither the exertion
of the will nor the powers of the individual who operated seem to
have been considered of any consequence. Besides, the absolute
neglect into which the Tractors soon declined is good evidence that
they were incapable of affording any considerable and permanent
relief in the complaints for the cure of which they were applied.
Of course a large number of apparent cures were due solely to nature;
which is true under every form of treatment, orthodox or empirical.
Of course many persons experienced at least temporary relief from the
strong impression made upon their minds by this novel and marvellous
method of treatment.
Many, again, influenced by the sanguine hopes of those about them,
like dying people, who often say sincerely, from day to day, that
they are getting better, cheated themselves into a false and short-
lived belief that they were cured; and as happens in such cases, the
public never knew more than the first half of the story.
When it was said to the Perkinists, that whatever effects they
produced were merely through the imagination, they declared (like the
advocates of the ROYAL TOUCH and the UNGUENTUM ARMARIUM) that this
explanation was sufficiently disproved by the fact of numerous and
successful cures which had been witnessed in infants and brute
animals. Dr. Haygarth replied to this, that "in these cases it is
not the Patient, but the Observer, who is deceived by his own
imagination," and that such may be the fact, we have seen in the case
of the good lady who thought she had conjured away the spot from her
friend's countenance, when it remained just as before.
As to the motives of the inventor and vender of the Tractors, the
facts must be allowed to speak for themselves. But when two little
bits of brass and iron are patented, as an invention, as the result
of numerous experiments, when people are led, or even allowed, to
infer that they are a peculiar compound, when they are artfully
associated with a new and brilliant discovery (which then happened to
be Galvanism), when they are sold at many hundred times their value,
and the seller prints his opinion that a Hospital will suffer
inconvenience, "unless it possesses many sets of the Tractors, and
these placed in the hands of the patients to practise on each other,"
one cannot but suspect that they were contrived in the neighborhood
of a wooden nutmeg factory; that legs of ham in that region are not
made of the best mahogany; and that such as buy their cucumber seed
in that vicinity have to wait for the fruit as long as the Indians
for their crop of gunpowder.
---------------------------
The succeeding lecture will be devoted to an examination of the
doctrines of Samuel Hahnemann and his disciples; doctrines which some
consider new and others old; the common title of which is variously
known as Ho-moeopathy, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy,
and the claims of which are considered by some as infinitely
important, and by many as immeasurably ridiculous.
I wish to state, for the sake of any who may be interested in the
subject, that I shall treat it, not by ridicule, but by argument;
perhaps with great freedom, but with good temper and in peaceable
language; with very little hope of reclaiming converts, with no
desire of making enemies, but with a firm belief that its pretensions
and assertions cannot stand before a single hour of calm
investigation.
II.
It may be thought that a direct attack upon the pretensions of
HOMOEOPATHY is an uncalled-for aggression upon an unoffending
doctrine and its peaceful advocates.
But a little inquiry will show that it has long assumed so hostile a
position with respect to the Medical Profession, that any trouble I,
or any other member of that profession, may choose to bestow upon it
may be considered merely as a matter of self-defence. It began with
an attempt to show the insignificance of all existing medical
knowledge. It not only laid claim to wonderful powers of its own,
but it declared the common practice to be attended with the most
positively injurious effects, that by it acute diseases are
aggravated, and chronic diseases rendered incurable. It has at
various times brought forward collections of figures having the air
of statistical documents, pretending to show a great proportional
mortality among the patients of the Medical Profession, as compared
with those treated according to its own rules. Not contented with
choosing a name of classical origin for itself, it invented one for
the whole community of innocent physicians, assuring them, to their
great surprise, that they were all ALLOPATHISTS, whether they knew it
or not, and including all the illustrious masters of the past, from
Hippocrates down to Hunter, under the same gratuitous title. The
line, then, has been drawn by the champions of the new doctrine; they
have lifted the lance, they have sounded the charge, and are
responsible for any little skirmishing which may happen.
But, independently of any such grounds of active resistance, the
subject involves interests so disproportioned to its intrinsic
claims, that it is no more than an act of humanity to give it a
public examination. If the new doctrine is not truth, it is a
dangerous, a deadly error. If it is a mere illusion, and acquires
the same degree of influence that we have often seen obtained by
other illusions, there is not one of my audience who may not have
occasion to deplore the fatal credulity which listened to its
promises.
I shall therefore undertake a sober examination of its principles,
its facts, and some points of its history. The limited time at my
disposal requires me to condense as much as possible what I have to
say, but I shall endeavor to be plain and direct in expressing it.
Not one statement shall be made which cannot be supported by
unimpeachable reference: not one word shall be uttered which I am not
as willing to print as to speak. I have no quibbles to utter, and I
shall stoop to answer none; but, with full faith in the sufficiency
of a plain statement of facts and reasons, I submit the subject to
the discernment of my audience.
The question may be asked in the outset,--Have you submitted the
doctrines you are professing to examine to the test of long-repeated
and careful experiment; have you tried to see whether they were true
or not? To this I answer, that it is abundantly evident, from what
has often happened, that it would be of no manner of use for me to
allege the results of any experiments I might have instituted. Again
and again have the most explicit statements been made by the most
competent persons of the utter failure of all their trials, and there
were the same abundant explanations offered as used to be for the
Unguentum Armarium arid the Metallic Tractors. I could by no
possibility perform any experiments the result of which could not be
easily explained away so as to be of no conclusive significance.
Besides, as arguments in favor of Homoeopathy are constantly
addressed to the public in journals, pamphlets, and even lectures, by
inexperienced dilettanti, the same channel must be open to all its
opponents.
It is necessary, for the sake of those to whom the whole subject may
be new, to give in the smallest possible compass the substance of the
Homoeopathic Doctrine. Samuel Hahnemann, its founder, is a German
physician, now living in Paris, [Hahnemann died in 1843.] at the age
of eighty-seven years. In 1796 he published the first paper
containing his peculiar notions; in 1805 his first work on the
subject; in 1810 his somewhat famous "Organon of the Healing Art;"
the next year what he called the "Pure Materia Medica;" and in 1828
his last work, the "Treatise on Chronic Diseases." He has therefore
been writing at intervals on his favorite subject for nearly half a
century.
The one great doctrine which constitutes the basis of Homoeopathy as
a system is expressed by the Latin aphorism,
"SIMILIA SIBILIBUS CURANTUR,"
or like cures like, that is, diseases are cured by agents capable of
producing symptoms resembling those found in the disease under
treatment. A disease for Hahnemann consists essentially in a group
of symptoms. The proper medicine for any disease is the one which is
capable of producing a similar group of symptoms when given to a
healthy person.
It is of course necessary to know what are the trains of symptoms
excited by different substances, when administered to persons in
health, if any such can be shown to exist. Hahnemann and his
disciples give catalogues of the symptoms which they affirm were
produced upon themselves or others by a large number of drugs which
they submitted to experiment.
The second great fact which Hahnemann professes to have established
is the efficacy of medicinal substances reduced to a wonderful degree
of minuteness or dilution. The following account of his mode of
preparing his medicines is from his work on Chronic Diseases, which
has not, I believe, yet been translated into English. A grain of the
substance, if it is solid, a drop if it is liquid, is to be added to
about a third part of one hundred grains of sugar of milk in an
unglazed porcelain capsule which has had the polish removed from the
lower part of its cavity by rubbing it with wet sand; they are to be
mingled for an instant with a bone or horn spatula, and then rubbed
together for six minutes; then the mass is to be scraped together
from the mortar and pestle, which is to take four minutes; then to be
again rubbed for six minutes. Four minutes are then to be devoted to
scraping the powder into a heap, and the second third of the hundred
grains of sugar of milk to be added. Then they are to be stirred an
instant and rubbed six minutes,--again to be scraped together four
minutes and forcibly rubbed six; once more scraped together for four
minutes, when the last third of the hundred grains of sugar of milk
is to be added and mingled by stirring with the spatula; six minutes
of forcible rubbing, four of scraping together, and six more
(positively the last six) of rubbing, finish this part of the
process.
Every grain of this powder contains the hundredth of a grain of the
medicinal substance mingled with the sugar of milk. If, therefore, a
grain of the powder just prepared is mingled with another hundred
grains of sugar of milk, and the process just described repeated, we
shall have a powder of which every grain contains the hundredth of
the hundredth, or the ten thousandth part of a grain of the medicinal
substance. Repeat the same process with the same quantity of fresh
sugar of milk, and every grain of your powder will contain the
millionth of a grain of the medicinal substance. When the powder is
of this strength, it is ready to employ in the further solutions and
dilutions to be made use of in practice.
A grain of the powder is to be taken, a hundred drops of alcohol are
to be poured on it, the vial is to be slowly turned for a few
minutes, until the powder is dissolved, and two shakes are to be
given to it. On this point I will quote Hahnemann's own words.
"A long experience and multiplied observations upon the sick lead me
within the last few years to prefer giving only two shakes to
medicinal liquids, whereas I formerly used to give ten." The process
of dilution is carried on in the same way as the attenuation of the
powder was done; each successive dilution with alcohol reducing the
medicine to a hundredth part of the quantity of that which preceded
it. In this way the dilution of the original millionth of a grain of
medicine contained in the grain of powder operated on is carried
successively to the billionth, trillionth, quadrillionth,
quintillionth, and very often much higher fractional divisions. A
dose of any of these medicines is a minute fraction of a drop,
obtained by moistening with them one or more little globules of
sugar, of which Hahnemann says it takes about two hundred to weigh a
grain.
As an instance of the strength of the medicines prescribed by
Hahnemann, I will mention carbonate of lime. He does not employ
common chalk, but prefers a little portion of the friable part of an
oystershell. Of this substance, carried to the sextillionth degree,
so much as one or two globules of the size mentioned can convey is a
common dose. But for persons of very delicate nerves it is proper
that the dilution should be carried to the decillionth degree. That
is, an important medicinal effect is to be expected from the two
hundredth or hundredth part of the millionth of the millionth of the
millionth of the millionth of the millionth of the millionth of the
millionth of the millionth of the millionth of the millionth of a
grain of oyster-shell. This is only the tenth degree of potency, but
some of his disciples profess to have obtained palpable effects from
"much higher dilutions."
The third great doctrine of Hahnemann is the following. Seven
eighths at least of all chronic diseases are produced by the
existence in the system of that infectious disorder known in the
language of science by the appellation of PSORA, but to the less
refined portion of the community by the name of ITCH. In the words
of Hahnemann's "Organon," "This Psora is the sole true and
fundamental cause that produces all the other countless forms of
disease, which, under the names of nervous debility, hysteria,
hypochondriasis, insanity, melancholy, idiocy, madness, epilepsy, and
spasms of all kinds, softening of the bones, or rickets, scoliosis
and cyphosis, caries, cancer, fungua haematodes, gout,--yellow
jaundice and cyanosis, dropsy,--"
["The degrees of DILUTION must not be confounded with those of
POTENCY. Their relations may be seen by this table:
lst dilution,--One hundredth of a drop or grain.
2d " One ten thousandth.
3d " One millionth, marked I.
4th " One hundred millionth.
5th " One ten thousand millionth.
6th " One million millionth, or one billionth, marked II.
7th " One hundred billionth.
8th " One ten thousand billionth.
9th " One million billionth, or one trillionth, marked III.
10th " One hundred trillionth.
11th " One ten thousand trillionth.
12th " One million trillionth, or one quadrillionth, marked
IV.,--and so on indefinitely.
The large figures denote the degrees of POTENCY.]
"gastralgia, epistaxis, haemoptysis,--asthma and suppuration of the
lungs,--megrim, deafness, cataract and amaurosis,--paralysis, loss of
sense, pains of every kind, etc., appear in our pathology as so many
peculiar, distinct, and independent diseases."
For the last three centuries, if the same authority may be trusted,
under the influence of the more refined personal habits which have
prevailed, and the application of various external remedies which
repel the affection from the skin; Psora has revealed itself in these
numerous forms of internal disease, instead of appearing, as in
former periods, under the aspect of an external malady.
These are the three cardinal doctrines of Hahnemann, as laid down in
those standard works of Homoeopathy, the "Organon" and the "Treatise
on Chronic Diseases."
Several other principles may be added, upon all of which he insists
with great force, and which are very generally received by his
disciples.
1. Very little power is allowed to the curative efforts of nature.
Hahnemann goes so far as to say that no one has ever seen the simple
efforts of nature effect the durable recovery of a patient from a
chronic disease. In general, the Homoeopathist calls every recovery
which happens under his treatment a cure.
2. Every medicinal substance must be administered in a state of the
most perfect purity, and uncombined with any other. The union of
several remedies in a single prescription destroys its utility, and,
according to the "Organon," frequently adds a new disease.
3. A large number of substances commonly thought to be inert develop
great medicinal powers when prepared in the manner already described;
and a great proportion of them are ascertained to have specific
antidotes in case their excessive effects require to be neutralized.
4. Diseases should be recognized, as far as possible, not by any of
the common names imposed upon them, as fever or epilepsy, but as
individual collections of symptoms, each of which differs from every
other collection.
5. The symptoms of any complaint must be described with the most
minute exactness, and so far as possible in the patient's own words.
To illustrate the kind of circumstances the patient is expected to
record, I will mention one or two from the 313th page of the
"Treatise on Chronic Diseases,"--being the first one at which I
opened accidentally.
"After dinner, disposition to sleep; the patient winks."
"After dinner, prostration and feeling of weakness (nine days after
taking the remedy)."
This remedy was that same oyster-shell which is to be prescribed
"fractions of the sextillionth or decillionth degree." According to
Hahnemann, the action of a single dose of the size mentioned does not
fully display itself in some cases until twenty-four or even thirty
days after it is taken, and in such instances has not exhausted its
good effects until towards the fortieth or fiftieth day,--before
which time it would be absurd and injurious to administer a new
remedy.
So much for the doctrines of Hahnemann, which have been stated
without comment, or exaggeration of any of their features, very much
as any adherent of his opinions might have stated them, if obliged to
compress them into so narrow a space.
Does Hahnemann himself represent Homoeopathy as it now exists? He
certainly ought to be its best representative, after having created
it, and devoted his life to it for half a century. He is spoken of
as the great physician of the time, in most, if not all Homoeopathic
works. If he is not authority on the subject of his own doctrines,
who is? So far as I am aware, not one tangible discovery in the
so-called science has ever been ascribed to any other observer; at
least, no general principle or law, of consequence enough to claim
any prominence in Homoeopathic works, has ever been pretended to have
originated with any of his illustrious disciples. He is one of the
only two Homoeopathic writers with whom, as I shall mention, the
Paris publisher will have anything to do upon his own account. The
other is Jahr, whose Manual is little more than a catalogue of
symptoms and remedies. If any persons choose to reject Hahnemann as
not in the main representing Homoeopathy, if they strike at his
authority, if they wink out of sight his deliberate and formally
announced results, it is an act of suicidal rashness; for upon his
sagacity and powers of observation, and experience, as embodied in
his works, and especially in his Materia Medica, repose the
foundations of Homoeopathy as a practical system.
So far as I can learn from the conflicting statements made upon the
subject, the following is the present condition of belief.
1. All of any note agree that the law Similia similibus is the only
fundamental principle in medicine. Of course if any man does not
agree to this the name Homoeopathist can no longer be applied to him
with propriety.
2. The belief in and employment of the infinitesimal doses is
general, and in some places universal, among the advocates of
Homoeopathy; but a distinct movement has been made in Germany to get
rid of any restriction to the use of these doses, and to employ
medicines with the same license as other practitioners.
3. The doctrine of the origin of most chronic diseases in Psora,
notwithstanding Hahnemann says it cost him twelve years of study and
research to establish the fact and its practical consequences, has
met with great neglect and even opposition from very many of his own
disciples.
It is true, notwithstanding, that, throughout most of their writings
which I have seen, there runs a prevailing tone of great deference to
Hahnemann's opinions, a constant reference to his authority, a
general agreement with the minor points of his belief, and a pretence
of harmonious union in a common faith. [Those who will take the
trouble to look over Hull's Translation of Jahr's Manual may observe
how little comparative space is given to remedies resting upon any
other authority than that of Hahnemann.]
Many persons, and most physicians and scientific men, would be
satisfied with the statement of these doctrines, and examine them no
further. They would consider it vastly more probable that any
observer in so fallacious and difficult a field of inquiry as
medicine had been led into error, or walked into it of his own
accord, than that such numerous and extraordinary facts had really
just come to light. They would feel a right to exercise the same
obduracy towards them as the French Institute is in the habit of
displaying when memoirs or models are offered to it relating to the
squaring of the circle or perpetual motion; which it is the rule to
pass over without notice. They would feel as astronomers and natural
philosophers must have felt when, some half a dozen years ago, an
unknown man came forward, and asked for an opportunity to demonstrate
to Arago and his colleagues that the moon and planets were at a
distance of a little more than a hundred miles from the earth. And
so they would not even look into Homoeopathy, though all its
advocates should exclaim in the words of Mr. Benjamin Douglass
Perkins, vender of the Metallic Tractors, that "On all discoveries
there are persons who, without descending to any inquiry into the
truth, pretend to know, as it were by intuition, that newly asserted
facts are founded in the grossest errors." And they would lay their
heads upon their pillows with a perfectly clear conscience, although
they were assured that they were behaving in the same way that people
of old did towards Harvey, Galileo, and Copernicus, the identical
great names which were invoked by Mr. Benjamin Douglass Perkins.
But experience has shown that the character of these assertions is
not sufficient to deter many, from examining their claims to belief.
I therefore lean but very slightly on the extravagance and extreme
apparent singularity of their pretensions. I might have omitted
them, but on the whole it seemed more just to the claims of my
argument to suggest the vast complication of improbabilities involved
in the statements enumerated. Every one must of course judge for
himself as to the weight of these objections, which are by no means
brought forward as a proof of the extravagance of Homoeopathy, but
simply as entitled to a brief consideration before the facts of the
case are submitted to our scrutiny.
The three great asserted discoveries of Hahnemann are entirely
unconnected with and independent of each other. Were there any
natural relation between them it would seem probable enough that the
discovery of the first would have led to that of the others. But
assuming it to be a fact that diseases are cured by remedies capable
of producing symptoms like their own, no manifest relation exists
between this fact and the next assertion, namely, the power of the
infinitesimal doses. And allowing both these to be true, neither has
the remotest affinity to the third new doctrine, that which declares
seven eighths of all chronic diseases to be owing to Psora.
This want of any obvious relation between Hahnemann's three cardinal
doctrines appears to be self-evident upon inspection. But if, as is
often true with his disciples, they prefer the authority of one of
their own number, I will refer them to Dr. Trinks's paper on the
present state of Homoeopathy in Europe, with which, of course, they
are familiar, as his name is mentioned as one of the most prominent
champions of their faith, in their American official organ. It would
be a fact without a parallel in the history, not merely of medicine,
but of science, that three such unconnected and astonishing
discoveries, each of them a complete revolution of all that ages of
the most varied experience had been taught to believe, should spring
full formed from the brain of a single individual.
Let us look a moment at the first of his doctrines. Improbable
though it may seem to some, there is no essential absurdity involved
in the proposition that diseases yield to remedies capable of
producing like symptoms. There are, on the other hand, some
analogies which lend a degree of plausibility to the statement.
There are well-ascertained facts, known from the earliest periods of
medicine, showing that, under certain circumstances, the very
medicine which, from its known effects, one would expect to aggravate
the disease, may contribute to its relief. I may be permitted to
allude, in the most general way, to the case in which the spontaneous
efforts of an overtasked stomach are quieted by the agency of a drug
which that organ refuses to entertain upon any terms. But that every
cure ever performed by medicine should have been founded upon this
principle, although without the knowledge of a physician; that the
Homoeopathic axiom is, as Hahnemann asserts, "the sole law of nature
in therapeutics," a law of which nothing more than a transient
glimpse ever presented itself to the innumerable host of medical
observers, is a dogma of such sweeping extent, and pregnant novelty,
that it demands a corresponding breadth and depth of unquestionable
facts to cover its vast pretensions.
So much ridicule has been thrown upon the pretended powers of the
minute doses that I shall only touch upon this point for the purpose
of conveying, by illustrations, some shadow of ideas far transcending
the powers of the imagination to realize. It must be remembered that
these comparisons are not matters susceptible of dispute, being
founded on simple arithmetical computations, level to the capacity of
any intelligent schoolboy. A person who once wrote a very small
pamphlet made some show of objecting to calculations of thus kind, on
the ground that the highest dilutions could easily be made with a few
ounces of alcohol. But he should have remembered that at every
successive dilution he lays aside or throws away ninety-nine
hundredths of the fluid on which he is operating, and that, although
he begins with a drop, he only prepares a millionth, billionth,
trillionth, and similar fractions of it, all of which, added
together, would constitute but a vastly minute portion of the drop
with which he began. But now let us suppose we take one single drop
of the Tincture of Camomile, and that the whole of this were to be
carried through the common series of dilutions.
A calculation nearly like the following was made by Dr. Panvini, and
may be readily followed in its essential particulars by any one who
chooses.
For the first dilution it would take 100 drops of alcohol.
For the second dilution it would take 10;000 drops, or about a pint.
For the third dilution it would take 100 pints.
For the fourth dilution it would take 10,000 pints, or more than
1,000 gallons, and so on to the ninth dilution, which would take ten
billion gallons, which he computed would fill the basin of Lake
Agnano, a body of water two miles in circumference. The twelfth
dilution would of course fill a million such lakes. By the time the
seventeenth degree of dilution should be reached, the alcohol
required would equal in quantity the waters of ten thousand Adriatic
seas. Trifling errors must be expected, but they are as likely to be
on one side as the other, and any little matter like Lake Superior or
the Caspian would be but a drop in the bucket.
Swallowers of globules, one of your little pellets, moistened in the
mingled waves of one million lakes of alcohol, each two miles in
circumference, with which had been blended that one drop of Tincture
of Camomile, would be of precisely the strength recommended for that
medicine in your favorite Jahr's Manual, "against the most sudden,
frightful, and fatal diseases!" [In the French edition of 1834, the
proper doses of the medicines are mentioned, and Camomile is marked
IV. Why are the doses omitted in Hull's Translation, except in three
instances out of the whole two hundred remedies, notwithstanding the
promise in the preface that "some remarks upon the doses used may be
found at the head of each medicine"? Possibly because it makes no
difference whether they are employed in one Homoeopathic dose or
another; but then it is very singular that such precise directions
were formerly given in the same work, and that Hahnemann's
"experience" should have led him to draw the nice distinctions we
have seen in a former part of this Lecture (p. 44).]
And proceeding on the common data, I have just made a calculation
which shows that this single drop of Tincture of Camomile, given in
the quantity ordered by Jahr's Manual, would have supplied every
individual of the whole human family, past and present, with more
than five billion doses each, the action of each dose lasting about
four days.
Yet this is given only at the quadrillionth, or fourth degree of
potency, and various substances are frequently administered at the
decillionth or tenth degree, and occasionally at still higher
attenuations with professed medicinal results. Is there not in this
as great an exception to all the hitherto received laws of nature as
in the miracle of the loaves and fishes? Ask this question of a
Homoeopathist, and he will answer by referring to the effects
produced by a very minute portion of vaccine matter, or the
extraordinary diffusion of odors. But the vaccine matter is one of
those substances called morbid poisons, of which it is a peculiar
character to multiply themselves, when introduced into the system, as
a seed does in the soil. Therefore the hundredth part of a grain of
the vaccine matter, if no more than this is employed, soon increases
in quantity, until, in the course of about a week, it is a grain or
more, and can be removed in considerable drops. And what is a very
curious illustration of Homoeopathy, it does not produce its most.
characteristic effects until it is already in sufficient quantity not
merely to be visible, but to be collected for further use. The
thoughtlessness which can allow an inference to be extended from a
product of disease possessing this susceptibility of multiplication
when conveyed into the living body, to substances of inorganic
origin, such as silex or sulphur, would be capable of arguing that a
pebble may produce a mountain, because an acorn can become a forest.
As to the analogy to be found between the alleged action of the
infinitely attenuated doses, and the effects of some odorous
substances which possess the extraordinary power of diffusing their
imponderable emanations through a very wide space, however it may be
abused in argument, and rapidly as it evaporates on examination, it
is not like that just mentioned, wholly without meaning. The fact of
the vast diffusion of some odors, as that of musk or the rose, for
instance, has long been cited as the most remarkable illustration of
the divisibility of matter, and the nicety of the senses. And if
this were compared with the effects of a very minute dose of morphia
on the whole system, or the sudden and fatal impression of a single
drop of prussic acid, or, with what comes still nearer, the poisonous
influence of an atmosphere impregnated with invisible malaria, we
should find in each of these examples an evidence of the degree to
which nature, in some few instances, concentrates powerful qualities
in minute or subtile forms of matter. But if a man comes to me with
a pestle and mortar in his hand, and tells me that he will take a
little speck of some substance which nobody ever thought to have any
smell at all, as, for instance, a grain of chalk or of charcoal, and
that he will, after an hour or two of rubbing and scraping, develop
in a portion of it an odor which, if the whole grain were used, would
be capable of pervading an apartment, a house, a village, a province,
an empire, nay, the entire atmosphere of this broad planet upon which
we tread; and that from each of fifty or sixty substances he can in
this way develop a distinct and hitherto unknown odor: and if he
tries to show that all this is rendered quite reasonable by the
analogy of musk and roses, I shall certainly be justified in
considering him incapable of reasoning, and beyond the reach of my
argument. What if, instead of this, he professes to develop new and
wonderful medicinal powers from the same speck of chalk or charcoal,
in such proportions as would impregnate every pond, lake, river, sea,
and ocean of our globe, and appeals to the same analogy in favor of
the probability of his assertion.
All this may be true, notwithstanding these considerations. But so
extraordinary would be the fact, that a single atom of substances
which a child might swallow without harm by the teaspoonful could, by
an easy mechanical process, be made to develop such inconceivable
powers, that nothing but the strictest agreement of the most cautious
experimenters, secured by every guaranty that they were honest and
faithful, appealing to repeated experiments in public, with every
precaution to guard against error, and with the most plain and
peremptory results, should induce us to lend any credence to such
pretensions.
The third doctrine, that Psora, the other name of which you remember,
is the cause of the great majority of chronic diseases, is a
startling one, to say the least. That an affection always recognized
as a very unpleasant personal companion, but generally regarded as a
mere temporary incommodity, readily yielding to treatment in those
unfortunate enough to suffer from it, and hardly known among the
better classes of society, should be all at once found out by a
German physician to be the great scourge of mankind, the cause of
their severest bodily and mental calamities, cancer and consumption,
idiocy and madness, must excite our unqualified surprise. And when
the originator of this singular truth ascribes, as in the page now
open before me, the declining health of a disgraced courtier, the
chronic malady of a bereaved mother, even the melancholy of the love-
sick and slighted maiden, to nothing more nor less than the
insignificant, unseemly, and almost unmentionable ITCH, does it not
seem as if the very soil upon which we stand were dissolving into
chaos, over the earthquake-heaving of discovery?
And when one man claims to have established these three independent
truths, which are about as remote from each other as the discovery of
the law of gravitation, the invention of printing, and that of the
mariner's compass, unless the facts in their favor are overwhelming
and unanimous, the question naturally arises, Is not this man
deceiving himself, or trying to deceive others?
I proceed to examine the proofs of the leading ideas of Hahnemann and
his school.
In order to show the axiom, similia similibus curantur (or like is
cured by like), to be the basis of the healing art,--"the sole law of
nature in therapeutics,"--it is necessary,
1. That the symptoms produced by drugs in healthy persons should be
faithfully studied and recorded.
2. That drugs should be shown to be always capable of curing those
diseases most like their own symptoms.
3. That remedies should be shown not to cure diseases when they do
not produce symptoms resembling those presented in these diseases.
1. The effects of drugs upon healthy persons have been studied by
Hahnemann and his associates. Their results were made known in his
Materia Medica, a work in three large volumes in the French
translation, published about eight years ago. The mode of
experimentation appears to have been, to take the substance on trial,
either in common or minute doses, and then to set down every little
sensation, every little movement of mind or body, which occurred
within many succeeding hours or days, as being produced solely by the
substance employed. When I have enumerated some of the symptoms
attributed to the power of the drugs taken, you will be able to judge
how much value is to be ascribed to the assertions of such observers.
The following list was taken literally from the Materia Medica of
Hahnemann, by my friend M. Vernois, for whose accuracy I am willing
to be responsible. He has given seven pages of these symptoms, not
selected, but taken at hazard from the French translation of the
work. I shall be very brief in my citations.
"After stooping some time, sense of painful weight about the head
upon resuming the erect posture."
"An itching, tickling sensation at the outer edge of the palm of the
left hand, which obliges the person to scratch." The medicine was
acetate of lime, and as the action of the globule taken is said to
last twenty-eight days, you may judge how many such symptoms as the
last might be supposed to happen.
Among the symptoms attributed to muriatic acid are these: a catarrh,
sighing, pimples; "after having written a long time with the back a
little bent over, violent pain in the back and shoulder-blades, as if
from a strain,"--"dreams which are not remembered,--disposition to
mental dejection,--wakefulness before and after midnight."
I might extend this catalogue almost indefinitely. I have not cited
these specimens with any view to exciting a sense of the ridiculous,
which many others of those mentioned would not fail to do, but to
show that the common accidents of sensation, the little bodily
inconveniences to which all of us are subject, are seriously and
systematically ascribed to whatever medicine may have been exhibited,
even in the minute doses I have mentioned, whole days or weeks
previously.
To these are added all the symptoms ever said by anybody, whether
deserving confidence or not, as I shall hereafter illustrate, to be
produced by the substance in question.
The effects of sixty-four medicinal substances, ascertained by one or
both of these methods, are enumerated in the Materia Medica of
Hahnemann, which may be considered as the basis of practical
Homoeopathy. In the Manual of Jahr, which is the common guide, so
far as I know, of those who practise Homoeopathy in these regions,
two hundred remedies are enumerated, many of which, however, have
never been employed in practice. In at least one edition there were
no means of distinguishing those which had been tried upon the sick
from the others. It is true that marks have been added in the
edition employed here, which serve to distinguish them; but what are
we to think of a standard practical author on Materia Medica, who at
one time omits to designate the proper doses of his remedies, and at
another to let us have any means of knowing whether a remedy has ever
been tried or not, while he is recommending its employment in the
most critical and threatening diseases?
I think that, from what I have shown of the character of Hahnemann's
experiments, it would be a satisfaction to any candid inquirer to
know whether other persons, to whose assertions he could look with
confidence, confirm these pretended facts. Now there are many
individuals, long and well known to the scientific world, who have
tried these experiments upon healthy subjects, and utterly deny that
their effects have at all corresponded to Hahnemann's assertions.
I will take, for instance, the statements of Andral (and I am not
referring to his well-known public experiments in his hospital) as
to the result of his own trials. This distinguished physician is
Professor of Medicine in the School of Paris, and one of the most
widely known and valued authors upon practical and theoretical
subjects the profession can claim in any country. He is a man of
great kindness of character, a most liberal eclectic by nature and
habit, of unquestioned integrity, and is called, in the leading
article of the first number of the "Homoepathic Examiner," "an
eminent and very enlightened allopathist." Assisted by a number of
other persons in good health, he experimented on the effects of
cinchona, aconite, sulphur, arnica, and the other most highly
extolled remedies. His experiments lasted a year, and he stated
publicly to the Academy of Medicine that they never produced the
slightest appearance of the symptoms attributed to them. The results
of a man like this, so extensively known as one of the most
philosophical and candid, as well as brilliant of instructors, and
whose admirable abilities and signal liberality are generally
conceded, ought to be of great weight in deciding the question.
M. Double, a well-known medical writer and a physician of high
standing in Paris, had occasion so long ago as 1801, before he had
heard of Homoeopathy, to make experiments upon Cinchona, or Peruvian
bark. He and several others took the drug in every kind of dose for
four months, and the fever it is pretended by Hahnemann to excite
never was produced.
M. Bonnet, President of the Royal Society of Medicine of Bordeaux,
had occasion to observe many soldiers during the Peninsular War, who
made use of Cinchona as a preservative against different diseases,
but he never found it to produce the pretended paroxysms.
If any objection were made to evidence of this kind, I would refer to
the express experiments on many of the Homoeopathic substances, which
were given to healthy persons with every precaution as to diet and
regimen, by M. Louis Fleury, without being followed by the slightest
of the pretended consequences. And let me mention as a curious fact,
that the same quantity of arsenic given to one animal in the common
form of the unprepared powder, and to another after having been
rubbed up into six hundred globules, offered no particular difference
of activity in the two cases.
This is a strange contradiction to the doctrine of the development of
what they call dynamic power, by means of friction and subdivision.
In 1835 a public challenge was offered to the best known Homoeopathic
physician in Paris to select any ten substances asserted to produce
the most striking effects; to prepare them himself; to choose one by
lot without knowing which of them he had taken, and try it upon
himself or any intelligent and devoted Homoeopatbist, and, waiting
his own time, to come forward and tell what substance had been
employed. The challenge was at first accepted, but the acceptance
retracted before the time of trial arrived.
From all this I think it fair to conclude that the catalogues of
symptoms attributed in Homoeopathic works to the influence of various
drugs upon healthy persons are not entitled to any confidence.
2. It is necessary to show, in the next place, that medicinal
substances are always capable of curing diseases most like their own
symptoms. For facts relating to this question we must look to two
sources; the recorded experience of the medical profession in
general, and the results of trials made according to Homoeopathic
principles, and capable of testing the truth of the doctrine.
No person, that I am aware of, has ever denied that in some cases
there exists a resemblance between the effects of a remedy and the
symptoms of diseases in which it is beneficial. This has been
recognized, as Hahnemann himself has shown, from the time of
Hippocrates. But according to the records of the medical profession,
as they have been hitherto interpreted, this is true of only a very
small proportion of useful remedies. Nor has it ever been considered
as an established truth that the efficacy of even these few remedies
was in any definite ratio to their power of producing symptoms more
or less like those they cured.
Such was the state of opinion when Hahnemann came forward with the
proposition that all the cases of successful treatment found in the
works of all preceding medical writers were to be ascribed solely to
the operation of the Homoeopathic principle, which had effected the
cure, although without the physician's knowledge that this was the
real secret. And strange as it may seem, he was enabled to give such
a degree of plausibility to this assertion, that any person not
acquainted somewhat with medical literature, not quite familiar, I
should rather say, with the relative value of medical evidence,
according to the sources whence it is derived, would be almost
frightened into the belief, at seeing the pages upon pages of Latin
names he has summoned as his witnesses.
It has hitherto been customary, when examining the writings of
authors of preceding ages, upon subjects as to which they were less
enlightened than ourselves, and which they were very liable to
misrepresent, to exercise some little discretion; to discriminate, in
some measure, between writers deserving confidence and those not
entitled to it. But there is not the least appearance of any such
delicacy on the part of Hahnemann. A large majority of the names of
old authors he cites are wholly unknown to science. With some of
them I have been long acquainted, and I know that their accounts of
diseases are no more to be trusted than their contemporary Ambroise
Pare's stories of mermen, and similar absurdities. But if my
judgment is rejected, as being a prejudiced one, I can refer to
Cullen, who mentioned three of Hahnemann's authors in one sentence,
as being "not necessarily bad authorities; but certainly such when
they delivered very improbable events;" and as this was said more
than half a century ago, it could not have had any reference to
Hahnemann. But although not the slightest sign of discrimination is
visible in his quotations,--although for him a handful of chaff from
Schenck is all the same thing as a measure of wheat from Morgagni,--
there is a formidable display of authorities, and an abundant proof
of ingenious researches to be found in each of the great works of
Hahnemann with which I am familiar. [Some painful surmises might
arise as to the erudition of Hahnemann's English Translator, who
makes two individuals of "Zacutus, Lucitanus," as well as respecting
that of the conductors of an American Homoeopathic periodical, who
suffer the name of the world-renowned Cardanus to be spelt Cardamus
in at least three places, were not this gross ignorance of course
attributable only to the printer.]
It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has
proved many of Hahnemann's quotations from old authors to be
adulterate and false. What particular instances he has pointed out I
have no means of learning. And it is probably wholly impossible on
this side of the Atlantic, and even in most of the public libraries
of Europe, to find anything more than a small fraction of the
innumerable obscure publications which the neglect of grocers and
trunkmakers has spared to be ransacked by the all-devouring genius of
Homoeopathy. I have endeavored to verify such passages as my own
library afforded me the means of doing. For some I have looked in
vain, for want, as I am willing to believe, of more exact references.
But this I am able to affirm, that, out of the very small number
which I have been able, to trace back to their original authors, I
have found two to be wrongly quoted, one of them being a gross
misrepresentation.
The first is from the ancient Roman author, Caelius Aurelianus; the
second from the venerable folio of Forestus. Hahnemann uses the
following expressions,--if he is not misrepresented in the English
Translation of the 'Organon': "Asclepiades on one occasion cured an
inflammation of the brain by administering a small quantity of wine."
After correcting the erroneous reference of the Translator, I can
find no such case alluded to in the chapter. But Caelius Aurelianus
mentions two modes of treatment employed by Asclepiades, into both of
which the use of wine entered, as being "in the highest degree
irrational and dangerous." [Caelius Aurel. De Morb. Acut. et
Chron. lib. I. cap. xv. not xvi. Amsterdam. Wetstein, 1755.]
In speaking of the oil of anise-seed, Hahnemann says that Forestus
observed violent colic caused by its administration. But, as the
author tells the story, a young man took, by the counsel of a
surgeon, an acrid and virulent medicine, the name of which is not
given, which brought on a most cruel fit of the gripes and colic.
After this another surgeon was called, who gave him oil of anise-seed
and wine, "which increased his suffering." [Observ. et Curat. Med.
lib. XXI obs. xiii. Frankfort, 1614.] Now if this was the
Homoeopathic remedy, as Hahnemann pretends, it might be a fair
question why the young man was not cured by it. But it is a much
graver question why a man who has shrewdness and learning enough to
go so far after his facts, should think it right to treat them with
such astonishing negligence or such artful unfairness.
Even if every word he had pretended to take from his old authorities
were to be found in them, even if the authority of every one of these
authors were beyond question, the looseness with which they are used
to prove whatever Hahnemann chooses is beyond the bounds of
credibility. Let me give one instance to illustrate the character of
this man's mind. Hahnemann asserts, in a note annexed to the 110th
paragraph of the "Organon," that the smell of the rose will cause
certain persons to faint. And he says in the text that substances
which produce peculiar effects of this nature on particular
constitutions cure the same symptoms in people in general. Then in
another note to the same paragraph he quotes the following fact from
one of the last sources one would have looked to for medical
information, the Byzantine Historians.
"It was by these means (i.e. Homoeopathically) that the Princess
Eudosia with rose-water restored a person who had fainted!"
Is it possible that a man who is guilty of such pedantic folly as
this,--a man who can see a confirmation of his doctrine in such a
recovery as this,--a recovery which is happening every day, from a
breath of air, a drop or two of water, untying a bonnet-string,
loosening a stay-lace, and which can hardly help happening, whatever
is done,--is it possible that a man, of whose pages, not here and
there one, but hundreds upon hundreds are loaded with such
trivialities, is the Newton, the Columbus, the Harvey of the
nineteenth century!
The whole process of demonstration he employs is this. An experiment
is instituted with some drug upon one or more healthy persons.
Everything that happens for a number of days or weeks is, as we have
seen, set down as an effect of the medicine. Old volumes are then
ransacked promiscuously, and every morbid sensation or change that
anybody ever said was produced by the drug in question is added to
the list of symptoms. By one or both of these methods, each of the
sixty-four substances enumerated by Hahnemann is shown to produce a
very large number of symptoms, the lowest in his scale being ninety-
seven, and the highest fourteen hundred and ninety-one. And having
made out this list respecting any drug, a catalogue which, as you may
observe in any Homoeopathic manual, contains various symptoms
belonging to every organ of the body, what can be easier than to find
alleged cures in every medical author which can at once be attributed
to the Homoeopathic principle; still more if the grave of
extinguished credulity is called upon to give up its dead bones as
living witnesses; and worst of all, if the monuments of the past are
to be mutilated in favor of "the sole law of Nature in therapeutics"?
There are a few familiar facts of which great use has been made as an
entering wedge for the Homoeopathic doctrine. They have been
suffered to pass current so long that it is time they should be
nailed to the counter, a little operation which I undertake, with
perfect cheerfulness, to perform for them.
The first is a supposed illustration of the Homoeopathic law found in
the precept given for the treatment of parts which have been frozen,
by friction with snow or similar means. But we deceive ourselves by
names, if we suppose the frozen part to be treated by cold, and not
by heat. The snow may even be actually warmer than the part to which
it is applied. But even if it were at the same temperature when
applied, it never did and never could do the least good to a frozen
part, except as a mode of regulating the application of what? of
heat. But the heat must be applied gradually, just as food must be
given a little at a time to those perishing with hunger. If the
patient were brought into a warm room, heat would be applied very
rapidly, were not something interposed to prevent this, and allow its
gradual admission. Snow or iced water is exactly what is wanted; it
is not cold to the part; it is very possibly warm, on the contrary,
for these terms are relative, and if it does not melt and let the
heat in, or is not taken away, the part will remain frozen up until
doomsday. Now the treatment of a frozen limb by heat, in large or
small quantities, is not Homoeopathy.
The next supposed illustration of the Homoeopathic law is the alleged
successful management of burns, by holding them to the fire. This is
a popular mode of treating those burns which are of too little
consequence to require any more efficacious remedy, and would
inevitably get well of themselves, without any trouble being bestowed
upon them. It produces a most acute pain in the part, which is
followed by some loss of sensibility, as happens with the eye after
exposure to strong light, and the ear after being subjected to very
intense sounds. This is all it is capable of doing, and all further
notions of its efficacy must be attributed merely to the vulgar love
of paradox. If this example affords any comfort to the
Homoeopathist, it seems as cruel to deprive him of it as it would be
to convince the mistress of the smoke-jack or the flatiron that the
fire does not literally "draw the fire out," which is her hypothesis.
But if it were true that frost-bites were cured by cold and burns by
heat, it would be subversive, so far as it went, of the great
principle of Homoeopathy.
For you will remember that this principle is that Like cures Like,
and not that Same cures Same; that there is resemblance and not
identity between the symptoms of the disease and those produced by
the drug which cures it, and none have been readier to insist upon
this distinction than the Homoeopathists themselves. For if Same
cures Same, then every poison must be its own antidote,--which is
neither a part of their theory nor their so-called experience. They
have been asked often enough, why it was that arsenic could not cure
the mischief which arsenic had caused, and why the infectious cause
of small-pox did not remedy the disease it had produced, and then
the; were ready enough to see the distinction I have pointed out. O
no! it was not the hair of the same dog, but only of one very much
like him!
A third instance in proof of the Homoeopathic law is sought for in
the acknowledged efficacy of vaccination. And how does the law apply
to this? It is granted by the advocates of Homoeopathy that there is
a resemblance between the effects of the vaccine virus on a person in
health and the symptoms of small-pox. Therefore, according to the
rule, the vaccine virus will cure the small-pox, which, as everybody
knows, is entirely untrue. But it prevents small-pox, say the
Homoeopathists. Yes, and so does small-pox prevent itself from ever
happening again, and we know just as much of the principle involved
in the one case as in the other. For this is only one of a series of
facts which we are wholly unable to explain. Small-pox, measles,
scarlet-fever, hooping-cough, protect those who have them once from
future attacks; but nettle-rash and catarrh and lung fever, each of
which is just as Homoeopathic to itself as any one of the others,
have no such preservative power. We are obliged to accept the fact,
unexplained, and we can do no more for vaccination than for the rest.
I come now to the most directly practical point connected with the
subject, namely,--
What is the state of the evidence as to the efficacy of the proper
Homoeopathic treatment in the cure of diseases.
As the treatment adopted by the Homoeopathists has been almost
universally by means of the infinitesimal doses, the question of
their efficacy is thrown open, in common with that of the truth of
their fundamental axiom, as both are tested in practice.
We must look for facts as to the actual working of Homoeopathy to
three sources.
1. The statements of the unprofessional public.
2. The assertions of Homoeopathic practitioners.
3. The results of trials by competent and honest physicians, not
pledged to the system.
I think, after what we have seen of medical facts, as they are
represented by incompetent persons, we are disposed to attribute
little value to all statements of wonderful cures, coming from those
who have never been accustomed to watch the caprices of disease, and
have not cooled down their young enthusiasm by the habit of tranquil
observation. Those who know nothing of the natural progress of a
malady, of its ordinary duration, of its various modes of
terminating, of its liability to accidental complications, of the
signs which mark its insignificance or severity, of what is to be
expected of it when left to itself, of how much or how little is to
be anticipated from remedies, those who know nothing or next to
nothing of all these things, and who are in a great state of
excitement from benevolence, sympathy, or zeal for a new medical
discovery, can hardly be expected to be sound judges of facts which
have misled so many sagacious men, who have spent their lives in the
daily study and observation of them. I believe that, after having
drawn the portrait of defunct Perkinism, with its five thousand
printed cures, and its million and a half computed ones, its miracles
blazoned about through America, Denmark, and England; after relating
that forty years ago women carried the Tractors about in their
pockets, and workmen could not make them fast enough for the public
demand; and then showing you, as a curiosity, a single one of these
instruments, an odd one of a pair, which I obtained only by a lucky
accident, so utterly lost is the memory of all their wonderful
achievements; I believe, after all this, I need not waste time in
showing that medical accuracy is not to be looked for in the florid
reports of benevolent associations, the assertions of illustrious
patrons, the lax effusions of daily journals, or the effervescent
gossip of the tea-table.
Dr. Hering, whose name is somewhat familiar to the champions of
Homoeopathy, has said that "the new healing art is not to be judged
by its success in isolated cases only, but according to its success
in general, its innate truth, and the incontrovertible nature of its
innate principles."
We have seen something of "the incontrovertible nature of its innate
principles," and it seems probable, on the whole, that its success in
general must be made up of its success in isolated cases. Some
attempts have been made, however, to finish the whole matter by
sweeping statistical documents, which are intended to prove its
triumphant success over the common practice.
It is well known to those who have had the good fortune to see the
"Homoeopathic Examiner," that this journal led off, in its first
number, with a grand display of everything the newly imported
doctrine had to show for itself. It is well remarked, on the twenty-
third page of this article, that "the comparison of bills of
mortality among an equal number of sick, treated by divers methods,
is a most poor and lame way to get at conclusions touching principles
of the healing art." In confirmation of which, the author proceeds
upon the twenty-fifth page to prove the superiority of the
Homoeopathic treatment of cholera, by precisely these very bills of
mortality. Now, every intelligent physician is aware that the poison
of cholera differed so much in its activity at different times and,
places, that it was next to impossible to form any opinion as to the
results of treatment, unless every precaution was taken to secure the
most perfectly corresponding conditions in the patients treated, and
hardly even then. Of course, then, a Russian Admiral, by the name of
Mordvinov, backed by a number of so-called physicians practising in
Russian villages, is singularly competent to the task of settling the
whole question of the utility of this or that kind of treatment; to
prove that, if not more than eight and a half per cent. of those
attacked with the disease perished, the rest owed their immunity to
Hahnemann. I can remember when more than a hundred patients in a
public institution were attacked with what, I doubt not, many
Homoeopathic physicians (to say nothing of Homoeopathic admirals)
would have called cholera, and not one of them died, though treated
in the common way, and it is my firm belief that, if such a result
had followed the administration of the omnipotent globules, it would
have been in the mouth of every adept in Europe, from Quin of London
to Spohr of Gandersheim. No longer ago than yesterday, in one of the
most widely circulated papers of this city, there was published an
assertion that the mortality in several Homoeopathic Hospitals was
not quite five in a hundred, whereas, in what are called by the
writer Allopathic Hospitals, it is said to be eleven in a hundred.
An honest man should be ashamed of such an argumentum ad ignorantiam.
The mortality of a hospital depends not merely on the treatment of
the patients, but on the class of diseases it is in the habit of
receiving, on the place where it is, on the season, and many other
circumstances. For instance, there are many hospitals in the great
cities of Europe that receive few diseases of a nature to endanger
life, and, on the other hand, there are others where dangerous
diseases are accumulated out of the common proportion. Thus, in the
wards of Louis, at the Hospital of La Pitie, a vast number of
patients in the last stages of consumption were constantly entering,
to swell the mortality of that hospital. It was because he was known
to pay particular attention to the diseases of the chest that
patients laboring under those fatal affections to an incurable extent
were so constantly coming in upon him. It is always a miserable
appeal to the thoughtlessness of the vulgar, to allege the naked fact
of the less comparative mortality in the practice of one hospital or
of one physician than another, as an evidence of the superiority of
their treatment. Other things being equal, it must always be
expected that those institutions and individuals enjoying to the
highest degree the confidence of the community will lose the largest
proportion of their patients; for the simple reason that they will
naturally be looked to by those suffering from the gravest class of
diseases; that many, who know that they are affected with mortal
disease, will choose to die under their care or shelter, while the
subjects of trifling maladies, and merely troublesome symptoms, amuse
themselves to any extent among the fancy practitioners. When,
therefore, Dr. Mublenbein, as stated in the "Homoeopathic Examiner,"
and quoted in yesterday's "Daily Advertiser," asserts that the
mortality among his patients is only one per cent. since he has
practised Homoeopathy, whereas it was six per cent. when he employed
the common mode of practice, I am convinced by this, his own
statement, that the citizens of Brunswick, whenever they are
seriously sick, take good care not to send for Dr. Muhlenbein!
It is evidently impossible that I should attempt, within the compass
of a single lecture, any detailed examination of the very numerous
cases reported in the Homoeopathic Treatises and Journals. Having
been in the habit of receiving the French "Archives of Homoeopathic
Medicine" until the premature decease of that Journal, I have had the
opportunity of becoming acquainted somewhat with the style of these
documents, and experiencing whatever degree of conviction they were
calculated to produce. Although of course I do not wish any value to
be assumed for my opinion, such as it is, I consider that you are
entitled to hear it. So far, then, as I am acquainted with the
general character of the cases reported by the Homoeopathic
physicians, they would for the most part be considered as wholly
undeserving a place in any English, French, or American periodical of
high standing, if, instead of favoring the doctrine they were
intended to support, they were brought forward to prove the efficacy
of any common remedy administered by any common practitioner. There
are occasional exceptions to this remark; but the general truth of it
is rendered probable by the fact that these cases are always, or
almost always, written with the single object of showing the efficacy
of the medicine used, or the skill of the practitioner, and it is
recognized as a general rule that such cases deserve very little
confidence. Yet they may sound well enough, one at a time, to those
who are not fully aware of the fallacies of medical evidence. Let me
state a case in illustration. Nobody doubts that some patients
recover under every form of practice. Probably all are willing to
allow that a large majority, for instance, ninety in a hundred, of
such cases as a physician is called to in daily practice, would
recover, sooner or later, with more or less difficulty, provided
nothing were done to interfere seriously with the efforts of nature.
Suppose, then, a physician who has a hundred patients prescribes to
each of them pills made of some entirely inert substance, as starch,
for instance. Ninety of them get well, or if he chooses to use such
language, he cures ninety of them. It is evident, according to the
doctrine of chances, that there must be a considerable number of
coincidences between the relief of the patient and the administration
of the remedy. It is altogether probable that there will happen two
or three very striking coincidences out of the whole ninety cases, in
which it would seem evident that the medicine produced the relief,
though it had, as we assumed, nothing to do with it. Now suppose
that the physician publishes these cases, will they not have a
plausible appearance of proving that which, as we granted at the
outset, was entirely false? Suppose that instead of pills of starch
he employs microscopic sugarplums, with the five' million billion
trillionth part of a suspicion of aconite or pulsatilla, and then
publishes his successful cases, through the leaden lips of the press,
or the living ones of his female acquaintances,--does that make the
impression a less erroneous one? But so it is that in Homoeopathic
works and journals and gossip one can never, or next to never, find
anything but successful cases, which might do very well as a proof of
superior skill, did it not prove as much for the swindling
advertisers whose certificates disgrace so many of our newspapers.
How long will it take mankind to learn that while they listen to "the
speaking hundreds and units, who make the world ring "with the
pretended triumphs they have witnessed, the "dumb millions" of
deluded and injured victims are paying the daily forfeit of their
misplaced confidence!
I am sorry to see, also, that a degree of ignorance as to the natural
course of diseases is often shown in these published cases, which,
although it may not be detected by the unprofessional reader, conveys
an unpleasant impression to those who are acquainted with the
subject. Thus a young woman affected with jaundice is mentioned in
the German "Annals of Clinical Homoeopathy" as having been cured in
twenty-nine days by pulsatilla and nux vomica. Rummel, a well-known
writer of the same school, speaks of curing a case of jaundice in
thirty-four days by Homoeopathic doses of pulsatilla, aconite, and
cinchona. I happened to have a case in my own household, a few weeks
since, which lasted about ten days, and this was longer than I have
repeatedly seen it in hospital practice, so that it was nothing to
boast of.
Dr. Munneche of Lichtenburg in Saxony is called to a patient with
sprained ankle who had been a fortnight under the common treatment.
The patient gets well by the use of arnica in a little more than a
month longer, and this extraordinary fact is published in the French
"Archives of Homoeopathic Medicine."
In the same Journal is recorded the case of a patient who with
nothing more, so far as any proof goes, than inluenza, gets down to
her shop upon the sixth day.
And again, the cool way in which everything favorable in a case is
set down by these people entirely to their treatment, may be seen in
a case of croup reported in the "Homoeopathic Gazette" of Leipsic,
in which leeches, blistering, inhalation of hot vapor, and powerful
internal medicine had been employed, and yet the merit was all
attributed to one drop of some Homoeopathic fluid.
I need not multiply these quotations, which illustrate the grounds of
an opinion which the time does not allow me to justify more at
length; other such cases are lying open before me; there is no end to
them if more were wanted; for nothing is necessary but to look into
any of the numerous broken-down Journals of Homoeopathy, the volumes
of which may be found on the shelves of those curious in such
matters.
A number of public trials of Homoeopathy have been made in different
parts of the world. Six of these are mentioned in the Manifesto of
the "Homoeopathic Examiner." Now to suppose that any trial can
absolutely silence people, would be to forget the whole experience of
the past. Dr. Haygarth and Dr. Alderson could not stop the sale of
the five-guinea Tractors, although they proved that they could work
the same miracles with pieces of wood and tobacco-pipe. It takes
time for truth to operate as well as Homoeopathic globules. Many
persons thought the results of these trials were decisive enough of
the nullity of the treatment; those who wish to see the kind of
special pleading and evasion by which it is attempted to cover
results which, stated by the "Homoeopathic Examiner" itself, look
exceedingly like a miserable failure, may consult the opening
flourish of that Journal. I had not the intention to speak of these
public trials at all, having abundant other evidence on the point.
But I think it best, on the whole, to mention two of them in a few
words,--that instituted at Naples and that of Andral.
There have been few names in the medical profession, for the last
half century, so widely known throughout the world of science as that
of M. Esquirol, whose life was devoted to the treatment of insanity,
and who was without a rival in that department of practical medicine.
It is from an analysis communicated by him to the "Gazette Medicale
de Paris" that I derive my acquaintance with the account of the trial
at Naples by Dr. Panvini, physician to the Hospital della Pace. This
account seems to be entirely deserving of credit. Ten patients were
set apart, and not allowed to take any medicine at all,--much against
the wish of the Homoeopathic physician. All of them got well, and of
course all of them would have been claimed as triumphs if they had
been submitted to the treatment. Six other slight cases (each of
which is specified) got well under the Homoeopathic treatment, none
of its asserted specific effects being manifested.
All the rest were cases of grave disease; and so far as the trial,
which was interrupted about the fortieth day, extended, the patients
grew worse, or received no benefit. A case is reported on the page
before me of a soldier affected with acute inflammation in the chest,
who took successively aconite, bryonia, nux vomica, and pulsatilla,
and after thirty-eight days of treatment remained without any
important change in his disease. The Homoeopathic physician who
treated these patients was M. de Horatiis, who had the previous year
been announcing his wonderful cures. And M. Esquirol asserted to the
Academy of Medicine in 1835, that this M. de Horatiis, who is one of
the prominent personages in the "Examiner's" Manifesto published in
1840, had subsequently renounced Homoeopathy. I may remark, by the
way, that this same periodical, which is so very easy in explaining
away the results of these trials, makes a mistake of only six years
or a little more as to the time when this at Naples was instituted.
M. Andral, the "eminent and very enlightened allopathist" of the
"Homoeopathic Examiner," made the following statement in March, 1835,
to the Academy of Medicine: "I have submitted this doctrine to
experiment; I can reckon at this time from one hundred and thirty to
one hundred and forty cases, recorded with perfect fairness, in a
great hospital, under the eye of numerous witnesses; to avoid every
objection--I obtained my remedies of M. Guibourt, who keeps a
Homoeopathic pharmacy, and whose strict exactness is well known; the
regimen has been scrupulously observed, and I obtained from the
sisters attached to the hospital a special regimen, such as Hahnemann
orders. I was told, however, some months since, that I had not been
faithful to all the rules of the doctrine. I therefore took the
trouble to begin again; I have studied the practice of the Parisian
Homoeopathists, as I had studied their books, and I became convinced
that they treated their patients as I had treated mine, and I affirm
that I have been as rigorously exact in the treatment as any other
person."
And he expressly asserts the entire nullity of the influence of all
the Homoeopathic remedies tried by him in modifying, so far as he
could observe, the progress or termination of diseases. It deserves
notice that he experimented with the most boasted substances,--
cinchona, aconite, mercury, bryonia, belladonna. Aconite, for
instance, he says he administered in more than forty cases of that
collection of feverish symptoms in which it exerts so much power,
according to Hahnemann, and in not one of them did it have the
slightest influence, the pulse and heat remaining as before.
These statements look pretty honest, and would seem hard to be
explained away, but it is calmly said that he "did not know enough of
the method to select the remedies with any tolerable precision."
["Homoeopathic Examiner, vol. i. p. 22.]
"Nothing is left to the caprice of the physician." (In a word,
instead of being dependent upon blind chance, that there is an
infallible law, guided by which; the physician MUST select the proper
remedies.') ['Ibid.,' in a notice of Menzel's paper.] Who are they
that practice Homoeopathy, and say this of a man with the Materia
Medica of Hahnemann lying before him? Who are they that send these
same globules, on which he experimented, accompanied by a little
book, into families, whose members are thought competent to employ
them, when they deny any such capacity to a man whose life has been
passed at the bedside of patients, the most prominent teacher in the
first Medical Faculty in the world, the consulting physician of the
King of France, and one of the most renowned practical writers, not
merely of his nation, but of his age? I leave the quibbles by which
such persons would try to creep out from under the crushing weight of
these conclusions to the unfortunates who suppose that a reply is
equivalent to an answer.
Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris,
invited two Homoeopathic practitioners to experiment in his wards.
One of these was Curie, now of London, whose works are on the
counters of some of our bookstores, and probably in the hands of some
of my audience. This gentleman, whom Dr. Baillie declares to be an
enlightened man, and perfectly sincere in his convictions, brought
his own medicines from the pharmacy which furnished Hahnemann
himself, and employed them for four or five months upon patients in
his ward, and with results equally unsatisfactory, as appears from
Dr. Baillie's statement at a meeting of the Academy of Medicine. And
a similar experiment was permitted by the Clinical Professor of the
Hotel Dieu of Lyons, with the same complete failure.
But these are old and prejudiced practitioners. Very well, then take
the statement of Dr. Fleury, a most intelligent young physician, who
treated homoeopathically more than fifty patients, suffering from
diseases which it was not dangerous to treat in this way, taking
every kind of precaution as to regimen, removal of disturbing
influences, and the state of the atmosphere, insisted upon by the
most vigorous partisans of the doctrine, and found not the slightest
effect produced by the medicines. And more than this, read nine of
these cases, which he has published, as I have just done, and observe
the absolute nullity of aconite, belladonna, and bryonia, against the
symptoms over which they are pretended to exert such palpable, such
obvious, such astonishing influences. In the view of these
statements, it is impossible not to realize the entire futility of
attempting to silence this asserted science by the flattest and most
peremptory results of experiment. Were all the hospital physicians
of Europe and America to devote themselves, for the requisite period,
to this sole pursuit, and were their results to be unanimous as to
the total worthlessness of the whole system in practice, this
slippery delusion would slide through their fingers without the
slightest discomposure, when, as they supposed, they had crushed
every joint in its tortuous and trailing body.
3. I have said, that to show the truth of the Homoeopathic doctrine,
as announced by Hahnemann, it would be necessary to show, in the
third place, that remedies never cure diseases when they are not
capable of producing similar symptoms! The burden of this somewhat
comprehensive demonstration lying entirely upon the advocates of this
doctrine, it may be left to their mature reflections.
It entered into my original plan to treat of the doctrine relating to
Psora, or itch,--an almost insane conception, which I am glad to get
rid of, for this is a subject one does not care to handle without
gloves. I am saved this trouble, however, by finding that many of
the disciples of Hahnemann, those disciples the very gospel of whose
faith stands upon his word, make very light of his authority on this
point, although he himself says, "It has cost me twelve years of
study and research to trace out the source of this incredible number
of chronic affections, to discover this great truth, which remained
concealed from all my predecessors and contemporaries, to establish
the basis of its demonstration, and find out, at the same time, the
curative medicines that were fit to combat this hydra in all its
different forms."
But, in the face of all this, the following remarks are made by
Wolff, of Dresden, whose essays, according to the editor of the
"Homoeopathic Examiner," "represent the opinions of a large majority
of Homoeopathists in Europe."
"It cannot be unknown to any one at all familiar with Homoeopathic
literature, that Hahnemann's idea of tracing the large majority of
chronic diseases to actual itch has met with the greatest opposition
from Homoeopathic physicians themselves." And again, "If the Psoric
theory has led to no proper schism, the reason is to be found in the
fact that it is almost without any influence in practice."
We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Duke
of Baden," and a "distinguished" Homoeopathist, actually asked
Hahnemann for the proof that chronic diseases, such as dropsy, for
instance, never arise from any other cause than itch; and that,
according to common report, the venerable sage was highly incensed
(fort courrouce) with Dr. Hartmann, of Leipsic, another
"distinguished" Homoeopathist, for maintaining that they certainly
did arise from other causes.
And Dr. Fielitz, in the "Homoeopathic Gazette" of Leipsic, after
saying, in a good-natured way, that Psora is the Devil in medicine,
and that physicians are divided on this point into diabolists and
exorcists, declares that, according to a remark of Hahnemann, the
whole civilized world is affected with Psora. I must therefore
disappoint any advocate of Hahnemann who may honor me with his
presence, by not attacking a doctrine on which some of the disciples
of his creed would be very happy to have its adversaries waste their
time and strength. I will not meddle with this excrescence, which,
though often used in time of peace, would be dropped, like the limb
of a shell-fish, the moment it was assailed; time is too precious,
and the harvest of living extravagances nods too heavily to my
sickle, that I should blunt it upon straw and stubble.
I will close the subject with a brief examination of some of the
statements made in Homoeopathic works, and more particularly in the
brilliant Manifesto of the "Examiner," before referred to. And
first, it is there stated under the head of "Homoeopathic
Literature," that "SEVEN HUNDRED volumes have been issued from the
press developing the peculiarities of the system, and many of them
possessed of a scientific character that savans know well how to
respect." If my assertion were proper evidence in the case, I should
declare, that, having seen a good many of these publications, from
the year 1834, when I bought the work of the Rev. Thomas Everest,"
[Dr. Curie speaks of this silly pamphlet as having been published in
1835.] to within a few weeks, when I received my last importation of
Homaeopathic literature, I have found that all, with a very few
exceptions, were stitched pamphlets varying from twenty or thirty
pages to somewhat less than a hundred, and generally resembling each
other as much as so many spelling-books.
But not being evidence in the case, I will give you the testimony of
Dr. Trinks, of Dresden, who flourishes on the fifteenth page of the
same Manifesto as one of the most distinguished among the
Homoeopathists of Europe. I translate the sentence literally from
the "Archives de la Medecine Homoeopathique."
"The literature of Homoeopathy, if that honorable name must be
applied to all kinds of book-making, has been degraded to the
condition of the humblest servitude. Productions without talent,
without spirit, without discrimination, flat and pitiful eulogies,
exaggerations surpassing the limits of the most robust faith,
invectives against such as dared to doubt the dogmas which had been
proclaimed, or catalogues of remedies; of such materials is it
composed! From distance to distance only, have appeared some memoirs
useful to science or practice, which appear as so many green oases in
the midst of this literary desert."
It is a very natural as well as a curious question to ask, What has
been the success of Homoeopathy in the different countries of Europe,
and what is its present condition?
The greatest reliance of the advocates of Homoeopathy is of course on
Germany. We know very little of its medical schools, its medical
doctrines, or its medical men, compared with those of England and
France. And, therefore, when an intelligent traveller gives a direct
account from personal inspection of the miserable condition of the
Homoeopathic hospital at Leipsic, the first established in Europe,
and the first on the list of the ever-memorable Manifesto, it is easy
enough answer or elude the fact by citing various hard names of
"distinguished" practitioners, which sound just as well to the
uninformed public as if they were Meckel, or Tiedemann, or
Langenbeck. Dr. Leo-Wolf, who, to be sure, is opposed to
Homoeopathy, but who is a scholar, and ought to know something
of his own countrymen, assures us that "Dr. Kopp is the only German
Homoeopathist, if we can call him so, who has been distinguished as
an author and practitioner before he examined this method." And Dr.
Lee, the same gentleman in whose travels the paragraph relating to
the Leipsic Hospital is to be found, says the same thing. And I will
cheerfully expose myself to any impertinent remark which it might
suggest, to assure my audience that I never heard or saw one
authentic Homoeopathic name of any country in Europe, which I had
ever heard mentioned before as connected with medical science by a
single word or deed sufficient to make it in any degree familiar to
my ears, unless Arnold of Heidelberg is the anatomist who discovered
a little nervous centre, called the otic ganglion. But you need ask
no better proof of who and what the German adherents of this doctrine
must be, than the testimony of a German Homoeopathist as to the
wretched character of the works they manufacture to enforce its
claims.
As for the act of this or that government tolerating or encouraging
Homoeopathy, every person of common intelligence knows that it is a
mere form granted or denied according to the general principles of
policy adopted in different states, or the degree of influence which
some few persons who have adopted it may happen to have at court.
What may be the value of certain pompous titles with which many of
the advocates of Homoeopathy are honored, it might be disrespectful
to question. But in the mean time the judicious inquirer may ponder
over an extract which I translate from a paper relating to a
personage well known to the community as Williams the Oculist, with
whom I had the honor of crossing the Atlantic some years since, and
who himself handed me two copies of the paper in question.
"To say that he was oculist of Louis XVIII. and of Charles X., and
that he now enjoys the same title with respect to His Majesty, Louis
Philippe, and the King of the Belgians, is unquestionably to say a
great deal; and yet it is one of the least of his titles to public
confidence. His reputation rests upon a basis more substantial even
than the numerous diplomas with which he is provided, than the
membership of the different medical societies which have chosen him
as their associate," etc., etc.
And as to one more point, it is time that the public should fully
understand that the common method of supporting barefaced imposture
at the present day, both in Europe and in this country, consists in
trumping up "Dispensaries," "Colleges of Health," and other
advertising charitable clap-traps, which use the poor as decoy-ducks
for the rich, and the proprietors of which have a strong predilection
for the title of "Professor." These names, therefore, have come to
be of little or no value as evidence of the good character, still
less of the high pretensions of those who invoke their authority.
Nor does it follow, even when a chair is founded in connection with a
well-known institution, that it has either a salary or an occupant;
so that it may be, and probably is, a mere harmless piece of
toleration on the part of the government if a Professorship of
Homoeopathy is really in existence at Jena or Heidelberg. And
finally, in order to correct the error of any who might suppose that
the whole Medical Profession of Germany has long since fallen into
the delusions of Hahnemann, I will quote two lines which a celebrated
anatomist and surgeon (whose name will occur again in this lecture in
connection with a very pleasing letter) addressed to the French
Academy of Medicine in 1835. "I happened to be in Germany some
months since, at a meeting of nearly six hundred physicians; one of
them wished to bring up the question of Homoeopathy; they would not
even listen to him." This may have been very impolite and bigoted,
but that is not precisely the point in reference to which I mention
the circumstance.
But if we cannot easily get at Germany, we can very easily obtain
exact information from France and England. I took the trouble to
write some months ago to two friends in Paris, in whom I could place
confidence, for information upon the subject. One of them answered
briefly to the effect that nothing was said about it. When the late
Curator of the Lowell Institute, at his request, asked about the
works upon the subject, he was told that they had remained a long
time on the shelves quite unsalable, and never spoken of.
The other gentleman, [Dr. Henry T. Bigelow, now Professor of
Surgery in Harvard University] whose name is well known to my
audience, and who needs no commendation of mine, had the kindness to
procure for me many publications upon the subject, and some
information which sets the whole matter at rest, so far as Paris is
concerned. He went directly to the Baillieres, the principal and
almost the only publishers of all the Homoeopathic books and journals
in that city. The following facts were taken by him from the
account-books of this publishing firm. Four Homoeopathic Journals
have been published in Paris; three of them by the Baillieres.
The reception they met with may be judged of by showing the number of
subscribers to each on the books of the publishing firm.
A Review published by some other house, which lasted one year, and
had about fifty subscribers, appeared in 1834, 1835.
There were only four Journals of Homoeopathy ever published in Paris.
The Baillieres informed my correspondent that the sale of
Homoeopathic books was much less than formerly, and that consequently
they should undertake to publish no new books upon the subject,
except those of Jahr or Hahnemann. "This man," says my
correspondent,--referring to one of the brothers,--"the publisher and
headquarters of Homoeopathy in Paris, informs me that it is going
down in England and Germany as well as in Paris." For all the facts
he had stated he pledged himself as responsible.
Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and
since then has been going down.
Louis told my correspondent that no person of distinction in Paris
had embraced Homoeopathy, and that it was declining. If you ask who
Louis is, I refer you to the well-known Homoeopathist, Peschier of
Geneva, who says, addressing him, "I respect no one more than
yourself; the feeling which guides your researches, your labors, and
your pen, is so honorable and rare, that I could not but bow down
before it; and I own, if there were any allopathist who inspired me
with higher veneration, it would be him and not yourself whom I
should address."
Among the names of "Distinguished Homoeopathists," however, displayed
in imposing columns, in the index of the "Homoeopathic Examiner," are
those of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the
world of science, and the last of them identified with some of the
most valuable contributions which anatomical knowledge has received
since the commencement of the present century. One Dr. Chrysaora,
who stands sponsor for many facts in that Journal, makes the
following statement among the rest: "Professors, who are esteemed
among the most distinguished of the Faculty (Faculty de Medicine),
both as to knowledge and reputation, have openly confessed the power
of Homoeopathia in forms of disease where the ordinary method of
practice proved totally insufficient. It affords me the highest
pleasure to select from among these gentlemen, Marjolin, Amussat, and
Breschet."
Here is a literal translation of an original letter, now in my
possession, from one of these Homoeopathists to my correspondent:--
"DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER:
"You have had the kindness to inform me in your letter that a new
American Journal, the 'New World,' has made use of my name in
support of the pretended Homoeopathic doctrines, and that I am
represented as one of the warmest partisans of Homoeopathy in France.
"I am vastly surprised at the reputation manufactured for me upon the
new continent; but I am obliged, in deference to truth, to reject it
with my whole energy. I spurn far from me everything which relates
to that charlatanism called Homoeopathy, for these pretended
doctrines cannot endure the scrutiny of wise and enlightened persons,
who are guided by honorable sentiments in the practice of the noblest
of arts.
"PARIS, 3d November, 1841
"I am, etc., etc.,
"G. BRESCHET,
"Professor in the Faculty of Medicine, Member of the Institute,
Surgeon of Hotel Dieu, and Consulting Surgeon to the King, etc."
[I first saw M. Breschet's name mentioned in that Journal]
Concerning Amussat, my correspondent writes, that he was informed by
Madame Hahnemann, who converses in French more readily than her
husband, and therefore often speaks for him, that "he was not a
physician, neither Homoeopathist nor Allopathist, but that he was the
surgeon of their own establishment; that is, performed as a surgeon
all the operations they had occasion for in their practice."
I regret not having made any inquiries as to Marjolin, who, I doubt
not, would strike his ponderous snuff-box until it resounded like the
Grecian horse, at hearing such a doctrine associated with his
respectable name. I was not aware, when writing to Paris, that this
worthy Professor, whose lectures I long attended, was included in
these audacious claims; but after the specimens I have given of the
accuracy of the foreign correspondence of the "Homoeopathic
Examiner," any further information I might obtain would seem so
superfluous as hardly to be worth the postage.
Homoeopathy may be said, then, to be in a sufficiently miserable
condition in Paris. Yet there lives, and there has lived for years,
the illustrious Samuel Hahnemann, who himself assured my
correspondent that no place offered the advantages of Paris in its
investigation, by reason of the attention there paid to it.
In England, it appears by the statement of Dr. Curie in October,
1839, about eight years after its introduction into the country, that
there were eighteen Homoeopathic physicians in the United Kingdom, of
whom only three were to be found out of London, and that many of
these practised Homoeopathy in secret.
It will be seen, therefore, that, according to the recent statement
of one of its leading English advocates, Homoeopathy had obtained not
quite half as many practical disciples in England as Perkinism could
show for itself in a somewhat less period from the time of its first
promulgation in that country.
Dr. Curie's letter, dated London, October 30, 1839, says there is
"one in Dublin, Dr. Luther; at Glasgow, Dr. Scott." The
"distinguished" Chrysaora writes from Paris, dating October 20, 1839,
"On the other hand, Homoeopathy is commencing to make an inroad into
England by the way of Ireland. At Dublin, distinguished physicians
have already embraced the new system, and a great part of the
nobility and gentry of that city have emancipated themselves from the
English fashion and professional authority."
But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize
Homoeopathy; the Queen Dowager Adelaide has been treated by a
Homoeopathic physician. "Jarley is the delight of the nobility and
gentry." "The Royal Family are the patrons of Jarley."
Let me ask if a Marquis and a Knight are better than two Lords, and
if the Dowager of Royalty is better than Royalty itself, all of which
illustrious dignities were claimed in behalf of Benjamin Douglass
Perkins?
But if the balance is thought too evenly suspended in this case,
another instance can be given in which the evidence of British
noblemen and their ladies is shown to be as valuable in establishing
the character of a medical man or doctrine, as would be the testimony
of the Marquis of Waterford concerning the present condition and
prospects of missionary enterprise. I have before me an octavo
volume of more than four hundred pages, in which, among much similar
matter, I find highly commendatory letters from the Marchioness of
Ormond, Lady Harriet Kavanagh, the Countess of Buckinghamshire, the
Right Hon. Viscount Ingestre, M. P., and the Most Noble, the Marquis
of Sligo,--all addressed to "John St. John Long, Esq," a wretched
charlatan, twice tried for, and once convicted of, manslaughter at
the Old Bailey.
This poor creature, too, like all of his tribe, speaks of the medical
profession as a great confederation of bigoted monopolists. He, too,
says that "If an innovator should appear, holding out hope to those
in despair, and curing disorders which the faculty have recorded as
irremediable, he is at once, and without inquiry, denounced as an
empiric and an impostor." He, too, cites the inevitable names of
Galileo and Harvey, and refers to the feelings excited by the great
discovery of Jenner. From the treatment of the great astronomer who
was visited with the punishment of other heretics by the
ecclesiastical authorities of a Catholic country some centuries
since, there is no very direct inference to be drawn to the medical
profession of the present time. His name should be babbled no
longer, after having been placarded for the hundredth time in the
pages of St. John Long. But if we are doomed to see constant
reference to the names of Harvey and Jenner in every worthless
pamphlet containing the prospectus of some new trick upon the public,
let us, once for all, stare the facts in the face, and see how the
discoveries of these great men were actually received by the medical
profession.
In 1628, Harvey published his first work upon the circulation. His
doctrines were a complete revolution of the prevailing opinions of
all antiquity. They immediately found both champions and opponents;
of which last, one only, Riolanus, seemed to Harvey worthy of an
answer, on account of his "rank, fame, and learning." Controversy in
science, as in religion, was not, in those days, carried on with all
the courtesy which our present habits demand, and it is possible that
some hard words may have been applied to Harvey, as it is very
certain that he used the most contemptuous expressions towards
others.
Harvey declares in his second letter to Riolanus, "Since the first
discovery of the circulation, hardly a day, or a moment, has passed
without my hearing it both well and ill spoken of; some attack it
with great hostility, others defend it with high encomiums; one party
believe that I have abundantly proved the truth of the doctrine
against all the weight of opposing arguments, by experiments,
observations, and dissections; others think it not yet sufficiently
cleared up, and free from objections." Two really eminent
Professors, Plempius of Louvain, and Walaeus of Leyden, were among
its early advocates.
The opinions sanctioned by the authority of long ages, and the names
of Hippocrates and Galen, dissolved away, gradually, but certainly,
before the demonstrations of Harvey. Twenty-four years after the
publication of his first work, and six years before his death, his
bust in marble was placed in the Hall of the College of Physicians,
with a suitable inscription recording his discoveries.
Two years after this he was unanimously invited to accept the
Presidency of that body; and he lived to see his doctrine
established, and all reputable opposition withdrawn.
There were many circumstances connected with the discovery of Dr.
Jenner which were of a nature to excite repugnance and opposition.
The practice of inoculation for the small-pox had already disarmed
that disease of many of its terrors. The introduction of a
contagious disease from a brute creature into the human system
naturally struck the public mind with a sensation of disgust and
apprehension, and a part of the medical public may have shared these
feelings. I find that Jenner's discovery of vaccination was made
public in June, 1798. In July of the same year the celebrated
surgeon, Mr. Cline, vaccinated a child with virus received from Dr.
Jenner, and in communicating the success of this experiment, he
mentions that Dr. Lister, formerly of the Small-Pox Hospital, and
himself, are convinced of the efficacy of the cow-pox. In November
of the same year, Dr. Pearson published his "Inquiry," containing the
testimony of numerous practitioners in different parts of the
kingdom, to the efficacy of the practice. Dr. HAYGARTH, who was so
conspicuous in exposing the follies of Perkinism, was among the very
earliest to express his opinion in favor of vaccination. In 1801,
Dr. Lettsom mentions the circumstance "as being to the honor of the
medical professors, that they have very generally encouraged this
salutary practice, although it is certainly calculated to lessen
their pecuniary advantages by its tendency to extirpate a fertile
source of professional practice."
In the same year the Medical Committee of Paris spoke of vaccination
in a public letter, as "the most brilliant and most important
discovery of the eighteenth century." The Directors of a Society for
the Extermination of the Small-Pox, in a Report dated October 1st,
1807, "congratulate the public on the very favorable opinion which
the Royal College of Physicians of London, after a most minute and
laborious investigation made by the command of his Majesty, have a
second time expressed on the subject of vaccination, in their Report
laid before the House of Commons, in the last session of Parliament;
in consequence of which the sum of twenty thousand pounds was voted
to Dr. Jenner, as a remuneration for his discovery, in addition to
ten thousand pounds before granted." (In June, 1802.)
These and similar accusations, so often brought up against the
Medical Profession, are only one mode in which is manifested a spirit
of opposition not merely to medical science, but to all science, and
to all sound knowledge. It is a spirit which neither understands
itself nor the object at which it is aiming. It gropes among the
loose records of the past, and the floating fables of the moment, to
glean a few truths or falsehoods tending to prove, if they prove
anything, that the persons who have passed their lives in the study
of a branch of knowledge the very essence of which must always
consist in long and accurate observation, are less competent to judge
of new doctrines in their own department than the rest of the
community. It belongs to the clown in society, the destructive in
politics, and the rogue in practice.
The name of Harvey, whose great discovery was the legitimate result
of his severe training and patient study, should be mentioned only to
check the pretensions of presumptuous ignorance. The example of
Jenner, who gave his inestimable secret, the result of twenty-two
years of experiment and researches, unpurchased, to the public,--
when, as was said in Parliament, he might have made a hundred
thousand pounds by it as well as any smaller sum,--should be referred
to only to rebuke the selfish venders of secret remedies, among whom
his early history obliges us reluctantly to record Samuel Hahnemann.
Those who speak of the great body of physicians as if they were
united in a league to support the superannuated notions of the past
against the progress of improvement, have read the history of
medicine to little purpose. The prevalent failing of this profession
has been, on the contrary, to lend a too credulous ear to ambitious
and plausible innovators. If at the present time ten years of public
notoriety have passed over any doctrine professing to be of
importance in medical science, and if it has not succeeded in raising
up a powerful body of able, learned, and ingenious advocates for its
claims, the fault must be in the doctrine and not in the medical
profession.
Homoeopathy has had a still more extended period of trial than this,
and we have seen with what results. It only remains to throw out a
few conjectures as to the particular manner in which it is to break
up and disappear.
1. The confidence of the few believers in this delusion will never
survive the loss of friends who may die of any acute disease, under a
treatment such as that prescribed by Homoeopathy. It is doubtful how
far cases of this kind will be trusted to its tender mercies, but
wherever it acquires any considerable foothold, such cases must come,
and with them the ruin of those who practise it, should any highly
valued life be thus sacrificed.
2. After its novelty has worn out, the ardent and capricious
individuals who constitute the most prominent class of its patrons
will return to visible doses, were it only for the sake of a change.
3. The Semi-Homoeopathic practitioner will gradually withdraw from
the rotten half of his business and try to make the public forget his
connection with it.
4. The ultra Homoeopathist will either recant and try to rejoin the
medical profession; or he will embrace some newer and if possible
equally extravagant doctrine; or he will stick to his colors and go
down with his sinking doctrine. Very few will pursue the course last
mentioned.
A single fact may serve to point out in what direction there will
probably be a movement of the dissolving atoms of Homoeopathy. On
the 13th page of the too frequently cited Manifesto of the "Examiner"
I read the following stately paragraph:
"Bigelius, M. D., physician to the Emperor of Russia, whose elevated
reputation is well known in Europe, has been an acknowledged advocate
of Hahnemann's doctrines for several years. He abandoned Allopathia
for Homoeopathia." The date of this statement is January, 1840. I
find on looking at the booksellers' catalogues that one Bigel, or
Bigelius, to speak more classically, has been at various times
publishing Homoeopathic books for some years.
Again, on looking into the "Encyclographie des Sciences Medicales"
for April, 1840, I find a work entitled "Manual of HYDROSUDOPATHY,
or the Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel,
Physician of the School of Strasburg, Member of the Medico-
Chirurgical Institute of Naples, of the Academy of St. Petersburg,--
Assessor of the College of the Empire of Russia, Physician of his
late Imperial Highness the Grand Duke Constantine, Chevalier of the
Legion of Honor, etc." Hydrosudopathy or Hydropathy, as it is
sometimes called, is a new medical doctrine or practice which has
sprung up in Germany since Homoeopathy, which it bids fair to drive
out of the market, if, as Dr. Bigel says, fourteen physicians
afflicted with diseases which defied themselves and their colleagues
came to Graefenberg, in the year 1836 alone, and were cured. Now Dr.
Bigel, "whose elevated reputation is well known in Europe," writes as
follows: "The reader will not fail to see in this defence of the
curative method of Graefenberg a profession of medical faith, and he
will be correct in so doing." And his work closes with the following
sentence, worthy of so distinguished an individual: "We believe, with
religion, that the water of baptism purifies the soul from its
original sin; let us believe also, with experience, that it is for
our corporeal sins the redeemer of the human body." If Bigel,
Physician to the late Grand Duke Constantine, is identical with Bigel
whom the "Examiner" calls Physician to the Emperor of Russia, it
appears that he is now actively engaged in throwing cold water at
once upon his patients and the future prospects of Homoeopathy.
If, as must be admitted, no one of Hahnemann's doctrines is received
with tolerable unanimity among his disciples, except the central
axiom, Similia similibus curantur; if this axiom itself relies mainly
for its support upon the folly and trickery of Hahnemann, what can we
think of those who announce themselves ready to relinquish all the
accumulated treasures of our art, to trifle with life upon the
strength of these fantastic theories? What shall we think of
professed practitioners of medicine, if, in the words of Jahr, "from
ignorance, for their personal convenience, or through charlatanism,
they treat their patients one day Homoeopathically and the next
Allopathically;" if they parade their pretended new science before
the unguarded portion of the community; if they suffer their names to
be coupled with it wherever it may gain a credulous patient; and deny
all responsibility for its character, refuse all argument for its
doctrines, allege no palliation for the ignorance and deception
interwoven with every thread of its flimsy tissue, when they are
questioned by those competent to judge and entitled to an answer?
Such is the pretended science of Homoeopathy, to which you are asked
to trust your lives and the lives of those dearest to you. A mingled
mass of perverse ingenuity, of tinsel erudition, of imbecile
credulity, and of artful misrepresentation, too often mingled in
practice, if we may trust the authority of its founder, with
heartless and shameless imposition. Because it is suffered so often
to appeal unanswered to the public, because it has its journals, its
patrons, its apostles, some are weak enough to suppose it can escape
the inevitable doom of utter disgrace and oblivion. Not many years
can pass away before the same curiosity excited by one of Perkins's
Tractors will be awakened at the sight of one of the Infinitesimal
Globules. If it should claim a longer existence, it can only be by
falling into the hands of the sordid wretches who wring their bread
from the cold grasp of disease and death in the hovels of ignorant
poverty.
As one humble member of a profession which for more than two thousand
years has devoted itself to the pursuit of the best earthly interests
of mankind, always assailed and insulted from without by such as are
ignorant of its infinite perplexities and labors, always striving in
unequal contest with the hundred-armed giant who walks in the
noonday, and sleeps not in the midnight, yet still toiling, not
merely for itself and the present moment, but for the race and the
future, I have lifted my voice against this lifeless delusion,
rolling its shapeless bulk into the path of a noble science it is too
weak to strike, or to injure.
THE CONTAGIOUSNESS OF PUERPERAL FEVER
Printed in 1843; reprinted with additions, 1855.
THE POINT AT ISSUE.
THE AFFIRMATIVE.
"The disease known as Puerperal Fever is so far contagious as to be
frequently carried from patient to patient by physicians and nurses."
O. W. Holmes, 1843.
THE NEGATIVE.
"The result of the whole discussion will, I trust, serve, not only to
exalt your views of the value and dignity of our profession, but to
divest your minds of the overpowering dread that you can ever become,
especially to woman, under the extremely interesting circumstances of
gestation and parturition, the minister of evil; that you can ever
convey, in any possible manner, a horrible virus, so destructive in
its effects, and so mysterious in its operations as that attributed
to puerperal fever."--Professor Hodge,
1852.
"I prefer to attribute them to accident, or Providence, of which I
can form a conception, rather than to a contagion of which I cannot
form any clear idea, at least as to this particular malady."--
Professor Meigs, 1852.
" . . . in the propagation of which they have no more to do, than
with the propagation of cholera from Jessore to San Francisco, and
from Mauritius to St. Petersburg."--Professor Meigs, 1854.
---------------------
"I arrived at that certainty in the matter, that I could venture to
foretell what women would be affected with the disease, upon hearing
by what midwife they were to be delivered, or by what nurse they were
to be attended, during their lying-in; and, almost in every instance,
my prediction was verified."--Gordon, 1795.
"A certain number of deaths is caused every year by the contagion of
puerperal fever, communicated by the nurses and medical attendants."
Farr, in Fifth Annual Report of Registrar-General of England, 1843.
". . . boards of health, if such exist, or, without them, the
medical institutions of a country, should have the power of coercing,
or of inflicting some kind of punishment on those who recklessly go
from cases of puerperal fevers to parturient or puerperal females,
without using due precaution; and who, having been shown the risk,
criminally encounter it, and convey pestilence and death to the
persons they are employed to aid in the most interesting and
suffering period of female existence."--Copland's Medical
Dictionary, Art. Puerperal States and Diseases, 1852.
"We conceive it unnecessary to go into detail to prove the contagious
nature of this disease, as there are few, if any, American
practitioners who do not believe in this doctrine."--Dr. Lee, in
Additions to Article last cited.
-----------------------
[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion
arose in a Medical Society of which I was a member, involving the
subject of a certain supposed cause of disease, about which something
was known, a good deal suspected, and not a little feared. The
discussion was suggested by a case, reported at the preceding
meeting, of a physician who made an examination of the body of a
patient who had died with puerperal fever, and who himself died in
less than a week, apparently in consequence of a wound received at
the examination, having attended several women in confinement in the
mean time, all of whom, as it was alleged, were attacked with
puerperal fever.
Whatever apprehensions and beliefs were entertained, it was plain
that a fuller knowledge of the facts relating to the subject would be
acceptable to all present. I therefore felt that it would be doing a
good service to look into the best records I could find, and inquire
of the most trustworthy practitioners I knew, to learn what
experience had to teach in the matter, and arrived at the results
contained in the following pages.
The Essay was read before the Boston Society for Medical Improvement,
and, at the request of the Society, printed in the "New England
Quarterly Journal of Medicine and Surgery" for April, 1843. As this
Journal never obtained a large circulation, and ceased to be
published after a year's existence, and as the few copies I had
struck off separately were soon lost sight of among the friends to
whom they were sent, the Essay can hardly be said to have been fully
brought before the Profession.
The subject of this Paper has the same profound interest for me at
the present moment as it had when I was first collecting the terrible
evidence out of which, as it seems to me, the commonest exercise of
reason could not help shaping the truth it involved. It is not
merely on account of the bearing of the question,--if there is a
question,--on all that is most sacred in human life and happiness,
that the subject cannot lose its interest. It is because it seems
evident that a fair statement of the facts must produce its proper
influence on a very large proportion of well-constituted and
unprejudiced minds. Individuals may, here and there, resist the
practical bearing of the evidence on their own feelings or interests;
some may fail to see its meaning, as some persons may be found who
cannot tell red from green; but I cannot doubt that most readers will
be satisfied and convinced, to loathing, long before they have
finished the dark obituary calendar laid before them.
I do not know that I shall ever again have so good an opportunity of
being useful as was granted me by the raising of the question which
produced this Essay. For I have abundant evidence that it has made
many practitioners more cautious in their relations with puerperal
females, and I have no doubt it will do so still, if it has a chance
of being read, though it should call out a hundred counterblasts,
proving to the satisfaction of their authors that it proved nothing.
And for my part, I had rather rescue one mother from being poisoned
by her attendant, than claim to have saved forty out of fifty
patients to whom I had carried the disease. Thus, I am willing to
avail myself of any hint coming from without to offer this paper once
more to the press. The occasion has presented itself, as will be
seen, in a convenient if not in a flattering form.
I send this Essay again to the MEDICAL PROFESSION, without the change
of a word or syllable. I find, on reviewing it, that it anticipates
and eliminates those secondary questions which cannot be entertained
for a moment until the one great point of fact is peremptorily
settled. In its very statement of the doctrine maintained it avoids
all discussion of the nature of the disease "known as puerperal
fever," and all the somewhat stale philology of the word contagion.
It mentions, fairly enough, the names of sceptics, or unbelievers as
to the reality of personal transmission; of Dewees, of Tonnelle, of
Duges, of Baudelocque, and others; of course, not including those
whose works were then unwritten or unpublished; nor enumerating all
the Continental writers who, in ignorance of the great mass of
evidence accumulated by British practitioners, could hardly be called
well informed on this subject. It meets all the array of negative
cases,--those in which disease did not follow exposure,--by the
striking example of small-pox, which, although one of the most
contagious of diseases, is subject to the most remarkable
irregularities and seeming caprices in its transmission. It makes
full allowance for other causes besides personal transmission,
especially for epidemic influences. It allows for the possibility of
different modes of conveyance of the destructive principle. It
recognizes and supports the belief that a series of cases may
originate from a single primitive source which affects each new
patient in turn; and especially from cases of Erysipelas. It does
not undertake to discuss the theoretical aspect of the subject; that
is a secondary matter of consideration. Where facts are numerous,
and unquestionable, and unequivocal in their significance, theory
must follow them as it best may, keeping time with their step, and
not go before them, marching to the sound of its own drum and
trumpet. Having thus narrowed its area to a limited practical
platform of discussion, a matter of life and death, and not of
phrases or theories, it covers every inch of it with a mass of
evidence which I conceive a Committee of Husbands, who can count
coincidences and draw conclusions as well as a Synod of Accoucheurs,
would justly consider as affording ample reasons for an unceremonious
dismissal of a practitioner (if it is conceivable that such a step
could be waited for), after five or six funerals had marked the path
of his daily visits, while other practitioners were not thus
escorted. To the Profession, therefore, I submit the paper in its
original form, and leave it to take care of itself.
To the MEDICAL STUDENTS, into whose hands this Essay may fall, some
words of introduction may be appropriate, and perhaps, to a small
number of them, necessary. There are some among them who, from
youth, or want of training, are easily bewildered and confused in any
conflict of opinions into which their studies lead them. They are
liable to lose sight of the main question in collateral issues, and
to be run away with by suggestive speculations. They confound belief
with evidence, often trusting the first because it is expressed with
energy, and slighting the latter because it is calm and
unimpassioned. They are not satisfied with proof; they cannot
believe a point is settled so long as everybody is not silenced.
They have not learned that error is got out of the minds that cherish
it, as the taenia is removed from the body, one joint, or a few
joints at a time, for the most part, rarely the whole evil at once.
They naturally have faith in their instructors, turning to them for
truth, and taking what they may choose to give them; babes in
knowledge, not yet able to tell the breast from the bottle, pumping
away for the milk of truth at all that offers, were it nothing better
than a Professor's shrivelled forefinger.
In the earliest and embryonic stage of professional development, any
violent impression on the instructor's mind is apt to be followed by
some lasting effect on that of the pupil. No mother's mark is more
permanent than the mental naevi and moles, and excrescences, and
mutilations, that students carry with them out of the lecture-room,
if once the teeming intellect which nourishes theirs has been scared
from its propriety by any misshapen fantasy. Even an impatient or
petulant expression, which to a philosopher would be a mere index of
the low state of amiability of the speaker at the moment of its
utterance, may pass into the young mind as an element of its future
constitution, to injure its temper or corrupt its judgment. It is a
duty, therefore, which we owe to this younger class of students, to
clear any important truth which may have been rendered questionable
in their minds by such language, or any truth-teller against whom
they may have been prejudiced by hasty epithets, from the impressions
such words have left. Until this is done, they are not ready for the
question, where there is a question, for them to decide. Even if we
ourselves are the subjects of the prejudice, there seems to be no
impropriety in showing that this prejudice is local or personal, and
not an acknowledged conviction with the public at large. It may be
necessary to break through our usual habits of reserve to do this,
but this is the fault of the position in which others have placed us.
Two widely-known and highly-esteemed practitioners, Professors in two
of the largest Medical Schools of the Union, teaching the branch of
art which includes the Diseases of Women, and therefore speaking with
authority; addressing in their lectures and printed publications
large numbers of young men, many of them in the tenderest immaturity
of knowledge, have recently taken ground in a formal way against the
doctrine maintained in this paper:
On the Non-Contagious Character of Puerperal Fever: An Introductory
Lecture. By Hugh L. Hodge, M. D., Professor of Obstetrics in the
University of Pennsylvania. Delivered Monday, October 11, 1852.
Philadelphia, 1852.
On the Nature, Signs, and Treatment of Childbed Fevers : in a Series
of Letters addressed to the Students of his Class. By Charles D.
Meigs, M. D., Professor of Midwifery and the Diseases of Women and
Children in Jefferson Medical College, Philadelphia, etc., etc.
Philadelphia, 1854. Letter VI.
The first of the two publications, Dr. Hodge's Lecture, while its
theoretical considerations and negative experiences do not seem to me
to require any further notice than such as lay ready for them in my
Essay written long before, is, I am pleased to say, unobjectionable
in tone and language, and may be read without offence.
This can hardly be said of the chapter of Dr. Meigs's volume which
treats of Contagion in Childbed Fever. There are expressions used in
it which might well put a stop to all scientific discussions, were
they to form the current coin in our exchange of opinions. I leave
the "very young gentlemen," whose careful expositions of the results
of practice in more than six thousand cases are characterized as "the
jejune and fizenless dreamings of sophomore writers," to the
sympathies of those "dear young friends," and "dear young gentlemen,"
who will judge how much to value their instructor's counsel to think
for themselves, knowing what they are to expect if they happen not to
think as he does.
One unpalatable expression I suppose the laws of construction oblige
me to appropriate to myself, as my reward for a certain amount of
labor bestowed on the investigation of a very important question of
evidence, and a statement of my own practical conclusions. I take no
offence, and attempt no retort. No man makes a quarrel with me over
the counterpane that covers a mother, with her new-born infant at her
breast. There is no epithet in the vocabulary of slight and sarcasm
that can reach my personal sensibilities in such a controversy. Only
just so far as a disrespectful phrase may turn the student aside from
the examination of the evidence, by discrediting or dishonoring the
witness, does it call for any word of notice.
I appeal from the disparaging language by which the Professor in the
Jefferson School of Philadelphia world dispose of my claims to be
listened to. I appeal, not to the vote of the Society for Medical
Improvement, although this was an unusual evidence of interest in the
paper in question, for it was a vote passed among my own townsmen;
nor to the opinion of any American, for none know better than the
Professors in the great Schools of Philadelphia how cheaply the
praise of native contemporary criticism is obtained. I appeal to the
recorded opinions of those whom I do not know, and who do not know
me, nor care for me, except for the truth that I may have uttered; to
Copland, in his "Medical Dictionary," who has spoken of my Essay in
phrases to which the pamphlets of American "scribblers" are seldom
used from European authorities; to Ramsbotham, whose compendious
eulogy is all that self-love could ask; to the "Fifth Annual Report"
of the Registrar-General of England, in which the second-hand
abstract of my Essay figures largely, and not without favorable
comment, in an important appended paper. These testimonies, half
forgotten until this circumstance recalled them, are dragged into the
light, not in a paroxysm of vanity, but to show that there may be
food for thought in the small pamphlet which the Philadelphia Teacher
treats so lightly. They were at least unsought for, and would never
have been proclaimed but for the sake of securing the privilege of a
decent and unprejudiced hearing.
I will take it for granted that they have so far counterpoised the
depreciating language of my fellow-countryman and fellow-teacher as
to gain me a reader here and there among the youthful class of
students I am now addressing. It is only for their sake that I think
it necessary to analyze, or explain, or illustrate, or corroborate
any portion of the following Essay. But I know that nothing can be
made too plain for beginners; and as I do not expect the
practitioner, or even the more mature student, to take the trouble to
follow me through an Introduction which I consider wholly unnecessary
and superfluous for them, I shall not hesitate to stoop to the most
elementary simplicity for the benefit of the younger student. I do
this more willingly because it affords a good opportunity, as it
seems to me, of exercising the untrained mind in that medical logic
which does not seem to have been either taught or practised in our
schools of late, to the extent that might be desired.
I will now exhibit, in a series of propositions reduced to their
simplest expression, the same essential statements and conclusions as
are contained in the Essay, with such commentaries and explanations
as may be profitable to the inexperienced class of readers addressed.
I. It has been long believed, by many competent observers, that
Puerperal Fever (so called) is sometimes carried from patient to
patient by medical assistants.
II. The express object of this Essay is to prove that it is so
carried.
III. In order to prove this point, it is not necessary to consult
any medical theorist as to whether or not it is consistent with his
preconceived notions that such a mode of transfer should exist.
IV. If the medical theorist insists on being consulted, and we see
fit to indulge him, he cannot be allowed to assume that the alleged
laws of contagion, deduced from observation in other diseases, shall
be cited to disprove the alleged laws deduced from observation in
this. Science would never make progress under such conditions.
Neither the long incubation of hydrophobia, nor the protecting power
of vaccination, would ever have been admitted, if the results of
observation in these affections had been rejected as contradictory to
the previously ascertained laws of contagion.
V. The disease in question is not a common one; producing, on the
average, about three deaths in a thousand births, according to the
English Registration returns which I have examined.
VI. When an unusually large number of cases of this disease occur
about the same time, it is inferred, therefore, that there exists
some special cause for this increased frequency. If the disease
prevails extensively over a wide region of country, it is attributed
without dispute to an epidemic influence. If it prevails in a single
locality, as in a hospital, and not elsewhere, this is considered
proof that some local cause is there active in its production.
VII. When a large number of cases of this disease occur in rapid
succession, in one individual's ordinary practice, and few or none
elsewhere, these cases appearing in scattered localities, in patients
of the same average condition as those who escape under the care of
others, there is the same reason for connecting the cause of the
disease with the person in this instance, as with the place in that
last mentioned.
VIII. Many series of cases, answering to these conditions, are given
in this Essay, and many others will be referred to which have
occurred since it was written.
IX. The alleged results of observation may be set aside; first,
because the so-called facts are in their own nature equivocal;
secondly, because they stand on insufficient authority; thirdly,
because they are not sufficiently numerous. But, in this case, the
disease is one of striking and well-marked character; the witnesses
are experts, interested in denying and disbelieving the facts; the
number of consecutive cases in many instances frightful, and the
number of series of cases such that I have no room for many of them
except by mere reference.
X. These results of observation, being admitted, may, we will
suppose, be interpreted in different methods. Thus the coincidences
may be considered the effect of chance. I have had the chances
calculated by a competent person, that a given practitioner, A.,
shall have sixteen fatal cases in a month, on the following data:
A. to average attendance upon two hundred and fifty births in a year;
three deaths in one thousand births to be assumed as the average from
puerperal fever; no epidemic to be at the time prevailing. It
follows, from the answer given me, that if we suppose every one of
the five hundred thousand annual births of England to have been
recorded during the last half-century, there would not be one chance
in a million million million millions that one such series should be
noted. No possible fractional error in this calculation can render
the chance a working probability. Applied to dozens of series of
various lengths, it is obviously an absurdity. Chance, therefore, is
out of the question as an explanation of the admitted coincidences.
XI. There is, therefore, some relation of cause and effect between
the physician's presence and the patient's disease.
XII. Until it is proved to what removable condition attaching to the
attendant the disease is owing, he is bound to stay away from his
patients so soon as he finds himself singled out to be tracked by the
disease. How long, and with what other precautions, I have
suggested, without dictating, at the close of my Essay. If the
physician does not at once act on any reasonable suspicion of his
being the medium of transfer, the families where he is engaged, if
they are allowed to know the facts, should decline his services for
the time. His feelings on the occasion, however interesting to
himself, should not be even named in this connection. A physician
who talks about ceremony and gratitude, and services rendered, and
the treatment he got, surely forgets himself; it is impossible that
he should seriously think of these small matters where there is even
a question whether he may not carry disease, and death, and
bereavement into any one of "his families," as they are sometimes
called.
I will now point out to the young student the mode in which he may
relieve his mind of any confusion, or possibly, if very young, any
doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised
in his mind.
The most prominent ideas of the Letter are, first, that the
transmissible nature of puerperal fever appears improbable, and,
secondly, that it would be very inconvenient to the writer.
Dr. Woodville, Physician to the Small-Pox and Inoculation Hospital in
London, found it improbable, and exceedingly inconvenient to himself,
that cow pox should prevent small-pox; but Dr. Jenner took the
liberty to prove the fact, notwithstanding.
I will first call the young student's attention to the show of
negative facts (exposure without subsequent disease), of which much
seems to be thought. And I may at the same time refer him to Dr.
Hodge's Lecture, where he will find the same kind of facts and
reasoning. Let him now take up Watson's Lectures, the good sense and
spirit of which have made his book a universal favorite, and open to
the chapter on Continued Fever. He will find a paragraph containing
the following sentence: "A man might say, 'I was in the battle of
Waterloo, and saw many men around me fall down and die, and it was
said that they were struck down by musket-balls; but I know better
than that, for I was there all the time, and so were many of my
friends, and we were never hit by any musket-balls. Musket-balls,
therefore, could not have been the cause of the deaths we witnessed.'
And if, like contagion, they were not palpable to the senses, such a
person might go on to affirm that no proof existed of there being any
such thing as musket-balls." Now let the student turn back to the
chapter on Hydrophobia in the same volume. He will find that John
Hunter knew a case in which, of twenty-one persons bitten, only one
died of the disease. He will find that one dog at Charenton was
bitten at different times by thirty different mad dogs, and outlived
it all. Is there no such thing, then, as hydrophobia? Would one
take no especial precautions if his wife, about to become a mother,
had been bitten by a rabid animal, because so many escape? Or let
him look at "Underwood on Diseases of Children,"[Philadelphia, 1842,
p. 244, note.] and he will find the case of a young woman who was
inoculated eight times in thirty days, at the same time attending
several children with smallpox, and yet was not infected. But seven
weeks afterwards she took the disease and died.
It would seem as if the force of this argument could hardly fail to
be seen, if it were granted that every one of these series of cases
were so reported as to prove that there could have been no transfer
of disease. There is not one of them so reported, in the Lecture or
the Letter, as to prove that the disease may not have been carried by
the practitioner. I strongly suspect that it was so carried in some
of these cases, but from the character of the very imperfect evidence
the question can never be settled without further disclosures.
Although the Letter is, as I have implied, principally taken up with
secondary and collateral questions, and might therefore be set aside
as in the main irrelevant, I am willing, for the student's sake, to
touch some of these questions briefly, as an illustration of its
logical character.
The first thing to be done, as I thought when I wrote my Essay, was
to throw out all discussions of the word contagion, and this I did
effectually by the careful wording of my statement of the subject to
be discussed. My object was not to settle the etymology or
definition of a word, but to show that women had often died in
childbed, poisoned in some way by their medical attendants. On the
other point, I, at least, have no controversy with anybody, and I
think the student will do well to avoid it in this connection. If I
must define my position, however, as well as the term in question, I
am contented with Worcester's definition; provided always this avowal
do not open another side controversy on the merits of his Dictionary,
which Dr. Meigs has not cited, as compared with Webster's, which he
has.
I cannot see the propriety of insisting that all the laws of the
eruptive fevers must necessarily hold true of this peculiar disease
of puerperal women. If there were any such propriety, the laws of
the eruptive fevers must at least be stated correctly. It is not
true, for instance, as Dr. Meigs states, that contagion is "no
respecter of persons;" that "it attacks all individuals alike." To
give one example: Dr. Gregory, of the Small-Pox Hospital, who ought
to know, says that persons pass through life apparently insensible to
or unsusceptible of the small-pox virus, and that the same persons do
not take the vaccine disease.
As to the short time of incubation, of which so much is made, we have
no right to decide beforehand whether it shall be long or short, in
the cases we are considering. A dissection wound may produce
symptoms of poisoning in six hours; the bite of a rabid animal may
take as many months.
After the student has read the case in Dr. Meigs's 136th paragraph,
and the following one, in which he exclaims against the idea of
contagion, because the patient, delivered on the 26th of December,
was attacked in twenty-four hours, and died on the third day, let him
read what happened at the "Black Assizes" of 1577 and 1750. In the
first case, six hundred persons sickened the same night of the
exposure, and three hundred more in three days. [Elliotson's
Practice, p. 298.] Of those attacked in the latter year, the
exposure being on the 11th of May, Alderman Lambert died on the 13th,
Under-Sheriff Cox on the 14th, and many of note before the
20th. But these are old stories. Let the student listen then to Dr.
Gerhard, whose reputation as a cautious observer he may be supposed
to know. "The nurse was shaving a man, who died in a few hours after
his entrance; he inhaled his breath, which had a nauseous taste, and
in an hour afterwards was taken with nausea, cephalalgia, and singing
of the ears. From that moment the attack began, and assumed a severe
character. The assistant was supporting another patient, who died
soon afterwards; he felt the pungent heat upon his skin, and was
taken immediately with the symptoms of typhus."[Am. Jour. Med.
Sciences, Feb. 1837, p. 299.] It is by notes of cases, rather
than notes of admiration, that we must be guided, when we study the
Revised Statutes of Nature, as laid down from the curule chairs of
Medicine.
Let the student read Dr. Meigs's 140th paragraph soberly, and then
remember, that not only does he infer, suspect, and surmise, but he
actually asserts (page 154), "there was poison in the house," because
three out of five patients admitted into a ward had puerperal fever
and died. Have I not as much right to draw a positive inference from
"Dr. A.'s" seventy exclusive cases as he from the three cases in the
ward of the Dublin Hospital? All practical medicine, and all action
in common affairs, is founded on inferences. How does Dr. Meigs know
that the patients he bled in puerperal fever would not have all got
well if he had not bled them?
"You see a man discharge a gun at another; you see the flash, you
hear the report, you see the person fall a lifeless corpse; and you
infer, from all these circumstances, that there was a ball discharged
from the gun, which entered his body and caused his death, because
such is the usual and natural cause of such an effect. But you did
not see the ball leave the gun, pass through the air, and enter the
body of the slain; and your testimony to the fact of killing is,
therefore, only inferential,--in other words, circumstantial. It is
possible that no ball was in the gun; and we infer that there was,
only because we cannot account for death on any other supposition."
[Chief Justice Gibson, in Am. Law Journal, vol. vi. p. 123.]
"The question always comes to this: Is the circumstance of
intercourse with the sick followed by the appearance of the disease
in a proportion of cases so much greater than any other circumstance
common to any portion of the inhabitants of the place under
observation, as to make it inconceivable that the succession of cases
occurring in persons having that intercourse should have been the
result of chance? If so, the inference is unavoidable, that that
intercourse must have acted as a cause of the disease. All
observations which do not bear strictly on that point are irrelevant,
and, in the case of an epidemic first appearing in a town or
district, a succession of two cases is sometimes sufficient to
furnish evidence which, on the principle I have stated, is nearly
irresistible."
Possibly an inexperienced youth may be awe-struck by the quotation
from Cuvier. These words, or their equivalent, are certainly to be
found in his Introduction. So are the words "top not come down"!
to be found in the Bible, and they were as much meant for the ladies'
head-dresses as the words of Cuvier were meant to make clinical
observation wait for a permit from anybody to look with its eyes and
count on its fingers. Let the inquiring youth read the whole
Introduction, and he will see what they mean.
I intend no breach of courtesy, but this is a proper place to warn
the student against skimming the prefaces and introductions of works
for mottoes and embellishments to his thesis. He cannot learn
anatomy by thrusting an exploring needle into the body. He will be
very liable to misquote his author's meaning while he is picking off
his outside sentences. He may make as great a blunder as that simple
prince who praised the conductor of his orchestra for the piece just
before the overture; the musician was too good a courtier to tell him
that it was only the tuning of the instruments.
To the six propositions in the 142d paragraph, and the remarks about
"specific" diseases, the answer, if any is necessary, seems very
simple. An inflammation of a serous membrane may give rise to
secretions which act as a poison, whether that be a "specific" poison
or not, as Dr. Homer has told his young readers, and as dissectors
know too well; and that poison may produce its symptoms in a few
hours after the system has received it, as any may see in Druitt's
"Surgery," if they care to look. Puerperal peritonitis may produce
such a poison, and puerperal women may be very sensible to its
influences, conveyed by contact or exhalation. Whether this is so or
not, facts alone can determine, and to facts we have had recourse to
settle it.
The following statement is made by Dr. Meigs in his 142d paragraph,
and developed more at length, with rhetorical amplifications, in the
134th. "No human being, save a pregnant or parturient woman, is
susceptible to the poison." This statement is wholly incorrect, as I
am sorry to have to point out to a Teacher in Dr. Meigs's position.
I do not object to the erudition which quotes Willis and Fernelius,
the last of whom was pleasantly said to have "preserved the dregs of
the Arabs in the honey of his Latinity." But I could wish that more
modern authorities had not been overlooked. On this point, for
instance, among the numerous facts disproving the statement, the
"American Journal of Medical Sciences," published not far from his
lecture-room, would have presented him with a respectable catalog of
such cases. Thus he might refer to Mr. Storrs's paper "On the
Contagious Effects of Puerperal Fever on the Male Subject; or on
Persons not Childbearing"(Jan. 1846), or to Dr. Reid's case (April,
1846), or to Dr. Barron's statement of the children's dying of
peritonitis in an epidemic of puerperal fever at the Philadelphia
Hospital (Oct. 1842), or to various instances cited in Dr.
Kneeland's article (April, 186). Or, if he would have referred to
the "New York Journal," he might have seen Prof. Austin Flint's
cases. Or, if he had honored my Essay so far, he might have found
striking instances of the same kind in the first of the new series of
cases there reported and elsewhere. I do not see the bearing of his
proposition, if it were true. But it is one of those assertions that
fall in a moment before a slight examination of the facts; and I
confess my surprise, that a professor who lectures on the Diseases of
Women should have ventured to make it.
Nearly seven pages are devoted to showing that I was wrong in saying
I would not be "understood to imply that there exists a doubt in the
mind of any well-informed member of the medical profession as to the
fact that puerperal fever is sometimes communicated from one person
to another, both directly and indirectly." I will devote seven lines
to these seven pages, which seven lines, if I may say it without
offence, are, as it seems to me, six more than are strictly
necessary.
The following authors are cited as sceptics by Dr. Meigs:
Dewees.--I cited the same passage. Did not know half the facts.
Robert Lee.--Believes the disease is sometimes communicable by
contagion. Tonnelle, Baudelocque. Both cited by me. Jacquemier.
--Published three years after my Essay. Kiwisch. Behindhand in
knowledge of Puerperal Fever." [B. & F. Med. Rev. Jan. 1842.]
Paul Dubois.--Scanzoni.
These Continental writers not well informed on this point.[See Dr.
Simpson's Remarks at Meeting of Edin. Med. Chir. Soc. (Am. Jour.
Oct. 1851.)]
The story of Von Busch is of interest and value, but there is nothing
in it which need perplex the student. It is not pretended that the
disease is always, or even, it may be, in the majority of cases,
carried about by attendants; only that it is so carried in certain
cases. That it may have local and epidemic causes, as well as that
depending on personal transmission, is not disputed. Remember how
small-pox often disappears from a community in spite of its
contagious character, and the necessary exposure of many persons to
those suffering from it; in both diseases contagion is only one of
the coefficients of the disease.
I have already spoken of the possibility that Dr. Meigs may have been
the medium of transfer of puerperal fever in some of the cases he has
briefly catalogued. Of Dr. Rutter's cases I do not know how to
speak. I only ask the student to read the facts stated by Dr.
Condie, as given in my Essay, and say whether or not a man should
allow his wife to be attended by a practitioner in whose hands
"scarcely a female that has been delivered for weeks past has escaped
an attack," "while no instance of the disease has occurred in the
patients of any other accoucheur practising in the same district."
If I understand Dr. Meigs and Dr. Hodge, they would not warn the
physician or spare the patient under such circumstances. They would
"go on," if I understand them, not to seven, or seventy, only, but to
seventy times seven, if they could find patients. If this is not
what they mean, may we respectfully ask them to state what they do
mean, to their next classes, in the name of humanity, if not of
science!
I might repeat the question asked concerning Dr. Rutter's cases, with
reference to those reported by Dr. Roberton. Perhaps, however, the
student would like to know the opinion of a person in the habit of
working at matters of this kind in a practical point of view. To
satisfy him on this ground, I addressed the following question to the
President of one of our principal Insurance Companies, leaving Dr.
Meigs's book and my Essay in his hands at the same time.
Question. "If such facts as Roberton's cases were before you, and
the attendant had had ten, or even five fatal cases, or three, or two
even, would you, or would you not, if insuring the life of the next
patient to be taken care of by that attendant, expect an extra
premium over that of an average case of childbirth?"
Answer. "Of course I should require a very large extra premium, if
I would take take risk at all."
But I do not choose to add the expressions of indignation which the
examination of the facts before him called out. I was satisfied from
the effect they produced on him, that if all the hideous catalogues
of cases now accumulated were fully brought to the knowledge of the
public, nothing, since the days of Burke and Hare, has raised such a
cry of horror as would be shrieked in the ears of the Profession.
Dr. Meigs has elsewhere invoked "Providence" as the alternative of
accident, to account for the "coincidences." ("Obstetrics," Phil.
1852, p. 631.) If so, Providence either acts through the agency of
secondary causes, as in other diseases, or not. If through such
causes, let us find out what they are, as we try to do in other
cases. It may be true that offences, or diseases, will come, but
"woe unto him through whom they come," if we catch him in the
voluntary or careless act of bringing them! But if Providence does
not act through secondary causes in this particular sphere of
etiology, then why does Dr. Meigs take such pains to reason so
extensively about the laws of contagion, which, on that supposition,
have no more to do with this case than with the plague which
destroyed the people after David had numbered them? Above all, what
becomes of the theological aspect of the question, when he asserts
that a practitioner was "only unlucky in meeting with the epidemic
cases?" (Op. cit. p. 633.) We do not deny that the God of battles
decides the fate of nations; but we like to have the biggest
squadrons on our side, and we are particular that our soldiers should
not only say their prayers, but also keep their powder dry. We do
not deny the agency of Providence in the disaster at Norwalk, but we
turn off the engineer, and charge the Company five thousand dollars
apiece for every life that is sacrificed.
Why a grand jury should not bring in a bill against a physician who
switches off a score of women one after the other along his private
track, when he knows that there is a black gulf at the end of it,
down which they are to plunge, while the great highway is clear, is
more than I can answer. It is not by laying the open draw to
Providence that he is to escape the charge of manslaughter.
To finish with all these lesser matters of question, I am unable to
see why a female must necessarily be unattended in her confinement,
because she declines the services of a particular practitioner. In
all the series of cases mentioned, the death-carrying attendant was
surrounded by others not tracked by disease and its consequences.
Which, I would ask, is worse,--to call in another, even a rival
practitioner, or to submit an unsuspecting female to a risk which an
Insurance Company would have nothing to do with?
I do not expect ever to return to this subject. There is a point of
mental saturation, beyond which argument cannot be forced without
breeding impatient, if not harsh, feelings towards those who refuse
to be convinced. If I have so far manifested neither, it is well to
stop here, and leave the rest to those younger friends who may have
more stomach for the dregs of a stale argument.
The extent of my prefatory remarks may lead some to think that I
attach too much importance to my own Essay. Others may wonder that I
should expend so many words upon the two productions referred to, the
Letter and the Lecture. I do consider my Essay of much importance so
long as the doctrine it maintains is treated as a question, and so
long as any important part of the defence of that doctrine is thought
to rest on its evidence or arguments. I cannot treat as
insignificant any opinions bearing on life, and interests dearer than
life, proclaimed yearly to hundreds of young men, who will carry them
to their legitimate results in practice.
The teachings of the two Professors in the great schools of
Philadelphia are sure to be listened to, not only by their immediate
pupils, but by the Profession at large. I am too much in earnest for
either humility or vanity, but I do entreat those who hold the keys
of life and death to listen to me also for this once. I ask no
personal favor; but I beg to be heard in behalf of the women whose
lives are at stake, until some stronger voice shall plead for them.
I trust that I have made the issue perfectly distinct and
intelligible. And let it be remembered that this is no subject to be
smoothed over by nicely adjusted phrases of half-assent and half-
censure divided between the parties. The balance must be struck
boldly and the result declared plainly. If I have been hasty,
presumptuous, ill-informed, illogical; if my array of facts means
nothing; if there is no reason for any caution in the view of these
facts; let me be told so on such authority that I must believe it,
and I will be silent henceforth, recognizing that my mind is in a
state of disorganization. If the doctrine I have maintained is a
mournful truth; if to disbelieve it, and to practise on this
disbelief, and to teach others so to disbelieve and practise, is to
carry desolation, and to charter others to carry it, into confiding
families, let it be proclaimed as plainly what is to be thought of
the teachings of those who sneer at the alleged dangers, and scout
the very idea of precaution. Let it be remembered that persons are
nothing in this matter; better that twenty pamphleteers should be
silenced, or as many professors unseated, than that one mother's life
should be taken. There is no quarrel here between men, but there is
deadly incompatibility and exterminating warfare between doctrines.
Coincidences, meaning nothing, though a man have a monopoly of the
disease for weeks or months; or cause and effect, the cause being in
some way connected with the person; this is the question. If I am
wrong, let me be put down by such a rebuke as no rash declaimer has
received since there has been a public opinion in the medical
profession of America; if I am right, let doctrines which lead to
professional homicide be no longer taught from the chairs of those
two great Institutions. Indifference will not do here; our
Journalists and Committees have no right to take up their pages with
minute anatomy and tediously detailed cases, while it is a question
whether or not the "blackdeath" of child-bed is to be scattered
broadcast by the agency of the mother's friend and adviser. Let the
men who mould opinions look to it; if there is any voluntary
blindness, any interested oversight, any culpable negligence, even,
in such a matter, and the facts shall reach the public ear; the
pestilence-carrier of the lying-in chamber must look to God for
pardon, for man will never forgive him.
THE CONTAGIOUSNESS OF PUERPERAL FEVER.
In collecting, enforcing, and adding to the evidence accumulated upon
this most serious subject, I would not be understood to imply that
there exists a doubt in the mind of any well-informed member of the
medical profession as to the fact that puerperal fever is sometimes
communicated from one person to another, both directly and
indirectly. In the present state of our knowledge upon this point I
should consider such doubts merely as a proof that the sceptic had
either not examined the evidence, or, having examined it, refused to
accept its plain and unavoidable consequences. I should be sorry to
think, with Dr. Rigby, that it was a case of "oblique vision;" I
should be unwilling to force home the argumentum ad hominem of Dr.
Blundell, but I would not consent to make a question of a momentous
fact which is no longer to be considered as a subject for trivial
discussions, but to be acted upon with silent promptitude. It
signifies nothing that wise and experienced practitioners have
sometimes doubted the reality of the danger in question; no man has
the right to doubt it any longer. No negative facts, no opposing
opinions, be they what they may, or whose they may, can form any
answer to the series of cases now within the reach of all who choose
to explore the records of medical science.
If there are some who conceive that any important end would be
answered by recording such opinions, or by collecting the history of
all the cases they could find in which no evidence of the influence
of contagion existed, I believe they are in error. Suppose a few
writers of authority can be found to profess a disbelief in
contagion,--and they are very few compared with those who think
differently,--is it quite clear that they formed their opinions on a
view of all the facts, or is it not apparent that they relied mostly
on their own solitary experience? Still further, of those whose
names are quoted, is it not true that scarcely a single one could by
any possibility have known the half or the tenth of the facts bearing
on the subject which have reached such a frightful amount within the
last few years? Again, as to the utility of negative facts, as we
may briefly call them,--instances, namely, in which exposure has not
been followed by disease,--although, like other truths, they may be
worth knowing, I do not see that they are like to shed any important
light upon the subject before us. Every such instance requires a
good deal of circumstantial explanation before it can be accepted.
It is not enough that a practitioner should have had a single case of
puerperal fever not followed by others. It must be known whether he
attended others while this case was in progress, whether he went
directly from one chamber to others, whether he took any, and what
precautions. It is important to know that several women were exposed
to infection derived from the patient, so that allowance may be made
for want of predisposition. Now if of negative facts so sifted there
could be accumulated a hundred for every one plain instance of
communication here recorded, I trust it need not be said that we are
bound to guard and watch over the hundredth tenant of our fold,
though the ninety and nine may be sure of escaping the wolf at its
entrance. If any one is disposed, then, to take a hundred instances
of lives endangered or sacrificed out of those I have mentioned, and
make it reasonably clear that within a similar time and compass ten
thousand escaped the same exposure, I shall thank him for his
industry, but I must be permitted to hold to my own practical
conclusions, and beg him to adopt or at least to examine them also.
Children that walk in calico before open fires are not always burned
to death; the instances to the contrary may be worth recording; but
by no means if they are to be used as arguments against woollen
frocks and high fenders.
I am not sure that this paper will escape another remark which it
might be wished were founded in justice. It may be said that the
facts are too generally known and acknowledged to require any formal
argument or exposition, that there is nothing new in the positions
advanced, and no need of laying additional statements before the
Profession. But on turning to two works, one almost universally, and
the other extensively appealed to as authority in this country, I see
ample reason to overlook this objection. In the last edition of
Dewees's Treatise on the "Diseases of Females," it is expressly said,
"In this country, under no circumstance that puerperal fever has
appeared hitherto, does it afford the slightest ground for the belief
that it is contagious." In the "Philadelphia Practice of Midwifery"
not one word can be found in the chapter devoted to this disease
which would lead the reader to suspect that the idea of contagion had
ever been entertained. It seems proper, therefore, to remind those
who are in the habit of referring to these works for guidance, that
there may possibly be some sources of danger they have slighted or
omitted, quite as important as a trifling irregularity of diet, or a
confined state of the bowels, and that whatever confidence a
physician may have in his own mode of treatment, his services are of
questionable value whenever he carries the bane as well as the
antidote about his person.
The practical point to be illustrated is the following:
The disease known as Puerperal Fever is so far contagious as to be
frequently carried from patient to patient by physicians and nurses.
Let me begin by throwing out certain incidental questions, which,
without being absolutely essential, would render the subject more
complicated, and by making such concessions and assumptions as may be
fairly supposed to be without the pale of discussion.
1. It is granted that all the forms of what is called puerperal
fever may not be, and probably are not, equally contagious or
infectious. I do not enter into the distinctions which have been
drawn by authors, because the facts do not appear to me sufficient to
establish any absolute line of demarcation between such forms as may
be propagated by contagion and those which are never so propagated.
This general result I shall only support by the authority of Dr.
Ramsbotham, who gives, as the result of his experience, that the same
symptoms belong to what he calls the infectious and the sporadic
forms of the disease, and the opinion of Armstrong in his original
Essay. If others can show any such distinction, I leave it to them
to do it. But there are cases enough that show the prevalence of the
disease among the patients of a single practitioner when it was in no
degree epidemic, in the proper sense of the term. I may refer to
those of Mr. Roberton and of Dr. Peirson, hereafter to be cited, as
examples.
2. I shall not enter into any dispute about the particular mode of
infection, whether it be by the atmosphere the physician carries
about him into the sick-chamber, or by the direct application of the
virus to the absorbing surfaces with which his hand comes in contact.
Many facts and opinions are in favor of each of these modes of
transmission. But it is obvious that in the majority of cases it
must be impossible to decide by which of these channels the disease
is conveyed, from the nature of the intercourse between the physician
and the patient.
3. It is not pretended that the contagion of puerperal fever must
always be followed by the disease. It is true of all contagious
diseases, that they frequently spare those who appear to be fully
submitted to their influence. Even the vaccine virus, fresh from the
subject, fails every day to produce its legitimate effect, though
every precaution is taken to insure its action. This is still more
remarkably the case with scarlet fever and some other diseases.
4. It is granted that the disease may be produced and variously
modified by many causes besides contagion, and more especially by
epidemic and endemic influences. But this is not peculiar to the
disease in question. There is no doubt that small-pox is propagated
to a great extent by contagion, yet it goes through the same periods
of periodical increase and diminution which have been remarked in
puerperal fever. If the question is asked how we are to reconcile
the great variations in the mortality of puerperal fever in different
seasons and places with the supposition of contagion, I will answer
it by another question from Mr. Farr's letter to the Registrar-
General. He makes the statement that "five die weekly of small-pox
in the metropolis when the disease is not epidemic,"--and adds, "The
problem for solution is,--Why do the five deaths become 10, 15, 20,
31, 58, 88, weekly, and then progressively fall through the same
measured steps?"
5. I take it for granted, that if it can be shown that great numbers
of lives have been and are sacrificed to ignorance or blindness on
this point, no other error of which physicians or nurses may be
occasionally suspected will be alleged in palliation of this; but
that whenever and wherever they can be shown to carry disease and
death instead of health and safety, the common instincts of humanity
will silence every attempt to explain away their responsibility.
The treatise of Dr. Gordon of Aberdeen was published in the year
1795, being among the earlier special works upon the disease. Apart
of his testimony has been occasionally copied into other works, but
his expressions are so clear, his experience is given with such manly
distinctness and disinterested honesty, that it may be quoted as a
model which might have been often followed with advantage.
"This disease seized such women only as were visited, or delivered by
a practitioner, or taken care of by a nurse, who had previously
attended patients affected with the disease."
"I had evident proofs of its infectious nature, and that the
infection was as readily communicated as that of the small-pox or
measles, and operated more speedily than any other infection with
which I am acquainted."
"I had evident proofs that every person who had been with a patient
in the puerperal fever became charged with an atmosphere of
infection, which was communicated to every pregnant woman who
happened to come within its sphere. This is not an assertion, but a
fact, admitting of demonstration, as may be seen by a perusal of the
foregoing table,"--referring to a table of seventy-seven cases, in
many of which the channel of propagation was evident.
He adds, "It is a disagreeable declaration for me to mention, that I
myself was the means of carrying the infection to a great number of
women." He then enumerates a number of instances in which the
disease was conveyed by midwives and others to the neighboring
villages, and declares that "these facts fully prove that the cause
of the puerperal fever, of which I treat, was a specific contagion,
or infection, altogether unconnected with a noxious constitution of
the atmosphere."
But his most terrible evidence is given in these words: "I ARRIVED AT
THAT CERTAINTY IN THE MATTER, THAT I COULD VENTURE TO FORETELL WHAT
WOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT
MIDWIFE THEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE
ATTENDED, DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE, MY
PREDICTION WAS VERIFIED."
Even previously to Gordon, Mr. White of Manchester had said, "I am
acquainted with two gentlemen in another town, where the whole
business of midwifery is divided betwixt them, and it is very
remarkable that one of them loses several patients every year of the
puerperal fever, and the other never so much as meets with the
disorder,"--a difference which he seems to attribute to their various
modes of treatment. [On the Management of Lying-in Women, p. 120.]
Dr. Armstrong has given a number of instances in his Essay on
Puerperal Fever, of the prevalence of the disease among the patients
of a single practitioner. At Sunderland, "in all, forty-three cases
occurred from the 1st of January to the 1st of October, when the
disease ceased; and of this number forty were witnessed by Mr.
Gregson and his assistant, Mr. Gregory, the remainder having been
separately seen by three accoucheurs." There is appended to the
London edition of this Essay, a letter from Mr. Gregson, in which
that gentleman says, in reference to the great number of cases
occurring in his practice, "The cause of this I cannot pretend fully
to explain, but I should be wanting in common liberality if I were to
make any hesitation in asserting, that the disease which appeared in
my practice was highly contagious, and communicable from one
puerperal woman to another." "It is customary among the lower and
middle ranks of people to make frequent personal visits to puerperal
women resident in the same neighborhood, and I have ample evidence
for affirming that the infection of the disease was often carried
about in that manner; and, however painful to my feelings, I must in
candor declare, that it is very probable the contagion was conveyed,
in some instances, by myself, though I took every possible care to
prevent such a thing from happening, the moment that I ascertained
that the distemper was infectious." Dr. Armstrong goes on to mention
six other instances within his knowledge, in which the disease had at
different times and places been limited, in the same singular manner,
to the practice of individuals, while it existed scarcely if at all
among the patients of others around them. Two of the gentlemen
became so convinced of their conveying the contagion, that they
withdrew for a time from practice.
I find a brief notice, in an American Journal, of another series of
cases, first mentioned by Mr. Davies, in the "Medical Repository."
This gentleman stated his conviction that the disease is contagious.
"In the autumn of 1822 he met with twelve cases, while his medical
friends in the neighborhood did not meet with any, 'or at least very
few.' He could attribute this circumstance to no other cause than
his having been present at the examination, after death, of two
cases, some time previous, and of his having imparted the disease to
his patients, notwithstanding every precaution."
Dr. Gooch says, "It is not uncommon for the greater number of cases
to occur in the practice of one man, whilst the other practitioners
of the neighborhood, who are not more skilful or more busy, meet with
few or none. A practitioner opened the body of a woman who had died
of puerperal fever, and continued to wear the same clothes. A lady
whom he delivered a few days afterwards was attacked with and died of
a similar disease; two more of his lying-in patients, in rapid
succession, met with the same fate; struck by the thought, that he
might have carried contagion in his clothes, he instantly changed
them, and 'met with no more cases of the kind.' A woman in the
country, who was employed as washerwoman and nurse, washed the linen
of one who had died of puerperal fever; the next lying-in patient she
nursed died of the same disease; a third nursed by her met with the
same fate, till the neighborhood, getting afraid of her, ceased to
employ her."
In the winter of the year 1824, "Several instances occurred of its
prevalence among the patients of particular practitioners, whilst
others who were equally busy met with few or none. One instance of
this kind was very remarkable. A general practitioner, in large
midwifery practice, lost so many patients from puerperal fever, that
he determined to deliver no more for some time, but that his partner
should attend in his place. This plan was pursued for one month,
during which not a case of the disease occurred in their practice.
The elder practitioner, being then sufficiently recovered, returned
to his practice, but the first patient he attended was attacked by
the disease and died. A physician, who met him in consultation soon
afterwards, about a case of a different kind, and who knew nothing of
his misfortune, asked him whether puerperal fever was at all
prevalent in his neighborhood, on which he burst into tears, and
related the above circumstances.
"Among the cases which I saw this season in consultation, four
occurred in one month in the practice of one medical man, and all of
them terminated fatally." [Lond. Med. Gaz. May 2, 1835.]
Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that he
had known the disease spread through a particular district, or be
confined to the practice of a particular person, almost every patient
being attacked with it, while others had not a single case. It
seemed capable, he thought, of conveyance, not only by common modes;
but through the dress of the attendants upon the patient.
In a letter to be found in the "London Medical Gazette" for January,
1840, Mr. Roberton of Manchester makes the statement which I here
give in a somewhat condensed form.
A midwife delivered a woman on the 4th of December, 1830, who died
soon after with the symptoms of puerperal fever. In one month from
this date the same midwife delivered thirty women, residing in
different parts of an extensive suburb, of which number sixteen
caught the disease and all died. These were the only cases which had
occurred for a considerable time in Manchester. The other midwives
connected with the same charitable institution as the woman already
mentioned are twenty-five in number, and deliver, on an average,
ninety women a week, or about three hundred and eighty a month. None
of these women had a case of puerperal fever. "Yet all this time
this woman was crossing the other midwives in every direction, scores
of the patients of the charity being delivered by them in the very
same quarters where her cases of fever were happening."
Mr. Roberton remarks, that little more than half the women she
delivered during this month took the fever; that on some days all
escaped, on others only one or more out of three or four; a
circumstance similar to what is seen in other infectious maladies.
Dr. Blundell says, "Those who have never made the experiment can have
but a faint conception how difficult it is to obtain the exact truth
respecting any occurrence in which feelings and interests are
concerned. Omitting particulars, then, I content myself with
remarking, generally, that from more than one district I have
received accounts of the prevalence of puerperal fever in the
practice of some individuals, while its occurrence in that of others,
in the same neighborhood, was not observed. Some, as I have been
told, have lost ten, twelve, or a greater number of patients, in
scarcely broken succession; like their evil genius, the puerperal
fever has seemed to stalk behind them wherever they went. Some have
deemed it prudent to retire for a time from practice. In fine, that
this fever may occur spontaneously, I admit; that its infectious
nature may be plausibly disputed, I do not deny; but I add,
considerately, that in my own family I had rather that those I
esteemed the most should be delivered, unaided, in a stable, by the
manger-side, than that they should receive the best help, in the
fairest apartment, but exposed to the vapors of this pitiless
disease. Gossiping friends, wet-nurses, monthly nurses, the
practitioner himself, these are the channels by which, as I suspect,
the infection is principally conveyed."
At a meeting of the Royal Medical and Chirurgical Society, Dr. King
mentioned that some years since a practitioner at Woolwich lost
sixteen patients from puerperal fever in the same year. He was
compelled to give up practice for one or two years, his business
being divided among the neighboring practitioners. No case of
puerperal fever occurred afterwards, neither had any of the
neighboring surgeons any cases of this disease.
At the same meeting Mr. Hutchinson mentioned the occurrence of three
consecutive cases of puerperal fever, followed subsequently by two
others, all in the practice of one accoucheur.[Lancet, May 2, 1840.]
Dr. Lee makes the following statement: "In the last two weeks of
September, 1827, five fatal cases of uterine inflammation came under
our observation. All the individuals so attacked had been attended
in labor by the same midwife, and no example of a febrile or
inflammatory disease of a serious nature occurred during that period
among the other patients of the Westminster General Dispensary, who
had been attended by the other midwives belonging to that
institution."
The recurrence of long series of cases like those I have cited,
reported by those most interested to disbelieve in contagion,
scattered along through an interval of half a century, might have
been thought sufficient to satisfy the minds of all inquirers that
here was something more than a singular coincidence. But if, on a
more extended observation, it should be found that the same ominous
groups of cases clustering about individual practitioners were
observed in a remote country, at different times, and in widely
separated regions, it would seem incredible that any should be found
too prejudiced or indolent to accept the solemn truth knelled into
their ears by the funeral bells from both sides of the ocean,--the
plain conclusion that the physician and the disease entered, hand in
hand, into the chamber of the unsuspecting patient.
That such series of cases have been observed in this country, and in
this neighborhood, I proceed to show.
In Dr. Francis's "Notes to Denman's Midwifery," a passage is cited
from Dr. Hosack, in which he refers to certain puerperal cases which
proved fatal to several lying-in women, and in some of which the
disease was supposed to be conveyed by the accoucheurs themselves.
A writer in the "New York Medical and Physical Journal" for October,
1829, in speaking of the occurrence of puerperal fever, confined to
one man's practice, remarks, "We have known cases of this kind occur,
though rarely, in New York."
I mention these little hints about the occurrence of such cases,
partly because they are the first I have met with in American medical
literature, but more especially because they serve to remind us that
behind the fearful array of published facts there lies a dark list of
similar events, unwritten in the records of science, but long
remembered by many a desolated fireside.
Certainly nothing can be more open and explicit than the account
given by Dr. Peirson of Salem, of the cases seen by him. In the
first nineteen days of January, 1829, he had five consecutive cases
of puerperal fever, every patient he attended being attacked, and the
three first cases proving fatal. In March of the same year he had
two moderate cases, in June, another case, and in July, another,
which proved fatal. "Up to this period," he remarks, "I am not
informed that a single case had occurred in the practice of any other
physician. Since that period I have had no fatal case in my
practice, although I have had several dangerous cases. I have
attended in all twenty cases of this disease, of which four have been
fatal. I am not aware that there has been any other case in the town
of distinct puerperal peritonitis, although I am willing to admit my
information may be very defective on this point. I have been told of
some I 'mixed cases,' and 'morbid affections after delivery.'"
In the "Quarterly Summary of the Transactions of the College of
Physicians of Philadelphia" may be found some most extraordinary
developments respecting a series of cases occurring in the practice
of a member of that body.
Dr. Condie called the attention of the Society to the prevalence, at
the present time, of puerperal fever of a peculiarly insidious and
malignant character. "In the practice of one gentleman extensively
engaged as an obstetrician, nearly every female he has attended in
confinement, during several weeks past, within the above limits" (the
southern sections and neighboring districts), "had been attacked by
the fever."
"An important query presents itself, the Doctor observed, in
reference to the particular form of fever now prevalent. Is it,
namely, capable of being propagated by contagion, and is a physician
who has been in attendance upon a case of the disease warranted in
continuing, without interruption, his practice as an obstetrician?
Dr. C., although not a believer in the contagious character of many
of those affections generally supposed to be propagated in this
manner, has nevertheless become convinced by the facts that have
fallen under his notice, that the puerperal fever now prevailing is
capable of being communicated by contagion. How otherwise can be
explained the very curious circumstance of the disease in one
district being exclusively confined to the practice of a single
physician, a Fellow of this College, extensively engaged in
obstetrical practice,--while no instance of the disease has occurred
in the patients under the care of any other accoucheur practising
within the same district; scarcely a female that has been delivered
for weeks past has escaped an attack?"
Dr. Rutter, the practitioner referred to, "observed that, after the
occurrence of a number of cases of the disease in his practice, he
had left the city and remained absent for a week, but on returning,
no article of clothing he then wore having been used by him before,
one of the very first cases of parturition he attended was followed
by an attack of the fever, and terminated fatally; he cannot,
readily, therefore, believe in the transmission of the disease from
female to female, in the person or clothes of the physician."
The meeting at which these remarks were made was held on the 3d of
May, 1842. In a letter dated December 20, 1842, addressed to Dr.
Meigs, and to be found in the "Medical Examiner," he speaks of
"those horrible cases of puerperal fever, some of which you did me
the favor to see with me during the past summer," and talks of his
experience in the disease, "now numbering nearly seventy cases, all
of which have occurred within less than a twelvemonth past."
And Dr. Meigs asserts, on the same page, "Indeed, I believe that his
practice in that department of the profession was greater than that
of any other gentleman, which was probably the cause of his seeing a
greater number of the cases." This from a professor of midwifery,
who some time ago assured a gentleman whom he met in consultation,
that the night on which they met was the eighteenth in succession
that he himself had been summoned from his repose, seems hardly
satisfactory.
I must call the attention of the inquirer most particularly to the
Quarterly Report above referred to, and the letters of Dr. Meigs and
Dr. Rutter, to be found in the "Medical Examiner." Whatever
impression they may produce upon his mind, I trust they will at least
convince him that there is some reason for looking into this
apparently uninviting subject.
At a meeting of the College of Physicians just mentioned, Dr.
Warrington stated, that a few days after assisting at an autopsy of
puerperal peritonitis, in which he laded out the contents of the
abdominal cavity with his hands, he was called upon to deliver three
women in rapid succession. All of these women were attacked with
different forms of what is commonly called puerperal fever. Soon
after these he saw two other patients, both on the same day, with the
same disease. Of these five patients two died.
At the same meeting, Dr. West mentioned a fact related to him by Dr.
Samuel Jackson of Northumberland. Seven females, delivered by Dr.
Jackson in rapid succession, while practising in Northumberland
County, were all attacked with puerperal fever, and five of them
died. "Women," he said, "who had expected me to attend upon them,
now becoming alarmed, removed out of my reach, and others sent for a
physician residing several miles distant. These women, as well as
those attended by midwives; all did well; nor did we hear of any
deaths in child-bed within a radius of fifty miles, excepting two,
and these I afterwards ascertained to have been caused by other
diseases." He underwent, as he thought, a thorough purification, and
still his next patient was attacked with the disease and died. He
was led to suspect that the contagion might have been carried in the
gloves which he had worn in attendance upon the previous cases. Two
months or more after this he had two other cases. He could find
nothing to account for these, unless it were the instruments for
giving enemata, which had been used in two of the former cases, and
were employed by these patients. When the first case occurred, he
was attending and dressing a limb extensively mortified from
erysipelas, and went immediately to the accouchement with his clothes
and gloves most thoroughly imbued with its efluvia. And here I may
mention, that this very Dr. Samuel Jackson of Northumberland is one
of Dr. Dewees's authorities against contagion.
The three following statements are now for the first time given to
the public. All of the cases referred to occurred within this State,
and two of the three series in Boston and its immediate vicinity.
I. The first is a series of cases which took place during the last
spring in a town at some distance from this neighborhood. A
physician of that town, Dr. C., had the following consecutive cases.
No. 1, delivered March 20, died March 24.
" 2, " April 9, " April 14.
" 3, " " 10, " " 14.
" 4, " " 11, " " 18.
" 5, " " 27, " May 3.
" 6, " " 28, had some symptoms,(recovered.)
" 7, " May 8, had some symptoms,(also recovered.)
These were the only cases attended by this physician during the
period referred to. "They were all attended by him until their
termination, with the exception of the patient No. 6, who fell into
the hands of another physician on the 2d of May. (Dr. C. left town
for a few days at this time.) Dr. C. attended cases immediately
before and after the above-named periods, none of which, however,
presented any peculiar symptoms of the disease."
About the 1st of July he attended another patient in a neighboring
village, who died two or three days after delivery.
The first patient, it is stated, was delivered on the 20th of March.
"On the 19th, Dr. C. made the autopsy of a man who died suddenly,
sick only forty-eight hours; had oedema of the thigh, and gangrene
extending from a little above the ankle into the cavity of the
abdomen." Dr. C. wounded himself, very slightly, in the right hand
during the autopsy. The hand was quite painful the night following,
during his attendance on the patient No. 1. He did not see this
patient after the 20th, being confined to the house, and very sick
from the wound just mentioned, from this time until the 3d of April.
Several cases of erysipelas occurred in the house where the autopsy
mentioned above took place, soon after the examination. There were
also many cases of erysipelas in town at the time of the fatal
puerperal cases which have been mentioned.
The nurse who laid out the body of the patient No. 3 was taken on the
evening of the same day with sore throat and erysipelas, and died in
ten days from the first attack.
The nurse who laid out the body of the patient No. 4 was taken on the
day following with symptoms like those of this patient, and died in a
week, without any external marks of erysipelas.
"No other cases of similar character with those of Dr. C. occurred in
the practice of any of the physicians in the town or vicinity at the
time. Deaths following confinement have occurred in the practice of
other physicians during the past year, but they were not cases of
puerperal fever. No post-mortem examinations were held in any of
these puerperal cases."
Some additional statements in this letter are deserving of insertion.
"A physician attended a woman in the immediate neighborhood of the
cases numbered 2, 3, and 4. This patient was confined the morning of
March 1st, and died on the night of March 7th. It is doubtful
whether this should be considered a case of puerperal fever. She had
suffered from canker, indigestion, and diarrhoea for a year previous
to her delivery. Her complaints were much aggravated for two or
three months previous to delivery; she had become greatly emaciated,
and weakened to such an extent that it had not been expected that she
would long survive her confinement, if indeed she reached that
period. Her labor was easy enough; she flowed a good deal, seemed
exceedingly prostrated, had ringing in the ears, and other symptoms
of exhaustion; the pulse was quick and small. On the second and
third day there was some tenderness and tumefaction of the abdomen,
which increased somewhat on the fourth and fifth. He had cases in
midwifery before and after this, which presented nothing peculiar."
It is also mentioned in the same letter, that another physician had a
case during the last summer and another last fall, both of which
recovered.
Another gentleman reports a case last December, a second case five
weeks, and another three weeks since. All these recovered. A case
also occurred very recently in the practice of a physician in the
village where the eighth patient of Dr. C. resides, which proved
fatal. "This patient had some patches of erysipelas on the legs and
arms. The same physician has delivered three cases since, which have
all done well. There have been no other cases in this town or its
vicinity recently. There have been some few cases of erysipelas."
It deserves notice that the partner of Dr. C., who attended the
autopsy of the man above mentioned and took an active part in it; who
also suffered very slightly from a prick under the thumb-nail
received during the examination, had twelve cases of midwifery
between March 26th and April 12th, all of which did well, and
presented no peculiar symptoms. It should also be stated, that
during these seventeen days he was in attendance on all the cases of
erysipelas in the house where the autopsy had been performed.
I owe these facts to the prompt kindness of a gentleman whose
intelligence and character are sufficient guaranty for their
accuracy.
The two following letters were addressed to my friend Dr. Scorer, by
the gentleman in whose practice the cases of puerperal fever
occurred. His name renders it unnecessary to refer more particularly
to these gentlemen, who on their part have manifested the most
perfect freedom and courtesy in affording these accounts of their
painful experience.
"January 28, 1843.
II. . . . "The time to which you allude was in 1830. The first
case was in February, during a very cold time. She was confined the
4th, and died the 12th. Between the 10th and 28th of this month, I
attended six women in labor, all of whom did well except the last, as
also two who were confined March 1st and 5th. Mrs. E., confined
February 28th, sickened, and died March 8th. The next day, 9th, I
inspected the body, and the night after attended a lady, Mrs. B., who
sickened, and died 16th. The 10th, I attended another, Mrs. G., who
sickened, but recovered. March 16th, I went from Mrs. G.'s room to
attend a Mrs. H., who sickened, and died 21st. The 17th, I inspected
Mrs. B. On the 19th, I went directly from Mrs. H.'s room to attend
another lady, Mrs. G., who also sickened, and died 22d. While Mrs.
B. was sick, on 15th, I went directly from her room a few rods, and
attended another woman, who was not sick. Up to 20th of this month I
wore the same clothes. I now refused to attend any labor, and did
not till April 21st, when, having thoroughly cleansed myself, I
resumed my practice, and had no more puerperal fever.
"The cases were not confined to a narrow space. The two nearest were
half a mile from each other, and half that distance from my
residence. The others were from two to three miles apart, and nearly
that distance from my residence. There were no other cases in their
immediate vicinity which came to my knowledge. The general health of
all the women was pretty good, and all the labors as good as common,
except the first. This woman, in consequence of my not arriving in
season, and the child being half-born at some time before I arrived,
was very much exposed to the cold at the time of confinement, and
afterwards, being confined in a very open, cold room. Of the six
cases you perceive only one recovered.
"In the winter of 1817 two of my patients had puerperal fever, one
very badly, the other not so badly. Both recovered. One other had
swelled leg, or phlegmasia dolens, and one or two others did not
recover as well as usual.
"In the summer of 1835 another disastrous period occurred in my
practice. July 1st, I attended a lady in labor, who was afterwards
quite ill and feverish; but at the time I did not consider her case a
decided puerperal fever. On the 8th, I attended one who did well.
On the 12th, one who was seriously sick. This was also an equivocal
case, apparently arising from constipation and irritation of the
rectum. These women were ten miles apart and five from my residence.
On 15th and 20th, two who did well. On 25th, I attended another.
This was a severe labor, and followed by unequivocal puerperal fever,
or peritonitis. She recovered. August 2d and 3d, in about twenty-
four hours I attended four persons. Two of them did very well; one
was attacked with some of the common symptoms, which however subsided
in a day or two, and the other had decided puerperal fever, but
recovered. This woman resided five miles from me. Up to this time I
wore the same coat. All my other clothes had frequently been
changed. On 6th, I attended two women, one of whom was not sick at
all; but the other, Mrs. L., was afterwards taken ill. On 10th, I
attended a lady, who did very well. I had previously changed all my
clothes, and had no garment on which had been in a puerperal room.
On 12th, I was called to Mrs. S., in labor. While she was ill, I
left her to visit Mrs. L., one of the ladies who was confined on 6th.
Mrs. L. had been more unwell than usual, but I had not considered
her case anything more than common till this visit. I had on a
surtout at this visit, which, on my return to Mrs. S., I left in
another room. Mrs. S. was delivered on 13th with forceps. These
women both died of decided puerperal fever.
"While I attended these women in their fevers, I changed my clothes,
and washed my hands in a solution of chloride of lime after each
visit. I attended seven women in labor during this period, all of
whom recovered without sickness.
"In my practice I have had several single cases of puerperal fever,
some of whom have died and some have recovered. Until the year 1830
I had no suspicion that the disease could be communicated from one
patient to another by a nurse or midwife; but I now think the
foregoing facts strongly favor that idea. I was so much convinced of
this fact, that I adopted the plan before related.
"I believe my own health was as good as usual at each of the above
periods. I have no recollections to the contrary.
"I believe I have answered all your questions. I have been more
particular on some points perhaps than necessary; but I thought you
could form your own opinion better than to take mine. In 1830 I
wrote to Dr. Charming a more particular statement of my cases. If I
have not answered your questions sufficiently, perhaps Dr. C. may
have my letter to him, and you can find your answer there." [In a
letter to myself, this gentleman also stated, "I do not recollect
that there was any erysipelas or any other disease particularly
prevalent at the time."]
"BOSTON, February 3, 1843.
III. "MY DEAR SIR,--I received a note from you last evening,
requesting me to answer certain questions therein proposed, touching
the cases of puerperal fever which came under my observation the past
summer. It gives me pleasure to comply with your request, so far as
it is in my power so to do, but, owing to the hurry in preparing for
a journey, the notes of the cases I had then taken were lost or
mislaid. The principal facts, however, are too vivid upon my
recollection to be soon forgotten. I think, therefore, that I shall
be able to give you all the information you may require.
"All the cases that occurred in my practice took place between the
7th of May and the 17th of June 1842.
"They were not confined to any particular part of the city. The
first two cases were patients residing at the South End, the next was
at the extreme North End, one living in Sea Street and the other in
Roxbury. The following is the order in which they occurred:
"Case 1. Mrs._____ was confined on the 7th of May, at 5 o'clock,
P. M., after a natural labor of six hours. At 12 o'clock at night,
on the 9th (thirty-one hours after confinement), she was taken with
severe chill, previous to which she was as comfortable as women
usually are under the circumstances. She died on the 10th.
"Case 2. Mrs._____ was confined on the 10th of June (four weeks
after Mrs. C.), at 11 A. M., after a natural, but somewhat severe
labor of five hours. At 7 o'clock, on the morning of the 11th, she
had a chill. Died on the 12th.
"Case 3. Mrs._____ , confined on the 14th of June, was comfortable
until the 18th, when symptoms of puerperal fever were manifest. She
died on the 20th.
"Case 4. Mrs._____ , confined June 17th, at 5 o'clock, A. M., was
doing well until the morning of the 19th. She died on the evening of
the 21st.
"Case 5. Mrs._____ was confined with her fifth child on the 17th of
June, at 6 o'clock in the evening. This patient had been attacked
with puerperal fever, at three of her previous confinements, but the
disease yielded to depletion and other remedies without difficulty.
This time, I regret to say, I was not so fortunate. She was not
attacked, as were the other patients, with a chill, but complained of
extreme pain in abdomen, and tenderness on pressure, almost from the
moment of her confinement. In this as in the other cases, the
disease resisted all remedies, and she died in great distress on the
22d of the same month. Owing to the extreme heat of the season, and
my own indisposition, none of the subjects were examined after death.
Dr. Channing, who was in attendance with me on the three last cases,
proposed to have a post-mortem examination of the subject of case No.
5, but from some cause which I do not now recollect it was not
obtained.
"You wish to know whether I wore the same clothes when attending the
different cases. I cannot positively say, but I should think I did
not, as the weather became warmer after the first two cases; I
therefore think it probable that I made a change of at least a part
of my dress. I have had no other case of puerperal fever in my own
practice for three years, save those above related, and I do not
remember to have lost a patient before with this disease. While
absent, last July, I visited two patients sick with puerperal fever,
with a friend of mine in the country. Both of them recovered.
"The cases that I have recorded were not confined to any particular
constitution or temperament, but it seized upon the strong and the
weak, the old and the young,--one being over forty years, and the
youngest under eighteen years of age . . . . If the disease is of
an erysipelatous nature, as many suppose, contagionists may perhaps
find some ground for their belief in the fact, that, for two weeks
previous to my first case of puerperal fever, I had been attending a
severe case of erysipelas, and the infection may have been conveyed
through me to the patient; but, on the other hand, why is not this
the case with other physicians, or with the same physician at all
times, for since my return from the country I have had a more
inveterate case of erysipelas than ever before, and no difficulty
whatever has attended any of my midwifery cases?"
I am assured, on unquestionable authority, that "About three years
since, a gentleman in extensive midwifery business, in a neighboring
State, lost in the course of a few weeks eight patients in child-bed,
seven of them being undoubted cases of puerperal fever. No other
physician of the town lost a single patient of this disease during
the same period." And from what I have heard in conversation with
some of our most experienced practitioners, I am inclined to think
many cases of the kind might be brought to light by extensive
inquiry.
This long catalogue of melancholy histories assumes a still darker
aspect when we remember how kindly nature deals with the parturient
female, when she is not immersed in the virulent atmosphere of an
impure lying-in hospital, or poisoned in her chamber by the
unsuspected breath of contagion. From all causes together, not more
than four deaths in a thousand births and miscarriages happened in
England and Wales during the period embraced by the first "Report of
the Registrar-General." In the second Report the mortality was shown
to be about five in one thousand. In the Dublin Lying-in Hospital,
during the seven years of Dr. Collins's mastership, there was one
case of puerperal fever to 178 deliveries, or less than six to the
thousand, and one death from this disease in 278 cases, or between
three and four to the thousand a yet during this period the disease
was endemic in the hospital, and might have gone on to rival the
horrors of the pestilence of the Maternite, had not the poison been
destroyed by a thorough purification.
In private practice, leaving out of view the cases that are to be
ascribed to the self-acting system of propagation, it would seem that
the disease must be far from common. Mr. White of Manchester says,
"Out of the whole number of lying-in patients whom I have delivered
(and I may safely call it a great one), I have never lost one, nor to
the best of my recollection has one been greatly endangered, by the
puerperal, miliary, low nervous, putrid malignant, or milk fever."
Dr. Joseph Clarke informed Dr. Collins, that in the course of forty-
five years' most extensive practice he lost but four patients from
this disease. One of the most eminent practitioners of Glasgow, who
has been engaged in very extensive practice for upwards of a quarter
of a century, testifies that he never saw more than twelve cases of
real puerperal fever.[Lancet, May 4, 1833]
I have myself been told by two gentlemen practising in this city, and
having for many years a large midwifery business, that they had
neither of them lost a patient from this disease, and by one of them
that he had only seen it in consultation with other physicians. In
five hundred cases of midwifery, of which Dr. Storer has given an
abstract in the first number of this Journal, there was only one
instance of fatal puerperal peritonitis.
In the view of these facts, it does appear a singular coincidence,
that one man or woman should have ten, twenty, thirty, or seventy
cases of this rare disease following his or her footsteps with the
keenness of a beagle, through the streets and lanes of a crowded
city, while the scores that cross the same paths on the same errands
know it only by name. It is a series of similar coincidences which
has led us to consider the dagger, the musket, and certain innocent-
looking white powders as having some little claim to be regarded as
dangerous. It is the practical inattention to similar coincidences
which has given rise to the unpleasant but often necessary documents
called indictments, which has sharpened a form of the cephalotome
sometimes employed in the case of adults, and adjusted that
modification of the fillet which delivers the world of those who
happen to be too much in the way while such striking coincidences are
taking place.
I shall now mention a few instances in which the disease appears to
have been conveyed by the process of direct inoculation.
Dr. Campbell of Edinburgh states that in October, 1821, he assisted
at the post-mortem examination of a patient who died with puerperal
fever. He carried the pelvic viscera in his pocket to the class-
room. The same evening he attended a woman in labor without
previously changing his clothes; this patient died. The next morning
he delivered a woman with the forceps; she died also, and of many
others who were seized with the disease within a few weeks, three
shared the same fate in succession.
In June, 1823, he assisted some of his pupils at the autopsy of a
case of puerperal fever. He was unable to wash his hands with proper
care, for want of the necessary accommodations. On getting home he
found that two patients required his assistance. He went without
further ablution, or changing his clothes; both these patients died
with puerperal fever. This same Dr. Campbell is one of Dr.
Churchill's authorities against contagion.
Mr. Roberton says that in one instance within his knowledge a
practitioner passed the catheter for a patient with puerperal fever
late in the evening; the same night he attended a lady who had the
symptoms of the disease on the second day. In another instance a
surgeon was called while in the act of inspecting the body of a woman
who had died of this fever, to attend a labor; within forty-eight
hours this patient was seized with the fever.'
On the 16th of March, 1831, a medical practitioner examined the body
of a woman who had died a few days after delivery, from puerperal
peritonitis. On the evening of the 17th he delivered a patient, who
was seized with puerperal fever on the 19th, and died on the 24th.
Between this period and the 6th of April, the same practitioner
attended two other patients, both of whom were attacked with the same
disease and died.
In the autumn of 1829 a physician was present at the examination of a
case of puerperal fever, dissected out the organs, and assisted in
sewing up the body. He had scarcely reached home when he was
summoned to attend a young lady in labor. In sixteen hours she was
attacked with the symptoms of puerperal fever, and narrowly escaped
with her life.
In December, 1830, a midwife, who had attended two fatal cases of
puerperal fever at the British Lying-in Hospital, examined a patient
who had just been admitted, to ascertain if labor had commenced.
This patient remained two days in the expectation that labor would
come on, when she returned home and was then suddenly taken in labor
and delivered before she could set out for the hospital. She went on
favorably for two days, and was then taken with puerperal fever and
died in thirty-six hours.
"A young practitioner, contrary to advice, examined the body of a
patient who had died from puerperal fever; there was no epidemic at
the time; the case appeared to be purely sporadic. He delivered
three other women shortly afterwards; they all died with puerperal
fever, the symptoms of which broke out very soon after labor. The
patients of his colleague did well, except one, where he assisted to
remove some coagula from the uterus; she was attacked in the same
manner as those whom he had attended, and died also." The writer in
the "British and Foreign Medical Review," from whom I quote this
statement,--and who is no other than Dr. Rigby, adds, "We trust that
this fact alone will forever silence such doubts, and stamp the well-
merited epithet of 'criminal,' as above quoted, upon such attempts."
[Brit. and For. Medical Review for Jan. 1842, p. 112.]
From the cases given by Mr. Ingleby, I select the following. Two
gentlemen, after having been engaged in conducting the post-mortem
examination of a case of puerperal fever, went in the same dress,
each respectively, to a case of midwifery. "The one patient was
seized with the rigor about thirty hours afterwards. The other
patient was seized with a rigor the third morning after delivery.
One recovered, one died." [Edin. Med. and Surg. Journal, April,
1838.]
One of these same gentlemen attended another woman in the same
clothes two days after the autopsy referred to. "The rigor did not
take place until the evening of the fifth day from the first visit.
Result fatal." These cases belonged to a series of seven, the first
of which was thought to have originated in a case of erysipelas.
"Several cases of a mild character followed the foregoing seven, and
their nature being now most unequivocal, my friend declined visiting
all midwifery cases for a time, and there was no recurrence of the
disease." These cases occurred in 1833. Five of them proved fatal.
Mr. Ingleby gives another series of seven eases which occurred to a
practitioner in 1836, the first of which was also attributed to his
having opened several erysipelatous abscesses a short time
previously.
I need not refer to the case lately read before this Society, in
which a physician went, soon after performing an autopsy of a case of
puerperal fever, to a woman in labor, who was seized with the same
disease and perished. The forfeit of that error has been already
paid.
At a meeting of the Medical and Chirurgical Society before referred
to, Dr. Merriman related an instance occurring in his own practice,
which excites a reasonable suspicion that two lives were sacrificed
to a still less dangerous experiment. He was at the examination of a
case of puerperal fever at two o'clock in the afternoon. He took
care not to touch the body. At nine o'clock the same evening he
attended a woman in labor; she was so nearly delivered that he had
scarcely anything to do. The next morning she had severe rigors, and
in forty-eight hours she was a corpse. Her infant had erysipelas and
died in two days. [Lancet, May 2, 1840.]
In connection with the facts which have been stated, it seems proper
to allude to the dangerous and often fatal effects which have
followed from wounds received in the post-mortem examination of
patients who have died of puerperal fever. The fact that such wounds
are attended with peculiar risk has been long noticed. I find that
Chaussier was in the habit of cautioning his students against the
danger to which they were exposed in these dissections. [Stein, L'Art
d'Accoucher, 1794; Dict. des Sciences Medicales, art. "Puerperal."]
The head pharmacien of the Hotel Dieu, in his analysis of the fluid
effused in puerperal peritonitis, says that practitioners are
convinced of its deleterious qualities, and that it is very dangerous
to apply it to the denuded skin. [Journal de Pharmacie, January,
1836.] Sir Benjamin Brodie speaks of it as being well known that the
inoculation of lymph or pus from the peritoneum of a puerperal
patient is often attended with dangerous and even fatal symptoms.
Three cases in confirmation of this statement, two of them fatal,
have been reported to this Society within a few months.
Of about fifty cases of injuries of this kind, of various degrees of
severity, which I have collected from different sources, at least
twelve were instances of infection from puerperal peritonitis. Some
of the others are so stated as to render it probable that they may
have been of the same nature. Five other cases were of peritoneal
inflammation; three in males. Three were what was called enteritis,
in one instance complicated with erysipelas; but it is well known
that this term has been often used to signify inflammation of the
peritoneum covering the intestines. On the other hand, no case of
typhus or typhoid fever is mentioned as giving rise to dangerous
consequences, with the exception of the single instance of an
undertaker mentioned by Mr. Travers, who seems to have been poisoned
by a fluid which exuded from the body. The other accidents were
produced by dissection, or some other mode of contact with bodies of
patients who had died of various affections. They also differed much
in severity, the cases of puerperal origin being among the most
formidable and fatal. Now a moment's reflection will show that the
number of cases of serious consequences ensuing from the dissection
of the bodies of those who had perished of puerperal fever is so
vastly disproportioned to the relatively small number of autopsies
made in this complaint as compared with typhus or pneumonia (from
which last disease not one case of poisoning happened), and still
more from all diseases put together, that the conclusion is
irresistible that a most fearful morbid poison is often generated in
the course of this disease. Whether or not it is sui generis,
confined to this disease, or produced in some others, as, for
instance, erysipelas, I need, not stop to inquire.
In connection with this may be taken the following statement of Dr.
Rigby. "That the discharges from a patient under puerperal fever are
in the highest degree contagious we have abundant evidence in the
history of lying-in hospitals. The puerperal abscesses are also
contagious, and may be communicated to healthy lying-in women by
washing with the same sponge; this fact has been repeatedly proved in
the Vienna Hospital; but they are equally communicable to women not
pregnant; on more than one occasion the women engaged in washing the
soiled bed-linen of the General Lying-in Hospital have been attacked
with abscess in the fingers or hands, attended with rapidly spreading
inflammation of the cellular tissue."
Now add to all this the undisputed fact, that within the walls of
lying-in hospitals there is often generated a miasm, palpable as the
chlorine used to destroy it, tenacious so as in some cases almost to
defy extirpation, deadly in some institutions as the plague; which
has killed women in a private hospital of London so fast that they
were buried two in one coffin to conceal its horrors; which enabled
Tonnelle to record two hundred and twenty-two autopsies at the
Maternite of Paris; which has led Dr. Lee to express his deliberate
conviction that the loss of life occasioned by these institutions
completely defeats the objects of their founders; and out of this
train of cumulative evidence, the multiplied groups of cases
clustering about individuals, the deadly results of autopsies, the
inoculation by fluids from the living patient, the murderous poison
of hospitals,--does there not result a conclusion that laughs all
sophistry to scorn, and renders all argument an insult?
I have had occasion to mention some instances in which there was an
apparent relation between puerperal fever and erysipelas. The length
to which this paper has extended does not allow me to enter into the
consideration of this most important subject. I will only say, that
the evidence appears to me altogether satisfactory that some most
fatal series of puerperal fever have been produced by an infection
originating in the matter or effluvia of erysipelas. In evidence of
some connection between the two diseases, I need not go back to the
older authors, as Pouteau or Gordon, but will content myself with
giving the following references, with their dates; from which it will
be seen that the testimony has been constantly coming before the
profession for the last few years.
"London Cyclopaedia of Practical Medicine," article Puerperal Fever,
1833.
Mr. Ceeley's Account of the Puerperal Fever at Aylesbury. "Lancet,"
1835.
Dr. Ramsbotham's Lecture. "London Medical Gazette," 1835.
Mr. Yates Ackerly's Letter in the same Journal, 1838.
Mr. Ingleby on Epidemic Puerperal Fever. "Edinburgh Medical and
Surgical Journal," 1838.
Mr. Paley's Letter. "London Medical Gazette," 1839.
Remarks at the Medical and Chirurgical Society. "Lancet," 1840.
Dr. Rigby's "System of Midwifery." 1841.
"Nunneley on Erysipelas,"--a work which contains a large number of
references on the subject. 1841.
"British and Foreign Quarterly Review," 1842.
Dr. S. Jackson of Northumberland, as already quoted from the Summary
of the College of Physicians, 1842.
And lastly, a startling series of cases by Mr. Storrs of Doncaster,
to be, found in the "American Journal of the Medical Sciences" for
January, 1843.
The relation of puerperal fever with other continued fevers would
seem to be remote and rarely obvious. Hey refers to two cases of
synochus occurring in the Royal Infirmary of Edinburgh, in women who
had attended upon puerperal patients. Dr. Collins refers to several
instances in which puerperal fever has appeared to originate from a
continued proximity to patients suffering with typhus.
Such occurrences as those just mentioned, though most important to be
remembered and guarded against, hardly attract our notice in the
midst of the gloomy facts by which they are surrounded. Of these
facts, at the risk of fatiguing repetitions, I have summoned a
sufficient number, as I believe, to convince the most incredulous
that every attempt to disguise the truth which underlies them all is
useless.
It is true that some of the historians of the disease, especially
Hulme, Hull, and Leake, in England; Tonnelle, Duges, and Baudelocque,
in France, profess not to have found puerperal fever contagious. At
the most they give us mere negative facts, worthless against an
extent of evidence which now overlaps the widest range of doubt, and
doubles upon itself in the redundancy of superfluous demonstration.
Examined in detail, this and much of the show of testimony brought up
to stare the daylight of conviction out of countenance, proves to be
in a great measure unmeaning and inapplicable, as might be easily
shown were it necessary. Nor do I feel the necessity of enforcing
the conclusion which arises spontaneously from the facts which have
been enumerated, by formally citing the opinions of those grave
authorities who have for the last half-century been sounding the
unwelcome truth it has cost so many lives to establish.
"It is to the British practitioner," says Dr. Rigby, "that we are
indebted for strongly insisting upon this important and dangerous
character of puerperal fever."
The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton,
Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee,
Ingleby, Locock, Abercrombie, Alison; Travers, Rigby, and Watson,
many of whose writings I have already referred to, may have some
influence with those who prefer the weight of authorities to the
simple deductions of their own reason from the facts laid before
them. A few Continental writers have adopted similar conclusions. It
gives me pleasure to remember, that while the doctrine has been
unceremoniously discredited in one of the leading Journals, and made
very light of by teachers in two of the principal Medical Schools, of
this country, Dr. Channing has for many years inculcated, and
enforced by examples, the danger to be apprehended and the
precautions to be taken in the disease under consideration.
I have no wish to express any harsh feeling with regard to the
painful subject which has come before us. If there are any so far
excited by the story of these dreadful events that they ask for some
word of indignant remonstrance to show that science does not turn the
hearts of its followers into ice or stone, let me remind them that
such words have been uttered by those who speak with an authority I
could not claim. It is as a lesson rather than as a reproach that I
call up the memory of these irreparable errors and wrongs. No tongue
can tell the heart-breaking calamity they have caused; they have
closed the eyes just opened upon a new world of love and happiness;
they have bowed the strength of manhood into the dust; they have cast
the helplessness of infancy into the stranger's arms, or bequeathed
it, with less cruelty, the death of its dying parent. There is no
tone deep enough for regret, and no voice loud enough for warning.
The woman about to become a mother, or with her new-born infant upon
her bosom, should be the object of trembling care and sympathy
wherever she bears her tender burden, or stretches her aching limbs.
The very outcast of the streets has pity upon her sister in
degradation, when the seal of promised maternity is impressed upon
her. The remorseless vengeance of the law, brought down upon its
victim by a machinery as sure as destiny, is arrested in its fall at
a word which reveals her transient claim for mercy. The solemn
prayer of the liturgy singles out her sorrows from the multiplied
trials of life, to plead for her in the hour of peril. God forbid
that any member of the profession to which she trusts her life,
doubly precious at that eventful period, should hazard it
negligently, unadvisedly, or selfishly!
There may be some among those whom I address who are disposed to ask
the question, What course are we to follow in relation to this
matter? The facts are before them, and the answer must be left to
their own judgment and conscience. If any should care to know my own
conclusions, they are the following; and in taking the liberty to
state them very freely and broadly, I would ask the inquirer to
examine them as freely in the light of the evidence which has been
laid before him.
1. A physician holding himself in readiness to attend cases of
midwifery should never take any active part in the post-mortem
examination of cases of puerperal fever.
2. If a physician is present at such autopsies, he should use
thorough ablution, change every article of dress, and allow twenty-
four hours or more to elapse before attending to any case of
midwifery. It may be well to extend the same caution to cases of
simple peritonitis.
3. Similar precautions should be taken after the autopsy or surgical
treatment of cases of erysipelas, if the physician is obliged to
unite such offices with his obstetrical duties, which is in the
highest degree inexpedient.
4. On the occurrence of a single case of puerperal fever in his
practice, the physician is bound to consider the next female he
attends in labor, unless some weeks at least have elapsed, as in
danger of being infected by him, and it is his duty to take every
precaution to diminish her risk of disease and death.
5. If within a short period two cases of puerperal fever happen
close to each other, in the practice of the same physician, the
disease not existing or prevailing in the neighborhood, he would do
wisely to relinquish his obstetrical practice for at least one month,
and endeavor to free himself by every available means from any
noxious influence he may carry about with him.
6. The occurrence of three or more closely connected cases, in the
practice of one individual, no others existing in the neighborhood,
and no other sufficient cause being alleged for the coincidence, is
prima facie evidence that he is the vehicle of contagion.
7. It is the duty of the physician to take every precaution that the
disease shall not be introduced by nurses or other assistants, by
making proper inquiries concerning them, and giving timely warning of
every suspected source of danger.
8. Whatever indulgence may be granted to those who have heretofore
been the ignorant causes of so much misery, the time has come when
the existence of a private pestilence in the sphere of a single
physician should be looked upon, not as a misfortune, but a crime;
and in the knowledge of such occurrences the duties of the
practitioner to his profession should give way to his paramount
obligations to society.
ADDITIONAL REFERENCES AND CASES.
Fifth Annual Report of the Registrar-General of England,
1843. Appendix. Letter from William Farr, Esq.--Several new series
of cases are given in the Letter of Mr. Stows, contained in the
Appendix to this Report. Mr. Stows suggests precautions similar to
those I have laid down, and these precautions are strongly enforced
by Mr. Farr, who is, therefore, obnoxious to the same criticisms as
myself.
Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844.-
Cases of puerperal fever seeming to originate in erysipelas.
Elkington, of Birmingham, in Provincial Med. Journal, cited in Am.
Journ. Med. Se. for April, 1844.--Six cases in less than a
fortnight, seeming to originate in a case of erysipelas.
West's Reports, in Brit. and For. Med. Review for October, 1845,
and January, 1847.--Affection of the arm, resembling malignant
pustule, after removing the placenta of a patient who died from
puerperal fever. Reference to cases at Wurzburg, as proving
contagion, and to Keiller's cases in the Monthly Journal for
February, 1846, as showing connection of puerperal fever and
erysipelas.
Kneeland.--Contagiousness of Puerperal Fever. Am. Jour. Med.
Se., January, 1846. Also, Connection between Puerperal Fever and
Epidemic Erysipelas. Ibid., April, 1846.
Robert Storrs.--Contagious Effects of Puerperal Fever on the Male
Subject; or on Persons not Child-bearing. (From Provincial Med. and
Surg. Journal.) Am. Jour. Med. Sc., January, 184,6. Numerous
cases. See also Dr. Reid's case in same Journal for April, 1846.
Routh's paper in Proc. of Royal Med. Chir. Soc., Am. Jour. Med.
Sc., April, 1849, also in B. and F. Med. Chir. Review, April,
1850.
Hill, of Leuchars.--A Series of Cases illustrating the Contagious
Nature of Erysipelas and of Puerperal Fever, and their Intimate
Pathological Connection. (From Monthly Journal of Med. Sc.) Am.
Jour. Med. Se., July, 1850.
Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits,
from inoculation with different morbid secretions.) Am. Jour. Med.
Se., October, 1850.
Arneth. Paper read before the National Academy of Medicine. Annales
d'Hygiene, Tome LXV. 2e Partie. (Means of Disinfection proposed by
M. "Semmeliveis" (Semmelweiss.) Lotions of chloride of lime and use
of nail-brush before admission to lying-in wards. Alleged sudden and
great decrease of mortality from puerperal fever. Cause of disease
attributed to inoculation with cadaveric matters.) See also Routh's
paper, mentioned above.
Moir. Remarks at a meeting of the Edinburgh Medico-Chirurgical
Society. Refers to cases of Dr. Kellie, of Leith. Sixteen in
succession, all fatal. Also to several instances of individual
pupils having had a succession of cases in various quarters of the
town, while others, practising as extensively in the same localities,
had none. Also to several special cases not mentioned elsewhere.
Am. Jour. Med. Se. for October, 1851. (From New Monthly Journal
of Med. Science.)
Simpson.--Observations at a Meeting of the Edinburgh Obstetrical
Society. (An "eminent gentleman," according to Dr. Meigs, whose
"name is as well known in America as in (his) native land."
Obstetrics. Phil. 1852, pp. 368, 375.) The student is referred to
this paper for a valuable resume of many of the facts, and the
necessary inferences, relating to this subject. Also for another
series of cases, Mr. Sidey's, five or six in rapid succession.
Dr. Simpson attended the dissection of two of Dr. Sidey's cases, and
freely handled the diseased parts. His next four child-bed patients
were affected with puerperal fever, and it was the first time he had
seen it in practice. As Dr. Simpson is a gentleman (Dr. Meigs, as
above), and as "a gentleman's hands are clean" (Dr. Meigs' Sixth
Letter), it follows that a gentleman with clean hands may carry the
disease. Am. Jour. Med. Sc., October, 1851.
Peddle.--The five or six cases of Dr. Sidey, followed by the four of
Dr. Simpson, did not end the series. A practitioner in Leith having
examined in Dr. Simpson's house, a portion of the uterus obtained
from one of the patients, had immediately afterwards three fatal
cases of puerperal fever. Dr. Veddie referred to two distinct
series of consecutive cases in his own practice. He had since taken
precautions, and not met with any such cases. Am. Jour. Med. Sc.,
October, 1851.
Copland. Considers it proved that puerperal fever maybe propagated
by the hands and the clothes, or either, of a third person, the bed-
clothes or body-clothes of a patient. Mentions a new series of
cases, one of which he saw, with the practitioner who had attended
them. She was the sixth he had had within a few days. All died.
Dr. Copland insisted that contagion had caused these cases; advised
precautionary measures, and the practitioner had no other cases for a
considerable time. Considers it criminal, after the evidence
adduced,--which he could have quadrupled,--and the weight of
authority brought forward, for a practitioner to be the medium of
transmitting contagion and death to his patients. Dr. Copland lays
down rules similar to those suggested by myself, and is therefore
entitled to the same epithet for so doing. Medical Dictionary, New
York, 1852. Article, Puerperal States and Diseases.
If there is any appetite for facts so craving as to be yet
unappeased,--Lesotho, necdum satiata,--more can be obtained.
Dr. Hodge remarks that "the frequency and importance of this
singular circumstance (that the disease is occasionally more
prevalent with one practitioner than another) has been exceedingly
overrated." More than thirty strings of cases, more than two hundred
and fifty sufferers from puerperal fever, more than one hundred and
thirty deaths appear as the results of a sparing estimate of such
among the facts I have gleaned as could be numerically valued. These
facts constitute, we may take it for granted, but a small fraction of
those that have actually occurred. The number of them might be
greater, but "'t is enough, 't will serve," in Mercutio's modest
phrase, so far as frequency is concerned. For a just estimate of the
importance of the singular circumstance, it might be proper to
consult the languid survivors, the widowed husbands, and the
motherless children, as well as "the unfortunate accoucheur."
III
CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
An Address delivered before the Massachusetts Medical Society, at the
Annual Meeting, May 30, 1860.
"Facultate magis quam violentia."
HIPPOCRATES.
Our Annual Meeting never fails to teach us at least one lesson. The
art whose province it is to heal and to save cannot protect its own
ranks from the inroads of disease and the waste of the Destroyer.
Seventeen of our associates have been taken from us since our last
Anniversary. Most of them followed their calling in the villages or
towns that lie among the hills or along the inland streams. Only
those who have lived the kindly, mutually dependent life of the
country, can tell how near the physician who is the main reliance in
sickness of all the families throughout a thinly settled region comes
to the hearts of the people among whom he labors, how they value him
while living, how they cherish his memory when dead. For these
friends of ours who have gone before, there is now no more toil; they
start from their slumbers no more at the cry of pain; they sally
forth no more into the storms; they ride no longer over the lonely
roads that knew them so well; their wheels are rusting on their axles
or rolling with other burdens; their watchful eyes are closed to all
the sorrows they lived to soothe. Not one of these was famous in the
great world; some were almost unknown beyond their own immediate
circle. But they have left behind them that loving remembrance which
is better than fame, and if their epitaphs are chiselled briefly in
stone, they are written at full length on living tablets in a
thousand homes to which they carried their ever-welcome aid and
sympathy.
One whom we have lost, very widely known and honored, was a leading
practitioner of this city. His image can hardly be dimmed in your
recollection, as he stood before you only three years ago, filling
the same place with which I am now honored. To speak of him at all
worthily, would be to write the history of professional success, won
without special aid at starting, by toil, patience, good sense, pure
character, and pleasing manners; won in a straight uphill ascent,
without one breathing-space until he sat down, not to rest, but to
die. If prayers could have shielded him from the stroke, if love
could have drawn forth the weapon, and skill could have healed the
wound, this passing tribute might have been left to other lips and to
another generation.
Let us hope that our dead have at last found that rest which neither
summer nor winter, nor day nor night, had granted to their unending
earthly labors! And let us remember that our duties to our brethren
do not cease when they become unable to share our toils, or leave
behind them in want and woe those whom their labor had supported. It
is honorable to the Profession that it has organized an Association a
for the relief of its suffering members and their families; it owes
this tribute to the ill-rewarded industry and sacrifices of its less
fortunate brothers who wear out health and life in the service of
humanity. I have great pleasure in referring to this excellent
movement, which gives our liberal profession a chance to show its
liberality, and serves to unite us all, the successful and those whom
fortune has cast down, in the bonds of a true brotherhood.
A medical man, as he goes about his daily business after twenty years
of practice, is apt to suppose that he treats his patients according
to the teachings of his experience. No doubt this is true to some
extent; to what extent depending much on the qualities of the
individual. But it is easy to prove that the prescriptions of even
wise physicians are very commonly founded on something quite
different from experience. Experience must be based on the permanent
facts of nature. But a glance at the prevalent modes of treatment of
any two successive generations will show that there is a changeable
as well as a permanent element in the art of healing; not merely
changeable as diseases vary, or as new remedies are introduced, but
changeable by the going out of fashion of special remedies, by the
decadence of a popular theory from which their fitness was deduced,
or other cause not more significant. There is no reason to suppose
that the present time is essentially different in this respect from
any other. Much, therefore, which is now very commonly considered to
be the result of experience, will be recognized in the next, or in
some succeeding generation, as no such result at all, but as a
foregone conclusion, based on some prevalent belief or fashion of the
time.
There are, of course, in every calling, those who go about the work
of the day before them, doing it according to the rules of their
craft, and asking no questions of the past or of the future, or of
the aim and end to which their special labor is contributing. These
often consider and call themselves practical men. They pull the oars
of society, and have no leisure to watch the currents running this or
that way; let theorists and philosophers attend to them. In the mean
time, however, these currents are carrying the practical men, too,
and all their work may be thrown away, and worse than thrown away, if
they do not take knowledge of them and get out of the wrong ones and
into the right ones as soon as they may. Sir Edward Parry and his
party were going straight towards the pole in one of their arctic
expeditions, travelling at the rate of ten miles a day. But the ice
over which they travelled was drifting straight towards the equator,
at the rate of twelve miles a day, and yet no man among them would
have known that he was travelling two miles a day backward unless he
had lifted his eyes from the track in which he was plodding. It is
not only going backward that the plain practical workman is liable
to, if he will not look up and look around; he may go forward to ends
he little dreams of. It is a simple business for a mason to build up
a niche in a wall; but what if, a hundred years afterwards when the
wall is torn down, the skeleton of a murdered man drop out of the
niche? It was a plain practical piece of carpentry for a Jewish
artisan to fit two pieces of timber together according to the legal
pattern in the time of Pontius Pilate; he asked no questions,
perhaps, but we know what burden the cross bore on the morrow! And
so, with subtler tools than trowels or axes, the statesman who works
in policy without principle, the theologian who works in forms
without a soul, the physician who, calling himself a practical man,
refuses to recognize the larger laws which govern his changing
practice, may all find that they have been building truth into the
wall, and hanging humanity upon the cross.
The truth is, that medicine, professedly founded on observation, is
as sensitive to outside influences, political, religious,
philosophical, imaginative, as is the barometer to the changes of
atmospheric density. Theoretically it ought to go on its own
straightforward inductive path, without regard to changes of
government or to fluctuations of public opinion. But look a moment
while I clash a few facts together, and see if some sparks do not
reveal by their light a closer relation between the Medical Sciences
and the conditions of Society and the general thought of the time,
than would at first be suspected.
Observe the coincidences between certain great political and
intellectual periods and the appearance of illustrious medical
reformers and teachers. It was in the age of Pericles, of Socrates,
of Plato, of Phidias, that Hippocrates gave to medical knowledge the
form which it retained for twenty centuries. With the world-
conquering Alexander, the world-embracing Aristotle, appropriating
anatomy and physiology, among his manifold spoils of study, marched
abreast of his royal pupil to wider conquests. Under the same
Ptolemies who founded the Alexandrian Library and Museum, and ordered
the Septuagint version of the Hebrew Scriptures, the infallible
Herophilus ["Contradicere Herophilo in anatomicis, est contradicere
evangelium," was a saying of Fallopius.] made those six hundred
dissections of which Tertullian accused him, and the sagacious
Erasistratus introduced his mild antiphlogistic treatment in
opposition to the polypharmacy and antidotal practice of his time.
It is significant that the large-minded Galen should have been the
physician and friend of the imperial philosopher Marcus Aurelius.
The Arabs gave laws in various branches of knowledge to those whom
their arms had invaded, or the terror of their spreading dominion had
reached, and the point from which they started was, as Humboldt
acknowledges, "the study of medicine, by which they long ruled the
Christian Schools," and to which they added the department of
chemical pharmacy.
Look at Vesalius, the contemporary of Luther. Who can fail to see
one common spirit in the radical ecclesiastic and the reforming
court-physician? Both still to some extent under the dominion of the
letter: Luther holding to the real presence; Vesalius actually
causing to be drawn and engraved two muscles which he knew were not
found in the human subject, because they had been described by Galen,
from dissections of the lower animals. Both breaking through old
traditions in the search of truth; one, knife in hand, at the risk of
life and reputation, the other at the risk of fire and fagot, with
that mightier weapon which all the devils could not silence, though
they had been thicker than the tiles on the house-tops. How much the
physician of the Catholic Charles V. had in common with the great
religious destructive, may be guessed by the relish with which he
tells the story how certain Pavian students exhumed the body of an
"elegans scortum," or lovely dame of ill repute, the favorite of a
monk of the order of St. Anthony, who does not seem to have resisted
temptation so well as the founder of his order. We have always
ranked the physician Rabelais among the early reformers, but I do not
know that Vesalius has ever been thanked for his hit at the morals of
the religious orders, or for turning to the good of science what was
intended for the "benefit of clergy."
Our unfortunate medical brother, Michael Servetus, the spiritual
patient to whom the theological moxa was applied over the entire
surface for the cure of his heresy, came very near anticipating
Harvey. The same quickened thought of the time which led him to
dispute the dogma of the Church, opened his mind to the facts which
contradicted the dogmas of the Faculty.
Harvey himself was but the posthumous child of the great Elizabethan
period. Bacon was at once his teacher and his patient. The founder
of the new inductive philosophy had only been dead two years when the
treatise on the Circulation, the first-fruit of the Restoration of
Science, was given to the world.
And is it to be looked at as a mere accidental coincidence, that
while Napoleon was modernizing the political world, Bichat was
revolutionizing the science of life and the art that is based upon
it; that while the young general was scaling the Alps, the young
surgeon was climbing the steeper summits of unexplored nature; that
the same year read the announcement of those admirable "Researches on
Life and Death," and the bulletins of the battle of Marengo?
If we come to our own country, who can fail to recognize that
Benjamin Rush, the most conspicuous of American physicians, was the
intellectual offspring of the movement which produced the Revolution?
"The same hand," says one of his biographers," which subscribed the
declaration of the political independence of these States,
accomplished their emancipation from medical systems formed in
foreign countries, and wholly unsuitable to the state of diseases in
America."
Following this general course of remark, I propose to indicate in a
few words the direction of the main intellectual current of the time,
and to point out more particularly some of the eddies which tend to
keep the science and art of medicine from moving with it, or even to
carry them backwards.
The two dominant words of our time are law and average, both pointing
to the uniformity of the order of being in which we live. Statistics
have tabulated everything,--population, growth, wealth, crime,
disease. We have shaded maps showing the geographical distribution
of larceny and suicide. Analysis and classification have been at
work upon all tangible and visible objects. The Positive Philosophy
of Comte has only given expression to the observing and computing
mind of the nineteenth century.
In the mean time, the great stronghold of intellectual conservatism,
traditional belief, has been assailed by facts which would have been
indicted as blasphemy but a few generations ago. Those new tables of
the law, placed in the hands of the geologist by the same living God
who spoke from Sinai to the Israelites of old, have remodelled the
beliefs of half the civilized world. The solemn scepticism of
science has replaced the sneering doubts of witty philosophers. The
more positive knowledge we gain, the more we incline to question all
that has been received without absolute proof.
As a matter of course, this movement has its partial reactions. The
province of faith is claimed as a port free of entry to unsupported
individual convictions. The tendency to question is met by the
unanalyzing instinct of reverence. The old church calls back its
frightened truants. Some who have lost their hereditary religious
belief find a resource in the revelations of Spiritualism. By a
parallel movement, some of those who have become medical infidels
pass over to the mystic band of believers in the fancied miracles of
Homoeopathy.
Under these influences transmitted to, or at least shared by, the
medical profession, the old question between "Nature," so called, and
"Art," or professional tradition, has reappeared with new interest.
I say the old question, for Hippocrates stated the case on the side
of "Nature" more than two thousand years ago. Miss Florence
Nightingale,--and if I name her next to the august Father of the
Healing Art, its noblest daughter well deserves that place of honor,
--Miss Florence Nightingale begins her late volume with a paraphrase
of his statement. But from a very early time to this there has
always been a strong party against "Nature." Themison called the
practice of Hippocrates "a meditation upon death." Dr. Rush says:
"It is impossible to calculate the mischief which Hippocrates, has
done, by first marking Nature with his name and afterwards letting
her loose upon sick people. Millions have perished by her hands in
all ages and countries." Sir John Forbes, whose defence of "Nature"
in disease you all know, and to the testimonial in whose honor four
of your Presidents have contributed, has been recently greeted, on
retiring from the profession, with a wish that his retirement had
been twenty years sooner, and the opinion that no man had done so
much to destroy the confidence of the public in the medical
profession.
In this Society we have had the Hippocratic and the Themisonic side
fairly represented. The treatise of one of your early Presidents on
the Mercurial Treatment is familiar to my older listeners. Others
who have held the same office have been noted for the boldness of
their practice, and even for partiality to the use of complex
medication.
On the side of "Nature" we have had, first of all, that remarkable
discourse on Self-Limited Diseases, [On Self-Limited Diseases. A
Discourse delivered before the Massachusetts Medical Society, at
their Annual Meeting, May 27, 1835. By Jacob Bigelow, M. D.] which
has given the key-note to the prevailing medical tendency of this
neighborhood, at least, for the quarter of a century since it was
delivered. Nor have we forgotten the address delivered at
Springfield twenty years later, [Search out the Secrets, of Nature.
By Augustus A. Gould, M. D. Read at the Annual Meeting, June 27,
1855.] full of good sense and useful suggestions, to one of which
suggestions we owe the learned, impartial, judicious, well-written
Prize Essay of Dr. Worthington Hooker. [Rational Therapeutics. A
Prize Essay. By Worthington Hooker, M. D., of New Haven. Boston.
1857.] We should not omit from the list the important address of
another of our colleagues, [On the Treatment of Compound and
Complicated Fractures. By William J. Walker, M. D. Read at the
Annual Meeting, May 29, 1845.] showing by numerous cases the power of
Nature in healing compound fractures to be much greater than is
frequently supposed,--affording, indeed, more striking illustrations
than can be obtained from the history of visceral disease, of the
supreme wisdom, forethought, and adaptive dexterity of that divine
Architect, as shown in repairing the shattered columns which support
the living temple of the body.
We who are on the side of "Nature" please ourselves with the idea
that we are in the great current in which the true intelligence of
the time is moving. We believe that some who oppose, or fear, or
denounce our movement are themselves caught in various eddies that
set back against the truth. And we do most earnestly desire and most
actively strive, that Medicine, which, it is painful to remember, has
been spoken of as "the withered branch of science" at a meeting of
the British Association, shall be at length brought fully to share,
if not to lead, the great wave of knowledge which rolls with the
tides that circle the globe.
If there is any State or city which might claim to be the American
headquarters of the nature-trusting heresy, provided it be one, that
State is Massachusetts, and that city is its capital. The effect
which these doctrines have upon the confidence reposed in the
profession is a matter of opinion. For myself, I do not believe this
confidence can be impaired by any investigations which tend to limit
the application of troublesome, painful, uncertain, or dangerous
remedies. Nay, I will venture to say this, that if every specific
were to fail utterly, if the cinchona trees all died out, and the
arsenic mines were exhausted, and the sulphur regions were burned up,
if every drug from the vegetable, animal, and mineral kingdom were to
disappear from the market, a body of enlightened men, organized as a
distinct profession, would be required just as much as now, and
respected and trusted as now, whose province should be to guard
against the causes of disease, to eliminate them if possible when
still present, to order all the conditions of the patient so as to
favor the efforts of the system to right itself, and to give those
predictions of the course of disease which only experience can
warrant, and which in so many cases relieve the exaggerated fears of
sufferers and their friends, or warn them in season of impending
danger. Great as the loss would be if certain active remedies could
no longer be obtained, it would leave the medical profession the most
essential part of it's duties, and all, and more than all, its
present share of honors; for it would be the death-blow to
charlatanism, which depends for its success almost entirely on drugs,
or at least on a nomenclature that suggests them.
There is no offence, then, or danger in expressing the opinion, that,
after all which has been said, the community is still overdosed: The
best proof of it is, that "no families take so little medicine as
those of doctors, except those of apothecaries, and that old
practitioners are more sparing of active medicines than younger
ones." [Dr. James Jackson has kindly permitted me to make the
following extract from a letter just received by him from Sir James
Clark, and dated May 26, 1860: "As a physician advances in age, he
generally, I think, places less confidence in the ordinary medical
treatment than he did, not only during his early, but even his middle
period of life."] The conclusion from these facts is one which the
least promising of Dr. Howe's pupils in the mental department could
hardly help drawing.
Part of the blame of over-medication must, I fear, rest with the
profession, for yielding to the tendency to self-delusion, which
seems inseparable from the practice of the art of healing. I need
only touch on the common modes of misunderstanding or misapplying the
evidence of nature.
First, there is the natural incapacity for sound observation, which
is like a faulty ear in music. We see this in many persons who know
a good deal about books, but who are not sharp-sighted enough to buy
a horse or deal with human diseases.
Secondly, there is in some persons a singular inability to weigh the
value of testimony; of which, I think, from a pretty careful
examination of his books, Hahnemann affords the best specimen outside
the walls of Bedlam.
The inveterate logical errors to which physicians have always been
subject are chiefly these:
The mode of inference per enumerationem simplicem, in scholastic
phrase; that is, counting only their favorable cases. This is the
old trick illustrated in Lord Bacon's story of the gifts of the
shipwrecked people, hung up in the temple.--Behold! they vowed these
gifts to the altar, and the gods saved them. Ay, said a doubting
bystander, but how many made vows of gifts and were shipwrecked
notwithstanding? The numerical system is the best corrective of this
and similar errors. The arguments commonly brought against its
application to all matters of medical observation, treatment
included, seem to apply rather to the tabulation of facts ill
observed, or improperly classified, than to the method itself.
The post hoc ergo propter hoc error: he got well after taking my
medicine; therefore in consequence of taking it.
The false induction from genuine facts of observation, leading to the
construction of theories which are then deductively applied in the
face of the results of direct observation. The school of Broussais
has furnished us with a good example of this error.
And lastly, the error which Sir Thomas Browne calls giving "a reason
of the golden tooth;" that is, assuming a falsehood as a fact, and
giving reasons for it, commonly fanciful ones, as is constantly done
by that class of incompetent observers who find their "golden tooth"
in the fabulous effects of the homoeopathie materia medica,--which
consists of sugar of milk and a nomenclature.
Another portion of the blame rests with the public itself, which
insists on being poisoned. Somebody buys all the quack medicines
that build palaces for the mushroom, say rather, the toadstool
millionaires. Who is it? These people have a constituency of
millions. The popular belief is all but universal that sick persons
should feed on noxious substances. One of our members was called not
long since to a man with a terribly sore mouth. On inquiry he found
that the man had picked up a box of unknown pills, in Howard Street,
and had proceeded to take them, on general principles, pills being
good for people. They happened to contain mercury, and hence the
trouble for which he consulted our associate.
The outside pressure, therefore, is immense upon the physician,
tending to force him to active treatment of some kind. Certain old
superstitions, still lingering in the mind of the public, and not yet
utterly expelled from that of the profession, are at the bottom of
this, or contribute to it largely. One of the most ancient is, that
disease is a malignant agency, or entity, to be driven out of the
body by offensive substances, as the smoke of the fish's heart and
liver drove the devil out of Tobit's bridal chamber, according to the
Apochrypha. Epileptics used to suck the blood from the wounds of
dying gladiators. [Plinii Hist. Mundi. lib. xxviii. c. 4.] The
Hon. Robert Boyle's little book was published some twenty or thirty
years before our late President, Dr. Holyoke, was born. [A Collection
of Choice and Safe Remedies. The Fifth Edition, corrected. London,
1712. Dr. Holyoke was born in 1728.] In it he recommends, as
internal medicines, most of the substances commonly used as
fertilizers of the soil. His "Album Graecum" is best left
untranslated, and his "Zebethum Occidentale" is still more
transcendentally unmentionable except in a strange dialect. It
sounds odiously to us to hear him recommend for dysentery a powder
made from "the sole of an old shoe worn by some man that walks much."
Perhaps nobody here ever heard of tying a stocking, which had been
worn during the day, round the neck at night for a sore throat. The
same idea of virtue in unlovely secretions! [The idea is very
ancient. "Sordes hominis" "Sudore et oleo medicinam facientibus."
--Plin. xxviii. 4.]
Even now the Homoeopathists have been introducing the venom of
serpents, under the learned title of Lachesis, and outraging human
nature with infusions of the pediculus capitis; that is, of course,
as we understand their dilutions, the names of these things; for if a
fine-tooth-comb insect were drowned in Lake Superior, we cannot agree
with them in thinking that every drop of its waters would be
impregnated with all the pedicular virtues they so highly value.
They know what they are doing. They are appealing to the detestable
old superstitious presumption in favor of whatever is nauseous and
noxious as being good for the sick.
Again, we all occasionally meet persons stained with nitrate of
silver, given for epilepsy. Read what Dr. Martin says, about the way
in which it came to be used, in his excellent address before the
Norfolk County Medical Society, and the evidence I can show, but have
not time for now, and then say what you think of the practice which
on such presumptions turns a white man as blue as the double-tattooed
King of the Cannibal Islands! [Note A.]
If medical superstitions have fought their way down through all the
rationalism and scepticism of the nineteenth century, of course the
theories of the schools, supported by great names, adopted into the
popular belief and incorporated with the general mass of
misapprehension with reference to disease, must be expected to meet
us at every turn in the shape of bad practice founded on false
doctrine. A French patient complains that his blood heats him, and
expects his doctor to bleed him. An English or American one says he
is bilious, and will not be easy without a dose of calomel. A doctor
looks at a patient's tongue, sees it coated, and says the stomach is
foul; his head full of the old saburral notion which the extreme
inflammation-doctrine of Broussais did so much to root out, but which
still leads, probably, to much needless and injurious wrong of the
stomach and bowels by evacuants, when all they want is to be let
alone. It is so hard to get anything out of the dead hand of medical
tradition! The mortmain of theorists extinct in science clings as
close as that of ecclesiastics defunct in law.
One practical hint may not be out of place here. It seems to be
sometimes forgotten, by those who must know the fact, that the tongue
is very different, anatomically and physiologically, from the
stomach. Its condition does not in the least imply a similar one of
the stomach, which is a very different structure, covered with a
different kind of epithelium, and furnished with entirely different
secretions. A silversmith will, for a dollar, make a small hoe, of
solid silver, which will last for centuries, and will give a patient
more comfort, used for the removal of the accumulated epithelium and
fungous growths which constitute the "fur," than many a prescription
with a split-footed Rx before it, addressed to the parts out of
reach.
I think more of this little implement on account of its agency in
saving the Colony at Plymouth in the year 1623. Edward Winslow heard
that Massasoit was sick and like to die. He found him with a
houseful of people about him, women rubbing his arms and legs, and
friends "making such a hellish noise" as they probably thought would
scare away the devil of sickness. Winslow gave him some conserve,
washed his mouth, scraped his tongue, which was in a horrid state,
got down some drink, made him some broth, dosed him with an infusion
of strawberry leaves and sassafras root, and had the satisfaction of
seeing him rapidly recover. Massasoit, full of gratitude, revealed
the plot which had been formed to destroy the colonists, whereupon
the Governor ordered Captain Miles Standish to see to them; who
thereupon, as everybody remembers, stabbed Pecksuot with his own
knife, broke up the plot, saved the colony, and thus rendered
Massachusetts and the Massachusetts Medical Society a possibility, as
they now are a fact before us. So much for this parenthesis of the
tongue-scraper, which helped to save the young colony from a much
more serious scrape, and may save the Union yet, if a Presidential
candidate should happen to be taken sick as Massasoit was, and his
tongue wanted cleaning,--which process would not hurt a good many
politicians, with or without a typhoid fever.
Again, see how the "bilious" theory works in every-day life here and
now, illustrated by a case from actual life. A youthful
practitioner, whose last molars have not been a great while cut,
meets an experienced and noted physician in consultation. This is
the case. A slender, lymphatic young woman is suckling two lusty
twins, the intervals of suction being occupied on her part with
palpitations, headaches, giddiness, throbbing in the head, and
various nervous symptoms, her cheeks meantime getting bloodless, and
her strength running away in company with her milk. The old
experienced physician, seeing the yellowish waxy look which is common
in anaemic patients, considers it a "bilious" case, and is for giving
a rousing emetic. Of course, he has to be wheedled out of this, a
recipe is written for beefsteaks and porter, the twins are
ignominiously expelled from the anaemic bosom, and forced to take
prematurely to the bottle, and this prolific mother is saved for
future usefulness in the line of maternity.
The practice of making a profit on the medicine ordered has been held
up to reprobation by one at least of the orators who have preceded
me. That the effect of this has been ruinous in English practice I
cannot doubt, and that in this country the standard of practice was
in former generations lowered through the same agency is not
unlikely. I have seen an old account-book in which the physician
charged an extra price for gilding his rich patients' pills. If all
medicine were very costly, and the expense of it always came out of
the physician's fee, it would really be a less objectionable
arrangement than this other most pernicious one. He would naturally
think twice before he gave an emetic or cathartic which evacuated his
own pocket, and be sparing of the cholagogues that emptied the
biliary ducts of his own wallet, unless he were sure they were
needed. If there is any temptation, it should not be in favor of
giving noxious agents, as it clearly must be in the case of English
druggists and "General Practitioners." The complaint against the
other course is a very old one. Pliny, inspired with as truly Roman
horror of quackery as the elder Cato,--who declared that the Greek
doctors had sworn to exterminate all barbarians, including the
Romans, with their drugs, but is said to have physicked his own wife
to death, notwithstanding,--Pliny says, in so many words, that the
cerates and cataplasms, plasters, collyria, and antidotes, so
abundant in his time, as in more recent days, were mere tricks to
make money.
A pretty strong eddy, then, or rather many eddies, setting constantly
back from the current of sober observation of nature, in the
direction of old superstitions and fancies, of exploded theories, of
old ways of making money, which are very slow to pass out of fashion
But there are other special American influences which we are bound to
take cognizance of. If I wished to show a student the difficulties
of getting at truth from medical experience, I would give him the
history of epilepsy to read. If I wished him to understand the
tendencies of the American medical mind, its sanguine enterprise, its
self-confidence, its audacious handling of Nature, its impatience
with her old-fashioned ways of taking time to get a sick man well, I
would make him read the life and writings of Benjamin Rush. Dr. Rush
thought and said that there were twenty times more intellect and a
hundred times more knowledge in the country in 1799 than before the
Revolution. His own mind was in a perpetual state of exaltation
produced by the stirring scenes in which he had taken a part, and the
quickened life of the time in which he lived. It was not the state
to favor sound, calm observation. He was impatient, and Nature is
profoundly imperturbable. We may adjust the beating of our hearts to
her pendulum if we will and can, but we may be very sure that she
will not change the pendulum's rate of going because our hearts are
palpitating. He thought he had mastered yellow-fever. "Thank God,"
he said, "out of one hundred patients whom I have visited or
prescribed for this day, I have lost none." Where was all his legacy
of knowledge when Norfolk was decimated? Where was it when the blue
flies were buzzing over the coffins of the unburied dead piled up in
the cemetery of New Orleans, at the edge of the huge trenches yawning
to receive them?
One such instance will do as well as twenty. Dr. Rush must have been
a charming teacher, as he was an admirable man. He was observing,
rather than a sound observer; eminently observing, curious, even,
about all manner of things. But he could not help feeling as if
Nature had been a good deal shaken by the Declaration of
Independence, and that American art was getting to be rather too much
for her,--especially as illustrated in his own practice. He taught
thousands of American students, he gave a direction to the medical
mind of the country more than any other one man; perhaps he typifies
it better than any other. It has clearly tended to extravagance in
remedies and trust in remedies, as in everything else. How could a
people which has a revolution once in four years, which has contrived
the Bowie-knife and the revolver, which has chewed the juice out of
all the superlatives in the language in Fourth of July orations, and
so used up its epithets in the rhetoric of abuse that it takes two
great quarto dictionaries to supply the demand; which insists in
sending out yachts and horses and boys to out-sail, out-run, out-
fight, and checkmate all the rest of creation; how could such a
people be content with any but "heroic" practice? What wonder that
the stars and stripes wave over doses of ninety grains of sulphate of
quinine, [More strictly, ninety-six grains in two hours. Dunglison's
Practice, 1842, vol. ii. p. 520. Eighty grains in one dose.
Ibid. p. 536. Ninety-six grains of sulphate of quinine are equal
to eight ounces of good bark.--Wood & Bache.] and that the American
eagle screams with delight to see three drachms of calomel given at a
single mouthful?
Add to this the great number of Medical Journals, all useful, we
hope, most of them necessary, we trust, many of them excellently well
conducted, but which must find something to fill their columns, and
so print all the new plans of treatment and new remedies they can get
hold of, as the newspapers, from a similar necessity, print the
shocking catastrophes and terrible murders.
Besides all this, here are we, the great body of teachers in the
numberless medical schools of the Union, some of us lecturing to
crowds who clap and stamp in the cities, some of us wandering over
the country, like other professional fertilizers, to fecundate the
minds of less demonstrative audiences at various scientific stations;
all of us talking habitually to those supposed to know less than
ourselves, and loving to claim as much for our art as we can, not to
say for our own schools, and possibly indirectly for our own
practical skill. Hence that annual crop of introductory lectures;
the useful blossoming into the ornamental, as the cabbage becomes
glorified in the cauliflower; that lecture-room literature of
adjectives, that declamatory exaggeration, that splendid show of
erudition borrowed from D'Israeli, and credited to Lord Bacon and the
rest, which have suggested to our friends of the Medical Journals an
occasional epigram at our expense. Hence the tendency in these
productions, and in medical lectures generally, to overstate the
efficacy of favorite methods of cure, and hence the premium offered
for showy talkers rather than sagacious observers, for the men of
adjectives rather than of nouns substantive in the more ambitious of
these institutions.
Such are some of the eddies in which we are liable to become involved
and carried back out of the broad stream of philosophical, or, in
other words, truth-loving, investigations. The causes of disease, in
the mean time, have been less earnestly studied in the eagerness of
the search for remedies. Speak softly! Women have been borne out
from an old-world hospital, two in one coffin, that the horrors of
their prison-house might not be known, while the very men who were
discussing the treatment of the disease were stupidly conveying the
infection from bed to bed, as rat-killers carry their poisons from
one household to another. Do not some of you remember that I have
had to fight this private-pestilence question against a scepticism
which sneered in the face of a mass of evidence such as the calm
statisticians of the Insurance office could not listen to without
horror and indignation? ["The Contagiousness of Puerperal Fever."--
N. E. Quar. Jour. of Medicine and Surgery, April, 1843. Reprinted,
with Additions. Boston: Ticknor & Fields. 1855.] Have we forgotten
what is told in one of the books published under our own sanction,
that a simple measure of ventilation, proposed by Dr. John Clark, had
saved more than sixteen thousand children's lives in a single
hospital? How long would it have taken small doses of calomel and
rhubarb to save as many children? These may be useful in prudent
hands, but how insignificant compared to the great hygienic
conditions! Causes, causes, and again causes,--more and more we fall
back on these as the chief objects of our attention. The shortest
system of medical practice that I know of is the oldest, but not the
worst. It is older than Hippocrates, older than Chiron the Centaur.
Nature taught it to the first mother when she saw her first-born
child putting some ugly pebble or lurid berry into its mouth. I know
not in what language it was spoken, but I know that in English it
would sound thus: Spit it out!
Art can do something more than say this. It can sometimes reach the
pebble or berry after it has been swallowed. But the great thing is
to keep these things out of children's mouths, and as soon as they
are beyond our reach, to be reasonable and patient with Nature, who
means well, but does not like to hurry, and who took nine calendar
months, more or less, to every mother's son among us, before she
thought he was fit to be shown to the public.
Suffer me now to lay down a few propositions, whether old or new it
matters little, not for your immediate acceptance, nor yet for your
hasty rejection, but for your calm consideration.
But first, there are a number of terms which we are in the habit of
using in a vague though not unintelligible way, and which it is as
well now to define. These terms are the tools with which we are to
work, and the first thing is to sharpen them. It is nothing to us
that they have been sharpened a thousand times before; they always
get dull in the using, and every new workman has a right to carry
them to the grindstone and sharpen them to suit himself.
Nature, in medical language, as opposed to Art, means trust in the
reactions of the living system against, ordinary normal impressions.
Art, in the same language, as opposed to Nature, means an intentional
resort to extraordinary abnormal impressions for the relief of
disease.
The reaction of the living system is the essence of both. Food is
nothing, if there is no digestive act to respond to it. We cannot
raise a blister on a dead man, or hope that a carminative forced
between his lips will produce its ordinary happy effect.
Disease, dis-ease,--disturbed quiet, uncomfortableness,--means
imperfect or abnormal reaction of the living system, and its more or
less permanent results.
Food, in its largest sense, is whatever helps to build up the normal
structures, or to maintain their natural actions.
Medicine, in distinction from food, is every unnatural or noxious
agent applied for the relief of disease.
Physic means properly the Natural art, and Physician is only the
Greek synonyme of Naturalist.
With these few explanations I proceed to unfold the propositions I
have mentioned.
Disease and death, if we may judge by the records of creation, are
inherently and essentially necessary in the present order of things.
A perfect intelligence, trained by a perfect education, could do no
more than keep the laws of the physical and spiritual universe. An
imperfect intelligence, imperfectly taught,--and this is the
condition of our finite humanity,--will certainly fail to keep all
these laws perfectly. Disease is one of the penalties of one of the
forms of such failure. It is prefigured in the perturbations of the
planets, in the disintegration of the elemental masses; it has left
its traces in the fossil organisms of extinct creations. [Professor
Agassiz has kindly handed me the following note: "There are abnormal
structures in animals of all ages anterior to the creation of
mankind. Malformed specimens of Crinoids are known from the Triassic
and Jurassic deposits. Malformed and diseased bones of tertiary
mammalia have been collected in the caverns of Gailenreuth with
traces of healing."]
But it is especially the prerogative, I had almost said privilege, of
educated and domesticated beings, from man down to the potato,
serving to teach them, and such as train them, the laws of life, and
to get rid of those who will not mind or cannot be kept subject to
these laws.
Disease, being always an effect, is always in exact proportion to the
sum of its causes, as much in the case of Spigelius, who dies of a
scratch, as in that of the man who recovers after an iron bar has
been shot through his brain. The one prevalent failing of the
medical art is to neglect the causes and quarrel with the effect.
There are certain general facts which include a good deal of what is
called and treated as disease. Thus, there are two opposite
movements of life to be seen in cities and elsewhere, belonging to
races which, from various persistent causes, are breeding down and
tending to run out, and to races which are breeding up, or
accumulating vital capital,--a descending and an ascending series.
Let me give an example of each; and that I may incidentally remove a
common impression about this country as compared with the Old World,
an impression which got tipsy with conceit and staggered into the
attitude of a formal proposition in the work of Dr. Robert Knox, I
will illustrate the downward movement from English experience, and
the upward movement from a family history belonging to this immediate
neighborhood.
Miss Nightingale speaks of "the fact so often seen of a
great-grandmother, who was a tower of physical vigor, descending into
a grandmother perhaps a little less vigorous, but still sound as a
bell, and healthy to the core, into a mother languid and confined to
her carriage and house; and lastly into a daughter sickly and
confined to her bed." So much for the descending English series; now
for the ascending American series.
Something more than one hundred and thirty years ago there graduated
at Harvard College a delicate youth, who lived an invalid life and
died at the age of about fifty. His two children were both of
moderate physical power, and one of them diminutive in stature. The
next generation rose in physical development, and reached eighty
years of age and more in some of its members. The fourth generation
was of fair average endowment. The fifth generation, great-great-
grandchildren of the slender invalid, are several of, them of
extraordinary bodily and mental power; large in stature, formidable
alike with their brains and their arms, organized on a more extensive
scale than either of their parents.
This brief account illustrates incidentally the fallacy of the
universal-degeneration theory applied to American life; the same on
which one of our countrymen has lately brought some very forcible
facts to bear in a muscular discussion of which we have heard rather
more than is good for us. But the two series, American and English,
ascending and descending, were adduced with the main purpose of
showing the immense difference of vital endowments in different
strains of blood; a difference to which all ordinary medication is in
all probability a matter of comparatively trivial purport. Many
affections which art has to strive against might be easily shown to
be vital to the well-being of society. Hydrocephalus, tabes
mesenterica, and other similar maladies, are natural agencies which
cut off the children of races that are sinking below the decent
minimum which nature has established as the condition of viability,
before they reach the age of reproduction. They are really not so
much diseases, as manifestations of congenital incapacity for life;
the race would be ruined if art could ever learn always to preserve
the individuals subject to them. We must do the best we can for
them, but we ought also to know what these "diseases" mean.
Again, invalidism is the normal state of many organizations. It can
be changed to disease, but never to absolute health by medicinal
appliances. There are many ladies, ancient and recent, who are
perpetually taking remedies for irremediable pains and aches. They
ought to have headaches and back-aches and stomach-aches; they are
not well if they do not have them. To expect them to live without
frequent twinges is like expecting a doctor's old chaise to go
without creaking; if it did, we might be sure the springs were
broken. There is no doubt that the constant demand for medicinal
remedies from patients of this class leads to their over-use; often
in the case of cathartics, sometimes in that of opiates. I have been
told by an intelligent practitioner in a Western town, that the
constant prescription of opiates by certain physicians in his
vicinity has rendered the habitual use of that drug in all that
region very prevalent; more common, I should think, than alcoholic
drunkenness in the most intemperate localities of which I have known
anything. A frightful endemic demoralization betrays itself in the
frequency with which the haggard features and drooping shoulders of
the opium-drunkards are met with in the streets.
The next proposition I would ask you to consider is this:
The presumption always is that every noxious agent, including
medicines proper, which hurts a well man, hurts a sick one.
[ Note B.]
Let me illustrate this proposition before you decide upon it. If it
were known that a prize-fighter were to have a drastic purgative
administered two or three days before a contest, or a large blister
applied to his back, no one will question that it would affect the
betting on his side unfavorably; we will say to the amount of five
per cent. Now the drain upon the resources of the system produced in
such a case must be at its minimum, for the subject is a powerful
man, in the prime of life, and in admirable condition. If the drug
or the blister takes five per cent. from his force of resistance, it
will take at least as large a fraction from any invalid. But this
invalid has to fight a champion who strikes hard but cannot be hit in
return, who will press him sharply for breath, but will never pant
himself while the wind can whistle through his fleshless ribs. The
suffering combatant is liable to want all his stamina, and five per
cent. may lose him the battle.
All noxious agents, all appliances which are not natural food or
stimuli, all medicines proper, cost a patient, on the average, five
per cent. of his vital force, let us say. Twenty times as much waste
of force produced by any of them, that is, would exactly kill him,
nothing less than kill him, and nothing more. If this, or something
like this, is true, then all these medications are, prima facie,
injurious.
In the game of Life-or-Death, Rouge et Noir, as played between the
Doctor and the Sexton, this five per cent., this certain small injury
entering into the chances is clearly the sexton's perquisite for
keeping the green table, over which the game is played, and where he
hoards up his gains. Suppose a blister to diminish a man's pain,
effusion or dyspnoea to the saving of twenty per cent. in vital
force; his profit from it is fifteen, in that case, for it always
hurts him five to begin with, according to our previous assumption.
Presumptions are of vast importance in medicine, as in law. A man is
presumed innocent until he is proved guilty. A medicine--that is, a
noxious agent, like a blister, a seton, an emetic, or a cathartic--
should always be presumed to be hurtful. It always is directly
hurtful; it may sometimes be indirectly beneficial. If this
presumption were established, and disease always assumed to be the
innocent victim of circumstances, and not punishable by medicines,
that is, noxious agents, or poisons, until the contrary was shown, we
should not so frequently hear the remark commonly, perhaps
erroneously, attributed to Sir Astley Cooper, but often repeated by
sensible persons, that, on the whole, more harm than good is done by
medication. Throw out opium, which the Creator himself seems to
prescribe, for we often see the scarlet poppy growing in the
cornfields, as if it were foreseen that wherever there is hunger to
be fed there must also be pain to be soothed; throw out a few
specifics which our art did not discover, and is hardly needed to
apply [ Note C.]; throw out wine, which is a food, and the vapors
which produce the miracle of anaesthesia, and I firmly believe that
if the whole materia medica, as now used, could be sunk to the bottom
of the sea, it would be all the better for mankind,--and all the
worse for the fishes.
But to justify this proposition, I must add that the injuries
inflicted by over-medication are to a great extent masked by disease.
Dr. Hooker believes that the typhus syncopatia of a preceding
generation in New England "was often in fact a brandy and opium
disease." How is a physician to distinguish the irritation produced
by his blister from that caused by the inflammation it was meant to
cure? How can he tell the exhaustion produced by his evacuants from
the collapse belonging to the disease they were meant to remove?
Lastly, medication without insuring favorable hygienic conditions is
like amputation without ligatures. I had a chance to learn this well
of old, when physician to the Broad Street district of the Boston
Dispensary. There, there was no help for the utter want of wholesome
conditions, and if anybody got well under my care, it must have been
in virtue of the rough-and-tumble constitution which emerges from the
struggle for life in the street gutters, rather than by the aid of my
prescriptions.
But if the materia medica were lost overboard, how much more pains
would be taken in ordering all the circumstances surrounding the
patient (as can be done everywhere out of the crowded pauper
districts), than are taken now by too many who think they do their
duty and earn their money when they write a recipe for a patient left
in an atmosphere of domestic malaria, or to the most negligent kind
of nursing! I confess that I should think my chance of recovery from
illness less with Hippocrates for my physician and Mrs. Gamp for my
nurse, than if I were in the hands of Hahnemann himself, with
Florence Nightingale or good Rebecca Taylor to care for me.
If I am right in maintaining that the presumption is always against
the use of noxious agents in disease, and if any whom I might
influence should adopt this as a principle of practice, they will
often find themselves embarrassed by the imperative demand of
patients and their friends for such agents where a case is not made
out against this standing presumption. I must be permitted to say,
that I think the French, a not wholly uncivilized people, are in
advance of the English and ourselves in the art of prescribing for
the sick without hurting them. And I do confess that I think their
varied ptisans and syrups are as much preferable to the mineral
regimen of bug-poison and ratsbane, so long in favor on the other
side of the Channel, as their art of preparing food for the table to
the rude cookery of those hard-feeding and much-dosing islanders.
We want a reorganized cuisine of invalidism perhaps as much as the
culinary, reform, for which our lyceum lecturers, and others who live
much at hotels and taverns, are so urgent. Will you think I am
disrespectful if I ask whether, even in Massachusetts, a dose of
calomel is not sometimes given by a physician on the same principle
as that upon which a landlord occasionally prescribes bacon and
eggs,--because he cannot think of anything else quite so handy? I
leave my suggestion of borrowing a hint from French practice to your
mature consideration.
I may, however, call your attention, briefly, to the singular fact,
that English and American practitioners are apt to accuse French
medical practice of inertness, and French surgical practice of
unnecessary activity. Thus, Dr. Bostock considers French medical
treatment, with certain exceptions, as "decidedly less effective"
than that of his own country. Mr. S. Cooper, again, defends the
simple British practice of procuring union by the first intention
against the attacks of M. Roux and Baron Larrey. [Cooper's Surg.
Diet. art. "Wounds." Yet Mr. John Bell gives the French surgeons
credit for introducing this doctrine of adhesion, and accuses
O'Halloran of "rudeness and ignorance," and "bold, uncivil language,"
in disputing their teaching. Princ. of Surgery, vol. i. p. 42.
Mr. Hunter succeeded at last in naturalizing the doctrine and
practice, but even he had to struggle against the perpetual jealousy
of rivals, and died at length assassinated by an insult.] We have
often heard similar opinions maintained by our own countrymen. While
Anglo-American criticism blows hot or cold on the two departments of
French practice, it is not, I hope, indecent to question whether all
the wisdom is necessarily with us in both cases.
Our art has had two or three lessons which have a deep meaning to
those who are willing to read them honestly. The use of water-
dressings in surgery completed the series of reforms by which was
abolished the "coarse and cruel practice" of the older surgeons, who
with their dressings and acrid balsams, their tents and leaden tubes,
"absolutely delayed the cure." The doctrine of Broussais, transient
as was its empire, reversed the practice of half of Christendom for a
season, and taught its hasty disciples to shun their old favorite
remedies as mortal poisons. This was not enough permanently to shift
the presumption about drugs where it belonged, and so at last, just
as the sympathetic powder and the Unguentum Armarium came in a
superstitious age to kill out the abuses of external over-medication,
the solemn farce of Homoeopathy was enacted in the face of our own
too credulous civilization, that under shelter of its pretences the
"inward bruises" of over-drugged viscera might be allowed to heal by
the first intention. Its lesson we must accept, whether we will or
not; its follies we are tired of talking about. The security of the
medical profession against this and all similar fancies is in the
average constitution of the human. mind with regard to the laws of
evidence.
My friends and brothers in Art! There is nothing to be feared from
the utterance of any seeming heresy to which you may have listened.
I cannot compromise your collective wisdom. If I have strained the
truth one hair's breadth for the sake of an epigram or an antithesis,
you are accustomed to count the normal pulse-beats of sound judgment,
and know full well how to recognize the fever-throbs of conceit and
the nervous palpitations of rhetoric.
The freedom with which each of us speaks his thought in this
presence, belongs in part to the assured position of the Profession
in our Commonwealth, to the attitude of Science, which is always
fearless, and to the genius of the soil on which we stand, from which
Nature withheld the fatal gift of malaria only to fill it with
exhalations that breed the fever of inquiry in our blood and in our
brain. But mainly we owe the large license of speech we enjoy to
those influences and privileges common to us all as self-governing
Americans.
This Republic is the chosen home of minorities, of the less power in
the presence of the greater. It is a common error to speak of our
distinction as consisting in the rule of the majority. Majorities,
the greater material powers, have always ruled before. The history
of most countries has been that of majorities, mounted majorities,
clad in iron, armed with death treading down the tenfold more
numerous minorities. In the old civilizations they root themselves
like oaks in the soil; men must live in their shadow or cut them
down. With us the majority is only the flower of the passing noon,
and the minority is the bud which may open in the next morning's sun.
We must be tolerant, for the thought which stammers on a single
tongue today may organize itself in the growing consciousness of the
time, and come back to us like the voice of the multitudinous waves
of the ocean on the morrow.
Twenty-five years have passed since one of your honored Presidents
spoke to this Society of certain limitations to the power of our Art,
now very generally conceded. Some were troubled, some were almost
angry, thinking the Profession might suffer from such concessions.
It has certainly not suffered here; if, as some affirm, it has lost
respect anywhere, it was probably for other, and no doubt sufficient
reasons.
Since that time the civilization of this planet has changed hands.
Strike out of existence at this moment every person who was breathing
on that day, May 27, 1835, and every institution of society, every
art and every science would remain intact and complete in the living
that would be left. Every idea the world then held has been since
dissolved and recrystallized.
We are repeating the same process. Not to make silver shrines for
our old divinities, even though by this craft we should have our
wealth, was this Society organized and carried on by the good men and
true who went before us. Not for this, but to melt the gold out of
the past, though its dross should fly in dust to all the winds of
heaven, to save all our old treasures of knowledge and mine deeply
for new, to cultivate that mutual respect of which outward courtesy
is the sign, to work together, to feel together, to take counsel
together, and to stand together for the truth, now, always, here,
everywhere; for this our fathers instituted, and we accept, the
offices and duties of this time-honored Society.
BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.
An Introductory Lecture delivered before the Medical Class
of Harvard University, November 6, 1861.
[This Lecture appears as it would have been delivered had the time
allowed been less strictly, limited. Passages necessarily omitted
have been restored, and points briefly touched have been more fully
considered. A few notes have been added for the benefit of that
limited class of students who care to track an author through the
highways and by-ways of his reading. I owe my thanks to several of
my professional brethren who have communicated with me on subjects
with which they are familiar; especially to Dr. John Dean, for the
opportunity of profiting by his unpublished labors, and to Dr. Hasket
Derby, for information and references to recent authorities relating
to the anatomy and physiology of the eye.]
The entrance upon a new course of Lectures is always a period of
interest to instructors and pupils. As the birth of a child to a
parent, so is the advent of a new class to a teacher. As the light
of the untried world to the infant, so is the dawning of the light
resting over the unexplored realms of science to the student. In the
name of the Faculty I welcome you, Gentlemen of the Medical Class,
new-born babes of science, or lustier nurslings, to this morning of
your medical life, and to the arms and the bosom of this ancient
University. Fourteen years ago I stood in this place for the first
time to address those who occupied these benches. As I recall these
past seasons of our joint labors, I feel that they have been on the
whole prosperous, and not undeserving of their prosperity.
For it has been my privilege to be associated with a body of true and
faithful workers; I cannot praise them freely to their faces, or I
should be proud to discourse of the harmonious diligence and the
noble spirit in which they have toiled together, not merely to teach
their several branches, but to elevate the whole standard of
teaching.
I may speak with less restraint of those gentlemen who have aided me
in the most laborious part of my daily duties, the Demonstrators, to
whom the successive classes have owed so much of their instruction.
They rise before me, the dead and the living, in the midst of the
most grateful recollections. The fair, manly face and stately figure
of my friend, Dr. Samuel Parkman, himself fit for the highest offices
of teaching, yet willing to be my faithful assistant in the time of
need, come back to me with the long sigh of regret for his early loss
to our earthly companionship. Every year I speak the eulogy of Dr.
Ainsworth's patient toil as I show his elaborate preparations: When I
take down my "American Cyclopaedia" and borrow instruction from the
learned articles of Dr. Kneeland, I cease to regret that his
indefatigable and intelligent industry was turned into a broader
channel. And what can I say too cordial of my long associated
companion and friend, Dr. Hodges, whose admirable skill, working
through the swiftest and surest fingers that ever held a scalpel
among us, has delighted class after class, and filled our Museum with
monuments which will convey his name to unborn generations?
This day belongs, however, not to myself and my recollections, but to
all of us who teach and all of you who listen, whether experts in our
specialties or aliens to their mysteries, or timid neophytes just
entering the portals of the hall of science. Look in with me, then,
while I attempt to throw some rays into its interior, which shall
illuminate a few of its pillars and cornices, and show at the same
time how many niches and alcoves remain in darkness.
SCIENCE is the topography of ignorance. From a few elevated points
we triangulate vast spaces, inclosing infinite unknown details. We
cast the lead, and draw up a little sand from abysses we may never
reach with our dredges.
The best part of our knowledge is that which teaches us where
knowledge leaves off and ignorance begins. Nothing more clearly
separates a vulgar from a superior mind, than the confusion in the
first between the little that it truly knows, on the one hand, and
what it half knows and what it thinks it knows on the other.
That which is true of every subject is especially true of the branch
of knowledge which deals with living beings. Their existence is a
perpetual death and reanimation. Their identity is only an idea, for
we put off our bodies many times during our lives, and dress in new
suits of bones and muscles.
"Thou art not thyself;
For thou exist'st on many a thousand grains
That issue out of dust."
If it is true that we understand ourselves but imperfectly in health,
this truth is more signally manifested in disease, where natural
actions imperfectly understood, disturbed in an obscure way by half-
seen causes, are creeping and winding along in the dark toward their
destined issue, sometimes using our remedies as safe stepping-stones,
occasionally, it may be, stumbling over them as obstacles.
I propose in this lecture to show you some points of contact between
our ignorance and our knowledge in several of the branches upon the
study of which you are entering. I may teach you a very little
directly, but I hope much more from the trains of thought I shall
suggest. Do not expect too much ground to be covered in this rapid
survey. Our task is only that of sending out a few pickets under the
starry flag of science to the edge of that dark domain where the
ensigns of the obstinate rebel, Ignorance, are flying undisputed. We
are not making a reconnoissance in force, still less advancing with
the main column. But here are a few roads along which we have to
march together, and we wish to see clearly how far our lines extend,
and where the enemy's outposts begin.
Before touching the branches of knowledge that deal with organization
and vital functions, let us glance at that science which meets you at
the threshold of your study, and prepares you in some measure to deal
with the more complex problems of the living laboratory.
CHEMISTRY. includes the art of separating and combining the elements
of matter, and the study of the changes produced by these operations.
We can hardly say too much of what it has contributed to our
knowledge of the universe and our power of dealing with its
materials. It has given us a catalogue raisonne of the substances
found upon our planet, and shown how everything living and dead is
put together from them. It is accomplishing wonders before us every
day, such as Arabian story-tellers used to string together in their
fables. It spreads the, sensitive film on the artificial retina
which looks upon us through the optician's lens for a few seconds,
and fixes an image that will outlive its original. It questions the
light of the sun, and detects the vaporized metals floating around
the great luminary,--iron, sodium, lithium, and the rest,--as if the
chemist of our remote planet could fill his bell-glasses from its
fiery atmosphere. It lends the power which flashes our messages in
thrills that leave the lazy chariot of day behind them. It seals up
a few dark grains in iron vases, and lo! at the touch of a single
spark, rises in smoke and flame a mighty Afrit with a voice like
thunder and an arm that shatters like an earthquake. The dreams of
Oriental fancy have become the sober facts of our every-day life, and
the chemist is the magician to whom we owe them.
To return to the colder scientific aspect of chemistry. It has shown
us how bodies stand affected to each other through an almost
boundless range of combinations. It has given us a most ingenious
theory to account for certain fixed relations in these combinations.
It has successfully eliminated a great number of proximate compounds,
more or less stable, from organic structures. It has invented others
which form the basis of long series of well-known composite
substances. In fact, we are perhaps becoming overburdened with our
list of proximate principles, demonstrated and hypothetical.
How much nearer have we come to the secret of force than Lully and
Geber and the whole crew of juggling alchemists? We have learned a
great deal about the how, what have we learned about the why?
Why does iron rust, while gold remains untarnished, and gold
amalgamate, while iron refuses the alliance of mercury?
The alchemists called gold Sol, the sun, and iron Mars, and pleased
themselves with fancied relations between these substances and the
heavenly bodies, by which they pretended to explain the facts they
observed. Some of their superstitions have lingered in practical
medicine to the present day, but chemistry has grown wise enough to
confess the fact of absolute ignorance.
What is it that makes common salt crystallize in the form of cubes,
and saltpetre in the shape of six-sided prisms? We see no reason why
it should not have been just the other way, salt in prisms and
saltpetre in cubes, or why either should take an exact geometrical
outline, any more than coagulating albumen.
But although we had given up attempting to explain the essential
nature of affinities and of crystalline types, we might have supposed
that we had at least fixed the identity of the substances with which
we deal, and determined the laws of their combination. All at once
we find that a simple substance changes face, puts off its
characteristic qualities and resumes them at will;--not merely when
we liquefy or vaporize a solid, or reverse the process; but that a
solid is literally transformed into another solid under our own eyes.
We thought we knew phosphorus. We warm a portion of it sealed in an
empty tube, for about a week. It has become a brown infusible
substance, which does not shine in the dark nor oxidate in the air.
We heat it to 500 F., and it becomes common phosphorus again. We
transmute sulphur in the same singular way. Nature, you know, gives
us carbon in the shape of coal and in that of the diamond. It is
easy to call these changes by the name allotropism, but not the less
do they confound our hasty generalizations.
These facts of allotropism have some corollaries connected with them
rather startling to us of the nineteenth century. There may be other
transmutations possible besides those of phosphorus and sulphur.
When Dr. Prout, in 1840, talked about azote and carbon being "formed"
in the living system, it was looked upon as one of those freaks of
fancy to which philosophers, like other men, are subject. But when
Professor Faraday, in 1851, says, at a meeting of the British
Association, that "his hopes are in the direction of proving that
bodies called simple were really compounds, and may be formed
artificially as soon as we are masters of the laws influencing their
combinations,"--when he comes forward and says that he has tried
experiments at transmutation, and means, if his life is spared, to
try them again,--how can we be surprised at the popular story of
1861, that Louis Napoleon has established a gold-factory and is
glutting the mints of Europe with bullion of his own making?
And so with reference to the law of combinations. The old maxim was,
Corpora non agunt nisi soluta. If two substances, a and b, are
inclosed in a glass vessel, c, we do not expect the glass to change
them, unless a or b or the compound a b has the power of dissolving
the glass. But if for a I take oxygen, for b hydrogen, and for c a
piece of spongy platinum, I find the first two combine with the
common signs of combustion and form water, the third in the mean time
undergoing no perceptible change. It has played the part of the
unwedded priest, who marries a pair without taking a fee or having
any further relation with the parties. We call this catalysis,
catalytic action, the action of presence, or by what learned name we
choose. Give what name to it we will, it is a manifestation of power
which crosses our established laws of combination at a very open
angle of intersection. I think we may find an analogy for it in
electrical induction, the disturbance of the equilibrium of the
electricity of a body by the approach of a charged body to it,
without interchange of electrical conditions between the two bodies.
But an analogy is not an explanation, and why a few drops of yeast
should change a saccharine mixture to carbonic acid and alcohol,--a
little leaven leavening the whole lump,--not by combining with it,
but by setting a movement at work, we not only cannot explain, but
the fact is such an exception to the recognized laws of combination
that Liebig is unwilling to admit the new force at all to which
Berzelius had given the name so generally accepted.
The phenomena of isomerism, or identity of composition and
proportions of constituents with difference of qualities, and of
isomorphism, or identity of form in crystals which have one element
substituted for another, were equally surprises to science; and
although the mechanism by which they are brought about can be to a
certain extent explained by a reference to the hypothetical atoms of
which the elements are constituted, yet this is only turning the
difficulty into a fraction with an infinitesimal denominator and an
infinite numerator.
So far we have studied the working of force and its seeming anomalies
in purely chemical phenomena. But we soon find that chemical force
is developed by various other physical agencies,--by heat, by light,
by electricity, by magnetism, by mechanical agencies; and, vice
versa, that chemical action develops heat, light, electricity,
magnetism, mechanical force, as we see in our matches, galvanic
batteries, and explosive compounds. Proceeding with our experiments,
we find that every kind of force is capable of producing all other
kinds, or, in Mr. Faraday's language, that "the various forms under
which the forces of matter are made manifest have a common origin,
or, in other words, are so directly related and mutually dependent
that they are convertible one into another."
Out of this doctrine naturally springs that of the conservation of
force, so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr.
Faraday. This idea is no novelty, though it seems so at first sight.
It was maintained and disputed among the giants of philosophy.
Des Cartes and Leibnitz denied that any new motion originated in
nature, or that any ever ceased to exist; all motion being in a
circle, passing from one body to another, one losing what the other
gained. Newton, on the other hand, believed that new motions were
generated and existing ones destroyed. On the first supposition,
there is a fixed amount of force always circulating in the universe.
On the second, the total amount may be increasing or diminishing.
You will find in the "Annual of Scientific Discovery" for 1858 a very
interesting lecture by Professor Helmholtz of Bonn, in which it is
maintained that a certain portion of force is lost in every natural
process, being converted into unchangeable heat, so that the universe
will come to a stand-still at last, all force passing into heat, and
all heat into a state of equilibrium.
The doctrines of the convertibility or specific equivalence of the
various forms of force, and of its conservation, which is its logical
consequence, are very generally accepted, as I believe, at the
present time, among physicists. We are naturally led to the
question, What is the nature of force? The three illustrious
philosophers just referred to agree in attributing the general
movements of the universe to the immediate Divine action. The
doctrine of "preestablished harmony" was an especial contrivance of
Leibnitz to remove the Creator from unworthy association with the
less divine acts of living beings. Obsolete as this expression
sounds to our ears, the phrase laws of the universe, which we use so
constantly with a wider application, appears to me essentially
identical with it.
Force does not admit of explanation, nor of proper definition, any
more than the hypothetical substratum of matter. If we assume the
Infinite as omnipresent, omniscient, omnipotent, we cannot suppose
Him excluded from any part of His creation, except from rebellious
souls which voluntarily exclude Him by the exercise of their fatal
prerogative of free-will. Force, then, is the act of immanent
Divinity. I find no meaning in mechanical explanations. Newton's
hypothesis of an ether filling the heavenly spaces does not, I
confess, help my conceptions. I will, and the muscles of my vocal
organs shape my speech. God wills, and the universe articulates His
power, wisdom, and goodness. That is all I know. There is no bridge
my mind can throw from the "immaterial" cause to the "material"
effect.
The problem of force meets us everywhere, and I prefer to encounter
it in the world of physical phenomena before reaching that of living
actions. It is only the name for the incomprehensible cause of
certain changes known to our consciousness, and assumed to be outside
of it. For me it is the Deity Himself in action.
I can therefore see a large significance in the somewhat bold
language of Burdach: "There is for me but one miracle, that of
infinite existence, and but one mystery, the manner in which the
finite proceeds from the infinite. So soon as we recognize this
incomprehensible act as the general and primordial miracle, of which
our reason perceives the necessity, but the manner of which our
intelligence cannot grasp, so soon as we contemplate the nature known
to us by experience in this light, there is for us no other
impenetrable miracle or mystery."
Let us turn to a branch of knowledge which deals with certainties up
to the limit of the senses, and is involved in no speculations beyond
them. In certain points of view, HUMAN ANATOMY may be considered an
almost exhausted science. From time to time some small organ which
had escaped earlier observers has been pointed out,--such parts as
the tensor tarsi, the otic ganglion, or the Pacinian bodies; but some
of our best anatomical works are those which have been classic for
many generations. The plates of the bones in Vesalius, three
centuries old, are still masterpieces of accuracy, as of art. The
magnificent work of Albinus on the muscles, published in 1747, is
still supreme in its department, as the constant references of the
most thorough recent treatise on the subject, that of Theile,
sufficiently show. More has been done in unravelling the mysteries
of the fasciae, but there has been a tendency to overdo this kind of
material analysis. Alexander Thomson split them up into cobwebs, as
you may see in the plates to Velpeau's Surgical Anatomy. I well
remember how he used to shake his head over the coarse work of Scarpa
and Astley Cooper,--as if Denner, who painted the separate hairs of
the beard and pores of the skin in his portraits, had spoken lightly
of the pictures of Rubens and Vandyk.
Not only has little been added to the catalogue of parts, but some
things long known had become half-forgotten. Louis and others
confounded the solitary glands of the lower part of the small
intestine with those which "the great Brunner," as Haller calls him,
described in 1687 as being found in the duodenum. The display of the
fibrous structure of the brain seemed a novelty as shown by
Spurzheim. One is startled to find the method anticipated by Raymond
Vieussens nearly two centuries ago. I can hardly think Gordon had
ever looked at his figures, though he names their author, when he
wrote the captious and sneering article which attracted so much
attention in the pages of the "Edinburgh Review."
This is the place, if anywhere, to mention any observations I could
pretend to have made in the course of my teaching the structure of
the human body. I can make no better show than most of my
predecessors in this well-reaped field. The nucleated cells found
connected with the cancellated structure of the bones, which I first
pointed out and had figured in 1847, and have shown yearly from that
time to the present, and the fossa masseterica, a shallow concavity
on the ramus of the lower jaw, for the lodgment of the masseter
muscle, which acquires significance when examined by the side of the
deep cavity on the corresponding part in some carnivora to which it
answers, may perhaps be claimed as deserving attention. I have also
pleased myself by making a special group of the six radiating muscles
which diverge from the spine of the axis, or second cervical
vertebra, and by giving to it the name stella musculosa nuchaee. But
this scanty catalogue is only an evidence that one may teach long and
see little that has not been noted by those who have gone before him.
Of course I do not think it necessary to include rare, but already
described anomalies, such as the episternal bones, the rectus
sternalis, and other interesting exceptional formations I have
encountered, which have shown a curious tendency to present
themselves several times in the same season, perhaps because the
first specimen found calls our attention to any we may subsequently
meet with.
The anatomy of the scalpel and the amphitheatre was, then, becoming
an exhausted branch of investigation. But during the present century
the study of the human body has changed its old aspect, and become
fertile in new observations. This rejuvenescence was effected by
means of two principal agencies,--new methods and a new instrument.
Descriptive anatomy, as known from an early date, is to the body what
geography is to the planet. Now geography was pretty well known so
long ago as when Arrowsmith, who was born in 1750, published his
admirable maps. But in that same year was born Werner, who taught a
new way of studying the earth, since become familiar to us all under
the name of Geology.
What geology has done for our knowledge of the earth, has been done
for our knowledge of the body by that method of study to which is
given the name of General Anatomy. It studies, not the organs as
such, but the elements out of which the organs are constructed. It
is the geology of the body, as that is the general anatomy of the
earth. The extraordinary genius of Bichat, to whom more than any
other we owe this new method of study, does not require Mr. Buckle's
testimony to impress the practitioner with the importance of its
achievements. I have heard a very wise physician question whether
any important result had accrued to practical medicine from Harvey's
discovery of the circulation. But Anatomy, Physiology, and Pathology
have received a new light from this novel method of contemplating the
living structures, which has had a vast influence in enabling the
practitioner at least to distinguish and predict the course of
disease. We know as well what differences to expect in the habits of
a mucous and of a serous membrane, as what mineral substances to look
for in the chalk or the coal measures. You have only to read
Cullen's description of inflammation of the lungs or of the bowels,
and compare it with such as you may find in Laennec or Watson, to see
the immense gain which diagnosis and prognosis have derived from
general anatomy.
The second new method of studying the human structure, beginning with
the labors of Scarpa, Burns, and Colles, grew up principally during
the first third of this century. It does not deal with organs, as
did the earlier anatomists, nor with tissues, after the manner of
Bichat. It maps the whole surface of the body into an arbitrary
number of regions, and studies each region successively from the
surface to the bone, or beneath it. This hardly deserves the name of
a science, although Velpeau has dignified it with that title, but it
furnishes an admirable practical way for the surgeon who has to
operate on a particular region of the body to study that region. If
we are buying a farm, we are not content with the State map or a
geological chart including the estate in question. We demand an
exact survey of that particular property, so that we may know what we
are dealing with. This is just what regional, or, as it is sometimes
called, surgical anatomy, does for the surgeon with reference to the
part on which his skill is to be exercised. It enables him to see
with the mind's eye through the opaque tissues down to the bone on
which they lie, as if the skin were transparent as the cornea, and
the organs it covers translucent as the gelatinous pulp of a medusa.
It is curious that the Japanese should have anticipated Europe in a
kind of rude regional anatomy. I have seen a manikin of Japanese
make traced all over with lines, and points marking their
intersection. By this their doctors are guided in the performance of
acupuncture, marking the safe places to thrust in needles, as we buoy
out our ship-channels, and doubtless indicating to learned eyes the
spots where incautious meddling had led to those little accidents of
shipwreck to which patients are unfortunately liable.
A change of method, then, has given us General and Regional Anatomy.
These, too, have been worked so thoroughly, that, if not exhausted,
they have at least become to a great extent fixed and positive
branches of knowledge. But the first of them, General Anatomy, would
never, have reached this positive condition but for the introduction
of that, instrument which I have mentioned as the second great aid to
modern progress.
This instrument is the achromatic microscope. For the history of the
successive steps by which it became the effective scientific
implement we now possess, I must refer you to the work of Mr.
Quekett, to an excellent article in the "Penny Cyclopaedia," or to
that of Sir David Brewster in the "Encyclopaedia Britannica." It is
a most interesting piece of scientific history, which shows how the
problem which Biot in 1821 pronounced insolvable was in the course of
a few years practically solved, with a success equal to that which
Dollond had long before obtained with the telescope. It is enough
for our purpose that we are now in possession of an instrument freed
from all confusions and illusions, which magnifies a thousand
diameters,--a million times in surface,--without serious distortion
or discoloration of its object.
A quarter of a century ago, or a little more, an instructor would not
have hesitated to put John Bell's "Anatomy" and Bostock's
"Physiology" into a student's hands, as good authority on their
respective subjects. Let us not be unjust to either of these
authors. John Bell is the liveliest medical writer that I can
remember who has written since the days of delightful old Ambroise
Pare. His picturesque descriptions and bold figures are as good now
as they ever were, and his book can never become obsolete. But
listen to what John Bell says of the microscope:
"Philosophers of the last age had been at infinite pains to find the
ultimate fibre of muscles, thinking to discover its properties in its
form; but they saw just in proportion to the glasses which they used,
or to their practice and skill in that art, which is now almost
forsaken."
Dr. Bostock's work, neglected as it is, is one which I value very
highly as a really learned compilation, full of original references.
But Dr. Bostock says: "Much as the naturalist has been indebted to
the microscope, by bringing into view many beings of which he could
not otherwise have ascertained the existence, the physiologist has
not yet derived any great benefit from the instrument."
These are only specimens of the manner in which the microscope and
its results were generally regarded by the generation just preceding
our own.
I have referred you to the proper authorities for the account of
those improvements which about the year 1830 rendered the compound
microscope an efficient and trustworthy instrument. It was now for
the first time that a true general anatomy became possible. As early
as 1816 Treviranus had attempted to resolve the tissues, of which
Bichat had admitted no less than twenty-one, into their simple
microscopic elements. How could such an attempt succeed, Henle well
asks, at a time when the most extensively diffused of all the
tissues, the areolar, was not at all understood? All that method
could do had been accomplished by Bichat and his followers. It was
for the optician to take the next step. The future of anatomy and
physiology, as an enthusiastic micrologist of the time said, was in
the hands of Messrs. Schieck and Pistor, famous opticians of Berlin.
In those earlier days of which I am speaking, all the points of
minute anatomy were involved in obscurity. Some found globules
everywhere, some fibres. Students disputed whether the conjunctiva
extended over the cornea or not, and worried themselves over Gaultier
de Claubry's stratified layers of the skin, or Breschet's
blennogenous and chromatogenous organs. The dartos was a puzzle, the
central spinal canal a myth, the decidua clothed in fable as much as
the golden fleece. The structure of bone, now so beautifully made
out,--even that of the teeth, in which old Leeuwenhoek, peeping with
his octogenarian eyes through the minute lenses wrought with his own
hands, had long ago seen the "pipes," as he called them,--was hardly
known at all. The minute structure of the viscera lay in the mists
of an uncertain microscopic vision. The intimate recesses of the
animal system were to the students of anatomy what the anterior of
Africa long was to geographers, and the stories of microscopic
explorers were as much sneered at as those of Bruce or Du Chailly,
and with better reason.
Now what have we come to in our own day? In the first place, the
minute structure of all the organs has been made out in the most
satisfactory way. The special arrangements of the vessels and the
ducts of all the glands, of the air-tubes and vesicles of the lungs,
of the parts which make up the skin and other membranes, all the
details of those complex parenchymatous organs which had confounded
investigation so long, have been lifted out of the invisible into the
sight of all observers. It is fair to mention here, that we owe a
great deal to the art of minute injection, by which we are enabled to
trace the smallest vessels in the midst of the tissues where they are
distributed. This is an old artifice of anatomists. The famous
Ruysch, who died a hundred and thirty years ago, showed that each of
the viscera has its terminal vessels arranged in its own peculiar
way; the same fact which you may see illustrated in Gerber's figures
after the minute injections of Berres. I hope to show you many
specimens of this kind in the microscope, the work of English and
American hands. Professor Agassiz allows me also to make use of a
very rich collection of injected preparations sent him by Professor
Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition
of which I had a number of microscopes made expressly, by Mr. Grunow,
during the past season. All this illustrates what has been done for
the elucidation of the intimate details of formation of the organs.
But the great triumph of the microscope as applied to anatomy has
been in the resolution of the organs and the tissues into their
simple constituent anatomical elements. It has taken up general
anatomy where Bichat left it. He had succeeded in reducing the
structural language of nature to syllables, if you will permit me to
use so bold an image. The microscopic observers who have come after
him have analyzed these into letters, as we may call them,--the
simple elements by the combination of which Nature spells out
successively tissues, which are her syllables, organs which are her
words, systems which are her chapters, and so goes on from the simple
to the complex, until she binds up in one living whole that wondrous
volume of power and wisdom which we call the human body.
The alphabet of the organization is so short and simple, that I will
risk fatiguing your attention by repeating it, according to the plan
I have long adopted.
A. Cells, either floating, as in the blood, or fixed, like those in
the cancellated structure of bone, already referred to. Very
commonly they have undergone a change of figure, most frequently a
flattening which reduces them to scales, as in the epidermis and the
epithelium.
B. Simple, translucent, homogeneous solid, such as is found at the
back of the cornea, or forming the intercellular substance of
cartilage.
C. The white fibrous element, consisting of very delicate, tenacious
threads. This is the long staple textile substance of the body. It
is to the organism what cotton is pretended to be to our Southern
States. It pervades the whole animal fabric as areolar tissue, which
is the universal packing and wrapping material. It forms the
ligaments which bind the whole frame-work together. It furnishes the
sinews, which are the channels of power. It enfolds every muscle.
It wraps the brain in its hard, insensible folds, and the heart
itself beats in a purse that is made of it.
D. The yellow elastic, fibrous element, the caoutchouc of the animal
mechanism, which pulls things back into place, as the India-rubber
band shuts the door we have opened.
E. The striped muscular fibre,--the red flesh, which shortens itself
in obedience to the will, and thus produces all voluntary active
motion.
F. The unstriped muscular fibre, more properly the fusiform-cell
fibre, which carries on the involuntary internal movements.
G. The nerve-cylinder, a glassy tube, with a pith of some firmness,
which conveys sensation to the brain and the principle which induces
motion from it.
H. The nerve-corpuscle, the centre of nervous power.
I. The mucous tissue, as Virchow calls it, common in embryonic
structures, seen in the vitreous humor of the adult.
To these add X, granules, of indeterminate shape and size, Y, for
inorganic matters, such as the salts of bone and teeth, and Z, to
stand as a symbol of the fluids, and you have the letters of what I
have ventured to call the alphabet of the body.
But just as in language certain diphthongs and syllables are
frequently recurring, so we have in the body certain secondary and
tertiary combinations, which we meet more frequently than the
solitary elements of which they are composed.
Thus A B, or a collection of cells united by simple structureless
solid, is seen to be extensively employed in the body under the name
of cartilage. Out of this the surfaces of the articulations and the
springs of the breathing apparatus are formed. But when Nature came
to the buffers of the spinal column (intervertebral disks) and the
washers of the joints (semilunar fibrocartilages of the knee, etc.),
she required more tenacity than common cartilage possessed. What did
she do? What does man do in a similar case of need? I need hardly
tell you. The mason lays his bricks in simple mortar. But the
plasterer works some hair into the mortar which he is going to lay in
large sheets on the walls. The children of Israel complained that
they had no straw to make their bricks with, though portions of it
may still be seen in the crumbling pyramid of Darshour, which they
are said to have built. I visited the old house on Witch Hill in
Salem a year or two ago, and there I found the walls coated with clay
in which straw was abundantly mingled;--the old Judaizing witch-
hangers copied the Israelites in a good many things. The Chinese and
the Corsicans blend the fibres of amianthus in their pottery to give
it tenacity. Now to return to Nature. To make her buffers and
washers hold together in the shocks to which they would be subjected,
she took common cartilage and mingled the white fibrous tissue with
it, to serve the same purpose as the hair in the mortar, the straw in
the bricks and in the plaster of the old wall, and the amianthus in
the earthen vessels. Thus we have the combination A B C, or fibro-
cartilage. Again, the bones were once only gristle or cartilage, A
B. To give them solidity they were infiltrated with stone, in the
form of salts of lime, an inorganic element, so that bone would be
spelt out by the letters A, B, and Y.
If from these organic syllables we proceed to form organic words, we
shall find that Nature employs three principal forms; namely,
Vessels, Membranes, and Parenchyma, or visceral tissue. The most
complex of them can be resolved into a combination of these few
simple anatomical constituents.
Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find
the same elements in morbid growths that we have met with in normal
structures. The pus-corpuscle and the white blood-corpuscle can only
be distinguished by tracing them to their origin. A frequent form of
so-called malignant disease proves to be only a collection of altered
epithelium-cells. Even cancer itself has no specific anatomical
element, and the diagnosis of a cancerous tumor by the microscope,
though tolerably sure under the eye of an expert, is based upon
accidental, and not essential points,--the crowding together of the
elements, the size of the cell-nuclei, and similar variable
characters.
Let us turn to PHYSIOLOGY. The microscope, which has made a new
science of the intimate structure of the organs, has at the same time
cleared up many uncertainties concerning the mechanism of the special
functions. Up to the time of the living generation of observers,
Nature had kept over all her inner workshops the forbidding
inscription, No Admittance! If any prying observer ventured to spy
through his magnifying tubes into the mysteries of her glands and
canals and fluids, she covered up her work in blinding mists and
bewildering halos, as the deities of old concealed their favored
heroes in the moment of danger.
Science has at length sifted the turbid light of her lenses, and
blanched their delusive rainbows.
Anatomy studies the organism in space. Physiology studies it also in
time. After the study of form and composition follows close that of
action, and this leads us along back to the first moment of the germ,
and forward to the resolution of the living frame into its lifeless
elements. In this way Anatomy, or rather that branch of it which we
call Histology, has become inseparably blended with the study of
function. The connection between the science of life and that of
intimate structure on the one hand, and composition on the other, is
illustrated in the titles of two recent works of remarkable
excellence,--"the Physiological Anatomy" of Todd and Bowman, and the
"Physiological Chemistry" of Lehmann.
Let me briefly recapitulate a few of our acquisitions in Physiology,
due in large measure to our new instruments and methods of research,
and at the same time indicate the limits which form the permanent or
the temporary boundaries of our knowledge. I will begin with the
largest fact and with the most absolute and universally encountered
limitation.
The "largest truth in Physiology" Mr. Paget considers to be "the
development of ova through multiplication and division of their
cells." I would state it more broadly as the agency of the cell in
all living processes. It seems at present necessary to abandon the
original idea of Schwann, that we can observe the building up of a
cell from the simple granules of a blastema, or formative fluid. The
evidence points rather towards the axiom, Omnis cellula a cellula;
that is, the germ of a new cell is always derived from a preexisting
cell. The doctrine of Schwann, as I remarked long ago (1844), runs
parallel with the nebular theory in astronomy, and they may yet stand
or fall together.
As we have seen Nature anticipating the plasterer in fibro-cartilage,
so we see her beforehand with the glassblower in her dealings with
the cell. The artisan blows his vitreous bubbles, large or small, to
be used afterwards as may be wanted. So Nature shapes her hyaline
vesicles and modifies them to serve the needs of the part where they
are found. The artisan whirls his rod, and his glass bubble becomes
a flattened disk, with its bull's-eye for a nucleus. These lips of
ours are all glazed with microscopic tiles formed of flattened cells,
each one of them with its nucleus still as plain and relatively as
prominent, to the eye of the microscopist, as the bull's-eye in the
old-fashioned windowpane. Everywhere we find cells, modified or
unchanged. They roll in inconceivable multitudes (five millions and
more to the cubic millimetre, according to Vierordt) as blood-disks
through our vessels. A close-fitting mail of flattened cells coats
our surface with a panoply of imbricated scales (more than twelve
thousand millions), as Harting has computed, as true a defence against
our enemies as the buckler of the armadillo or the carapace of the
tortoise against theirs. The same little protecting organs pave all
the great highways of the interior system. Cells, again, preside
over the chemical processes which elaborate the living fluids; they
change their form to become the agents of voluntary and involuntary
motion; the soul itself sits on a throne of nucleated cells, and
flashes its mandates through skeins of glassy filaments which once
were simple chains of vesicles. And, as if to reduce the problem of
living force to its simplest expression, we see the yolk of a
transparent egg dividing itself in whole or in part, and again
dividing and subdividing, until it becomes a mass of cells, out of
which the harmonious diversity of the organs arranges itself, worm or
man, as God has willed from the beginning.
This differentiation having been effected, each several part assumes
its special office, having a life of its own adjusted to that of
other parts and the whole. "Just as a tree constitutes a mass
arranged in a definite manner, in which, in every single part, in the
leaves as in the root, in the trunk as in the blossom, cells are
discovered to be the ultimate elements, so is it also with the forms
of animal life. Every animal presents itself as a sum of vital
unities, every one of which manifests all the characteristics of
life."
The mechanism is as clear, as unquestionable, as absolutely settled
and universally accepted, as the order of movement of the heavenly
bodies, which we compute backward to the days of the observatories on
the plains of Shinar, and on the faith of which we regulate the
movements of war and trade by the predictions of our ephemeris.
The mechanism, and that is all. We see the workman and the tools,
but the skill that guides the work and the power that performs it are
as invisible as ever. I fear that not every listener took the
significance of those pregnant words in the passage I quoted from
John Bell,--"thinking to discover its properties in its form." We
have discovered the working bee in this great hive of organization.
We have detected the cell in the very act of forming itself from a
nucleus, of transforming itself into various tissues, of selecting
the elements of various secretions. But why one cell becomes nerve
and another muscle, why one selects bile and another fat, we can no
more pretend to tell, than why one grape sucks out of the soil the
generous juice which princes hoard in their cellars, and another the
wine which it takes three men to drink,--one to pour it down, another
to swallow it, and a third to hold him while it is going down.
Certain analogies between this selecting power and the phenomena of
endosmosis in the elective affinities of chemistry we can find, but
the problem of force remains here, as everywhere, unsolved and
insolvable.
Do we gain anything by attempting to get rid of the idea of a special
vital force because we find certain mutually convertible relations
between forces in the body and out of it? I think not, any more than
we should gain by getting rid of the idea and expression Magnetism
because of its correlation with electricity. We may concede the
unity of all forms of force, but we cannot overlook the fixed
differences of its manifestations according to the conditions under
which it acts. It is a mistake, however, to think the mystery is
greater in an organized body than in any other. We see a stone fall
or a crystal form, and there is nothing stranger left to wonder at,
for we have seen the Infinite in action.
Just so far as we can recognize the ordinary modes of operation of
the common forces of nature,--gravity, cohesion, elasticity,
transudation, chemical action, and the rest,--we see the so-called
vital acts in the light of a larger range of known facts and familiar
analogies. Matteuecci's well-remembered lectures contain many and
striking examples of the working of physical forces in physiological
processes. Wherever rigid experiment carries us, we are safe in
following this lead; but the moment we begin to theorize beyond our
strict observation, we are in danger of falling into those mechanical
follies which true science has long outgrown.
Recognizing the fact, then, that we have learned nothing but the
machinery of life, and are no nearer to its essence, what is it that
we have gained by this great discovery of the cell formation and
function?
It would have been reward enough to learn the method Nature pursues
for its own sake. If the sovereign Artificer lets us into his own
laboratories and workshops, we need not ask more than the privilege
of looking on at his work. We do not know where we now stand in the
hierarchy of created intelligences. We were made a little lower than
the angels. I speak it not irreverently; as the lower animals
surpass man in some of their attributes, so it may be that not every
angel's eye can see as broadly and as deeply into the material works
of God as man himself, looking at the firmament through an equatorial
of fifteen inches' aperture, and searching into the tissues with a
twelfth of an inch objective.
But there are other positive gains of a more practical character.
Thus we are no longer permitted to place the seat of the living
actions in the extreme vessels, which are only the carriers from
which each part takes what it wants by the divine right of the
omnipotent nucleated cell. The organism has become, in the words
already borrowed from Virchow, "a sum of vital unities." The
strictum and laxum, the increased and diminished action of the
vessels, out of which medical theories and methods of treatment have
grown up, have yielded to the doctrine of local cell-communities,
belonging to this or that vascular district, from which they help
themselves, as contractors are wont to do from the national treasury.
I cannot promise to do more than to select a few of the points of
contact between our ignorance and our knowledge which present
particular interest in the existing state of our physiological
acquisitions. Some of them involve the microscopic discoveries of
which I have been speaking, some belong to the domain of chemistry,
and some have relations with other departments of physical science.
If we should begin with the digestive function, we should find that
the long-agitated question of the nature of the acid of the gastric
juice is becoming settled in favor of the lactic. But the whole
solvent agency of the digestive fluid enters into the category of
that exceptional mode of action already familiar to us in chemistry
as catalysis. It is therefore doubly difficult of explanation;
first, as being, like all reactions, a fact not to be accounted for
except by the imaginative appeal to "affinity," and secondly, as
being one of those peculiar reactions provoked by an element which
stands outside and looks on without compromising itself.
The doctrine of Mulder, so widely diffused in popular and scientific
belief, of the existence of a common base of all albuminous
substances, the so-called protein, has not stood the test of rigorous
analysis. The division of food into azotized and non-azotized is no
doubt important, but the attempt to show that the first only is
plastic or nutritive, while the second is simply calorifacient, or
heat-producing, fails entirely in the face of the facts revealed by
the study of man in different climates, and of numerous experiments
in the feeding of animals. I must return to this subject in
connection with the respiratory function.
The sugar-making faculty of the liver is another "catalytic" mystery,
as great as the rest of them, and no greater. Liver-tissue brings
sugar out of the blood, or out of its own substance;--why?
Quia est in eo
Virtus saccharitiva.
Just what becomes of the sugar beyond the fact of its disappearance
before it can get into the general circulation and sweeten our
tempers, it is hard to say.
The pancreatic fluid makes an emulsion of the fat contained in our
food, but just how the fatty particles get into the villi we must
leave Brucke and Kolliker to settle if they can.
No one has shown satisfactorily the process by which the blood-
corpuscles are formed out of the lymph-corpuscles, nor what becomes
of them. These two questions are like those famous household
puzzles,--Where do the flies come from? and, Where do the pins go
to?
There is a series of organs in the body which has long puzzled
physiologists,--organs of glandular aspect, but having no ducts,--the
spleen, the thyroid and thymus bodies, and the suprarenal capsules.
We call them vascular glands, and we believe that they elaborate
colored and uncolored blood-cells; but just what changes they effect,
and just how they effect them, it has proved a very difficult matter
to determine. So of the noted glandules which form Peyer's patches,
their precise office, though seemingly like those of the lymphatic
glands, cannot be positively assigned, so far as I know, at the
present time. It is of obvious interest to learn it with reference
to the pathology of typhoid fever. It will be remarked that the
coincidence of their changes in this disease with enlargement of the
spleen suggests the idea of a similarity of function in these two
organs.
The theories of the production of animal heat, from the times of
Black, Lavoisier, and Crawford to those of Liebig, are familiar to
all who have paid any attention to physiological studies. The
simplicity of Liebig's views, and the popular form in which they have
been presented, have given them wide currency, and incorporated them
in the common belief and language of our text-books. Direct
oxidation or combustion of the carbon and hydrogen contained in the
food, or in the tissues themselves; the division of alimentary
substances into respiratory, or non-azotized, and azotized,--these
doctrines are familiar even to the classes in our high-schools. But
this simple statement is boldly questioned. Nothing proves that
oxygen combines (in the system) with hydrogen and carbon in
particular, rather than with sulphur and azote. Such is the well-
grounded statement of Robin and Verdeil. "It is very probable that
animal heat is entirely produced by the chemical actions which take
place in the organism, but the phenomenon is too complex to admit of
our calculating it according to the quality of oxygen consumed."
These last are the words of Regnault, as cited by Mr. Lewes, whose
intelligent discussion of this and many of the most interesting
physiological problems I strongly recommend to your attention.
This single illustration covers a wider ground than the special
function to which it belongs. We are learning that the chemistry of
the body must be studied, not simply by its ingesta and egesta, but
that there is a long intermediate series of changes which must be
investigated in their own light, under their own special conditions.
The expression "sum of vital unities" applies to the chemical
actions, as well as to other actions localized in special parts; and
when the distinguished chemists whom I have just cited entitle their
work a treatise on the immediate principles of the body, they only
indicate the nature of that profound and subtile analysis which must
take the place of all hasty generalizations founded on a comparison
of the food with residual products.
I will only call your attention to the fact, that the exceptional
phenomenon of the laboratory is the prevailing law of the organism.
Nutrition itself is but one great catalytic process. As the blood
travels its rounds, each part selects its appropriate element and
transforms it to its own likeness. Whether the appropriating agent
be cell or nucleus, or a structureless solid like the intercellular
substance of cartilage, the fact of its presence determines the
separation of its proper constituents from the circulating fluid, so
that even when we are wounded bone is replaced by bone, skin by skin,
and nerve by nerve.
It is hardly without a smile that we resuscitate the old question of
the 'vis insita' of the muscular fibre, so famous in the discussions of
Haller and his contemporaries. Speaking generally, I think we may
say that Haller's doctrine is the one now commonly received; namely,
that the muscles contract in virtue of their own inherent endowments.
It is true that Kolliker says no perfectly decisive fact has been
brought forward to prove that the striated muscles contract with.
out having been acted on by nerves. Yet Mr. Bowman's observations on
the contraction of isolated fibres appear decisive enough (unless we
consider them invalidated by Dr. Lionel Beale's recent researches),
tending to show that each elementary fibre is supplied with nerves;
and as to the smooth muscular fibres, we have Virchow's statement
respecting the contractility of those of the umbilical cord, where
there is not a trace of any nerves.
In the investigation of the nervous system, anatomy and physiology
have gone hand in hand. It is very singular that so important, and
seemingly simple, a fact as the connection of the nerve-tubes, at
their origin or in their course, with the nerve-cells, should have so
long remained open to doubt, as you may see that it did by referring
to the very complete work of Sharpey and Quain (edition of 1849), the
histological portion of which is cordially approved by Kolliker
himself.
Several most interesting points of the minute anatomy of the nervous
centres have been laboriously and skilfully worked out by a recent
graduate of this Medical School, in a monograph worthy to stand in
line with those of Lockhart Clarke, Stilling, and Schroder van der
Kolk. I have had the privilege of examining and of showing some of
you a number of Dr. Dean's skilful preparations. I have no space to
give even an abstract of his conclusions. I can only refer to his
proof of the fact, that a single cell may send its processes into
several different bundles of nerve-roots, and to his demonstration of
the curved ascending and descending fibres from the posterior
nerveroots, to reach what he has called the longitudinal columns of
the cornea. I must also mention Dr. Dean's exquisite microscopic
photographs from sections of the medulla oblongata, which appear to
me to promise a new development, if not a new epoch, in anatomical
art.
It having been settled that the nerve-tubes can very commonly be
traced directly to the nerve-cells, the object of all the observers
in this department of anatomy is to follow these tubes to their
origin. We have an infinite snarl of telegraph wires, and we may be
reasonably sure, that, if we can follow them up, we shall find each
of them ends in a battery somewhere. One of the most interesting
problems is to find the ganglionic origin of the great nerves of the
medulla oblongata, and this is the end to which, by the aid of the
most delicate sections, colored so as to bring out their details,
mounted so as to be imperishable, magnified by the best instruments,
and now self-recorded in the light of the truth-telling sunbeam, our
fellow-student is making a steady progress in a labor which I think
bids fair to rank with the most valuable contributions to histology
that we have had from this side of the Atlantic.
It is interesting to see how old questions are incidentally settled
in the course of these new investigations. Thus, Mr. Clarke's
dissections, confirmed by preparations of Mr. Dean's which I have
myself examined, placed the fact of the decussation of the pyramids--
denied by Haller, by Morgagni, and even by Stilling--beyond doubt.
So the spinal canal, the existence of which, at least in the adult,
has been so often disputed, appears as a coarse and unequivocal
anatomical fact in many of the preparations referred to.
While these studies of the structure of the cord have been going on,
the ingenious and indefatigable Brown-Sequard has been investigating
the functions of its different parts with equal diligence. The
microscopic anatomists had shown that the ganglionic corpuscles of
the gray matter of the cord are connected with each other by their
processes, as well as with the nerve-roots. M. Brown-Sequard has
proved by numerous experiments that the gray substance transmits
sensitive impressions and muscular stimulation. The oblique
ascending and descending fibres from the posterior nerve-roots,
joining the "longitudinal columns of the cornua," account for the
results of Brown-Sequard's sections of the posterior columns. The
physiological experimenter has also made it evident that the
decussation of the conductors of sensitive impressions has its seat
in the spinal core, and not in the encephalon, as had been supposed.
Not less remarkable than these results are the facts, which I with
others of my audience have had the opportunity of observing, as shown
by M. Brown-Sequard, of the artificial production of epilepsy in
animals by injuring the spinal cord, and the induction of the
paroxysm by pinching a certain portion of the skin. I would also
call the student's attention to his account of the relations of the
nervous centres to nutrition and secretion, the last of which
relations has been made the subject of an extended essay by our
fellow countryman, Dr. H. F. Campbell of Georgia.
The physiology of the spinal cord seems a simple matter as you study
it in Longet. The experiments of Brown-Sequard have shown the
problem to be a complex one, and raised almost as many doubts as they
have solved questions; at any rate, I believe all lecturers on
physiology agree that there is no part of their task they dread so
much as the analysis of the evidence relating to the special offices
of the different portions of the medulla spinalis. In the brain we
are sure that we do not know how to localize functions; in the spinal
cord, we think we do know something; but there are so many anomalies,
and seeming contradictions, and sources of fallacy, that beyond the
facts of crossed paralysis of sensation, and the conducting agency of
the gray substance, I am afraid we retain no cardinal principles
discovered since the development of the reflex function took its
place by Sir Charles Bell's great discovery.
By the manner in which I spoke of the brain, you will see that I am
obliged to leave phrenology sub Jove,--out in the cold,--as not one
of the household of science. I am not one of its haters; on the
contrary, I am grateful for the incidental good it has done. I love
to amuse myself in its plaster Golgothas, and listen to the glib
professor, as he discovers by his manipulations
"All that disgraced my betters met in me."
I loved of old to see square-headed, heavy-jawed Spurzheim make a
brain flower out into a corolla of marrowy filaments, as Vieussens
had done before him, and to hear the dry-fibred but human-hearted
George Combe teach good sense under the disguise of his equivocal
system. But the pseudo-sciences, phrenology and the rest, seem to me
only appeals to weak minds and the weak points of strong ones. There
is a pica or false appetite in many intelligences; they take to odd
fancies in place of wholesome truth, as girls gnaw at chalk and
charcoal. Phrenology juggles with nature. It is so adjusted as to
soak up all evidence that helps it, and shed all that harms it. It
crawls forward in all weathers, like Richard Edgeworth's hygrometer.
It does not stand at the boundary of our ignorance, it seems to me,
but is one of the will-o'-the-wisps of its undisputed central domain
of bog and quicksand. Yet I should not have devoted so many words to
it, did I not recognize the light it has thrown on human actions by
its study of congenital organic tendencies. Its maps of the.
surface of the head are, I feel sure, founded on a delusion, but its
studies of individual character are always interesting and
instructive.
The "snapping-turtle" strikes after its natural fashion when it first
comes out of the egg. Children betray their tendencies in their way
of dealing with the breasts that nourish them; nay, lean venture to
affirm, that long before they are born they teach their mothers
something of their turbulent or quiet tempers.
"Castor gaudet equis, ovo proanatus eodem
Pugnis."
Strike out the false pretensions of phrenology; call it anthropology;
let it study man the individual in distinction from man the
abstraction, the metaphysical or theological lay-figure; and it
becomes "the proper study of mankind," one of the noblest and most
interesting of pursuits.
The whole physiology of the nervous system, from the simplest
manifestation of its power in an insect up to the supreme act of the
human intelligence working through the brain, is full of the most
difficult yet profoundly interesting questions. The singular
relations between electricity and nerve-force, relations which it has
been attempted to interpret as meaning identity, in the face of
palpable differences, require still more extended studies. You may
be interested by Professor Faraday's statement of his opinion on the
matter. "Though I am not satisfied that the nervous fluid is only
electricity, still I think that the agent in the nervous system maybe
an inorganic force; and if there be reason for supposing that
magnetism is a higher relation of force than electricity, so it may
well be imagined that the nervous power may be of a still more
exalted character, and yet within the reach of experiment."
In connection with this statement, it is interesting to refer to the
experiments of Helmholtz on the rapidity of transmission of the
nervous actions. The rate is given differently in Valentin's report
of these experiments and in that found in the "Scientific Annual" for
1858. One hundred and eighty to three hundred feet per second is the
rate of movement assigned for sensation, but all such results must be
very vaguely approximative. Boxers, fencers, players at the Italian
game of morn, "prestidigitators," and all who depend for their
success on rapidity of motion, know what differences there are in the
personal equation of movement.
Reflex action, the mechanical sympathy, if I may so call it, of
distant parts; Instinct, which is crystallized intelligence,--an
absolute law with its invariable planes and angles introduced into
the sphere of consciousness, as raphides are inclosed in the living
cells of plants; Intellect,--the operation of the thinking principle
through material organs, with an appreciable waste of tissue in every
act of thought, so that our clergymen's blood has more phosphates to
get rid of on Monday than on any other day of the week; Will,--
theoretically the absolute determining power, practically limited in
different degrees by the varying organization of races and
individuals, annulled or perverted by different ill-understood
organic changes; on all these subjects our knowledge is in its
infancy, and from the study of some of them the interdict of the
Vatican is hardly yet removed.
I must allude to one or two points in the histology and physiology of
the organs of sense. The anterior continuation of the retina beyond
the ora serrata has been a subject of much discussion. If H. Muller
and Kolliker can be relied upon, this question is settled by
recognizing that a layer of cells, continued from the retina, passes
over the surface of the zonula Zinnii, but that no proper nervous
element is so prolonged forward.
I observe that Kolliker calls the true nervous elements of the retina
"the layer of gray cerebral substance." In fact, the ganglionic
corpuscles of each eye may be considered as constituting a little
brain, connected with the masses behind by the commissure, commonly
called the optic nerve. We are prepared, therefore, to find these
two little brains in the most intimate relations with each other, as
we find the cerebral hemispheres. We know that they are directly
connected by fibres that arch round through the chiasma.
I mention these anatomical facts to introduce a physiological
observation of my own, first announced in one of the lectures before
the Medical Class, subsequently communicated to the American Academy
of Arts and Sciences, and printed in its "Transactions" for February
14, 1860. I refer to the apparent transfer of impressions from one
retina to the other, to which I have given the name reflex vision.
The idea was suggested to me in consequence of certain effects
noticed in employing the stereoscope. Professor William B. Rodgers
has since called the attention of the American Scientific Association
to some facts bearing on the subject, and to a very curious
experiment of Leonardo da Vinci's, which enables the observer to look
through the palm of his hand (or seem to), as if it had a hole bored
through it. As he and others hesitated to accept my explanation, I
was not sorry to find recently the following words in the
"Observations on Man" of that acute observer and thinker, David
Hartley. "An impression made on the right eye alone by a single
object may propagate itself into the left, and there raise up an
image almost equal in vividness to itself; and consequently when we
see with one eye only, we may, however, have pictures in both eyes."
Hartley, in 1784, had anticipated many of the doctrines which have
since been systematized into the theory of reflex actions, and with
which I have attempted to associate this act of reflex vision. My
sixth experiment, however, in the communication referred to, appears
to me to be a crucial one, proving the correctness of my explanation,
and I am not aware that it has been before instituted.
Another point of great interest connected with the physiology of
vision, and involved for a long time in great obscurity, is that of
the adjustment of the eye to different distances. Dr. Clay Wallace
of New York, who published a very ingenious little book on the eye
about twenty years ago, with vignettes reminding one of Bewick, was
among the first, if not the first, to describe the ciliary muscle, to
which the power of adjustment is generally ascribed. It is
ascertained, by exact experiment with the phacueidoscope, that
accommodation depends on change of form of the crystalline lens.
Where the crystalline is wanting, as Mr. Ware long ago taught, no
power of accommodation remains. The ciliary muscle is generally
thought to effect the change of form of the crystalline. The power
of accommodation is lost after the application of atropine, in
consequence, as is supposed, of the paralysis of this muscle. This,
I believe, is the nearest approach to a demonstration we have on this
point.
I have only time briefly to refer to Professor Draper's most
ingenious theory as to the photographic nature of vision, for an
account of which I must refer to his original and interesting
Treatise on Physiology.
It were to be wished that the elaborate and very interesting
researches of the Marquis Corti, which have revealed such singular
complexity of structure in the cochlea of the ear, had done more to
clear up its doubtful physiology; but I am afraid we have nothing but
hypotheses for the special part it plays in the act of hearing, and
that we must say the same respecting the office of the semicircular
canals.
The microscope has achieved some of its greatest triumphs in teaching
us the changes which occur in the development of the embryo. No more
interesting discovery stands recorded in the voluminous literature of
this subject than the one originally announced by Martin Barry,
afterwards discredited, and still later confirmed by Mr. Newport and
others; namely the fact that the fertilizing filament reaches the
interior of the ovum in various animals;--a striking parallel to the
action of the pollen-tube in the vegetable. But beyond the
mechanical facts all is mystery in the movements of organization, as
profound as in the fall of a stone or the formation of a crystal.
To the chemist and the microscopist the living body presents the same
difficulties, arising from the fact that everything is in perpetual
change in the organism. The fibrine of the blood puzzles the one as
much as its globules puzzle the other. The difference between the
branches of science which deal with space only, and those which deal
with space and time, is this: we have no glasses that can magnify
time. The figure I here show you a was photographed from an object
(pleurosigma angulatum) magnified a thousand diameters, or presenting
a million times its natural surface. This other figure of the same
object, enlarged from the one just shown, is magnified seven thousand
diameters, or forty-nine million times in surface. When we can make
the forty-nine millionth of a second as long as its integer,
physiology and chemistry will approach nearer the completeness of
anatomy.
Our reverence becomes more worthy, or, if you will, less unworthy of
its Infinite Object in proportion as our intelligence is lifted and
expanded to a higher and broader understanding of the Divine methods
of action. If Galen called his heathen readers to admire, the power,
the wisdom, the providence, the goodness of the "Framer of the animal
body,"--if Mr. Boyle, the student of nature, as Addison and that
friend of his who had known him for forty years tell us, never
uttered the name of the Supreme Being without making a distinct pause
in his speech, in token of his devout recognition of its awful
meaning,--surely we, who inherit the accumulated wisdom of nearly two
hundred years since the time of the British philosopher, and of
almost two thousand since the Greek physician, may well lift our
thoughts from the works we study to their great Artificer. These
wonderful discoveries which we owe to that mighty little instrument,
the telescope of the inner firmament with all its included worlds;
these simple formulae by which we condense the observations of a
generation in a single axiom; these logical analyses by which we
fence out the ignorance we cannot reclaim, and fix the limits of our
knowledge,--all lead us up to the inspiration of the Almighty, which
gives understanding to the world's great teachers. To fear science
or knowledge, lest it disturb our old beliefs, is to fear the influx
of the Divine wisdom into the souls of our fellow-men; for what is
science but the piecemeal revelation,--uncovering,--of the plan of
creation, by the agency of those chosen prophets of nature whom God
has illuminated from the central light of truth for that single
purpose?
The studies which we have glanced at are preliminary in your
education to the practical arts which make use of them,--the arts of
healing,--surgery and medicine. The more you examine the structure
of the organs and the laws of life, the more you will find how
resolutely each of the cell-republics which make up the E pluribus
unum of the body maintains its independence. Guard it, feed it, air
it, warm it, exercise or rest it properly, and the working elements
will do their best to keep well or to get well. What do we do with
ailing vegetables? Dr. Warren, my honored predecessor in this chair,
bought a country-place, including half of an old orchard. A few
years afterwards I saw the trees on his side of the fence looking in
good health, while those on the other side were scraggy and
miserable. How do you suppose this change was brought about? By
watering them with Fowler's solution? By digging in calomel freely
about their roots? Not at all; but by loosening the soil round them,
and supplying them with the right kind of food in fitting quantities.
Now a man is not a plant, or, at least, he is a very curious one, for
he carries his soil in his stomach, which is a kind--of portable
flower-pot, and he grows round it, instead of out of it. He has,
besides, a singularly complex nutritive apparatus and a nervous
system. But recollect the doctrine already enunciated in the
language of Virchow, that an animal, like a tree, is a sum of vital
unities, of which the cell is the ultimate element. Every healthy
cell, whether in a vegetable or an animal, necessarily performs its
function properly so long as it is supplied with its proper materials
and stimuli. A cell may, it is true, be congenitally defective, in
which case disease is, so to speak, its normal state. But if
originally sound and subsequently diseased, there has certainly been
some excess, deficiency, or wrong quality in the materials or stimuli
applied to it. You remove this injurious influence and substitute a
normal one; remove the baked coal-ashes, for instance, from the roots
of a tree, and replace them with loam; take away the salt meat from
the patient's table, and replace it with fresh meat and vegetables,
and the cells of the tree or the man return to their duty.
I do not know that we ever apply to a plant any element which is not
a natural constituent of the vegetable structure, except perhaps
externally, for the accidental purpose of killing parasites. The
whole art of cultivation consists in learning the proper food and
conditions of plants, and supplying them. We give them water,
earths, salts of various kinds such as they are made of, with a
chance to help themselves to air and light. The farmer would be
laughed at who undertook to manure his fields or his trees with a
salt of lead or of arsenic. These elements are not constituents of
healthy plants. The gardener uses the waste of the arsenic furnaces
to kill the weeds in his walks.
If the law of the animal cell, and of the animal organism, which is
built up of such cells, is like that of the vegetable, we might
expect that we should treat all morbid conditions of any of the vital
unities belonging to an animal in the same way, by increasing,
diminishing, or changing its natural food or stimuli.
That is an aliment which nourishes; whatever we find in the
organism, as a constant and integral element, either forming part of
its structure, or one of the conditions of vital processes, that and
that only deserves the name of aliment. I see no reason,
therefore, why iron, phosphate of lime, sulphur, should not be
considered food for man, as much as guano or poudrette for
vegetables. Whether one or another of them is best in any given
case,--whether they shall be taken alone or in combination, in large
or small quantities, are separate questions. But they are elements
belonging to the body, and even in moderate excess will produce
little disturbance. There is no presumption against any of this
class of substances, any more than against water or salt, provided
they are used in fitting combinations, proportions, and forms.
But when it comes to substances alien to the healthy system, which
never belong to it as normal constituents, the case is very
different. There is a presumption against putting lead or arsenic
into the human body, as against putting them into plants, because
they do not belong there, any more than pounded glass, which, it is
said, used to be given as a poison. The same thing is true of
mercury and silver. What becomes of these alien substances after
they get into the system we cannot always tell. But in the case of
silver, from the accident of its changing color under the influence
of light, we do know what happens. It is thrown out, in part at
least, under the epidermis, and there it remains to the patient's
dying day. This is a striking illustration of the difficulty which
the system finds in dealing with non-assimilable elements, and
justifies in some measure the vulgar prejudice against mineral
poisons.
I trust the youngest student on these benches will not commit the
childish error of confounding a presumption against a particular
class of agents with a condemnation of them. Mercury, for instance,
is alien to the system, and eminently disturbing in its influence.
Yet its efficacy in certain forms of specific disease is acknowledged
by all but the most sceptical theorists. Even the esprit moqueur of
Ricord, the Voltaire of pelvic literature, submits to the time-
honored constitutional authority of this great panacea in the class
of cases to which he has devoted his brilliant intelligence. Still,
there is no telling what evils have arisen from the abuse of this
mineral. Dr. Armstrong long ago pointed out some of them, and they
have become matters of common notoriety. I am pleased, therefore,
when I find so able and experienced a practitioner as Dr. Williams of
this city proving that iritis is best treated without mercury, and
Dr. Vanderpoel showing the same thing to be true for pericarditis.
Whatever elements nature does not introduce into vegetables, the
natural food of all animal life,--directly of herbivorous, indirectly
of carnivorous animals,--are to be regarded with suspicion. Arsenic-
eating may seem to improve the condition of horses for a time,--and
even of human beings, if Tschudi's stories can be trusted,--but it
soon appears that its alien qualities are at war with the animal
organization. So of copper, antimony, and other non-alimentary
simple substances; everyone of them is an intruder in the living
system, as much as a constable would be, quartered in our household.
This does not mean that they may not, any of them, be called in for a
special need, as we send for the constable when we have good reason
to think we have a thief under our roof; but a man's body is his
castle, as well as his house, and the presumption is that we are to
keep our alimentary doors bolted against these perturbing agents.
Now the feeling is very apt to be just contrary to this. The habit
has been very general with well-taught practitioners, to have
recourse to the introduction of these alien elements into the system
on the occasion of any slight disturbance. The tongue was a little
coated, and mercury must be given; the skin was a little dry, and the
patient must take antimony. It was like sending for the constable
and the posse comitatus when there is only a carpet to shake or a
refuse-barrel to empty. [Dr. James Johnson advises persons not ailing
to take five grains of blue pill with one or two of aloes twice a
week for three or four months in the year, with half a pint of
compound decoction of sarsaparilla every day for the same period, to
preserve health and prolong life. Pract. Treatise on Dis. of
Liver, etc. p. 272.] The constitution bears slow poisoning a great
deal better than might be expected; yet the most intelligent men in
the profession have gradually got out of the habit of prescribing
these powerful alien substances in the old routine way. Mr. Metcalf
will tell you how much more sparingly they are given by our
practitioners at the present time, than when he first inaugurated the
new era of pharmacy among us. Still, the presumption in favor of
poisoning out every spontaneous reaction of outraged nature is not
extinct in those who are trusted with the lives of their fellow-
citizens. "On examining the file of prescriptions at the hospital, I
discovered that they were rudely written, and indicated a treatment,
as they consisted chiefly of tartar emetic, ipecacuanha, and epsom
salts, hardly favorable to the cure of the prevailing diarrhoea and
dysenteries." In a report of a poisoning case now on trial, where
we are told that arsenic enough was found in the stomach to produce
death in twenty-four hours, the patient is said to have been treated
by arsenic, phosphorus, bryonia, aconite, nux vomica, and muriatic
acid,--by a practitioner of what school it may be imagined.
The traditional idea of always poisoning out disease, as we smoke out
vermin, is now seeking its last refuge behind the wooden cannon and
painted port-holes of that unblushing system of false scientific
pretences which I do not care to name in a discourse addressed to an
audience devoted to the study of the laws of nature in the light of
the laws of evidence. It is extraordinary to observe that the system
which, by its reducing medicine to a name and a farce, has accustomed
all who have sense enough to see through its thin artifices to the
idea that diseases get well without being "cured," should now be the
main support of the tottering poison-cure doctrine. It has
unquestionably helped to teach wise people that nature heals most
diseases without help from pharmaceutic art, but it continues to
persuade fools that art can arrest them all with its specifics.
It is worse than useless to attempt in any way to check the freest
expression of opinion as to the efficacy of any or all of the
"heroic" means of treatment employed by practitioners of different
schools and periods. Medical experience is a great thing, but we
must not forget that there is a higher experience, which tries its
results in a court of a still larger jurisdiction; that, namely, in
which the laws of human belief are summoned to the witness-box, and
obliged to testify to the sources of error which beset the medical
practitioner. The verdict is as old as the father of medicine, who
announces it in the words, "judgment is difficult." Physicians
differed so in his time, that some denied that there was any such
thing as an art of medicine.
One man's best remedies were held as mischievous by another. The art
of healing was like soothsaying, so the common people said; "the same
bird was lucky or unlucky, according as he flew to the right or
left."
The practice of medicine has undergone great changes within the
period of my own observation. Venesection, for instance, has so far
gone out of fashion, that, as I am told by residents of the New York
Bellevue and the Massachusetts General Hospitals, it is almost
obsolete in these institutions, at least in medical practice. The
old Brunonian stimulating treatment has come into vogue again in the
practice of Dr. Todd and his followers. The compounds of mercury
have yielded their place as drugs of all work, and specifics for that
very frequent subjective complaint, nescio quid faciam,--to compounds
of iodine. [Sir Astley Cooper has the boldness,--or honesty,--to
speak of medicines which "are given as much to assist the medical man
as his patient." Lectures (London, 1832), p. 14.] Opium is believed
in, and quinine, and "rum," using that expressive monosyllable to
mean all alcoholic cordials. If Moliere were writing now, instead of
saignare, purgare, and the other, he would be more like to say,
Stimulare, opium dare et potassio-iodizare.
I have been in relation successively with the English and American
evacuant and alterative practice, in which calomel and antimony
figured so largely that, as you may see in Dr. Jackson's last
"Letter," Dr. Holyoke, a good representative of sterling old-
fashioned medical art, counted them with opium and Peruvian bark as
his chief remedies; with the moderately expectant practice of Louis;
the blood-letting "coup sur coup" of Bouillaud; the contra-stimulant
method of Rasori and his followers; the anti-irritant system of
Broussais, with its leeching and gum-water; I have heard from our own
students of the simple opium practice of the renowned German teacher,
Oppolzer; and now I find the medical community brought round by the
revolving cycle of opinion to that same old plan of treatment which
John Brown taught in Edinburgh in the last quarter of the last
century, and Miner and Tully fiercely advocated among ourselves in
the early years of the present. The worthy physicians last
mentioned, and their antagonist Dr. Gallup, used stronger language
than we of these degenerate days permit ourselves. "The lancet is a
weapon which annually slays more than the sword," says Dr. Tully.
"It is probable that, for forty years past, opium and its
preparations have done seven times the injury they have rendered
benefit, on the great scale of the world," says Dr. Gallup.
What is the meaning of these perpetual changes and conflicts of
medical opinion and practice, from an early antiquity to our own
time? Simply this: all "methods" of treatment end in disappointment
of those extravagant expectations which men are wont to entertain of
medical art. The bills of mortality are more obviously affected by
drainage, than by this or that method of practice. The insurance
companies do not commonly charge a different percentage on the lives
of the patients of this or that physician. In the course of a
generation, more or less, physicians themselves are liable to get
tired of a practice which has so little effect upon the average
movement of vital decomposition. Then they are ready for a change,
even if it were back again to a method which has already been tried,
and found wanting.
Our practitioners, or many of them, have got back to the ways of old
Dr. Samuel Danforth, who, as it is well known, had strong objections
to the use of the lancet. By and by a new reputation will be made by
some discontented practitioner, who, tired of seeing patients die
with their skins full of whiskey and their brains muddy with opium,
returns to a bold antiphlogistic treatment, and has the luck to see a
few patients of note get well under it. So of the remedies which
have gone out of fashion and been superseded by others. It can
hardly be doubted that they will come into vogue again, more or less
extensively, under the influence of that irresistible demand for
change just referred to.
Then will come the usual talk about a change in the character of
disease, which has about as much meaning as that concerning
"old-fashioned snow-storms." "Epidemic constitutions" of disease
mean something, no doubt; a great deal as applied to malarious
affections; but that the whole type of diseases undergoes such
changes that the practice must be reversed from depleting to
stimulating, and vice versa, is much less likely than that methods of
treatment go out of fashion and come in again. If there is any
disease which claims its percentage with reasonable uniformity, it is
phthisis. Yet I remember that the reverend and venerable Dr. Prince
of Salem told me one Commencement day, as I was jogging along towards
Cambridge with him, that he recollected the time when that disease
was hardly hardly known; and in confirmation of his statement
mentioned a case in which it was told as a great event, that somebody
down on "the Cape" had died of "a consumption." This story does not
sound probable to myself, as I repeat it, yet I assure you it is
true, and it shows how cautiously we must receive all popular stories
of great changes in the habits of disease.
Is there no progress, then, but do we return to the same beliefs and
practices which our forefathers wore out and threw away? I trust and
believe that there is a real progress. We may, for instance, return
in a measure to the Brunonian stimulating system, but it must be in a
modified way, for we cannot go back to the simple Brunonian
pathology, since we have learned too much of diseased action to
accept its convenient dualism. So of other doctrines, each new
Avatar strips them of some of their old pretensions, until they take
their fitting place at last, if they have any truth in them, or
disappear, if they were mere phantasms of the imagination.
In the mean time, while medical theories are coming in and going out,
there is a set of sensible men who are never run away with by them,
but practise their art sagaciously and faithfully in much the same
way from generation to generation. From the time of Hippocrates to
that of our own medical patriarch, there has been an apostolic
succession of wise and good practitioners. If you will look at the
first aphorism of the ancient Master you will see that before all
remedies he places the proper conduct of the patient and his
attendants, and the fit ordering of all the conditions surrounding
him. The class of practitioners I have referred to have always been
the most faithful in attending to these points. No doubt they have
sometimes prescribed unwisely, in compliance with the prejudices of
their time, but they have grown wiser as they have grown older, and
learned to trust more in nature and less in their plans of
interference. I believe common opinion confirms Sir James Clark's
observation to this effect.
The experience of the profession must, I think, run parallel with
that of the wisest of its individual members. Each time a plan of
treatment or a particular remedy comes up for trial, it is submitted
to a sharper scrutiny. When Cullen wrote his Materia Medica, he had
seriously to assail the practice of giving burnt toad, which was
still countenanced by at least one medical authority of note. I have
read recently in some medical journal, that an American practitioner,
whose name is known to the country, is prescribing the hoof of a
horse for epilepsy. It was doubtless suggested by that old fancy of
wearing a portion of elk's hoof hung round the neck or in a ring, for
this disease. But it is hard to persuade reasonable people to
swallow the abominations of a former period. The evidence which
satisfied Fernelius will not serve one of our hospital physicians.
In this way those articles of the Materia Medica which had nothing
but loathsomeness to recommend them have been gradually dropped, and
are not like to obtain any general favor again with civilized
communities. The next culprits to be tried are the poisons. I have
never been in the least sceptical as to the utility of some of them,
when properly employed. Though I believe that at present, taking the
world at large, and leaving out a few powerful agents of such immense
value that they rank next to food in importance, the poisons
prescribed for disease do more hurt than good, I have no doubt, and
never professed to have any, that they do much good in prudent and
instructed hands. But I am very willing to confess a great jealousy
of many agents, and I could almost wish to see the Materia Medica so
classed as to call suspicion upon certain ones among them.
Thus the alien elements, those which do not properly enter into the
composition of any living tissue, are the most to be suspected,--
mercury, lead, antimony, silver, and the rest, for the reasons I have
before mentioned. Even iodine, which, as it is found in certain
plants, seems less remote from the animal tissues, gives unequivocal
proofs from time to time that it is hostile to some portions of the
glandular system.
There is, of course, less prima facie objection to those agents which
consist of assimilable elements, such as are found making a part of
healthy tissues. These are divisible into three classes,--foods,
poisons, and inert, mostly because insoluble, substances. The food
of one animal or of one human being is sometimes poison to another,
and vice versa; inert substances may act mechanically, so as to
produce the effect of poisons; but this division holds exactly enough
for our purpose.
Strictly speaking, every poison consisting of assimilable elements
may be considered as unwholesome food. It is rejected by the
stomach, or it produces diarrhoea, or it causes vertigo or
disturbance of the heart's action, or some other symptom for which
the subject of it would consult the physician, if it came on from any
other cause than taking it under the name of medicine. Yet portions
of this unwholesome food which we call medicine, we have reason to
believe, are assimilated; thus, castor-oil appears to be partially
digested by infants, so that they require large doses to affect them
medicinally. Even that deadliest of poisons, hydrocyanic acid, is
probably assimilated, and helps to make living tissue, if it do not
kill the patient, for the assimilable elements which it contains,
given in the separate forms of amygdalin and emulsin, produce no
disturbance, unless, as in Bernard's experiments, they are suffered
to meet in the digestive organs. A medicine consisting of
assimilable substances being then simply unwholesome food, we
understand what is meant by those cumulative effects of such remedies
often observed, as in the case of digitalis and strychnia. They are
precisely similar to the cumulative effects of a salt diet in
producing scurvy, or of spurred rye in producing dry gangrene. As
the effects of such substances are a violence to the organs, we
should exercise the same caution with regard to their use that we
would exercise about any other kind of poisonous food,--partridges at
certain seasons, for instance. Even where these poisonous kinds of
food seem to be useful, we should still regard them with great
jealousy. Digitalis lowers the pulse in febrile conditions.
Veratrum viride does the same thing. How do we know that a rapid
pulse is not a normal adjustment of nature to the condition it
accompanies? Digitalis has gone out of favor; how sure are we that
Veratrum viride will not be found to do more harm than good in a case
of internal inflammation, taking the whole course of the disease into
consideration? Think of the change of opinion with regard to the use
of opium in delirium tremens (which you remember is sometimes called
delirium vigilans), where it seemed so obviously indicated, since the
publication of Dr. Ware's admirable essay. I respect the evidence of
my contemporaries, but I cannot forget the sayings of the Father of
medicine,--Ars longa, judicium diffcile.
I am not presuming to express an opinion concerning Veratrum viride,
which was little heard of when I was still practising medicine. I am
only appealing to that higher court of experience which sits in
judgment on all decisions of the lower medical tribunals, and which
requires more than one generation for its final verdict.
Once change the habit of mind so long prevalent among practitioners
of medicine; once let it be everywhere understood that the
presumption is in favor of food, and not of alien substances, of
innocuous, and not of unwholesome food, for the sick; that this
presumption requires very strong evidence in each particular case to
overcome it; but that, when such evidence is afforded, the alien
substance or the unwholesome food should be given boldly, in
sufficient quantities, in the same spirit as that with which the
surgeon lifts his knife against a patient,--that is, with the same
reluctance and the same determination,--and I think we shall have and
hear much less of charlatanism in and out of the profession. The
disgrace of medicine has been that colossal system of self-deception,
in obedience to which mines have been emptied of their cankering
minerals, the vegetable kingdom robbed of all its noxious growths,
the entrails of animals taxed for their impurities, the poison-bags
of reptiles drained of their venom, and all the inconceivable
abominations thus obtained thrust down the throats of human beings
suffering from some fault of organization, nourishment, or vital
stimulation.
Much as we have gained, we have not yet thoroughly shaken off the
notion that poison is the natural food of disease, as wholesome
aliment is the support of health. Cowper's lines, in "The Task,"
show the matter-of-course practice of his time:
"He does not scorn it, who has long endured
A fever's agonies, and fed on drugs."
Dr. Kimball of Lowell, who has been in the habit of seeing a great
deal more of typhoid fever than most practitioners, and whose
surgical exploits show him not to be wanting in boldness or
enterprise, can tell you whether he finds it necessary to feed his
patients on drugs or not. His experience is, I believe, that of the
most enlightened and advanced portion of the profession; yet I think
that even in typhoid fever, and certainly in many other complaints,
the effects of ancient habits and prejudices may still be seen in the
practice of some educated physicians.
To you, young men, it belongs to judge all that has gone before you.
You come nearer to the great fathers of modern medicine than some of
you imagine. Three of my own instructors attended Dr. Rush's
Lectures. The illustrious Haller mentions Rush's inaugural thesis in
his "Bibliotheca Anatomica;" and this same Haller, brought so close
to us, tells us he remembers Ruysch, then an old man, and used to
carry letters between him and Boerhaave. Look through the history of
medicine from Boerhaave to this present day. You will see at once
that medical doctrine and practice have undergone a long series of
changes. You will see that the doctrine and practice of our own time
must probably change in their turn, and that, if we can trust at all
to the indications of their course, it will be in the direction of an
improved hygiene and a simplified treatment. Especially will the old
habit of violating the instincts of the sick give place to a
judicious study of these same instincts. It will be found that
bodily, like mental insanity, is best managed, for the most part, by
natural soothing agencies. Two centuries ago there was a
prescription for scurvy containing "stercoris taurini et anserini
par, quantitas trium magnarum nucum," of the hell-broth containing
which "guoties-cumque sitit oeger, large bibit." When I have
recalled the humane common-sense of Captain Cook in the matter of
preventing this disease; when I have heard my friend, Mr. Dana,
describing the avidity with which the scurvy-stricken sailors snuffed
up the earthy fragrance of fresh raw potatoes, the food which was to
supply the elements wanting to their spongy tissues, I have
recognized that the perfection of art is often a return to nature,
and seen in this single instance the germ of innumerable beneficent
future medical reforms.
I cannot help believing that medical curative treatment will by and
by resolve itself in great measure into modifications of the food,
swallowed and breathed, and of the natural stimuli, and that less
will be expected from specifics and noxious disturbing agents, either
alien or assimilable. The noted mineral-waters containing iron,
sulphur, carbonic acid, supply nutritious or stimulating materials to
the body as much as phosphate of lime and ammoniacal compounds do to
the cereal plants. The effects of a milk and vegetable diet, of
gluten bread in diabetes, of cod-liver oil in phthisis, even of such
audacious innovations as the water-cure and the grape-cure, are only
hints of what will be accomplished when we have learned to discover
what organic elements are deficient or in excess in a case of chronic
disease, and the best way of correcting the abnormal condition, just
as an agriculturist ascertains the wants of his crops and modifies
the composition of his soil. In acute febrile diseases we have long
ago discovered that far above all drug-medication is the use of mild
liquid diet in the period of excitement, and of stimulant and
nutritious food in that of exhaustion. Hippocrates himself was as
particular about his barley-ptisan as any Florence Nightingale of our
time could be.
The generation to which you, who are just entering the profession,
belong, will make a vast stride forward, as I believe, in the
direction of treatment by natural rather than violent agencies. What
is it that makes the reputation of Sydenham, as the chief of English
physicians? His prescriptions consisted principally of simples. An
aperient or an opiate, a "cardiac" or a tonic, may be commonly found
in the midst of a somewhat fantastic miscellany of garden herbs. It
was not by his pharmaceutic prescriptions that he gained his great
name. It was by daring to order fresh air for small-pox patients,
and riding on horseback for consumptives, in place of the smothering
system, and the noxious and often loathsome rubbish of the
established schools. Of course Sydenham was much abused by his
contemporaries, as he frequently takes occasion to remind his reader.
"I must needs conclude," he says, "either that I am void of merit, or
that the candid and ingenuous part of mankind, who are formed with so
excellent a temper of mind as to be no strangers to gratitude, make a
very small part of the whole." If in the fearless pursuit of truth
you should find the world as ungracious in the nineteenth century as
he found it in the seventeenth, you may learn a lesson of self-
reliance from another utterance of the same illustrious physician:
"'T is none of my business to inquire what other persons think, but
to establish my own observations; in order to which, I ask no favor
of the reader but to peruse my writings with temper."
The physician has learned a great deal from the surgeon, who is
naturally in advance of him, because he has a better opportunity of
seeing the effects of his remedies. Let me shorten one of Ambroise
Pare's stories for you. There had been a great victory at the pass
of Susa, and they were riding into the city. The wounded cried out
as the horses trampled them under their hoofs, which caused good
Ambroise great pity, and made him wish himself back in Paris. Going
into a stable he saw four dead soldiers, and three desperately
wounded, placed with their backs against the wall. An old campaigner
came up.--"Can these fellows get well?" he said. "No!" answered the
surgeon. Thereupon, the old soldier walked up to them and cut all
their throats, sweetly, and without wrath (doulcement et sans
cholere). Ambroise told him he was a bad man to do such a thing.
"I hope to God;" he said, "somebody will do as much for me if I ever
get into such a scrape" (accoustre de telle facon). "I was not much
salted in those days" (bien doux de sel), says Ambroise, "and little
acquainted with the treatment of wounds." However, as he tells us,
he proceeded to apply boiling oil of Sambuc (elder) after the
approved fashion of the time,--with what torture to the patient may
be guessed. At last his precious oil gave out, and he used instead
an insignificant mixture of his own contrivance. He could not sleep
that night for fear his patients who had not been scalded with the
boiling oil would be poisoned by the gunpowder conveyed into their
wounds by the balls. To his surprise, he found them much better than
the others the next morning, and resolved never again to burn his
patients with hot oil for gun-shot wounds.
This was the beginning, as nearly as we can fix it, of that reform
which has introduced plain water-dressings in the place of the
farrago of external applications which had been a source of profit to
apothecaries and disgrace to art from, and before, the time when
Pliny complained of them. A young surgeon who was at Sudley Church,
laboring among the wounded of Bull Run, tells me they had nothing but
water for dressing, and he (being also doux de sel) was astonished to
see how well the wounds did under that simple treatment.
Let me here mention a fact or two which may be of use to some of you
who mean to enter the public service. You will, as it seems, have
gun-shot wounds almost exclusively to deal with. Three different
surgeons, the one just mentioned and two who saw the wounded of Big
Bethel, assured me that they found no sabre-cuts or bayonet wounds.
It is the rifle-bullet from a safe distance which pierces the breasts
of our soldiers, and not the gallant charge of broad platoons and
sweeping squadrons, such as we have been in the habit of considering
the chosen mode of warfare of ancient and modern chivalry. [Sir
Charles James Napier had the same experience in Virginia in 1813.
"Potomac. We have nasty sort of fighting here, amongst creeks and
bushes, and lose men without show." "Yankee never shows himself, he
keeps in the thickest wood, fires and runs off."--These five
thousand in the open field might be attacked, but behind works it
would be throwing away lives." He calls it "an inglorious warfare,"
--says one of the leaders is "a little deficient in gumption,"--but
--still my opinion is, that if we tuck up our sleeves and lay our
ears back we might thrash them; that is, if we caught them out of
their trees, so as to slap at them with the bayonet."--Life, etc.
vol. i. p. 218 et seq.]
Another fact parallels the story of the old campaigner, and may teach
some of you caution in selecting your assistants. A chaplain told it
to two of our officers personally known to myself. He overheard the
examination of a man who wished to drive one of the "avalanche"
wagons, as they call them. The man was asked if he knew how to deal
with wounded men. "Oh yes," he answered; "if they're hit here,"
pointing to the abdomen, "knock 'em on the head,--they can't get
well."
In art and outside of it you will meet the same barbarisms that
Ambroise Pare met with,--for men differ less from century to century
than we are apt to suppose; you will encounter the same opposition,
if you attack any prevailing opinion, that Sydenham complained of.
So far as possible, let not such experiences breed in you a contempt
for those who are the subjects of folly or prejudice, or foster any
love of dispute for its own sake. Should you become authors, express
your opinions freely; defend them rarely. It is not often that an
opinion is worth expressing, which cannot take care of itself.
Opposition is the best mordant to fix the color of your thought in
the general belief.
It is time to bring these crowded remarks to a close. The day has
been when at the beginning of a course of Lectures I should have
thought it fitting to exhort you to diligence and entire devotion to
your tasks as students. It is not so now. The young man who has not
heard the clarion-voices of honor and of duty now sounding throughout
the land, will heed no word of mine. In the camp or the city, in the
field or the hospital, under sheltering roof, or half-protecting
canvas, or open sky, shedding our own blood or stanching that of our
wounded defenders, students or teachers, whatever our calling and our
ability, we belong, not to ourselves, but to our imperilled country,
whose danger is our calamity, whose ruin would be our enslavement,
whose rescue shall be our earthly salvation!
SCHOLASTIC AND BEDSIDE TEACHING.
An Introductory Lecture delivered before the Medical Class of Harvard
University, November 6, 1867.
The idea is entertained by some of our most sincere professional
brethren, that to lengthen and multiply our Winter Lectures will be
of necessity to advance the cause of medical education. It is a fair
subject for consideration whether they do not overrate the relative
importance of that particular mode of instruction which forms the
larger part of these courses.
As this School could only lengthen its lecture term at the expense of
its "Summer Session," in which more direct, personal, and familiar
teaching takes the place of our academic discourses, and in which
more time can be given to hospitals, infirmaries, and practical
instruction in various important specialties, whatever might be
gained, a good deal would certainly be lost in our case by the
exchange.
The most essential part of a student's instruction is obtained, as I
believe, not in the lecture-room, but at the bedside. Nothing seen
there is lost; the rhythms of disease are learned by frequent
repetition; its unforeseen occurrences stamp themselves indelibly in
the memory. Before the student is aware of what he has acquired, he
has learned the aspects and course and probable issue of the diseases
he has seen with his teacher, and the proper mode of dealing with
them, so far as his master knows it. On the other hand, our ex
cathedra prelections have a strong tendency to run into details
which, however interesting they may be to ourselves and a few of our
more curious listeners, have nothing in them which will ever be of
use to the student as a practitioner. It is a perfectly fair
question whether I and some other American Professors do not teach
quite enough that is useless already. Is it not well to remind the
student from time to time that a physician's business is to avert
disease, to heal the sick, to prolong life, and to diminish
suffering? Is it not true that the young man of average ability will
find it as much as he can do to fit himself for these simple duties?
Is it not best to begin, at any rate, by making sure of such
knowledge as he will require in his daily walk, by no means
discouraging him from any study for which his genius fits him when he
once feels that he has become master of his chosen art.
I know that many branches of science are of the greatest value as
feeders of our medical reservoirs. But the practising physician's
office is to draw the healing waters, and while he gives his time to
this labor he can hardly be expected to explore all the sources that
spread themselves over the wide domain of science. The traveller who
would not drink of the Nile until he had tracked it to its parent
lakes, would be like to die of thirst; and the medical practitioner
who would not use the results of many laborers in other departments
without sharing their special toils, would find life far too short
and art immeasurably too long.
We owe much to Chemistry, one of the most captivating as well as
important of studies; but the medical man must as a general rule
content himself with a clear view of its principles and a limited
acquaintance with its facts; such especially as are pertinent to his
pursuits. I am in little danger of underrating Anatomy or
Physiology; but as each of these branches splits up into specialties,
any one of which may take up a scientific life-time, I would have
them taught with a certain judgment and reserve, so that they shall
not crowd the more immediately practical branches. So of all the
other ancillary and auxiliary kinds of knowledge, I would have them
strictly subordinated to that particular kind of knowledge for which
the community looks to its medical advisers.
A medical school is not a scientific school, except just so far as
medicine itself is a science. On the natural history side, medicine
is a science; on the curative side, chiefly an art. This is implied
in Hufeland's aphorism: "The physician must generalize the disease
and individualize the patient."
The coordinated and classified results of empirical observation, in
distinction from scientific experiment, have furnished almost all we
know about food, the medicine of health, and medicine, the food of
sickness. We eat the root of the Solanum tuberosum and throw away
its fruit; we eat the fruit of the Solanum Lycopersicum and throw
away its root. Nothing but vulgar experience has taught us to reject
the potato ball and cook the tomato. So of most of our remedies.
The subchloride of mercury, calomel, is the great British specific;
the protochloride of mercury, corrosive sublimate, kills like
arsenic, but no chemist could have told us it would be so.
From observations like these we can obtain certain principles from
which we can argue deductively to facts of a like nature, but the
process is limited, and we are suspicious of all reasoning in that
direction applied to the processes of healthy and diseased life. We
are continually appealing to special facts. We are willing to give
Liebig's artificial milk when we cannot do better, but we watch the
child anxiously whose wet-nurse is a chemist's pipkin. A pair of
substantial mammary glands has the advantage over the two hemispheres
of the most learned Professor's brain, in the art of compounding a
nutritious fluid for infants.
The bedside is always the true centre of medical teaching. Certain
branches must be taught in the lecture-room, and will necessarily
involve a good deal that is not directly useful to the future
practitioner. But the over ambitious and active student must not be
led away by the seduction of knowledge for its own sake from his
principal pursuit. The humble beginner, who is alarmed at the vast
fields of knowledge opened to him, may be encouraged by the assurance
that with a very slender provision of science, in distinction from
practical skill, he may be a useful and acceptable member of the
profession to which the health of the community is intrusted.
To those who are not to engage in practice, the various pursuits of
science hardly require to be commended. Only they must not be
disappointed if they find many subjects treated in our courses as a
medical class requires, rather than as a scientific class would
expect, that is, with special limitations and constant reference to
practical ends. Fortunately they are within easy reach of the
highest scientific instruction. The business of a school like this
is to make useful working physicians, and to succeed in this it is
almost as important not to overcrowd the mind of the pupil with
merely curious knowledge as it is to store it with useful
information.
In this direction I have written my lecture, not to undervalue any
form of scientific labor in its place, an unworthy thought from which
I hope I need not defend myself,--but to discourage any undue
inflation of the scholastic programme, which even now asks more of
the student than the teacher is able to obtain from the great
majority of those who present themselves for examination. I wish to
take a hint in education from the Secretary of the Massachusetts
Board of Agriculture, who regards the cultivation of too much land as
a great defect in our New England farming. I hope that our Medical
Institutions may never lay themselves open to the kind of accusation
Mr. Lowe brings against the English Universities, when he says that
their education is made up "of words that few understand and most
will shortly forget; of arts that can never be used, if indeed they
can even be learnt; of histories inapplicable to our times; of
languages dead and even mouldy; of grammatical rules that never had
living use and are only post mortem examinations; and of statements
fagoted with utter disregard of their comparative value."
This general thought will be kept in view throughout my somewhat
discursive address, which will begin with an imaginary clinical
lesson from the lips of an historical personage, and close with the
portrait from real life of one who, both as teacher and practitioner,
was long loved and honored among us. If I somewhat overrun my hour,
you must pardon me, for I can say with Pascal that I have not had the
time to make my lecture shorter.
In the year 1647, that good man John Eliot, commonly called the
Apostle Eliot, writing to Mr. Thomas Shepherd, the pious minister of
Cambridge, referring to the great need of medical instruction for the
Indians, used these words:
"I have thought in my heart that it were a singular good work, if the
Lord would stirre up the hearts of some or other of his people in
England to give some maintenance toward some Schoole or Collegiate
exercise this way, wherein there should be Anatomies and other
instructions that way, and where there might be some recompence given
to any that should bring in any vegetable or other thing that is
vertuous in the way of Physick.
"There is another reason which moves my thought and desires this way,
namely that our young students in Physick may be trained up better
then they yet bee, who have onely theoreticall knowledge, and are
forced to fall to practise before ever they saw an Anatomy made, or
duely trained up in making experiments, for we never had but one
Anatomy in the countrey, which Mr. Giles Firman [Firmin] now in
England, did make and read upon very well, but no more of that now."
Since the time of the Apostle Eliot the Lord has stirred up the
hearts of our people to the building of many Schools and Colleges
where medicine is taught in all its branches. Mr. Giles Firmin's
"Anatomy" may be considered the first ancestor of a long line of
skeletons which have been dangling and rattling in our lecture-rooms
for more than a century.
Teaching in New England in 1647 was a grave but simple matter. A
single person, combining in many cases, as in that of Mr. Giles
Firmin, the offices of physician and preacher, taught what he knew to
a few disciples whom he gathered about him. Of the making of that
"Anatomy" on which my first predecessor in the branch I teach" did
read very well" we can know nothing. The body of some poor wretch
who had swung upon the gallows, was probably conveyed by night to
some lonely dwelling at the outskirts of the village, and there by
the light of flaring torches hastily dissected by hands that trembled
over the unwonted task. And ever and anon the master turned to his
book, as he laid bare the mysteries of the hidden organs; to his
precious Vesalius, it might be, or his figures repeated in the
multifarious volume of Ambroise Pare; to the Aldine octavo in which
Fallopius recorded his fresh observations; or that giant folio of
Spigelius just issued from the press of Amsterdam, in which lovely
ladies display their viscera with a coquettish grace implying that it
is rather a pleasure than otherwise to show the lace-like omentum,
and hold up their appendices epiploicae as if they were saying "these
are our jewels."
His teaching of medicine was no doubt chiefly clinical, and received
with the same kind of faith as that which accepted his words from the
pulpit. His notions of disease were based on what he had observed,
seen always in the light of the traditional doctrines in which he was
bred. His discourse savored of the weighty doctrines of Hippocrates,
diluted by the subtle speculations of Galen, reinforced by the
curious comments of the Arabian schoolmen as they were conveyed in
the mellifluous language of Fernelius, blended, it may be, with
something of the lofty mysticism of Van Helmont, and perhaps stealing
a flavor of that earlier form of Homoeopathy which had lately come to
light in Sir Kenelm Digby's "Discourse concerning the Cure of Wounds
by the Sympathetic Powder."
His Pathology was mythology. A malformed foetus, as the readers of
Winthrop's Journal may remember, was enough to scare the colonists
from their propriety, and suggest the gravest fears of portended
disaster. The student of the seventeenth century opened his Licetus
and saw figures of a lion with the head of a woman, and a man with
the head of an elephant. He had offered to his gaze, as born of a
human mother, the effigy of a winged cherub, a pterocephalous
specimen, which our Professor of Pathological Anatomy would hardly
know whether to treat with the reverence due to its celestial aspect,
or to imprison in one of his immortalizing jars of alcohol.
His pharmacopoeia consisted mainly of simples, such as the venerable
"Herball" of Gerard describes and figures in abounding affluence.
St. John's wort and Clown's All-heal, with Spurge and Fennel, Saffron
and Parsley, Elder and Snake-root, with opium in some form, and
roasted rhubarb and the Four Great Cold Seeds, and the two Resins, of
which it used to be said that whatever the Tacamahaca has not cured,
the Caranna will, with the more familiar Scammony and Jalap and Black
Hellebore, made up a good part of his probable list of remedies. He
would have ordered Iron now and then, and possibly an occasional dose
of Antimony. He would perhaps have had a rheumatic patient wrapped
in the skin of a wolf or a wild cat, and in case of a malignant fever
with "purples" or petechiae, or of an obstinate king's evil, he might
have prescribed a certain black powder, which had been made by
calcining toads in an earthen pot; a choice remedy, taken internally,
or applied to any outward grief.
Except for the toad-powder and the peremptory drastics, one might
have borne up against this herb doctoring as well as against some
more modern styles of medication. Barbeyrac and his scholar Sydenham
had not yet cleansed the Pharmacopoeia of its perilous stuff, but
there is no doubt that the more sensible physicians of that day knew
well enough that a good honest herb-tea which amused the patient and
his nurses was all that was required to carry him through all common
disorders.
The student soon learned the physiognomy of disease by going about
with his master; fevers, pleurisies, asthmas, dropsies, fluxes,
small-pox, sore-throats, measles, consumptions. He saw what was done
for them. He put up the medicines, gathered the herbs, and so
learned something of materia medico and botany. He learned these few
things easily and well, for he could give his whole attention to
them. Chirurgery was a separate specialty. Women in child-birth
were cared for by midwives. There was no chemistry deserving the
name to require his study. He did not learn a great deal, perhaps,
but what he did learn was his business, namely, how to take care of
sick people.
Let me give you a picture of the old=fashioned way of instruction, by
carrying you with me in imagination in the company of worthy Master
Giles Firmin as he makes his round of visits among the good folk of
Ipswich, followed by his one student, who shall answer to the
scriptural name of Luke. It will not be for entertainment chiefly,
but to illustrate the one mode of teaching which can never be
superseded, and which, I venture to say, is more important than all
the rest put together. The student is a green hand, as you will
perceive.
In the first dwelling they come to, a stout fellow is bellowing with
colic.
"He will die, Master, of a surety, methinks," says the timid youth in
a whisper.
"Nay, Luke," the Master answers, "'t is but a dry belly-ache. Didst
thou not mark that he stayed his roaring when I did press hard over
the lesser bowels? Note that he hath not the pulse of them with
fevers, and by what Dorcas telleth me there hath been no long
shutting up of the vice naturales. We will steep certain comforting
herbs which I will shew thee, and put them in a bag and lay them on
his belly. Likewise he shall have my cordial julep with a portion of
this confection which we do call Theriaca Andromachi, which hath
juice of poppy in it, and is a great stayer of anguish. This fellow
is at his prayers to-day, but I warrant thee he shall be swearing
with the best of them to-morrow."
They jog along the bridle-path on their horses until they come to
another lowly dwelling. They sit a while with a delicate looking
girl in whom the ingenuous youth naturally takes a special interest.
The good physician talks cheerfully with her, asks her a few
questions. Then to her mother: "Good-wife, Margaret hath somewhat
profited, as she telleth, by the goat's milk she hath taken night and
morning. Do thou pluck a maniple--that is an handful--of the plant
called Maidenhair, and make a syrup therewith as I have shewed thee.
Let her take a cup full of the same, fasting, before she sleepeth,
also before she riseth from her bed." And so they leave the house.
"What thinkest thou, Luke, of the maid we have been visiting?" "She
seemeth not much ailing, Master, according to my poor judgment. For
she did say she was better. And she had a red cheek and a bright
eye, and she spake of being soon able to walk unto the meeting, and
did seem greatly hopeful, but spare of flesh, methought, and her
voice something hoarse, as of one that hath a defluxion, with some
small coughing from a cold, as she did say. Speak I not truly,
Master, that she will be well speedily?"
"Yea, Luke, I do think she shall be well, and mayhap speedily. But
it is not here with us she shall be well. For that redness of the
cheek is but the sign of the fever which, after the Grecians, we do
call the hectical; and that shining of the eyes is but a sickly
glazing, and they which do every day get better and likewise thinner
and weaker shall find that way leadeth to the church-yard gate. This
is the malady which the ancients did call tubes, or the wasting
disease, and some do name the consumption. A disease whereof most
that fall ailing do perish. This Margaret is not long for earth--but
she knoweth it not, and still hopeth."
"Why, then, Master, didst thou give her of thy medicine, seeing that
her ail is unto death?"
"Thou shalt learn, boy, that they which are sick must have somewhat
wherewith to busy their thoughts. There be some who do give these
tabid or consumptives a certain posset made with lime-water and anise
and liquorice and raisins of the sun, and there be other some who do
give the juice of craw-fishes boiled in barley-water with chicken-
broth, but these be toys, as I do think, and ye shall find as good
virtue, nay better, in this syrup of the simple called Maidenhair."
Something after this manner might Master Giles Firmin have delivered
his clinical instructions. Somewhat in this way, a century and a
half later, another New England physician, Dr. Edward Augustus
Holyoke, taught a young man who came to study with him, a very
diligent and intelligent youth, James Jackson by name, the same whose
portrait in his advanced years hangs upon this wall, long the honored
Professor of Theory and Practice in this Institution, of whom I shall
say something in this Lecture. Our venerated Teacher studied
assiduously afterwards in the great London Hospitals, but I think he
used to quote his "old Master" ten times where he quoted Mr. Cline or
Dr. Woodville once.
When I compare this direct transfer of the practical experience of a
wise man into the mind of a student,--every fact one that he can use
in the battle of life and death,--with the far off, unserviceable
"scientific" truths that I and some others are in the habit of
teaching, I cannot help asking myself whether, if we concede that our
forefathers taught too little, there is not--a possibility that we
may sometimes attempt to teach too much. I almost blush when I think
of myself as describing the eight several facets on two slender
processes of the palate bone, or the seven little twigs that branch
off from the minute tympanic nerve, and I wonder whether my excellent
colleague feels in the same way when he pictures himself as giving
the constitution of neurin, which as he and I know very well is that
of the hydrate of trimethyle-oxethyle-ammonium, or the formula for
the production of alloxan, which, though none but the Professors and
older students can be expected to remember it, is C10 H4 N4 O6+ 2HO,
NO5}=C8 H4 N2 O10+2CO2+N2+NH4 O, NO5.
I can bear the voice of some rough iconoclast addressing the
Anatomist and the Chemist in tones of contemptuous indignation: "What
is this stuff with which you are cramming the brains of young men who
are to hold the lives of the community in their hands? Here is a man
fallen in a fit; you can tell me all about the eight surfaces of the
two processes of the palate bone, but you have not had the sense to
loosen that man's neck-cloth, and the old women are all calling you a
fool? Here is a fellow that has just swallowed poison. I want
something to turn his stomach inside out at the shortest notice. Oh,
you have forgotten the dose of the sulphate of zinc, but you remember
the formula for the production of alloxan!"
"Look you, Master Doctor,--if I go to a carpenter to come and stop a
leak in my roof that is flooding the house, do you suppose I care
whether he is a botanist or not? Cannot a man work in wood without
knowing all about endogens and exogens, or must he attend Professor
Gray's Lectures before he can be trusted to make a box-trap? If my
horse casts a shoe, do you think I will not trust a blacksmith to
shoe him until I have made sure that he is sound on the distinction
between the sesquioxide and the protosesquioxide of iron?"
--But my scientific labor is to lead to useful results by and by, in
the next generation, or in some possible remote future.--
"Diavolo!" as your Dr. Rabelais has it,--answers the iconoclast,--
"what is that to me and my colic, to me and my strangury? I pay the
Captain of the Cunard steamship to carry me quickly and safely to
Liverpool, not to make a chart of the Atlantic for after voyagers!
If Professor Peirce undertakes to pilot me into Boston Harbor and
runs me on Cohasset rocks, what answer is it to tell me that he is
Superintendent of the Coast Survey? No, Sir! I want a plain man in
a pea-jacket and a sou'wester, who knows the channel of Boston
Harbor, and the rocks of Boston Harbor, and the distinguished
Professor is quite of my mind as to the matter, for I took the pains
to ask him before I ventured to use his name in the way of
illustration."
I do not know how the remarks of the image-breaker may strike others,
but I feel that they put me on my defence with regard to much of my
teaching. Some years ago I ventured to show in an introductory
Lecture how very small a proportion of the anatomical facts taught in
a regular course, as delivered by myself and others, had any
practical bearing whatever on the treatment of disease. How can I,
how can any medical teacher justify himself in teaching anything that
is not like to be of practical use to a class of young men who are to
hold in their hands the balance in which life and death, ease and
anguish, happiness and wretchedness are to be daily weighed?
I hope we are not all wrong. Oftentimes in finding how sadly
ignorant of really essential and vital facts and rules were some of
those whom we had been larding with the choicest scraps of science, I
have doubted whether the old one-man system of teaching, when the one
man was of the right sort, did not turn out better working physicians
than our more elaborate method. The best practitioner I ever knew
was mainly shaped to excellence in that way. I can understand
perfectly the regrets of my friend Dr. John Brown of Edinburgh, for
the good that was lost with the old apprenticeship system. I
understand as well Dr. Latham's fear "that many men of the best
abilities and good education will be deterred from prosecuting physic
as a profession, in consequence of the necessity indiscriminately
laid upon all for impossible attainments."
I feel therefore impelled to say a very few words in defence of that
system of teaching adopted in our Colleges, by which we wish to
supplement and complete the instruction given by private individuals
or by what are often called Summer Schools.
The reason why we teach so much that is not practical and in itself
useful, is because we find that the easiest way of teaching what is
practical and useful. If we could in any way eliminate all that
would help a man to deal successfully with disease, and teach it by
itself so that it should be as tenaciously rooted in the memory, as
easily summoned when wanted, as fertile in suggestion of related
facts, as satisfactory to the peremptory demands of the intelligence
as if taught in its scientific connections, I think it would be our
duty so to teach the momentous truths of medicine, and to regard all
useless additions as an intrusion on the time which should be
otherwise occupied.
But we cannot successfully eliminate and teach by itself that which
is purely practical. The easiest and surest why of acquiring facts
is to learn them in groups, in systems, and systematized knowledge is
science. You can very often carry two facts fastened together more
easily than one by itself, as a housemaid can carry two pails of
water with a hoop more easily than one without it. You can remember
a man's face, made up of many features, better than you can his nose
or his mouth or his eye-brow. Scores of proverbs show you that you
can remember two lines that rhyme better than one without the jingle.
The ancients, who knew the laws of memory, grouped the seven cities
that contended for the honor of being Homer's birthplace in a line
thus given by Aulus Gellius:
Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai.
I remember, in the earlier political days of Martin Van Buren, that
Colonel Stone, of the "New York Commercial," or one of his
correspondents, said that six towns of New York would claim in the
same way to have been the birth-place of the "Little Magician," as he
was then called; and thus he gave their names, any one of which I
should long ago have forgotten, but which as a group have stuck tight
in my memory from that day to this;
Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac.
If the memory gains so much by mere rhythmical association, how much
more will it gain when isolated facts are brought together under laws
and principles, when organs are examined in their natural
connections, when structure is coupled with function, and healthy and
diseased action are studied as they pass one into the other!
Systematic, or scientific study is invaluable as supplying a natural
kind of mnemonics, if for nothing else. You cannot properly learn
the facts you want from Anatomy and Chemistry in any way so easily as
by taking them in their regular order, with other allied facts, only
there must be common sense exercised in leaving out a great deal
which belongs to each of the two branches as pure science. The
dullest of teachers is the one who does not know what to omit.
The larger aim of scientific training is to furnish you with
principles to which you will be able to refer isolated facts, and so
bring these within the range of recorded experience. See what the
"London Times" said about the three Germans who cracked open John
Bull Chatwood's strong-box at the Fair the other day, while the three
Englishmen hammered away in vain at Brother Jonathan Herring's. The
Englishmen represented brute force. The Germans had been trained to
appreciate principle. The Englishman "knows his business by rote and
rule of thumb"--science, which would "teach him to do in an hour what
has hitherto occupied him two hours," "is in a manner forbidden to
him." To this cause the "Times" attributes the falling off of
English workmen in comparison with those of the Continent.
Granting all this, we must not expect too much from "science" as
distinguished from common experience. There are ten thousand
experimenters without special apparatus for every one in the
laboratory. Accident is the great chemist and toxicologist. Battle
is the great vivisector. Hunger has instituted researches on food
such as no Liebig, no Academic Commission has ever recorded.
Medicine, sometimes impertinently, often ignorantly, often carelessly
called "allopathy," appropriates everything from every source that
can be of the slightest use to anybody who is ailing in any way, or
like to be ailing from any cause. It learned from a monk how to use
antimony, from a Jesuit how to cure agues, from a friar how to cut
for stone, from a soldier how to treat gout, from a sailor how to
keep off scurvy, from a postmaster how to sound the Eustachian tube,
from a dairy-maid how to prevent small-pox, and from an old market-
woman how to catch the itch-insect. It borrowed acupuncture and the
moxa from the Japanese heathen, and was taught the use of lobelia by
the American savage. It stands ready to-day to accept anything from
any theorist, from any empiric who can make out a good case for his
discovery or his remedy. "Science" is one of its benefactors, but
only one, out of many. Ask the wisest practising physician you know,
what branches of science help him habitually, and what amount of
knowledge relating to each branch he requires for his professional
duties. He will tell you that scientific training has a value
independent of all the special knowledge acquired. He will tell you
that many facts are explained by studying them in the wider range of
related facts to which they belong. He will gratefully recognize
that the anatomist has furnished him with indispensable data, that
the physiologist has sometimes put him on the track of new modes of
treatment, that the chemist has isolated the active principles of his
medicines, has taught him how to combine them, has from time to time
offered him new remedial agencies, and so of others of his allies.
But he will also tell you, if I am not mistaken, that his own branch
of knowledge is so extensive and so perplexing that he must accept
most of his facts ready made at their hands. He will own to you that
in the struggle for life which goes on day and night in our thoughts
as in the outside world of nature, much that he learned under the
name of science has died out, and that simple homely experience has
largely taken the place of that scholastic knowledge to which he and
perhaps some of his instructors once attached a paremount importance.
This, then, is my view of scientific training as conducted in courses
such as you are entering on. Up to a certain point I believe in set
Lectures as excellent adjuncts to what is far more important,
practical instruction at the bedside, in the operating room, and
under the eye of the Demonstrator. But I am so far from wishing
these courses extended, that I think some of them--suppose I say my
own--would almost bear curtailing. Do you want me to describe more
branches of the sciatic and crural nerves? I can take Fischer's
plates, and lecturing on that scale fill up my whole course and not
finish the nerves alone. We must stop somewhere, and for my own part
I think the scholastic exercises of our colleges have already claimed
their full share of the student's time without our seeking to extend
them.
I trust I have vindicated the apparent inconsequence of teaching
young students a good deal that seems at first sight profitless, but
which helps them to learn and retain what is profitable. But this is
an inquisitive age, and if we insist on piling up beyond a certain
height knowledge which is in itself mere trash and lumber to a man
whose life is to be one long fight with death and disease, there will
be some sharp questions asked by and by, and our quick-witted people
will perhaps find they can get along as well without the professor's
cap as without the bishop's mitre and the monarch's crown.
I myself have nothing to do with clinical teaching. Yet I do not
hesitate to say it is more essential than all the rest put together,
so far as the ordinary practice of medicine is concerned; and this is
by far the most important thing to be learned, because it deals with
so many more lives than any other branch of the profession. So of
personal instruction, such as we give and others give in the interval
of lectures, much of it at the bedside, some of it in the laboratory,
some in the microscope-room, some in the recitation-room, I think it
has many advantages of its own over the winter course, and I do not
wish to see it shortened for the sake of prolonging what seems to me
long enough already.
If I am jealous of the tendency to expand the time given to the
acquisition of curious knowledge, at the expense of the plain old-
fashioned bedside teachings, I only share the feeling which Sydenham
expressed two hundred years ago, using an image I have already
borrowed. "He would be no honest and successful pilot who was to
apply himself with less industry to avoid rocks and sands and bring
his vessel safely home, than to search into the causes of the ebbing
and flowing of the sea, which, though very well for a philosopher, is
foreign to him whose business it is to secure the ship. So neither
will a physician, whose province it is to cure diseases, be able to
do so, though he be a person of great genius, who bestows less time
on the hidden and intricate method of nature, and adapting his means
thereto, than on curious and subtle speculation."
"Medicine is my wife and Science is my mistress," said Dr. Rush. I
do not think that the breach of the seventh commandment can be shown
to have been of advantage to the legitimate owner of his affections.
Read what Dr. Elisha Bartlett says of him as a practitioner, or ask
one of our own honored ex-professors, who studied under him, whether
Dr. Rush had ever learned the meaning of that saying of Lord Bacon,
that man is the minister and interpreter of Nature, or whether he did
not speak habitually of Nature as an intruder in the sick room, from
which his art was to expel her as an incompetent and a meddler.
All a man's powers are not too much for such a profession as
Medicine. "He is a learned man," said old Parson Emmons of Franklin,
"who understands one subject, and he is a very learned man who
understands two subjects." Schonbein says he has been studying
oxygen for thirty years. Mitscherlich said it took fourteen years to
establish a new fact in chemistry. Aubrey says of Harvey, the
discoverer of the circulation, that "though all his profession would
allow him to be an excellent anatomist, I have never heard of any who
admired his therapeutic way." My learned and excellent friend before
referred to, Dr. Brown of Edinburgh, from whose very lively and
sensible Essay, "Locke and Sydenham," I have borrowed several of my
citations, contrasts Sir Charles Bell, the discoverer, the man of
science, with Dr. Abercrombie, the master in the diagnosis and
treatment of disease. It is through one of the rarest of
combinations that we have in our Faculty a teacher on whom the
scientific mantle of Bell has fallen, and who yet stands preeminent
in the practical treatment of the class of diseases which his
inventive and ardent experimental genius has illustrated. M. Brown-
Sequard's example is as, eloquent as his teaching in proof of the
advantages of well directed scientific investigation. But those who
emulate his success at once as a discoverer and a practitioner must
be content like him to limit their field of practice. The highest
genius cannot afford in our time to forget the ancient precept,
Divide et impera.
"I suppose I must go and earn this guinea," said a medical man who
was sent for while he was dissecting an animal. I should not have
cared to be his patient. His dissection would do me no good, and his
thoughts would be too much upon it. I want a whole man for my
doctor, not a half one. I would have sent for a humbler
practitioner, who would have given himself entirely to me, and told
the other--who was no less a man than John Hunter--to go on and
finish the dissection of his tiger.
Sydenham's "Read Don Quixote" should be addressed not to the student,
but to the Professor of today. Aimed at him it means, "Do not be too
learned."
Do not think you are going to lecture to picked young men who are
training themselves to be scientific discoverers. They are of fair
average capacity, and they are going to be working doctors.
These young men are to have some very serious vital facts to deal
with. I will mention a few of them.
Every other resident adult you meet in these streets is or will be
more or less tuberculous. This is not an extravagant estimate, as
very nearly one third of the deaths of adults in Boston last year
were from phthisis. If the relative number is less in our other
northern cities, it is probably in a great measure because they are
more unhealthy; that is, they have as much, or nearly as much,
consumption, but they have more fevers or other fatal diseases.
These heavy-eyed men with the alcoholized brains, these pallid youths
with the nicotized optic ganglia and thinking-marrows brown as their
own meerschaums, of whom you meet too many,--will ask all your wisdom
to deal with their poisoned nerves and their enfeebled wills.
Nearly seventeen hundred children under five years of age died last
year in this city. A poor human article, no doubt, in many cases,
still, worth an attempt to save them, especially when we remember the
effect of Dr. Clarke's suggestion at the Dublin Hospital, by which
some twenty-five or thirty thousand children's lives have probably
been saved in a single city.
Again, the complaint is often heard that the native population is not
increasing so rapidly as in former generations. The breeding and
nursing period of American women is one of peculiar delicacy and
frequent infirmity. Many of them must require a considerable
interval between the reproductive efforts, to repair damages arid
regain strength. This matter is not to be decided by an appeal to
unschooled nature. It is the same question as that of the deformed
pelvis,--one of degree. The facts of mal-vitalization are as much to
be attended to as those of mal-formation. If the woman with a
twisted pelvis is to be considered an exempt, the woman with a
defective organization should be recognized as belonging to the
invalid corps. We shudder to hear what is alleged as to the
prevalence of criminal practices; if back of these there can be shown
organic incapacity or overtaxing of too limited powers, the facts
belong to the province of the practical physician, as well as of the
moralist and the legislator, and require his gravest consideration.
Take the important question of bleeding. Is venesection done with
forever? Six years ago it was said here in an introductory Lecture
that it would doubtless come back again sooner or later. A fortnight
ago I found myself in the cars with one of the most sensible and
esteemed practitioners in New England. He took out his wallet and
showed me two lancets, which he carried with him; he had never given
up their use. This is a point you will have to consider.
Or, to mention one out of many questionable remedies, shall you give
Veratrum Viride in fevers and inflammations? It makes the pulse
slower in these affections. Then the presumption would naturally be
that it does harm. The caution with reference to it on this ground
was long ago recorded in the Lecture above referred to. See what Dr.
John Hughes Bennett says of it in the recent edition of his work on
Medicine. Nothing but the most careful clinical experience can
settle this and such points of treatment.
These are all practical questions--questions of life and death, and
every day will be full of just such questions. Take the problem of
climate. A patient comes to you with asthma and wants to know where
he can breathe; another comes to you with phthisis and wants to know
where he can live. What boy's play is nine tenths of all that is
taught in many a pretentious course of lectures, compared with what
an accurate and extensive knowledge of the advantages and
disadvantages of different residences in these and other complaints
would be to a practising physician
I saw the other day a gentleman living in Canada, who had spent seven
successive winters in Egypt, with the entire relief of certain
obscure thoracic symptoms which troubled him while at home. I saw,
two months ago, another gentleman from Minnesota, an observer and a
man of sense, who considered that State as the great sanatorium for
all pulmonary complaints. If half our grown population are or will
be more or less tuberculous, the question of colonizing Florida
assumes a new aspect. Even within the borders of our own State, the
very interesting researches of Dr. Bowditch show that there is a
great variation in the amount of tuberculous disease in different
towns, apparently connected with local conditions. The hygienic map
of a State is quite as valuable as its geological map, and it is the
business of every practising physician to know it thoroughly. They
understand this in England, and send a patient with a dry irritating
cough to Torquay or Penzance, while they send another with relaxed
bronchial membranes to Clifton or Brighton. Here is another great
field for practical study.
So as to the all-important question of diet. "Of all the means of
cure at our command," says Dr. Bennett, "a regulation of the quantity
and quality of the diet is by far the most powerful." Dr. MacCormac
would perhaps except the air we breathe, for he thinks that impure
air, especially in sleeping rooms, is the great cause of tubercle.
It is sufficiently proved that the American,--the New Englander,--the
Bostonian, can breed strong and sound children, generation after
generation,--nay, I have shown by the record of a particular family
that vital losses may be retrieved, and a feeble race grow to lusty
vigor in this very climate and locality. Is not the question why our
young men and women so often break down, and how they can be kept
from breaking down, far more important for physicians to settle than
whether there is one cranial vertebra, or whether there are four, or
none?
--But I have a taste for the homologies, I want to go deeply into the
subject of embryology, I want to analyze the protonihilates
precipitated from pigeon's milk by the action of the lunar spectrum,-
shall I not follow my star,--shall I not obey my instinct,--shall I
not give myself to the lofty pursuits of science for its own sake?
Certainly you may, if you like. But take down your sign, or never
put it up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and
Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the
difficulty. We all admire the achievements of this band of
distinguished doctors who do not practise. But we say of their work
and of all pure science, as the French officer said of the charge of
the six hundred at Balaclava, "C'est magnifique, mais ce n'est pas la
guerre,"--it is very splendid, but it is not a practising doctor's
business. His patient has a right to the cream of his life and not
merely to the thin milk that is left after "science" has skimmed it
off. The best a physician can give is never too good for the
patient.
It is often a disadvantage to a young practitioner to be known for
any accomplishment outside of his profession. Haller lost his
election as Physician to the Hospital in his native city of Berne,
principally on the ground that he was a poet. In his later years the
physician may venture more boldly. Astruc was sixty-nine years old
when he published his "Conjectures," the first attempt, we are told,
to decide the authorship of the Pentateuch showing anything like a
discerning criticism. Sir Benjamin Brodie was seventy years old
before he left his physiological and surgical studies to indulge in
psychological speculations. The period of pupilage will be busy
enough in acquiring the knowledge needed, and the season of active
practice will leave little leisure for any but professional studies.
Dr. Graves of Dublin, one of the first clinical teachers of our time,
always insisted on his students' beginning at once to visit the
hospital. At the bedside the student must learn to treat disease,
and just as certainly as we spin out and multiply our academic
prelections we shall work in more and more stuffing, more and more
rubbish, more and more irrelevant, useless detail which the student
will get rid of just as soon as he leaves us. Then the next thing
will be a new organization, with an examining board of first-rate
practical men, who will ask the candidate questions that mean
business,--who will make him operate if he is to be a surgeon, and
try him at the bedside if he is to be a physician,--and not puzzle
him with scientific conundrums which not more than one of the
questioners could answer himself or ever heard of since he graduated.
Or these women who are hammering at the gates on which is written "No
admittance for the mothers of mankind," will by and by organize an
institution, which starting from that skilful kind of nursing which
Florence Nightingale taught so well, will work backwards through
anodynes, palliatives, curatives, preventives, until with little show
of science it imparts most of what is most valuable in those branches
of the healing art it professes to teach. When that time comes, the
fitness of women for certain medical duties, which Hecquet advocated
in 1708, which Douglas maintained in 1736, which Dr. John Ware, long
the honored Professor of Theory and Practice in this Institution,
upheld within our own recollection in the face of his own recorded
opinion to the contrary, will very possibly be recognized.
My advice to every teacher less experienced than myself would be,
therefore: Do not fret over the details you have to omit; you
probably teach altogether too many as it is. Individuals may learn a
thing with once hearing it, but the only way of teaching a whole
class is by enormous repetition, representation, and illustration in
all possible forms. Now and then you will have a young man on your
benches like the late Waldo Burnett,--not very often, if you lecture
half a century. You cannot pretend to lecture chiefly for men like
that,--a Mississippi raft might as well take an ocean-steamer in tow.
To meet his wants you would have to leave the rest of your class
behind and that you must not do. President Allen of Jefferson
College says that his instruction has been successful in proportion
as it has been elementary. It may be a humiliating statement, but it
is one which I have found true in my own experience.
To the student I would say, that however plain and simple may be our
teaching, he must expect to forget much which he follows
intelligently in the lecture-room. But it is not the same as if he
had never learned it. A man must get a thing before he can forget
it. There is a great world of ideas we cannot voluntarily recall,--
they are outside the limits of the will. But they sway our conscious
thought as the unseen planets influence the movements of those within
the sphere of vision. No man knows how much he knows,--how many
ideas he has,--any more than he knows how many blood-globules roll in
his veins. Sometimes accident brings back here and there one, but
the mind is full of irrevocable remembrances and unthinkable
thoughts, which take a part in all its judgments as indestructible
forces. Some of you must feel your scientific deficiencies painfully
after your best efforts. But every one can acquire what is most
essential. A man of very moderate ability may be a good physician,
if he devotes himself faithfully to the work. More than this, a
positively dull man, in the ordinary acceptation of the term,
sometimes makes a safer practitioner than one who has, we will say,
five per cent. more brains than his average neighbor, but who thinks
it is fifty per cent. more. Skulls belonging to this last variety of
the human race are more common, I may remark, than specimens like the
Neanderthal cranium, a cast of which you will find on the table in
the Museum.
Whether the average talent be high or low, the Colleges of the land
must make the best commodity they can out of such material as the
country and the cities furnish them. The community must have Doctors
as it must have bread. It uses up its Doctors just as it wears out
its shoes, and requires new ones. All the bread need not be French
rolls, all the shoes need not be patent leather ones; but the bread
must be something that can be eaten, and the shoes must be something
that can be worn. Life must somehow find food for the two forces
that rub everything to pieces, or burn it to ashes,--friction and
oxygen. Doctors are oxydable products, and the schools must keep
furnishing new ones as the old ones turn into oxyds; some of first-
rate quality that burn with a great light, some of a lower grade of
brilliancy, some honestly, unmistakably, by the grace of God, of
moderate gifts, or in simpler phrase, dull.
The public will give every honest and reasonably competent worker in
the healing art a hearty welcome. It is on the whole very loyal to
the Medical Profession. Three successive years have borne witness to
the feeling with which this Institution, representing it in its
educational aspect, is regarded by those who are themselves most
honored and esteemed. The great Master of Natural Science bade the
last year's class farewell in our behalf, in those accents which
delight every audience. The Head of our ancient University honored
us in the same way in the preceding season. And how can we forget
that other occasion when the Chief Magistrate of the Commonwealth,
that noble citizen whom we have just lost, large-souled, sweet-
natured, always ready for every kind office, came among us at our
bidding, and talked to us of our duties in words as full of wisdom as
his heart was of goodness?
You have not much to fear, I think, from the fancy practitioners.
The vulgar quackeries drop off, atrophied, one after another.
Homoeopathy has long been encysted, and is carried on the body
medical as quietly as an old wen. Every year gives you a more
reasoning and reasonable people to deal with. See how it is in
Literature. The dynasty of British dogmatists, after lasting a
hundred years and more, is on its last legs. Thomas Carlyle, third
in the line of descent, finds an audience very different from those
which listened to the silver speech of Samuel Taylor Coleridge and
the sonorous phrases of Samuel Johnson. We read him, we smile at his
clotted English, his "swarmery" and other picturesque expressions,
but we lay down his tirade as we do one of Dr. Cumming's
interpretations of prophecy, which tells us that the world is coming
to an end next week or next month, if the weather permits,--not
otherwise,--feeling very sure that the weather will be unfavorable.
It is the same common-sense public you will appeal to. The less
pretension you make, the better they will like you in the long run.
I hope we shall make everything as plain and as simple to you as we
can. I would never use a long word, even, where a short one would
answer the purpose. I know there are professors in this country who
"ligate" arteries. Other surgeons only tie them, and it stops the
bleeding just as well. It is the familiarity and simplicity of
bedside instruction which makes it so pleasant as well as so
profitable. A good clinical teacher is himself a Medical School. We
need not wonder that our young men are beginning to announce
themselves not only as graduates of this or that College, but also as
pupils of some one distinguished master.
I wish to close this Lecture, if you will allow me a few moments
longer, with a brief sketch of an instructor and practitioner whose
character was as nearly a model one in both capacities as I can find
anywhere recorded.
Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine
in this University from 1812 to 1846, and whose name has been since
retained on our rolls as Professor Emeritus, died on the 27th of
August last, in the ninetieth year of his age. He studied his
profession, as I have already mentioned, with Dr. Holyoke of Salem,
one of the few physicians who have borne witness to their knowledge
of the laws of life by living to complete their hundredth year. I
think the student took his Old Master, as he always loved to call
him, as his model; each was worthy of the other, and both were bright
examples to all who come after them.
I remember that in the sermon preached by Dr. Grazer after Dr.
Holyoke's death, one of the points most insisted upon as
characteristic of that wise and good old man was the perfect balance
of all his faculties. The same harmonious adjustment of powers, the
same symmetrical arrangement of life, the same complete fulfilment of
every day's duties, without haste and without needless delay, which
characterized the master, equally distinguished the scholar. A
glance at the life of our own Old Master, if I can do any justice at
all to his excellences, will give you something to carry away from
this hour's meeting not unworthy to be remembered.
From December, 1797, to October, 1799, he remained with Dr. Holyoke
as a student, a period which he has spoken of as a most interesting
and most gratifying part of his life. After this he passed eight
months in London, and on his return, in October, 1800, he began
business in Boston.
He had followed Mr. Cline, as I have mentioned, and was competent to
practise Surgery. But he found Dr. John Collins Warren had already
occupied the ground which at that day hardly called for more than one
leading practitioner, and wisely chose the Medical branch of the
profession. He had only himself to rely upon, but he had confidence
in his prospects, conscious, doubtless, of his own powers, knowing
his own industry and determination, and being of an eminently
cheerful and hopeful disposition. No better proof of his spirit can
be given than that, just a year from the time when he began to
practise as a physician, he took that eventful step which in such a
man implies that he sees his way clear to a position; he married a
lady blessed with many gifts, but not bringing him a fortune to
paralyze his industry.
He had not miscalculated his chances in life. He very soon rose into
a good practice, and began the founding of that reputation which grew
with his years, until he stood by general consent at the head of his
chosen branch of the profession, to say the least, in this city and
in all this region of country. His skill and wisdom were the last
tribunal to which the sick and suffering could appeal. The community
trusted and loved him, the profession recognized him as the noblest
type of the physician. The young men whom he had taught wandered
through foreign hospitals; where they learned many things that were
valuable, and many that were curious; but as they grew older and
began to think more of their ability to help the sick than their
power of talking about phenomena, they began to look back to the
teaching of Dr. Jackson, as he, after his London experience, looked
back to that of Dr. Holyoke. And so it came to be at last that the
bare mention of his name in any of our medical assemblies would call
forth such a tribute of affectionate regard as is only yielded to age
when it brings with it the record of a life spent in well doing.
No accident ever carries a man to eminence such as his in the medical
profession. He who looks for it must want it earnestly and work for
it vigorously; Nature must have qualified him in many ways, and
education must have equipped him with various knowledge, or his
reputation will evaporate before it reaches the noon-day blaze of
fame. How did Dr. Jackson gain the position which all conceded to
him? In the answer to this question some among you may find a key
that shall unlock the gate opening on that fair field of the future
of which all dream but which not all will ever reach.
First of all, he truly loved his profession. He had no intellectual
ambitions outside of it, literary, scientific or political. To him
it was occupation enough to apply at the bedside the best of all that
he knew for the good of his patient; to protect the community against
the inroads of pestilence; to teach the young all that he himself had
been taught, with all that his own experience had added; to leave on
record some of the most important results of his long observation.
With his patients he was so perfect at all points that it is hard to
overpraise him. I have seen many noted British and French and
American practitioners, but I never saw the man so altogether
admirable at the bedside of the sick as Dr. James Jackson. His smile
was itself a remedy better than the potable gold and the dissolved
pearls that comforted the praecordia of mediaeval monarchs. Did a
patient, alarmed without cause, need encouragement, it carried the
sunshine of hope into his heart and put all his whims to flight, as
David's harp cleared the haunted chamber of the sullen king. Had the
hour come, not for encouragement, but for sympathy, his face, his
voice, his manner all showed it, because his heart felt it. So
gentle was he, so thoughtful, so calm, so absorbed in the case before
him, not to turn round and look for a tribute to his sagacity, not to
bolster himself in a favorite theory, but to find out all he could,
and to weigh gravely and cautiously all that he found, that to follow
him in his morning visit was not only to take a lesson in the healing
art, it was learning how to learn, how to move, how to look, how to
feel, if that can be learned. To visit with Dr. Jackson was a
medical education.
He was very firm, with all his kindness. He would have the truth
about his patients. The nurses found it out; and the shrewder ones
never ventured to tell him anything but a straight story. A clinical
dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse
in the Massachusetts General Hospital, a mistress in her calling, was
as good questioning and answering as one would be like to hear
outside of the court-room.
Of his practice you can form an opinion from his book called "Letters
to a Young Physician." Like all sensible men from the days of
Hippocrates to the present, he knew that diet and regimen were more
important than any drug or than all drugs put together. Witness his
treatment of phthisis and of epilepsy. He retained, however, more
confidence in some remedial agents than most of the younger
generation would concede to them. Yet his materia medica was a
simple one.
"When I first went to live with Dr. Holyoke," he says, "in 1797,
showing me his shop, he said, 'There seems to you to be a great
variety of medicines here, and that it will take you long to get
acquainted with them, but most of them are unimportant. There are
four which are equal to all the rest, namely, Mercury, Antimony, Bark
and Opium.'" And Dr. Jackson adds, "I can only say of his practice,
the longer I have lived, I have thought better and better of it."
When he thought it necessary to give medicine, he gave it in earnest.
He hated half-practice--giving a little of this or that, so as to be
able to say that one had done something, in case a consultation was
held, or a still more ominous event occurred. He would give opium,
for instance, as boldly as the late Dr. Fisher of Beverly, but he
followed the aphorism of the Father of Medicine, and kept extreme
remedies for extreme cases.
When it came to the "non-naturals," as he would sometimes call them,
after the old physicians,--namely, air, meat and drink, sleep and
watching, motion and rest, the retentions and excretions, and the
affections of the mind,--he was, as I have said, of the school of
sensible practitioners, in distinction from that vast community of
quacks, with or without the diploma, who think the chief end of man
is to support apothecaries, and are never easy until they can get
every patient upon a regular course of something nasty or noxious.
Nobody was so precise in his directions about diet, air, and
exercise, as Dr. Jackson. He had the same dislike to the a peu pres,
the about so much, about so often, about so long, which I afterwards
found among the punctilious adherents of the numerical system at La
Pitie.
He used to insist on one small point with a certain philological
precision, namely, the true meaning of the word "cure." He would
have it that to cure a patient was simply to care for him. I refer
to it as showing what his idea was of the relation of the physician
to the patient. It was indeed to care for him, as if his life were
bound up in him, to watch his incomings and outgoings, to stand guard
at every avenue that disease might enter, to leave nothing to chance;
not merely to throw a few pills and powders into one pan of the
scales of Fate, while Death the skeleton was seated in the other, but
to lean with his whole weight on the side of life, and shift the
balance in its favor if it lay in human power to do it. Such
devotion as this is only to be looked for in the man who gives
himself wholly up to the business of healing, who considers Medicine
itself a Science, or if not a science, is willing to follow it as an
art,--the noblest of arts, which the gods and demigods of ancient
religions did not disdain to practise and to teach.
The same zeal made him always ready to listen to any new suggestion
which promised to be useful, at a period of life when many men find
it hard to learn new methods and accept new doctrines. Few of his
generation became so accomplished as he in the arts of direct
exploration; coming straight from the Parisian experts, I have
examined many patients with him, and have had frequent opportunities
of observing his skill in percussion and auscultation.
One element in his success, a trivial one compared with others, but
not to be despised, was his punctuality. He always carried two
watches,--I doubt if he told why, any more than Dr. Johnson told what
he did with the orange-peel,--but probably with reference to this
virtue. He was as much to be depended upon at the appointed time as
the solstice or the equinox. There was another point I have heard
him speak of as an important rule with him; to come at the hour when
he was expected; if he had made his visit for several days
successively at ten o'clock, for instance, not to put it off, if be
could possibly help it, until eleven, and so keep a nervous patient
and an anxious family waiting for him through a long, weary hour.
If I should attempt to characterize his teaching, I should say that
while it conveyed the best results of his sagacious and extended
observation, it was singularly modest, cautious, simple, sincere.
Nothing was for show, for self-love; there was no rhetoric, no
declamation, no triumphant "I told you so," but the plain statement
of a clear-headed honest man, who knows that he is handling one of
the gravest subjects that interest humanity. His positive
instructions were full of value, but the spirit in which he taught
inspired that loyal love of truth which lies at the bottom of all
real excellence.
I will not say that, during his long career, Dr. Jackson never made
an enemy. I have heard him tell how, in his very early days, old Dr.
Danforth got into a towering passion with him about some professional
consultation, and exploded a monosyllable or two of the more
energetic kind on the occasion. I remember that that somewhat
peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson
succeeded to his place as Professor of Theory and Practice. A young
man of Dr. Jackson's talent and energy could hardly take the position
that belonged to him without crowding somebody in a profession where
three in a bed is the common rule of the household. But he was a
peaceful man and a peace-maker all his days. No man ever did more,
if so much, to produce and maintain the spirit of harmony for which
we consider our medical community as somewhat exceptionally
distinguished.
If this harmony should ever be threatened, I could wish that every
impatient and irritable member of the profession would read that
beautiful, that noble Preface to the "Letters," addressed to John
Collins Warren. I know nothing finer in the medical literature of
all time than this Prefatory Introduction. It is a golden prelude,
fit to go with the three great Prefaces which challenge the
admiration of scholars,--Calvin's to his Institutes, De Thou's to his
History, and Casaubon's to his Polybius,--not because of any learning
or rhetoric, though it is charmingly written, but for a spirit
flowing through it to which learning and rhetoric are but as the
breath that is wasted on the air to the Mood that warms the heart.
Of a similar character is this short extract which I am permitted to
make from a private letter of his to a dear young friend. He was
eighty-three years old at the time of writing it.
"I have not loved everybody whom I have known, but I have striven to
see the good points in the characters of all men and women. At first
I must have done this from something in my own nature, for I was not
aware of it, and yet was doing it without any plan, when one day,
sixty years ago, a friend whom I loved and respected said this to me,
'Ah, James, I see that you are destined to succeed in the world, and
to make friends, because you are so ready to see the good point in
the characters of those you meet.'"
I close this imperfect notice of some features in the character of
this most honored and beloved of physicians by applying to him the
words which were written of William Heberden, whose career was not
unlike his own, and who lived to the same patriarchal age.
"From his early youth he had always entertained a deep sense of
religion, a consummate love of virtue, an ardent thirst after
knowledge, and an earnest desire to promote the welfare and happiness
of all mankind. By these qualities, accompanied with great sweetness
of manners, he acquired the love and esteem of all good men, in a
degree which perhaps very few have experienced; and after passing an
active life with the uniform testimony of a good conscience, he
became an eminent example of its influence, in the cheerfulness and
serenity of his latest age."
Such was the man whom I offer to you as a model, young gentlemen, at
the outset of your medical career. I hope that many of you will
recognize some traits of your own special teachers scattered through
various parts of the land in the picture I have drawn. Let me assure
you that whatever you may learn in this or any other course of public
lectures,--and I trust you will learn a great deal,--the daily
guidance, counsel, example, of your medical father, for such the Oath
of Hippocrates tells you to consider your preceptor, will, if he is
in any degree like him of whom I have spoken, be the foundation on
which all that we teach is reared, and perhaps outlive most of our
teachings, as in Dr. Jackson's memory the last lessons that remained
with him were those of his Old Master.
THE MEDICAL PROFESSION IN MASSACHUSETTS.
A Lecture of a Course by members of the Massachusetts Historical
Society, delivered before the Lowell Institute, January 29, 1869.
The medical history of eight generations, told in an hour, must be in
many parts a mere outline. The details I shall give will relate
chiefly to the first century. I shall only indicate the leading
occurrences, with the more prominent names of the two centuries which
follow, and add some considerations suggested by the facts which have
been passed in review.
A geographer who was asked to describe the tides of Massachusetts
Bay, would have to recognize the circumstance that they are a limited
manifestation of a great oceanic movement. To consider them apart
from this, would be to localize a planetary phenomenon, and to
provincialize a law of the universe. The art of healing in
Massachusetts has shared more or less fully and readily the movement
which, with its periods of ebb and flow, has been raising its level
from age to age throughout the better part of Christendom. Its
practitioners brought with them much of the knowledge and many of the
errors of the Old World; they have always been in communication with
its wisdom and its folly; it is not without interest to see how far
the new conditions in which they found themselves have been favorable
or unfavorable to the growth of sound medical knowledge and practice.
The state of medicine is an index of the civilization of an age and
country,--one of the best, perhaps, by which it can be judged.
Surgery invokes the aid of all the mechanical arts. From the rude
violences of the age of stone,--a relic of which we may find in the
practice of Zipporah, the wife of Moses,--to the delicate operations
of to-day upon patients lulled into temporary insensibility, is a
progress which presupposes a skill in metallurgy and in the labors of
the workshop and the laboratory it has taken uncounted generations to
accumulate. Before the morphia which deadens the pain of neuralgia,
or the quinine which arrests the fit of an ague, can find their place
in our pharmacies, commerce must have perfected its machinery, and
science must have refined its processes, through periods only to be
counted by the life of nations. Before the means which nature and
art have put in the hands of the medical practitioner can be fairly
brought into use, the prejudices of the vulgar must be overcome, the
intrusions of false philosophy must be fenced out, and the
partnership with the priesthood dissolved. All this implies that
freedom and activity of thought which belong only to the most
advanced conditions of society; and the progress towards this is by
gradations as significant of wide-spread changes, as are the varying
states of the barometer of far-extended conditions of the atmosphere.
Apart, then, from its special and technical interest, my subject has
a meaning which gives a certain importance, and even dignity, to
details in themselves trivial and almost unworthy of record. A
medical entry in Governor Winthrop's journal may seem at first sight
a mere curiosity; but, rightly interpreted, it is a key to his whole
system of belief as to the order of the universe and the relations
between man and his Maker. Nothing sheds such light on the
superstitions of an age as the prevailing interpretation and
treatment of disease. When the touch of a profligate monarch was a
cure for one of the most inveterate of maladies, when the common
symptoms of hysteria were prayed over as marks of demoniacal
possession, we might well expect the spiritual realms of thought to
be peopled with still stranger delusions.
Let us go before the Pilgrims of the Mayflower, and look at the
shores on which they were soon to land. A wasting pestilence had so
thinned the savage tribes that it was sometimes piously interpreted
as having providentially prepared the way for the feeble band of
exiles. Cotton Mather, who, next to the witches, hated the
"tawnies," "wild beasts," "blood-hounds," "rattlesnakes,"
"infidels," as in different places he calls the unhappy Aborigines,
describes the condition of things in his lively way, thus:
"The Indians in these Parts had newly, even about a Year or Two
before, been visited with such a prodigious Pestilence; as carried
away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of
Twenty) among them so that the Woods were almost cleared of those
pernicious Creatures to make Room for a better Growth."
What this pestilence was has been much discussed. It is variously
mentioned by different early writers as "the plague," "a great and
grievous plague," "a sore consumption," as attended with spots which
left unhealed places on those who recovered, as making the "whole
surface yellow as with a garment." Perhaps no disease answers all
these conditions so well as smallpox. We know from different sources
what frightful havoc it made among the Indians in after years,--in
1631, for instance, when it swept away the aboriginal inhabitants of
"whole towns," and in 1633. We have seen a whole tribe, the Mandans,
extirpated by it in our own day. The word "plague" was used very
vaguely, as in the description of the "great sickness" found among
the Indians by the expedition of 1622. This same great sickness
could hardly have been yellow fever, as it occurred in the month of
November. I cannot think, therefore, that either the scourge of the
East or our Southern malarial pestilence was the disease that wasted
the Indians. As for the yellowness like a garment, that is too
familiar to the eyes of all who have ever looked on the hideous mask
of confluent variola.
Without the presence or the fear of these exotic maladies, the
forlorn voyagers of the Mayflower had sickness enough to contend
with. At their first landing at Cape Cod, gaunt and hungry and
longing for fresh food, they found upon the sandy shore "great
mussel's, and very fat and full of sea-pearl." Sailors and
passengers indulged in the treacherous delicacy; which seems to have
been the sea-clam; and found that these mollusks, like the shell the
poet tells of, remembered their august abode, and treated the way-
worn adventurers to a gastric reminiscence of the heaving billows.
In the mean time it blew and snowed and froze. The water turned to
ice on their clothes, and made them many times like coats of iron.
Edward Tilley had like to have "sounded" with cold. The gunner, too,
was sick unto death, but "hope of trucking" kept him on his feet,--a
Yankee, it should seem, when he first touched the shore of New
England. Most, if not all, got colds and coughs, which afterwards
turned to scurvy, whereof many died.
How can we wonder that the crowded and tempest-tossed voyagers, many
of them already suffering, should have fallen before the trials of
the first winter in Plymouth? Their imperfect shelter, their
insufficient supply of bread, their salted food, now in unwholesome
condition, account too well for the diseases and the mortality that
marked this first dreadful season; weakness, swelling of the limbs,
and other signs of scurvy, betrayed the want of proper nourishment
and protection from the elements. In December six of their number
died, in January eight, in February, seventeen, in March thirteen.
With the advance of spring the mortality diminished, the sick and
lame began to recover, and the colonists, saddened but not
disheartened, applied themselves to the labors of the opening year.
One of the most pressing needs of the early colonists must have been
that of physicians and surgeons. In Mr. Savage's remarkable
Genealogical Dictionary of the first settlers who came over before
1692 and their descendants to the third generation, I find scattered
through the four crowded volumes the names of one hundred and thirty-
four medical practitioners. Of these, twelve, and probably many
more, practised surgery; three were barber-surgeons. A little
incident throws a glimmer from the dark lantern of memory upon
William Direly, one of these practitioners with the razor and the
lancet. He was lost between Boston and Roxbury in a violent tempest
of wind and snow; ten days afterwards a son was born to his widow,
and with a touch of homely sentiment, I had almost said poetry, they
called the little creature "Fathergone" Direly. Six or seven,
probably a larger number, were ministers as well as physicians, one
of whom, I am sorry to say, took to drink and tumbled into the
Connecticut River, and so ended. One was not only doctor, but also
schoolmaster and poet. One practised medicine and kept a tavern.
One was a butcher, but calls himself a surgeon in his will, a union
of callings which suggests an obvious pleasantry. One female
practitioner, employed by her own sex,--Ann Moore,--was the precursor
of that intrepid sisterhood whose cause it has long been my pleasure
and privilege to advocate on all fitting occasions.
Outside of this list I must place the name of Thomas Wilkinson, who
was complained of, is 1676, for practising contrary to law.
Many names in the catalogue of these early physicians have been
associated, in later periods, with the practice of the profession,--
among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge,
Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams,
Woodward. Touton was a Huguenot, Burchsted a German from Silesia,
Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the
honor of the profession, was only Peacock disguised under this alias,
which would not, I fear, prove very attractive to patients.
What doctrines and practice were these colonists likely to bring,
with them?
Two principal schools of medical practice prevailed in the Old World
during the greater part of the seventeenth century. The first held
to the old methods of Galen: its theory was that the body, the
microcosm, like the macrocosm, was made up of the four elements--
fire, air, water, earth; having respectively the qualities hot, dry,
moist, cold. The body was to be preserved in health by keeping each
of these qualities in its natural proportion; heat, by the proper
temperature; moisture, by the due amount of fluid; and so as to the
rest. Diseases which arose from excess of heat were to be attacked
by cooling remedies; those from excess of cold, by heating ones; and
so of the other derangements of balance. This was truly the
principle of contraries contrariis, which ill-informed persons have
attempted to make out to be the general doctrine of medicine, whereas
there is no general dogma other than this: disease is to be treated
by anything that is proved to cure it. The means the Galenist
employed were chiefly diet and vegetable remedies, with the use of
the lancet and other depleting agents. He attributed the four
fundamental qualities to different vegetables, in four different
degrees; thus chicory was cold in the fourth degree, pepper was hot
in the fourth, endive was cold and dry in the second, and bitter
almonds were hot in the first and dry in the second degree. When we
say "cool as a cucumber," we are talking Galenism. The seeds of that
vegetable ranked as one of "the four greater cold seeds" of this
system.
Galenism prevailed mostly in the south of Europe and France. The
readers of Moliere will have no difficulty in recalling some of its
favorite modes of treatment, and the abundant mirth he extracted from
them.
These Galenists were what we should call "herb-doctors" to-day.
Their insignificant infusions lost credit after a time; their
absurdly complicated mixtures excited contempt, and their nauseous
prescriptions provoked loathing and disgust. A simpler and bolder
practice found welcome in Germany, depending chiefly on mineral
remedies, mercury, antimony, sulphur, arsenic, and the use, sometimes
the secret use, of opium. Whatever we think of Paracelsus, the chief
agent in the introduction of these remedies, and whatever limits we
may assign to the use of these long-trusted mineral drugs, there can
be no doubt that the chemical school, as it was called, did a great
deal towards the expurgation of the old, overloaded, and repulsive
pharmacopoeia. We shall find evidence in the practice of our New-
England physicians of the first century, that they often employed
chemical remedies, and that, by the early part of the following
century, their chief trust was in the few simple, potent drugs of
Paracelsus.
We have seen that many of the practitioners of medicine, during the
first century of New England, were clergymen. This relation between
medicine and theology has existed from a very early period; from the
Egyptian priest to the Indian medicine-man, the alliance has been
maintained in one form or another. The partnership was very common
among our British ancestors. Mr. Ward, the Vicar of Stratford-on-
Avon, himself a notable example of the union of the two characters,
writing about 1660, says,
"The Saxons had their blood-letters, but under the Normans physicke,
begunne in England; 300 years agoe itt was not a distinct profession
by itself, but practised by men in orders, witness Nicholas de
Ternham, the chief English physician and Bishop of Durham; Hugh of
Evesham, a physician and cardinal; Grysant, physician and pope; John
Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul
Bush, a bachelor of divinitie in Oxford, was a man well read in
physick as well as divinitie, he was the first bishop of Bristol."
"Again in King Richard the Second's time physicians and divines were
not distinct professions; for one Tydeman, Bishop of Landaph and
Worcester, was physician to King Richard the Second."
This alliance may have had its share in creating and keeping up the
many superstitions which have figured so largely in the history of
medicine. It is curious to see that a medical work left in
manuscript by the Rev. Cotton Mather and hereafter to be referred to,
is running over with follies and superstitious fancies; while his
contemporary and fellow-townsman, William Douglass, relied on the
same few simple remedies which, through Dr. Edward Holyoke and Dr.
James Jackson, have come down to our own time, as the most important
articles of the materia medica.
Let us now take a general glance at some of the conditions of the
early settlers; and first, as to the healthfulness of the climate.
The mortality of the season that followed the landing of the Pilgrims
at Plymouth has been sufficiently accounted for. After this, the
colonists seem to have found the new country agreeing very well with
their English constitutions. Its clear air is the subject of eulogy.
Its dainty springs of sweet water are praised not only by Higginson
and Wood, but even the mischievous Morton says, that for its delicate
waters Canaan came not near this country." There is a tendency to
dilate on these simple blessings, which reminds one a little of the
Marchioness in Dickens's story, with her orange-peel-and-water
beverage. Still more does one feel the warmth of coloring,--such as
we expect from converts to a new faith, and settlers who want to
entice others over to their clearings, when Winslow speaks, in 1621,
of "abundance of roses, white, red, and damask; single, but very
sweet indeed;" a most of all, however, when, in the same connection,
he says, "Here are grapes white and red, and very sweet and strong
also." This of our wild grape, a little vegetable Indian, which
scalps a civilized man's mouth, as his animal representative scalps
his cranium. But there is something quite charming in Winslow's
picture of the luxury in which they are living. Lobsters, oysters,
eels, mussels, fish and fowl, delicious fruit, including the grapes
aforesaid,--if they only had "kine, horses, and sheep," he makes no
question but men would live as contented here as in any part of the
world. We cannot help admiring the way in which they took their
trials, and made the most of their blessings.
"And how Content they were," says Cotton Mather, "when an Honest Man,
as I have heard, inviting his Friends to a Dish of Clams, at the
Table gave Thanks to Heaven, who had given them to suck the abundance
of the Seas, and of the Treasures Aid in the Sands!"
Strangely enough, as it would seem, except for this buoyant
determination to make the best of everything, they hardly appear to
recognize the difference of the climate from that which they had
left. After almost three years' experience, Winslow says, he can
scarce distinguish New England from Old England, in respect of heat
and cold, frost, snow, rain, winds, etc. The winter, he thinks (if
there is a difference), is sharper and longer; but yet he may be
deceived by the want of the comforts he enjoyed at home. He cannot
conceive any climate to agree better with the constitution of the
English, not being oppressed with extremity of heats, nor nipped by
biting cold:
"By which means, blessed be God, we enjoy our health, notwithstanding
those difficulties we have undergone, in such a measure as would have
been admired, if we had lived in England with the like means."
Edward Johnson, after mentioning the shifts to which they were put
for food, says,--
"And yet, methinks, our children are as cheerful, fat, and lusty,
with feeding upon those mussels, clams, and other fish, as they were
in England with their fill of bread."
Higginson, himself a dyspeptic, "continually in physic," as he says,
and accustomed to dress in thick clothing, and to comfort his stomach
with drink that was "both strong and stale,"--the "jolly good ale and
old," I suppose, of free and easy Bishop Still's song,--found that he
both could and did oftentimes drink New England water very well,
--which he seems to look upon as a remarkable feat. He could go as
lightclad as any, too, with only a light stuff cassock upon his
shirt, and stuff breeches without linings. Two of his children were
sickly: one,--little misshapen Mary,--died on the passage, and, in
her father's words, "was the first in our ship that was buried in the
bowels of the great Atlantic sea;" the other, who had been "most
lamentably handled" by disease, recovered almost entirely "by the
very wholesomeness of the air, altering, digesting, and drying up the
cold and crude humors of the body." Wherefore, he thinks it a wise
course for all cold complexions to come to take physic in New
England, and ends with those often quoted words, that "a sup of New
England's air is better than a whole draught of Old England's ale."
Mr. Higginson died, however, "of a hectic fever," a little more than
a year after his arrival.
The medical records which I shall cite show that the colonists were
not exempt from the complaints of the Old World. Besides the common
diseases to which their descendants are subject, there were two
others, to say nothing of the dreaded small-pox, which later medical
science has disarmed,--little known among us at the present day, but
frequent among the first settlers. The first of these was the
scurvy, already mentioned, of which Winthrop speaks in 1630, saying,
that it proved fatal to those who fell into discontent, and lingered
after their former conditions in England; the poor homesick creatures
in fact, whom we so forget in our florid pictures of the early times
of the little band in the wilderness. Many who were suffering from
scurvy got well when the Lyon arrived from England, bringing store of
juice of lemons. The Governor speaks of another case in 1644; and it
seems probable that the disease was not of rare occurrence.
The other complaint from which they suffered, but which has nearly
disappeared from among us, was intermittent fever, or fever and ague.
I investigated the question as to the prevalence of this disease in
New England, in a dissertation, which was published in a volume with
other papers, in the year 1838. I can add little to the facts there
recorded. One which escaped me was, that Joshua Scottow, in "Old
Men's Tears," dated 1691, speaks of "shaking agues," as among the
trials to which they had been subjected. The outline map of New
England, accompanying the dissertation above referred to, indicates
all the places where I had evidence that the disease had originated.
It was plain enough that it used to be known in many localities where
it has long ceased to be feared. Still it was and is remarkable to
see what a clean bill of health in this particular respect our barren
soil inherited with its sterility. There are some malarious spots on
the edge of Lake Champlain, arid there have been some temporary
centres of malaria, within the memory of man, on one or more of our
Massachusetts rivers, but these are harmless enough, for the most
part, unless the millers dam them, when they are apt to retaliate
with a whiff from their meadows, that sets the whole neighborhood
shaking with fever and ague.
The Pilgrims of the Mayflower had with them a good physician, a man
of standing, a deacon of their church, one whom they loved and
trusted, Dr. Samuel Fuller. But no medical skill could keep cold and
hunger and bad food, and, probably enough, desperate homesickness in
some of the feebler sort, from doing their work. No detailed record
remains of what they suffered or what was attempted for their relief
during the first sad winter. The graves of those who died were
levelled and sowed with grain that the losses of the little band
might not be suspected by the savage tenants of the wilderness, and
their story remains untold.
Of Dr. Fuller's practice, at a later period, we have an account in a
letter of his to Governor Bradford, dated June, 1630. "I have been
to Matapan" (now Dorchester), he says, "and let some twenty of those
people blood." Such wholesale depletion as this, except with avowed
homicidal intent, is quite unknown in these days; though I once saw
the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy,
order some ten or fifteen patients, taken almost indiscriminately, to
be bled in a single morning.
Dr. Fuller's two visits to Salem, at the request of Governor
Endicott, seem to have been very satisfactory to that gentleman.
Morton, the wild fellow of Merry Mount, gives a rather questionable
reason for the Governor's being so well pleased with the physician's
doings. The names under which he mentions the two personages, it
will be seen, are not intended to be complimentary. "Dr. Noddy did a
great cure for Captain Littleworth. He cured him of a disease called
a wife." William Gager, who came out with Winthrop, is spoken of as
"a right godly man and skilful chyrurgeon, but died of a malignant
fever not very long after his arrival."
Two practitioners of the ancient town of Newbury are entitled to
special notice, for different reasons. The first is Dr. John Clark,
who is said by tradition to have been the first regularly educated
physician who resided in New England. His portrait, in close-fitting
skull-cap, with long locks and venerable flowing beard, is familiar
to our eyes on the wall of our Society's antechamber. His left hand
rests upon a skull, his right hand holds an instrument which deserves
a passing comment. It is a trephine, a surgical implement for
cutting round pieces out of broken skulls, so as to get at the
fragments which have been driven in, and lift them up. It has a
handle like that of a gimlet, with a claw like a hammer, to lift
with, I suppose, which last contrivance I do not see figured in my
books. But the point I refer to is this: the old instrument, the
trepan, had a handle like a wimble, what we call a brace or bit-
stock. The trephine is not mentioned at all in Peter Lowe's book,
London, 1634; nor in Wiseman's great work on Surgery, London, 1676;
nor in the translation of Dionis, published by Jacob Tonson, in 1710.
In fact it was only brought into more general use by Cheselden and
Sharpe so late as the beginning of the last century. As John Clark
died in 1661, it is remarkable to see the last fashion in the way of
skull-sawing contrivances in his hands,--to say nothing of the claw
on the handle, and a Hey's saw, so called in England, lying on the
table by him, and painted there more than a hundred years before Hey
was born. This saw is an old invention, perhaps as old as
Hippocrates, and may be seen figured in the "Armamentarium
Chirurgicum" of Scultetus, or in the Works of Ambroise Pare.
Dr. Clark is said to have received a diploma before be came, for
skill in lithotomy. He loved horses, as a good many doctors do, and
left a good property, as they all ought to do. His grave and noble
presence, with the few facts concerning him, told with more or less
traditional authority, give us the feeling that the people of
Newbury, and afterwards of Boston, had a wise and skilful medical
adviser and surgeon in Dr. John Clark.
The venerable town of Newbury had another physician who was less
fortunate. The following is a court record of 1652:
"This is to certify whom it may concern, that we the subscribers,
being called upon to testify against doctor William Snelling for
words by him uttered, affirm that being in way of merry discourse, a
health being drank to all friends, he answered,
"I'll pledge my friends,
And for my foes
A plague for their heels
And,'---
[a similar malediction on the other extremity of their feet.]
"Since when he hath affirmed that he only intended the proverb used
in the west country, nor do we believe he intended otherwise.
"[Signed]
"WILLIAM THOMAS.
"THOMAS MILWARD.
"March 12th 1651, All which I acknowledge, and am sorry I did not
expresse my intent, or that I was so weak as to use so foolish a
proverb.
"[Signed]
"GULIELMUS SNELLING."
Notwithstanding this confession and apology, the record tells us that
"William Snelling in his presentment for cursing is fined ten
shillings and the fees of court."
I will mention one other name among those of the Fathers of the
medical profession in New England. The "apostle" Eliot says, writing
in 1647, "We never had but one anatomy in the country, which Mr.
Giles Firman, now in England, did make and read upon very well."
Giles Firmin, as the name is commonly spelled, practised physic in
this country for a time. He seems to have found it a poor business;
for, in a letter to Governor Winthrop, he says, "I am strongly sett
upon to studye divinitie: my studyes else must be lost, for physick
is but a meene helpe."
Giles Firmin's Lectures on Anatomy were the first scientific
teachings of the New World. While the Fathers were enlightened
enough to permit such instructions, they were severe in dealing with
quackery; for, in 1631, our court records show that one Nicholas
Knopp, or Knapp, was sentenced to be fined or whipped "for taking
upon him to cure the scurvey by a water of noe worth nor value, which
he solde att a very deare rate." Empty purses or sore backs would be
common with us to-day if such a rule were enforced.
Besides the few worthies spoken of, and others whose names I have not
space to record, we must remember that there were many clergymen who
took charge of the bodies as well as the souls of their patients,
among them two Presidents of Harvard College, Charles Chauncy and
Leonard Hoar,--and Thomas Thacher, first minister of the "Old South,"
author of the earliest medical treatises printed in the country,[A
Brief Rule to Guide the Common People in Small pox and
Measles. 1674.] whose epitaph in Latin and Greek, said to have been
written by Eleazer, an "Indian Youth" and a member of the Senior
Class of Harvard College, may be found in the "Magnalia." I miss
this noble savage's name in our triennial catalogue; and as there is
many a slip between the cup and lip, one is tempted to guess that he
may have lost his degree by some display of his native instinct,--
possibly a flourish of the tomahawk or scalping-knife. However this
may have been, the good man he celebrated was a notable instance of
the Angelical Conjunction, as the author of the "Magnalia" calls it,
of the offices of clergyman and medical practitioner.
Michael Wigglesworth, author of the "Day of Doom," attended the sick,
"not only as a Pastor, but as a Physician too, and this, not only in
his own town, but also in all those of the vicinity." Mather says of
the sons of Charles Chauncy, "All of these did, while they had
Opportunity, Preach the Gospel; and most, if not all of them, like
their excellent Father before them, had an eminent skill in physick
added unto their other accomplishments," etc. Roger Williams is said
to have saved many in a kind of pestilence which swept away many
Indians.
To these names must be added, as sustaining a certain relation to the
healing art, that of the first Governor Winthrop, who is said by John
Cotton to have been "Help for our Bodies by Physick [and] for our
Estates by Law," and that of his son, the Governor of Connecticut,
who, as we shall see, was as much physician as magistrate.
I had submitted to me for examination, in 1862, a manuscript found
among the Winthrop Papers, marked with the superscription, "For my
worthy friend Mr. Wintrop," dated in 1643, London, signed Edward
Stafford, and containing medical directions and prescriptions. It
may be remembered by some present that I wrote a report on this
paper, which was published in the "Proceedings" of this Society.
Whether the paper was written for Governor John Winthrop of
Massachusetts, or for his son, Governor John of Connecticut, there is
no positive evidence that I have been able to obtain. It is very
interesting, however, as giving short and simple practical
directions, such as would be most like to be wanted and most useful,
in the opinion of a physician in repute of that day.
The diseases prescribed for are plague, small-pox, fevers, king's
evil, insanity, falling-sickness, and the like; with such injuries as
broken bones, dislocations, and burning with gunpowder. The remedies
are of three kinds: simples, such as St. John's wort, Clown's all-
heal, elder, parsley, maidenhair, mineral drugs, such as lime,
saltpetre, Armenian bole, crocus metallorum, or sulphuret of
antimony; and thaumaturgic or mystical, of which the chief is, "My
black powder against the plague, small-pox; purples, all sorts of
feavers; Poyson; either, by Way of Prevention or after Infection."
This marvellous remedy was made by putting live toads into an earthen
pot so as to half fill it, and baking and burning them "in the open
ayre, not in an house,"--concerning which latter possibility I
suspect Madam Winthrop would have had something to say,--until they
could be reduced by pounding, first into a brown, and then into a
black, powder. Blood-letting in some inflammations, fasting in the
early stage of fevers, and some of those peremptory drugs with which
most of us have been well acquainted in our time, the infragrant
memories of which I will not pursue beyond this slight allusion, are
among his remedies.
The Winthrops, to one of whom Dr. Stafford's directions were
addressed, were the medical as well as the political advisers of
their fellow-citizens for three or four successive generations. One
of them, Governor John of Connecticut, practised so extensively,
that, but for his more distinguished title in the State, he would
have been remembered as the Doctor. The fact that he practised in
another colony, for the most part, makes little difference in the
value of the records we have of his medical experience, which have
fortunately been preserved, and give a very fair idea, in all
probability, of the way in which patients were treated in
Massachusetts, when they fell into intelligent and somewhat educated
hands, a little after the middle of the seventeenth century:
I have before me, while writing, a manuscript collection of the
medical cases treated by him, and recorded at the time in his own
hand, which has been intrusted to me by our President, his
descendant.
They are generally marked Hartford, and extend from the year 1657 to
1669. From these, manuscripts, and from the letters printed in the
Winthrop Papers published by our Society, I have endeavored to obtain
some idea of the practice of Governor John Winthrop, Junior. The
learned eye of Mr. Pulsifer would have helped me, no doubt, as it has
done in other cases; but I have ventured this time to attempt finding
my own way among the hieroglyphics of these old pages. By careful
comparison of many prescriptions, and by the aid of Schroder, Salmon,
Culpeper, and other old compilers, I have deciphered many of his
difficult paragraphs with their mysterious recipes.
The Governor employed a number of the simples dear to ancient women,
--elecampane and elder and wormwood and anise and the rest; but he
also employed certain mineral remedies, which he almost always
indicates by their ancient symbols, or by a name which should leave
them a mystery to the vulgar. I am now prepared to reveal the mystic
secrets of the Governor's beneficent art, which rendered so many good
and great as well as so many poor and dependent people his debtors,-
at least, in their simple belief,--for their health and their lives.
His great remedy, which he gave oftener than any other, was nitre;
which he ordered in doses of twenty or thirty grains to adults, and
of three grains to infants. Measles, colics, sciatica, headache,
giddiness, and many other ailments, all found themselves treated, and
I trust bettered, by nitre; a pretty safe medicine in moderate doses,
and one not likely to keep the good Governor awake at night, thinking
whether it might not kill, if it did not cure. We may say as much
for spermaceti, which he seems to have considered "the sovereign'st
thing on earth" for inward bruises, and often prescribes after falls
and similar injuries.
One of the next remedies, in point of frequency, which he was in the
habit of giving, was (probably diaphoretic) antimony; a mild form of
that very active metal, and which, mild as it was, left his patients
very commonly with a pretty strong conviction that they had been
taking something that did not exactly agree with them. Now and then
he gave a little iron or sulphur or calomel, but very rarely;
occasionally, a good, honest dose of rhubarb or jalap; a taste of
stinging horseradish, oftener of warming guiacum; sometimes an
anodyne, in the shape of mithridate,--the famous old farrago, which
owed its virtue to poppy juice; [This is the remedy which a Boston
divine tried to simplify. See Electuarium Novum Alexipharmacum, by
Rev. Thomas Harward, lecturer at the Royal Chappell. Boston, 1732.
This tract is in our Society's library.] very often, a harmless
powder of coral; less frequently, an inert prescription of pleasing
amber; and (let me say it softly within possible hearing of his
honored descendant), twice or oftener,--let us hope as a last
resort,--an electuary of millipedes,--sowbugs, if we must give them
their homely English name. One or two other prescriptions, of the
many unmentionable ones which disgraced the pharmacopoeia of the
seventeenth century, are to be found, but only in very rare
instances, in the faded characters of the manuscript.
The excellent Governor's accounts of diseases are so brief, that we
get only a very general notion of the complaints for which he
prescribed. Measles and their consequences are at first more
prominent than any other one affection, but the common infirmities of
both sexes and of all ages seem to have come under his healing hand.
Fever and ague appears to have been of frequent occurrence.
His published correspondence shows that many noted people were in
communication with him as his patients. Roger Williams wants a
little of his medicine for Mrs. Weekes's daughter; worshipful John
Haynes is in receipt of his powders; troublesome Captain Underhill
wants "a little white vitterall" for his wife, and something to cure
his wife's friend's neuralgia, (I think his wife's friend's husband
had a little rather have had it sent by the hands of Mrs. Underhill,
than by those of the gallant and discursive captain); and pious John
Davenport says, his wife "tooke but one halfe of one of the papers"
(which probably contained the medicine he called rubila), "but could
not beare the taste of it, and is discouraged from taking any more;"
and honored William Leete asks for more powders for his "poore little
daughter Graciana," though he found it "hard to make her take it,"
delicate, and of course sensitive, child as she was, languishing and
dying before her time, in spite of all the bitter things she
swallowed,--God help all little children in the hands of dosing
doctors and howling dervishes! Restless Samuel Gorton, now tamed by
the burden of fourscore and two years, writes so touching an account
of his infirmities, and expresses such overflowing gratitude for the
relief he has obtained from the Governor's prescriptions, wondering
how "a thing so little in quantity, so little in sent, so little in
taste, and so little to sence in operation, should beget and bring
forth such efects," that we repent our hasty exclamation, and bless
the memory of the good Governor, who gave relief to the worn-out
frame of our long-departed brother, the sturdy old heretic of Rhode
Island.
What was that medicine which so frequently occurs in the printed
letters under the name of "rubila"? It is evidently a secret remedy,
and, so far as I know, has not yet been made out. I had almost given
it up in despair, when I found what appears to be a key to the
mystery. In the vast multitude of prescriptions contained in the
manuscripts, most of them written in symbols, I find one which I thus
interpret:
"Four grains of (diaphoretic) antimony, with twenty grains of nitre,
with a little salt of tin, making rubila." Perhaps something was
added to redden the powder, as he constantly speaks of "rubifying"
or "viridating" his prescriptions; a very common practice of
prescribers, when their powders look a little too much like plain
salt or sugar.
Waitstill Winthrop, the Governor's son, "was a skilful physician,"
says Mr. Sewall, in his funeral sermon; "and generously gave, not
only his advice, but also his Medicines, for the healing of the Sick,
which, by the Blessing of God, were made successful for the recovery
of many." "His son John, a member of the Royal Society, speaks of
himself as 'Dr. Winthrop,' and mentions one of his own prescriptions
in a letter to Cotton Mather." Our President tells me that there was
an heirloom of the ancient skill in his family, within his own
remembrance, in the form of a certain precious eye-water, to which
the late President John Quincy Adams ascribed rare virtue, and which
he used to obtain from the possessor of the ancient recipe.
These inherited prescriptions are often treasured in families, I do
not doubt, for many generations. When I was yet of trivial age, and
suffering occasionally, as many children do, from what one of my
Cambridgeport schoolmates used to call the "ager,"--meaning thereby
toothache or face-ache,--I used to get relief from a certain plaster
which never went by any other name in the family than "Dr. Oliver."
Dr. James Oliver was my great-great-grandfather, graduated in 1680,
and died in 1703. This was, no doubt, one of his nostrums; for
nostrum, as is well known, means nothing more than our own or my own
particular medicine, or other possession or secret, and physicians in
old times used to keep their choice recipes to themselves a good
deal, as we have had occasion to see.
Some years ago I found among my old books a small manuscript marked
"James Oliver. This Book Begun Aug. 12, 1685." It is a rough sort
of account-book, containing among other things prescriptions for
patients, and charges for the same, with counter-charges for the
purchase of medicines and other matters. Dr. Oliver practised in
Cambridge, where may be seen his tomb with inscriptions, and with
sculptured figures that look more like Diana of the Ephesians, as
given in Calmet's Dictionary, than like any angels admitted into good
society here or elsewhere.
I do not find any particular record of what his patients suffered
from, but I have carefully copied out the remedies he mentions, and
find that they form a very respectable catalogue. Besides the usual
simples, elder, parsley, fennel, saffron, snake-root, wormwood, I
find the Elixir Proprietatis, with other elixire and cordials, as if
he rather fancied warming medicines; but he called in the aid of some
of the more energetic remedies, including iron, and probably mercury,
as he bought two pounds of it at one time.
The most interesting item is his bill against the estate of Samuel
Pason of Roxbury, for services during his last illness. He attended
this gentleman,--for such he must have been, by the amount of physic
which he took, and which his heirs paid for,--from June 4th, 1696, to
September 3d of the same year, three months. I observe he charges
for visits as well as for medicines, which is not the case in most of
his bills. He opens the attack with a carminative appeal to the
visceral conscience, and follows it up with good hard-hitting
remedies for dropsy,--as I suppose the disease would have been
called,--and finishes off with a rallying dose of hartshorn and iron.
It is a source of honest pride to his descendant that his bill, which
was honestly paid, as it seems to have been honorably earned,
amounted to the handsome total of seven pounds and two shillings.
Let me add that he repeatedly prescribes plaster, one of which was
very probably the "Dr. Oliver" that soothed my infant griefs, and for
which I blush to say that my venerated ancestor received from Goodman
Hancock the painfully exiguous sum of no pounds, no shillings, and
sixpence.
I have illustrated the practice of the first century, from the two
manuscripts I have examined, as giving an impartial idea of its
every-day methods. The Governor, Johannes Secundus, it is fair to
remember, was an amateur practitioner, while my ancestor was a
professed physician. Comparing their modes of treatment with the
many scientific follies still prevailing in the Old World, and still
more with the extraordinary theological superstitions of the
community in which they lived, we shall find reason, I think, to
consider the art of healing as in a comparatively creditable state
during the first century of New England.
In addition to the evidence as to methods of treatment furnished by
the manuscripts I have cited, I subjoin the following document, to
which my attention was called by Dr. Shurtleff, our present Mayor.
This is a letter of which the original is to be found in vol. lxix.
page 10 of the "Archives" preserved at the State House in Boston. It
will be seen that what the surgeon wanted consisted chiefly of
opiates, stimulants, cathartics, plasters, and materials for
bandages. The complex and varied formulae have given place to
simpler and often more effective forms of the same remedies; but the
list and the manner in which it is made out are proofs of the good
sense and schooling of the surgeon, who, it may be noted, was in such
haste that he neglected all his stops. He might well be in a hurry,
as on the very day upon which he wrote, a great body of Indians--
supposed to be six or seven hundred--appeared before Hatfield; and
twenty-five resolute young men of Hadley, from which town he wrote,
crossed the river and drove them away.
HADLY May 30: 76
Mr RAWSON Sr
What we have recd by Tho: Houey the past month is not the cheifest of
our wants as you have love for poor wounded I pray let us not want
for these following medicines if you have not a speedy conveyance of
them I pray send on purpose they are those things mentioned in my
former letter but to prevent future mistakes I have wrote them att
large wee have great want with the greatest halt and speed let
us be supplyed.
Sr
Yr Sert
WILL LOCHS
(Endorsed)
Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye
Council with it but could not obtaine any thing to be sent in answer
thereto 13 June 1676
I have given some idea of the chief remedies used by our earlier
physicians, which were both Galenic and chemical; that is, vegetable
and mineral. They, of course, employed the usual perturbing
medicines which Montaigne says are the chief reliance of their craft.
There were, doubtless, individual practitioners who employed special
remedies with exceptional boldness and perhaps success. Mr. Eliot is
spoken of, in a letter of William Leete to Winthrop, Junior, as being
under Mr. Greenland's mercurial administrations. The latter was
probably enough one of these specialists.
There is another class of remedies which appears to have been
employed occasionally, but, on the whole, is so little prominent as
to imply a good deal of common sense among the medical practitioners,
as compared with the superstitions prevailing around them. I have
said that I have caught the good Governor, now and then, prescribing
the electuary of millipedes; but he is entirely excused by the almost
incredible fact that they were retained in the materia medica so late
as when Rees's Cyclopaedia was published, and we there find the
directions formerly given by the College of Edinburgh for their
preparation. Once or twice we have found him admitting still more
objectionable articles into his materia medica; in doing which, I am
sorry to say that he could plead grave and learned authority. But
these instances are very rare exceptions in a medical practice of
many years, which is, on the whole, very respectable, considering the
time and circumstances.
Some remedies of questionable though not odious character appear
occasionally to have been employed by the early practitioners, but
they were such as still had the support of the medical profession.
Governor John Winthrop, the first, sends for East Indian bezoar, with
other commodities he is writing for. Governor Endicott sends him one
he had of Mr. Humfrey. I hope it was genuine, for they cheated
infamously in the matter of this concretion, which ought to come out
of an animal's stomach, but the real history of which resembles what
is sometimes told of modern sausages.
There is a famous law-case of James the First's time, in which a
goldsmith sold a hundred pounds' worth of what he called bezoar,
which was proved to be false, and the purchaser got a verdict against
him. Governor Endicott also sends Winthrop a unicorn's horn, which
was the property of a certain Mrs. Beggarly, who, in spite of her
name, seems to have been rich in medical knowledge and possessions.
The famous Thomas Bartholinus wrote a treatise on the virtues of this
fabulous-sounding remedy, which was published in 1641, and
republished in 1678.
The "antimonial cup," a drinking vessel made of that metal, which,
like our quassia-wood cups, might be filled and emptied in saecula
saeculorum without exhausting its virtues, is mentioned by Matthew
Cradock, in a letter to the elder Winthrop, but in a doubtful way, as
it was thought, he says, to have shortened the days of Sir Nathaniel
Riche; and Winthrop himself, as I think, refers to its use, calling
it simply "the cup." An antimonial cup is included in the inventory
of Samuel Seabury, who died 1680, and is valued at five shillings.
There is a treatise entitled "The Universall Remedy, or the Vertues
of the Antimoniall Cup, By John Evans, Minister and Preacher of God's
Word, London, 1634," in our own Society's library.
One other special remedy deserves notice, because of native growth.
I do not know when Culver's root, Leptandra Virginica of our National
Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to
John Winthrop of New London, speaks of it as famous for the cure of
consumptions, and wishes to get some of it, through his mediation,
for Katharine, his eldest daughter. He gets it, and gives it to the
"poor damsel," who is languishing, as he says, and who dies the next
month,--all the sooner, I have little doubt, for this uncertain and
violent drug, with which the meddlesome pedant tormented her in that
spirit of well-meant but restless quackery, which could touch nothing
without making mischief, not even a quotation, and yet proved at
length the means of bringing a great blessing to our community, as we
shall see by and by; so does Providence use our very vanities and
infirmities for its wise purposes.
Externally, I find the practitioners on whom I have chiefly relied
used the plasters of Paracelsus, of melilot, diachylon, and probably
diaphoenicon, all well known to the old pharmacopoeias, and some of
them to the modern ones,--to say nothing of "my yellow salve," of
Governor John, the second, for the composition of which we must apply
to his respected descendant.
The authors I find quoted are Barbette's Surgery, Camerarius on Gout,
and Wecherus, of all whom notices may be found in the pages of Haller
and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's
Practice of Physic and Anatomy, the last as belonging to Samuel
Seabury, chirurgeon, before mentioned. Nicholas Culpeper was a
shrewd charlatan, and as impudent a varlet as ever prescribed for a
colic; but knew very well what he was about, and badgers the College
with great vigor. A copy of Spigelius's famous Anatomy, in the
Boston Athenaeum, has the names of Increase and Samuel Mather written
in it, and was doubtless early overhauled by the youthful Cotton, who
refers to the great anatomist's singular death, among his curious
stories in the "Magnalia," and quotes him among nearly a hundred
authors whom he cites in his manuscript "The Angel of Bethesda." Dr.
John Clark's "books and instruments, with several chirurgery
materials in the closet," a were valued in his inventory at sixty
pounds; Dr. Matthew Fuller, who died in 1678, left a library valued
at ten pounds; and a surgeon's chest and drugs valued at sixteen
pounds.'
Here we leave the first century and all attempts at any further
detailed accounts of medicine and its practitioners. It is necessary
to show in a brief glance what had been going on in Europe during the
latter part of that century, the first quarter of which had been made
illustrious in the history of medical science by the discovery of the
circulation.
Charles Barbeyrac, a Protestant in his religion, was a practitioner
and teacher of medicine at Montpellier. His creed was in the way of
his obtaining office; but the young men followed his instructions
with enthusiasm. Religious and scientific freedom breed in and in,
until it becomes hard to tell the family of one from that of the
other. Barbeyrac threw overboard the old complex medical farragos of
the pharmacopoeias, as his church had disburdened itself of the
popish ceremonies.
Among the students who followed his instructions were two Englishmen:
one of them, John Locke, afterwards author of an "Essay on the Human
Understanding," three years younger than his teacher; the other,
Thomas Sydenham, five years older. Both returned to England. Locke,
whose medical knowledge is borne witness to by Sydenham, had the good
fortune to form a correct opinion on a disease from which the Earl of
Shaftesbury was suffering, which led to an operation that saved his
life. Less felicitous was his experience with a certain ancilla
culinaria virgo,--which I am afraid would in those days have been
translated kitchen-wench, instead of lady of the culinary
department,--who turned him off after she had got tired of him, and
called in another practitioner. [Locke and Sydenham, p. 124. By John
Brown, M. D. Edinburgh, 1866.] This helped, perhaps, to spoil a
promising doctor, and make an immortal metaphysician. At any rate,
Locke laid down the professional wig and cane, and took to other
studies.
The name of Thomas Sydenham is as distinguished in the history of
medicine as that of John Locke in philosophy. As Barbeyrac was found
in opposition to the established religion, as Locke took the rational
side against orthodox Bishop Stillingfleet, so Sydenham went with
Parliament against Charles, and was never admitted a Fellow by the
College of Physicians, which, after he was dead, placed his bust in
their hall by the side of that of Harvey.
What Sydenham did for medicine was briefly this he studied the course
of diseases carefully, and especially as affected by the particular
season; to patients with fever he gave air and cooling drinks,
instead of smothering and heating them, with the idea of sweating out
their disease; he ordered horseback exercise to consumptives; he,
like his teacher, used few and comparatively simple remedies; he did
not give any drug at all, if he thought none was needed, but let well
enough alone. He was a sensible man, in short, who applied his
common sense to diseases which he had studied with the best light of
science that he could obtain.
The influence of the reform he introduced must have been more or less
felt in this country, but not much before the beginning of the
eighteenth century, as his great work was not published until 1675,
and then in Latin. I very strongly suspect that there was not so
much to reform in the simple practice of the physicians of the new
community, as there was in that of the learned big-wigs of the
"College," who valued their remedies too much in proportion to their
complexity, and the extravagant and fantastic ingredients which went
to their making.
During the memorable century which bred and bore the Revolution, the
medical profession gave great names to our history. But John Brooks
belonged to the State, and Joseph Warren belongs to the country and
mankind, and to speak of them would lead me beyond my limited--
subject. There would be little pleasure in dwelling on the name of
Benjamin Church; and as for the medical politicians, like Elisha
Cooke in the early part of the century, or Charles Jarvis, the bald
eagle of Boston, in its later years, whether their practice was
heroic or not, their patients were, for he is a bold man who trusts
one that is making speeches and coaxing voters, to meddle with the
internal politics of his corporeal republic.
One great event stands out in the medical history of this eighteenth
century; namely, the introduction of the practice of inoculation for
small-pox. Six epidemics of this complaint had visited Boston in the
course of a hundred years. Prayers had been asked in the churches
for more than a hundred sick in a single day, and this many times.
About a thousand persons had died in a twelvemonth, we are told, and,
as we may infer, chiefly from this cause.
In 1721, this disease, after a respite of nineteen years, again
appeared as an epidemic. In that year it was that Cotton Mather,
browsing, as was his wont, on all the printed fodder that came within
reach of his ever-grinding mandibles, came upon an account of
inoculation as practised in Turkey, contained in the "Philosophical
Transactions." He spoke of it to several physicians, who paid little
heed to his story; for they knew his medical whims, and had probably
been bored, as we say now-a-days, many of them, with listening to his
"Angel of Bethesda," and satiated with his speculations on the
Nishmath Chajim.
The Reverend Mather,--I use a mode of expression he often employed
when speaking of his honored brethren,--the Reverend Mather was right
this time, and the irreverent doctors who laughed at him were wrong.
One only of their number disputes his claim to giving the first
impulse to the practice, in Boston. This is what that person says:
"The Small-Pox spread in Boston, New England, A.1721, and the
Reverend Dr. Cotton Mather, having had the use of these
Communications from Dr. William Douglass (that is, the writer of
these words); surreptitiously, without the knowledge of his Informer,
that he might have the honour of a New fangled notion, sets an
Undaunted Operator to work, and in this Country about 290 were
inoculated."
All this has not deprived Cotton Mather of the credit of suggesting,
and a bold and intelligent physician of the honor of carrying out,
the new practice. On the twenty-seventh day of June, 1721, Zabdiel
Boylston of Boston inoculated his only son for smallpox,--the first
person ever submitted to the operation in the New World. The story
of the fierce resistance to the introduction of the practice; of how
Boylston was mobbed, and Mather had a hand-grenade thrown in at his
window; of how William Douglass, the Scotchman, "always positive, and
sometimes accurate," as was neatly said of him, at once depreciated
the practice and tried to get the credit of suggesting it, and how
Lawrence Dalhonde, the Frenchman, testified to its destructive
consequences; of how Edmund Massey, lecturer at St. Albans, preached
against sinfully endeavoring to alter the course of nature by
presumptuous interposition, which he would leave to the atheist and
the scoffer, the heathen and unbeliever, while in the face of his
sermon, afterwards reprinted in Boston, many of our New England
clergy stood up boldly in defence of the practice,--all this has been
told so well and so often that I spare you its details. Set this
good hint of Cotton Mather against that letter of his to John
Richards, recommending the search after witch-marks, and the
application of the water-ordeal, which means throw your grandmother
into the water, if she has a mole on her arm;--if she swims, she is a
witch and must be hanged; if she sinks, the Lord have mercy on her
soul!
Thus did America receive this great discovery, destined to save
thousands of lives, via Boston, from the hands of one of our own
Massachusetts physicians.
The year 1735 was rendered sadly memorable by the epidemic of the
terrible disease known as "throat distemper," and regarded by many as
the same as our "diphtheria." Dr. Holyoke thinks the more general
use of mercurials in inflammatory complaints dates from the time of
their employment in this disease, in which they were thought to have
proved specially useful.
At some time in the course of this century medical practice had
settled down on four remedies as its chief reliance. I must repeat
an incident which I have related in another of these Essays. When
Dr. Holyoke, nearly seventy years ago, received young Mr. James
Jackson as his student, he showed him the formidable array of
bottles, jars, and drawers around his office, and then named the four
remedies referred to as being of more importance than all the rest
put together. These were "Mercury, Antimony, Opium, and Peruvian
Bark." I doubt if either of them remembered that, nearly seventy
years before, in 1730, Dr. William Douglass, the disputatious
Scotchman, mentioned those same four remedies, in the dedication of
his quarrelsome essay on inoculation, as the most important ones in
the hands of the physicians of his time.
In the "Proceedings" of this Society for the year 1863 is a very
pleasant paper by the late Dr. Ephraim Eliot, giving an account of
the leading physicians of Boston during the last quarter of the last
century. The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch,
Danforth, John Warren, Jeffries, are all famous in local history, and
are commemorated in our medical biographies. One of them, at least,
appears to have been more widely known, not only as one of the first
aerial voyagers, but as an explorer in the almost equally hazardous
realm of medical theory. Dr. John Jeffries, the first of that name,
is considered by Broussais as a leader of medical opinion in America,
and so referred to in his famous "Examen des Doctrines Medicales."
Two great movements took place in this eighteenth century, the effect
of which has been chiefly felt in our own time; namely, the
establishment of the Massachusetts Medical Society, and the founding
of the Medical School of Harvard University.
The third century of our medical history began with the introduction
of the second great medical discovery of modern times,--of all time
up to that date, I may say,--once more via Boston, if we count the
University village as its suburb, and once more by one of our
Massachusetts physicians. In the month of July, 1800, Dr. Benjamin
Waterhouse of Cambridge submitted four of his own children to the new
process of vaccination,--the first persons vaccinated, as Dr. Zabdiel
Boylston's son had been the first person inoculated in the New World.
A little before the first half of this century was completed, in the
autumn of 1846, the great discovery went forth from the Massachusetts
General Hospital, which repaid the debt of America to the science of
the Old World, and gave immortality to the place of its origin in the
memory and the heart of mankind. The production of temporary
insensibility at will--tuto, cito, jucunde, safely, quickly,
pleasantly--is one of those triumphs over the infirmities of our
mortal condition which change the aspect of life ever afterwards.
Rhetoric can add nothing to its glory; gratitude, and the pride
permitted to human weakness, that our Bethlehem should have been
chosen as the birthplace of this new embodiment of the divine mercy,
are all we can yet find room for.
The present century has seen the establishment of all those great
charitable institutions for the cure of diseases of the body and of
the mind, which our State and our city have a right to consider as
among the chief ornaments of their civilization.
The last century had very little to show, in our State, in the way of
medical literature. The worthies who took care of our grandfathers
and great-grandfathers, like the Revolutionary heroes, fought (with
disease) and bled (their patients) and died (in spite of their own
remedies); but their names, once familiar, are heard only at rare
intervals. Honored in their day, not unremembered by a few solitary
students of the past, their memories are going sweetly to sleep in
the arms of the patient old dry-nurse, whose "blackdrop" is the
never-failing anodyne of the restless generations of men. Except the
lively controversy on inoculation, and floating papers in journals,
we have not much of value for that long period, in the shape of
medical records.
But while the trouble with the last century is to find authors to
mention, the trouble of this would be to name all that we find. Of
these, a very few claim unquestioned preeminence.
Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical
School of our University, did a great work for the advancement of
medicine and surgery in New England, by his labors as teacher and
author, greater, it is claimed by some, than was ever done by any
other man. The two Warrens, of our time, each left a large and
permanent record of a most extended surgical practice. James Jackson
not only educated a whole generation by his lessons of wisdom, but
bequeathed some of the most valuable results of his experience to
those who came after him, in a series of letters singularly pleasant
and kindly as well as instructive. John Ware, keen and cautious,
earnest and deliberate, wrote the two remarkable essays which have
identified his name, for all time, with two important diseases, on
which he has shed new light by his original observations.
I must do violence to the modesty of the living by referring to the
many important contributions to medical science by Dr. Jacob Bigelow,
and especially to his discourse on "Self-limited Diseases," an
address which can be read in a single hour, but the influence of
which will be felt for a century.
Nor would the profession forgive me if I forgot to mention the
admirable museum of pathological anatomy, created almost entirely by
the hands of Dr. John Barnard Swett Jackson, and illustrated by his
own printed descriptive catalogue, justly spoken of by a
distinguished professor in the University of Pennsylvania as the most
important contribution which had ever been made in this country to
the branch to which it relates.
When we look at the literature of mental disease, as seen in hospital
reports and special treatises, we can mention the names of Wyman,
Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts
or placed at the head of her institutions for the treatment of the
insane.
We have a right to claim also one who is known all over the civilized
world as a philanthropist, to us as a townsman and a graduate of our
own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor
of a great multitude who were born to a world of inward or of outward
darkness.
I cannot pass over in silence the part taken by our own physicians in
those sanitary movements which are assuming every year greater
importance. Two diseases especially have attracted attention, above
all others, with reference to their causes and prevention; cholera,
the "black death" of the nineteenth century, and consumption, the
white plague of the North, both of which have been faithfully studied
and reported on by physicians of our own State and city. The
cultivation of medical and surgical specialties, which is fast
becoming prevalent, is beginning to show its effects in the
literature of the profession, which is every year growing richer in
original observations and investigations.
To these benefactors who have labored for us in their peaceful
vocation, we must add the noble army of surgeons, who went with the
soldiers who fought the battles of their country, sharing many of
their dangers, not rarely falling victims to fatigue, disease, or the
deadly volleys to which they often exposed themselves in the
discharge of their duties.
The pleasant biographies of the venerable Dr. Thacher, and the worthy
and kind-hearted gleaner, Dr. Stephen W. Williams, who came after
him, are filled with the names of men who served their generation
well, and rest from their labors, followed by the blessing of those
for whom they endured the toils and fatigues inseparable from their
calling. The hardworking, intelligent country physician more
especially deserves the gratitude of his own generation, for he
rarely leaves any permanent record in the literature of his
profession. Books are hard to obtain; hospitals, which are always
centres of intelligence, are remote; thoroughly educated and superior
men are separated by wide intervals; and long rides, though favorable
to reflection, take up much of the time which might otherwise be
given to the labors of the study. So it is that men of ability and
vast experience, like the late Dr. Twitchell, for instance, make a
great and deserved reputation, become the oracles of large districts,
and yet leave nothing, or next to nothing, by which their names shall
be preserved from blank oblivion.
One or two other facts deserve mention, as showing the readiness of
our medical community to receive and adopt any important idea or
discovery. The new science of Histology, as it is now called, was
first brought fully before the profession of this country by the
translation of Bichat's great work, "Anatomie Generale," by the late
Dr. George Hayward.
The first work printed in this country on Auscultation,--that
wonderful art of discovering disease, which, as it were, puts a
window in the breast, through which the vital organs can be seen, to
all intents and purposes, was the manual published anonymously by
"A Member of the Massachusetts Medical Society."
We are now in some slight measure prepared to weigh the record of the
medical profession in Massachusetts, and pass our judgment upon it.
But in-order to do justice to the first generation of practitioners,
we must compare what we know of their treatment of disease with the
state of the art in England, and the superstitions which they saw all
around them in other departments of knowledge or belief.
English medical literature must have been at a pretty low ebb when
Sydenham recommended Don Quixote to Sir Richard Blackmore for
professional reading. The College Pharmacopoeia was loaded with the
most absurd compound mixtures, one of the most complex of which (the
same which the Reverend Mr. Harward, "Lecturer at the Royal Chappel
in Boston," tried to simplify), was not dropped until the year 1801.
Sir Kenelm Digby was playing his fantastic tricks with the
Sympathetic powder, and teaching Governor Winthrop, the second, how
to cure fever and ague, which some may like to know. "Pare the
patient's nails; put the parings in a little bag, and hang the bag
round the neck of a live eel, and put him in a tub of water. The eel
will die, and the patient will recover."
Wiseman, the great surgeon, was discoursing eloquently on the
efficacy of the royal touch in scrofula. The founder of the
Ashmolean Museum at Oxford, consorting with alchemists and
astrologers, was treasuring the manuscripts of the late pious Dr.
Richard Napier, in which certain letters (Rx Ris) were understood to
mean Responsum Raphaelis,--the answer of the angel Raphael to the
good man's medical questions. The illustrious Robert Boyle was
making his collection of choice and safe remedies, including the sole
of an old shoe, the thigh bone of a hanged man, and things far worse
than these, as articles of his materia medica. Dr. Stafford, whose
paper of directions to his "friend, Mr. Wintrop," I cited, was
probably a man of standing in London; yet toad-powder was his
sovereign remedy.
See what was the state of belief in other matters among the most
intelligent persons of the colonies, magistrates and clergymen.
Jonathan Brewster, son of the church-elder, writes the wildest
letters to John Winthrop about alchemy,--"mad for making gold as the
Lynn rock-borers are for finding it."
Remember the theology and the diabology of the time. Mr. Cotton's
Theocracy was a royal government, with the King of kings as its
nominal head, but with an upper chamber of saints, and a tremendous
opposition in the lower house; the leader of which may have been
equalled, but cannot have been surpassed by any of our earth-born
politicians. The demons were prowling round the houses every night,
as the foxes were sneaking about the hen-roosts. The men of
Gloucester fired whole flasks of gunpowder at devils disguised as
Indians and Frenchmen.
How deeply the notion of miraculous interference with the course of
nature was rooted, is shown by the tenacity of the superstition about
earthquakes. We can hardly believe that our Professor Winthrop,
father of the old judge and the "squire," whom many of us Cambridge
people remember so well, had to defend himself against the learned
and excellent Dr. Prince, of the Old South Church, for discussing
their phenomena as if they belonged to the province of natural
science:
Not for the sake of degrading the aspect of the noble men who founded
our State, do I refer to their idle beliefs and painful delusions,
but to show against what influences the common sense of the medical
profession had to assert itself.
Think, then, of the blazing stars, that shook their horrid hair in
the sky; the phantom ship, that brought its message direct from the
other world; the story of the mouse and the snake at Watertown; of
the mice and the prayer-book; of the snake in church; of the calf
with two heads; and of the cabbage in the perfect form of a cutlash,
--all which innocent occurrences were accepted or feared as alarming
portents.
We can smile at these: but we cannot smile at the account of unhappy
Mary Dyer's malformed offspring; or of Mrs. Hutchinson's domestic
misfortune of similar character, in the story of which the physician,
Dr. John Clark of Rhode Island, alone appears to advantage; or as we
read the Rev. Samuel Willard's fifteen alarming pages about an
unfortunate young woman suffering with hysteria. Or go a little
deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia,
first admonished, then whipped; at last, taking her own little
daughter's life; put on trial, and standing mute, threatened to be
pressed to death, confessing, sentenced, praying to be beheaded; and
none the less pitilessly swung from the fatal ladder.
The cooper's crazy wife--crazy in the belief that she has committed
the unpardonable sin--tries to drown her child, to save it from
misery; and the poor lunatic, who would be tenderly cared for to-day
in a quiet asylum, is judged to be acting under the instigation of
Satan himself. Yet, after all, what can we say, who put Bunyan's
"Pilgrim's Progress," full of nightmare dreams of horror, into all
our children's hands; a story in which the awful image of the man in
the cage might well turn the nursery where it is read into a
madhouse?
The miserable delusion of witchcraft illustrates, in a still more
impressive way, the false ideas which governed the supposed relation
of men with the spiritual world. I have no doubt many physicians
shared in these superstitions. Mr. Upham says they--that is, some of
them--were in the habit of attributing their want of success to the
fact, that an "evil hand" was on their patient. The temptation was
strong, no doubt, when magistrates and ministers and all that
followed their lead were contented with such an explanation. But how
was it in Salem, according to Mr. Upham's own statement? Dr. John
Swinnerton was, he says, for many years the principal physician of
Salem. And he says, also, "The Swinnerton family were all along
opposed to Mr. Parris, and kept remarkably clear from the witchcraft
delusion." Dr. John Swinnerton--the same, by the way, whose memory
is illuminated by a ray from the genius of Hawthorne--died the very
year before the great witchcraft explosion took place. But who can
doubt that it was from him that the family had learned to despise and
to resist the base superstition; or that Bridget Bishop, whose house
he rented, as Mr. Upham tells me, the first person hanged in the time
of the delusion, would have found an efficient protector in her
tenant, had he been living, to head the opposition of his family to
the misguided clergymen and magistrates?
I cannot doubt that our early physicians brought with them many Old-
World medical superstitions, and I have no question that they were
more or less involved in the prevailing errors of the community in
which they lived. But, on the whole, their record is a clean one, so
far as we can get at it; and where it is questionable we must
remember that there must have been many little-educated persons among
them; and that all must have felt, to some extent, the influence of
those sincere and devoted but unsafe men, the physic-practising
clergymen, who often used spiritual means as a substitute for
temporal ones, who looked upon a hysteric patient as possessed by the
devil, and treated a fractured skull by prayers and plasters,
following the advice of a ruling elder in opposition to the "unanimous
opinion of seven surgeons."
To what results the union of the two professions was liable to lead,
may be seen by the example of a learned and famous person, who has
left on record the product of his labors in the double capacity of
clergyman and physician.
I have had the privilege of examining a manuscript of Cotton Mather's
relating to medicine, by the kindness of the librarian of the
American Antiquarian Society, to which society it belongs. A brief
notice of this curious document may prove not uninteresting.
It is entitled "The Angel of Bethesda: an Essay upon the Common
Maladies of Mankind, offering, first, the sentiments of Piety," etc.,
etc., and "a collection of plain but potent and Approved REMEDIES for
the Maladies." There are sixty-six "Capsula's," as he calls them, or
chapters, in his table of contents; of which, five--from the
fifteenth to the nineteenth, inclusive--are missing. This is a most
unfortunate loss, as the eighteenth capsula treated of agues, and we
could have learned from it something of their degree of frequency in
this part of New England. There is no date to the manuscript; which,
however, refers to a case observed Nov. 14, 1724.
The divine takes precedence of the physician in this extraordinary
production. He begins by preaching a sermon at his unfortunate
patient. Having thrown him into a cold sweat by his spiritual
sudorific, he attacks him with his material remedies, which are often
quite as unpalatable. The simple and cleanly practice of Sydenham,
with whose works he was acquainted, seems to have been thrown away
upon him. Everything he could find mentioned in the seventy or
eighty authors he cites, all that the old women of both sexes had
ever told him of, gets into his text, or squeezes itself into his
margin.
Evolving disease out of sin, he hates it, one would say, as he hates
its cause, and would drive it out of the body with all noisome
appliances. "Sickness is in Fact Flagellum Dei pro peccatis mundi."
So saying, he encourages the young mother whose babe is wasting away
upon her breast with these reflections:
"Think; oh the grievous Effects of Sin! This wretched Infant has not
arrived unto years of sense enough, to sin after the similitude of
the transgression committed by Adam. Nevertheless the Transgression
of Adam, who had all mankind Foederally, yea, Naturally, in him, has
involved this Infant in the guilt of it. And the poison of the old
serpent, which infected Adam when he fell into his Transgression, by
hearkening to the Tempter, has corrupted all mankind, and is a seed
unto such diseases as this Infant is now laboring under. Lord, what
are we, and what are our children, but a Generation of Vipers?"
Many of his remedies are at least harmless, but his pedantry and
utter want of judgment betray themselves everywhere. He piles his
prescriptions one upon another, without the least discrimination. He
is run away with by all sorts of fancies and superstitions. He
prescribes euphrasia, eye-bright, for disease of the eyes; appealing
confidently to the strange old doctrine of signatures, which inferred
its use from the resemblance of its flower to the organ of vision.
For the scattering of wens, the efficacy of a Dead Hand has been out
of measure wonderful. But when he once comes to the odious class of
remedies, he revels in them like a scarabeus. This allusion will
bring us quite near enough to the inconceivable abominations with
which he proposed to outrage the sinful stomachs of the unhappy
confederates and accomplices of Adam.
It is well that the treatise was never printed, yet there are
passages in it worth preserving. He speaks of some remedies which
have since become more universally known:
"Among the plants of our soyl, Sir William Temple singles out Five
[Six] as being of the greatest virtue and most friendly to health:
and his favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and
Elder."
"But these Five [Six] plants may admitt of some competitors. The
QUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!"
Of Ipecacuanha, he says,--
"This is now in its reign; the most fashionable vomit."
"I am not sorry that antimonial emetics begin to be disused."
He quotes "Mr. Lock" as recommending red poppy-water and abstinence
from flesh as often useful in children's diseases.
One of his "Capsula's" is devoted to the animalcular origin of
diseases, at the end of which he says, speaking of remedies for this
supposed source of our distempers:
"Mercury we know thee: But we are afraid thou wilt kill us too, if we
employ thee to kill them that kill us.
"And yett, for the cleansing of the small Blood Vessels, and making
way for the free circulation of the Blood and Lymph--there is nothing
like Mercurial Deobstruents."
From this we learn that mercury was already in common use, and the
subject of the same popular prejudice as in our own time.
His poetical turn shows itself here and there:
"O Nightingale, with a Thorn at thy Breast; Under the trouble of a
Cough, what can be more proper than such thoughts as these?"...
If there is pathos in this, there is bathos in his apostrophe to the
millipede, beginning "Poor sowbug!" and eulogizing the healing
virtues of that odious little beast; of which he tells us to take
"half a pound, putt 'em alive into a quart or two of wine," with
saffron and other drugs, and take two ounces twice a day.
The "Capsula" entitled "Nishmath Chajim" was printed in 1722, at
New London, and is in the possession of our own Society. He means,
by these words, something like the Archxus of Van Helmont, of which
he discourses in a style wonderfully resembling that of Mr. Jenkinson
in the "Vicar of Wakefield." "Many of the Ancients thought there was
much of a Real History in the Parable, and their Opinion was that
there is, DIAPHORA KATA TAS MORPHAS, A Distinction (and so a
Resemblance) of men as to their Shapes after Death." And so on, with
Ireaeus, Tertullian, Thespesius, and "the TA TONE PSEUCONE CROMATA,"
in the place of "Sanconiathon, Manetho, Berosus," and "Anarchon ara
kai ateleutaion to pan."
One other passage deserves notice, as it relates to the single
medical suggestion which does honor to Cotton Mather's memory. It
does not appear that he availed himself of the information which he
says, he obtained from his slave, for such I suppose he was.
In his appendix to "Variolae Triumphatae," he says,--
"There has been a wonderful practice lately used in several parts of
the world, which indeed is not yet become common in our nation.
"I was first informed of it by a Garamantee servant of my own, long
before I knew that any Europeans or Asiaticks had the least
acquaintance with it, and some years before I was enriched with the
communications of the learned Foreigners, whose accounts I found
agreeing with what I received of my servant, when he shewed me the
Scar of the Wound made for the operation; and said, That no person
ever died of the smallpox, in their countrey, that had the courage to
use it.
"I have since met with a considerable Number of these Africans, who
all agree in one story; That in their countrey grandy-many dy of the
small-pox: But now they learn this way: people take juice of smallpox
and cutty-skin and put in a Drop; then by'nd by a little sicky,
sicky: then very few little things like small-pox; and nobody dy of
it; and nobody have small-pox any more. Thus, in Africa, where the
poor creatures dy of the smallpox like Rotten Sheep, a merciful God
has taught them an Infallible preservative. 'T is a common practice,
and is attended with a constant success."
What has come down to us of the first century of medical practice, in
the hands of Winthrop and Oliver, is comparatively simple and
reasonable. I suspect that the conditions of rude, stern life, in
which the colonists found themselves in the wilderness, took the
nonsense out of them, as the exigencies of a campaign did out of our
physicians and surgeons in the late war. Good food and enough of it,
pure air and water, cleanliness, good attendance, an anaesthetic, an
opiate, a stimulant, quinine, and two or three common drugs, proved
to be the marrow of medical treatment; and the fopperies of the
pharmacopoeia went the way of embroidered shirts and white kid gloves
and malacca joints, in their time of need. "Good wine is the best
cordiall for her," said Governor John Winthrop, Junior, to Samuel
Symonds, speaking of that gentleman's wife,--just as Sydenham,
instead of physic, once ordered a roast chicken and a pint of canary
for his patient in male hysterics.
But the profession of medicine never could reach its full development
until it became entirely separated from that of divinity. The
spiritual guide, the consoler in afliction, the confessor who is
admitted into the secrets of our souls, has his own noble sphere of
duties; but the healer of men must confine himself solely to the
revelations of God in nature, as he sees their miracles with his own
eyes. No doctrine of prayer or special providence is to be his
excuse for not looking straight at secondary causes, and acting,
exactly so far as experience justifies him, as if he were himself the
divine agent which antiquity fabled him to be. While pious men were
praying--humbly, sincerely, rightly, according to their knowledge--
over the endless succession of little children dying of spasms in the
great Dublin Hospital, a sagacious physician knocked some holes in
the walls of the ward, let God's blessed air in on the little
creatures, and so had already saved in that single hospital, as it
was soberly calculated thirty years ago, more than sixteen thousand
lives of these infant heirs of immortality. [Collins's Midwifery, p.
312. Published by order of the Massachusetts Medical Society.
Boston, 1841.]
Let it be, if you will, that the wise inspiration of the physician
was granted in virtue of the clergyman's supplications. Still, the
habit of dealing with things seen generates another kind of
knowledge, and another way of thought, from that of dealing with
things unseen; which knowledge and way of thought are special means
granted by Providence, and to be thankfully accepted.
The mediaeval ecclesiastics expressed a great truth in that saying,
so often quoted, as carrying a reproach with it: "Ubi tres medici,
duo athei,"--"Where there are three physicians, there are two
atheists."
It was true then, it is true to-day, that the physician very
commonly, if not very generally, denies and repudiates the deity of
ecclesiastical commerce. The Being whom Ambroise Pare meant when he
spoke those memorable words, which you may read over the professor's
chair in the French School of Medicine, "Te le pensay, et Dieu le
guarit," "I dressed his wound, and God healed it,"--is a different
being from the God that scholastic theologians have projected from
their consciousness, or shaped even from the sacred pages which have
proved so plastic in their hands. He is a God who never leaves
himself without witness, who repenteth him of the evil, who never
allows a disease or an injury, compatible with the enjoyment of life,
to take its course without establishing an effort, limited by certain
fixed conditions, it is true, but an effort, always, to restore the
broken body or the shattered mind. In the perpetual presence of this
great Healing Agent, who stays the bleeding of wounds, who knits the
fractured bone, who expels the splinter by a gentle natural process,
who walls in the inflammation that might involve the vital organs,
who draws a cordon to separate the dead part from the living, who
sends his three natural anaesthetics to the over-tasked frame in due
order, according to its need,--sleep, fainting, death; in this
perpetual presence, it is doubtless hard for the physician to realize
the theological fact of a vast and permanent sphere of the universe,
where no organ finds itself in its natural medium, where no wound
heals kindly, where the executive has abrogated the pardoning power,
and mercy forgets its errand; where the omnipotent is unfelt save in
malignant agencies, and the omnipresent is unseen and unrepresented;
hard to accept the God of Dante's "Inferno," and of Bunyan's caged
lunatic. If this is atheism, call three, instead of two of the trio,
atheists, and it will probably come nearer the truth.
I am not disposed to deny the occasional injurious effect of the
materializing influences to which the physician is subjected.
A spiritual guild is absolutely necessary to keep him, to keep us
all, from becoming the "fingering slaves" that Wordsworth treats with
such shrivelling scorn. But it is well that the two callings have
been separated, and it is fitting that they remain apart. In
settling the affairs of the late concern, I am afraid our good
friends remain a little in our debt. We lent them our physician
Michael Servetus in fair condition, and they returned him so damaged
by fire as to be quite useless for our purposes. Their Reverend
Samuel Willard wrote us a not over-wise report of a case of hysteria;
and our Jean Astruc gave them (if we may trust Dr. Smith's Dictionary
of the Bible) the first discerning criticism on the authorship of the
Pentateuch. Our John Locke enlightened them with his letters
concerning toleration; and their Cotton Mather obscured our twilight
with his "Nishmath Chajim."
Yet we must remember that the name of Basil Valentine, the monk, is
associated with whatever good and harm we can ascribe to antimony;
and that the most remarkable of our specifics long bore the name of
"Jesuit's Bark," from an old legend connected with its introduction.
"Frere Jacques," who taught the lithotomists of Paris, owes his
ecclesiastical title to courtesy, as he did not belong to a religious
order.
Medical science, and especially the study of mental disease, is
destined, I believe, to react to much greater advantage on the
theology of the future than theology has acted on medicine in the
past. The liberal spirit very generally prevailing in both
professions, and the good understanding between their most
enlightened members, promise well for the future of both in a
community which holds every point of human belief, every institution
in human hands, and every word written in a human dialect, open to
free discussion today, to-morrow, and to the end of time. Whether
the world at large will ever be cured of trusting to specifics as a
substitute for observing the laws of health, and to mechanical or
intellectual formula as a substitute for character, may admit of
question. Quackery and idolatry are all but immortal.
We can find most of the old beliefs alive amongst us to-day, only
having changed their dresses and the social spheres in which they
thrive. We think the quarrels of Galenists and chemists belong to
the past, forgetting that Thomsonism has its numerous apostles in our
community; that it is common to see remedies vaunted as purely
vegetable, and that the prejudice against "mineral poisons,"
especially mercury, is as strong in many quarters now as it was at
the beginning of the seventeenth century. Names are only air, and
blow away with a change of wind; but beliefs are rooted in human
wants and weakness, and die hard. The oaks of Dodona are prostrate,
and the shrine of Delphi is desolate; but the Pythoness and the Sibyl
may be consulted in Lowell Street for a very moderate compensation.
Nostradamus and Lilly seem impossible in our time; but we have seen
the advertisements of an astrologer in our Boston papers year after
year, which seems to imply that he found believers and patrons. You
smiled when I related Sir Kenelm Digby's prescription with the live
eel in it; but if each of you were to empty his or her pockets, would
there not roll out, from more than one of them, a horse-chestnut,
carried about as a cure for rheumatism? The brazen head of Roger
Bacon is mute; but is not "Planchette" uttering her responses in a
hundred houses of this city? We think of palmistry or chiromancy as
belonging to the days of Albertus Magnus, or, if existing in our
time, as given over to the gypsies; but a very distinguished person
has recently shown me the line of life, and the line of fortune, on
the palm of his hand, with a seeming confidence in the sanguine
predictions of his career which had been drawn from them. What shall
we say of the plausible and well-dressed charlatans of our own time,
who trade in false pretences, like Nicholas Knapp of old, but without
any fear of being fined or whipped; or of the many follies and
inanities, imposing on the credulous part of the community, each of
them gaping with eager, open mouth for a gratuitous advertisement by
the mention of its foolish name in any respectable connection?
I turn from this less pleasing aspect of the common intelligence
which renders such follies possible, to close the honorable record of
the medical profession in this, our ancient Commonwealth.
We have seen it in the first century divided among clergymen,
magistrates, and regular practitioners; yet, on the whole, for the
time, and under the circumstances, respectable, except where it
invoked supernatural agencies to account for natural phenomena.
In the second century it simplified its practice, educated many
intelligent practitioners, and began the work of organizing for
concerted action, and for medical teaching.
In this, our own century, it has built hospitals, perfected and
multiplied its associations and educational institutions, enlarged
and created museums, and challenged a place in the world of science
by its literature.
In reviewing the whole course of its history we read a long list of
honored names, and a precious record written in private memories, in
public charities, in permanent contributions to medical science, in
generous sacrifices for the country. We can point to our capital as
the port of entry for the New World of the great medical discoveries
of two successive centuries, and we can claim for it the triumph over
the most dreaded foe that assails the human body,--a triumph which
the annals of the race can hardly match in three thousand years of
medical history.
THE YOUNG PRACTITIONER
[A Valedictory Address delivered to the Graduating Class of the
Bellevue Hospital College, March 2, 1871.]
The occasion which calls us together reminds us not a little of that
other ceremony which unites a man and woman for life. The banns have
already been pronounced which have wedded our young friends to the
profession of their choice. It remains only to address to them some
friendly words of cheering counsel, and to bestow upon them the
parting benediction.
This is not the time for rhetorical display or ambitious eloquence.
We must forget ourselves, and think only of them. To us it is an
occasion; to them it is an epoch. The spectators at the wedding look
curiously at the bride and bridegroom; at the bridal veil, the
orange-flower garland, the giving and receiving of the ring; they
listen for the tremulous "I will," and wonder what are the mysterious
syllables the clergyman whispers in the ear of the married maiden.
But to the newly-wedded pair what meaning in those words, "for
better, for worse," "in sickness and in health," "till death us do
part!" To the father, to the mother, who know too well how often the
deadly nightshade is interwoven with the wreath of orange-blossoms,
how empty the pageant, how momentous the reality!
You will not wonder that I address myself chiefly to those who are
just leaving academic life for the sterner struggle and the larger
tasks of matured and instructed manhood. The hour belongs to them;
if others find patience to listen, they will kindly remember that,
after all, they are but as the spectators at the wedding, and that
the priest is thinking less of them than of their friends who are
kneeling at the altar.
I speak more directly to you, then, gentlemen of the graduating
class. The days of your education, as pupils of trained instructors,
are over. Your first harvest is all garnered. Henceforth you are to
be sowers as well as reapers, and your field is the world. How does
your knowledge stand to-day? What have you gained as a permanent
possession? What must you expect to forget? What remains for you
yet to learn? These are questions which it may interest you to
consider.
There is another question which must force itself on the thoughts of
many among you: "How am I to obtain patients and to keep their
confidence? "You have chosen a laborious calling, and made many
sacrifices to fit yourselves for its successful pursuit. You wish to
be employed that you may be useful, and that you may receive the
reward of your industry. I would take advantage of these most
receptive moments to give you some hints which may help you to
realize your hopes and expectations. Such is the outline of the
familiar talk I shall offer you.
Your acquaintance with some of the accessory branches is probably
greater now than it will be in a year from now,--much greater than it
will by ten years from now. The progress of knowledge, it may be
feared, or hoped, will have outrun the text-books in which you
studied these branches. Chemistry, for instance, is very apt to
spoil on one's hands. "Nous avons change tout cela" might serve as
the standing motto of many of our manuals. Science is a great
traveller, and wears her shoes out pretty fast, as might be expected.
You are now fresh from the lecture-room and the laboratory. You can
pass an examination in anatomy, physiology, chemistry, materia
medica, which the men in large practice all around you would find a
more potent sudorific than any in the Pharmacopceia. These masters
of the art of healing were once as ready with their answers as you
are now, but they have got rid of a great deal of the less
immediately practical part of their acquisitions, and you must
undergo the same depleting process. Hard work will train it off, as
sharp exercise trains off the fat of a prize-fighter.
Yet, pause a moment before you infer that your teachers must have
been in fault when they furnished you with mental stores not directly
convertible to practical purposes, and likely in a few years to lose
their place in your memory. All systematic knowledge involves much
that is not practical, yet it is the only kind of knowledge which
satisfies the mind, and systematic study proves, in the long-run, the
easiest way of acquiring and retaining facts which are practical.
There are many things which we can afford to forget, which yet it was
well to learn. Your mental condition is not the same as if you had
never known what you now try in vain to recall. There is a perpetual
metempsychosis of thought, and the knowledge of to-day finds a soil
in the forgotten facts of yesterday. You cannot see anything in the
new season of the guano you placed last year about the roots of your
climbing plants, but it is blushing and breathing fragrance in your
trellised roses; it has scaled your porch in the bee-haunted honey-
suckle; it has found its way where the ivy is green; it is gone where
the woodbine expands its luxuriant foliage.
Your diploma seems very broad to-day with your list of
accomplishments, but it begins to shrink from this hour like the Peau
de Chagrin of Balzac's story. Do not worry about it, for all the
while there will be making out for you an ampler and fairer
parchment, signed by old Father Time himself as President of that
great University in which experience is the one perpetual and all-
sufficient professor.
Your present plethora of acquirements will soon cure itself.
Knowledge that is not wanted dies out like the eyes of the fishes of
the Mammoth Cave. When you come to handle life and death as your
daily business, your memory will of itself bid good-by to such
inmates as the well-known foramina of the sphenoid bone and the
familiar oxides of methyl-ethylamyl-phenyl-ammonium. Be thankful
that you have once known them, and remember that even the learned
ignorance of a nomenclature is something to have mastered, and may
furnish pegs to hang facts upon which would otherwise have strewed
the floor of memory in loose disorder.
But your education has, after all, been very largely practical. You
have studied medicine and surgery, not chiefly in books, but at the
bedside and in the operating amphitheatre. It is the special
advantage of large cities that they afford the opportunity of seeing
a great deal of disease in a short space of time, and of seeing many
cases of the same kind of disease brought together. Let us not be
unjust to the claims of the schools remote from the larger centres of
population. Who among us has taught better than Nathan Smith, better
than Elisha Bartlett? who teaches better than some of our living
contemporaries who divide their time between city and country
schools? I am afraid we do not always do justice to our country
brethren, whose merits are less conspicuously exhibited than those of
the great city physicians and surgeons, such especially as have
charge of large hospitals. There are modest practitioners living in
remote rural districts who are gifted by nature with such sagacity
and wisdom, trained so well in what is most essential to the practice
of their art, taught so thoroughly by varied experience, forced to
such manly self-reliance by their comparative isolation, that, from
converse with them alone, from riding with them on their long rounds
as they pass from village to village, from talking over cases with
them, putting up their prescriptions, watching their expedients,
listening to their cautions, marking the event of their predictions,
hearing them tell of their mistakes, and now and then glory a little
in the detection of another's blunder, a young man would find himself
better fitted for his real work than many who have followed long
courses of lectures and passed a showy examination. But the young
man is exceptionally fortunate who enjoys the intimacy of such a
teacher. And it must be confessed that the great hospitals,
infirmaries, and dispensaries of large cities, where men of well-
sifted reputations are in constant attendance, are the true centres
of medical education. No students, I believe, are more thoroughly
aware of this than those who have graduated at this institution.
Here, as in all our larger city schools, the greatest pains are taken
to teach things as well as names. You have entered into the
inheritance of a vast amount of transmitted skill and wisdom, which
you have taken, warm, as it were, with the life of your well-schooled
instructors. You have not learned all that art has to teach you, but
you are safer practitioners to-day than were many of those whose
names we hardly mention without a genuflection. I had rather be
cared for in a fever by the best-taught among you than by the
renowned Fernelius or the illustrious Boerhaave, could they come back
to us from that better world where there are no physicians needed,
and, if the old adage can be trusted, not many within call. I had
rather have one of you exercise his surgical skill upon me than find
myself in the hands of a resuscitated Fabricius Hildanus, or even of
a wise Ambroise Pare, revisiting earth in the light of the nineteenth
century.
You will not accuse me of underrating your accomplishments. You know
what to do for a child in a fit, for an alderman in an apoplexy, for
a girl that has fainted, for a woman in hysterics, for a leg that is
broken, for an arm that is out of joint, for fevers of every color,
for the sailor's rheumatism, and the tailor's cachexy. In fact you
do really know so much at this very hour, that nothing but the
searching test of time can fully teach you the limitations of your
knowledge.
Of some of these you will permit me to remind you. You will never
have outgrown the possibility of new acquisitions, for Nature is
endless in her variety. But even the knowledge which you may be said
to possess will be a different thing after long habit has made it a
part of your existence. The tactus eruditus extends to the mind as
well as to the finger-ends. Experience means the knowledge gained by
habitual trial, and an expert is one who has been in the habit of
trying. This is the kind of knowledge that made Ulysses wise in the
ways of men. Many cities had he seen, and known the minds of those
who dwelt in them. This knowledge it was that Chaucer's Shipman
brought home with him from the sea a
"In many a tempest had his berd be shake."
This is the knowledge we place most confidence in, in the practical
affairs of life.
Our training has two stages. The first stage deals with our
intelligence, which takes the idea of what is to be done with the
most charming ease and readiness. Let it be a game of billiards, for
instance, which the marker is going to teach us. We have nothing to
do but to make this ball glance from that ball and hit that other
ball, and to knock that ball with this ball into a certain caecal
sacculus or diverticulum which our professional friend calls a
pocket. Nothing can be clearer; it is as easy as "playing upon this
pipe," for which Hamlet gives Guildenstern such lucid directions.
But this intelligent Me, who steps forward as the senior partner in
our dual personality, turns out to be a terrible bungler. He misses
those glancing hits which the hard-featured young professional person
calls "carroms," and insists on pocketing his own ball instead of the
other one.
It is the unintelligent Me, stupid as an idiot, that has to try a
thing a thousand times before he can do it, and then never knows how
he does it, that at last does it well. We have to educate ourselves
through the pretentious claims of intellect, into the humble accuracy
of instinct, and we end at last by acquiring the dexterity, the
perfection, the certainty, which those masters of arts, the bee and
the spider, inherit from Nature.
Book-knowledge, lecture-knowledge, examination-knowledge, are all in
the brain. But work-knowledge is not only in the brain, it is in the
senses, in the muscles, in the ganglia of the sympathetic nerves,--
all over the man, as one may say, as instinct seems diffused through
every part of those lower animals that have no such distinct organ as
a brain. See a skilful surgeon handle a broken limb; see a wise old
physician smile away a case that looks to a novice as if the sexton
would soon be sent for; mark what a large experience has done for
those who were fitted to profit by it, and you will feel convinced
that, much as you know, something is still left for you to learn.
May I venture to contrast youth and experience in medical practice,
something in the way the man painted the lion, that is, the lion
under?
The young man knows the rules, but the old man knows-the exceptions.
The young man knows his patient, but the old man knows also his
patient's family, dead and alive, up and down for generations. He
can tell beforehand what diseases their unborn children will be
subject to, what they will die of if they live long enough, and
whether they had better live at all, or remain unrealized
possibilities, as belonging to a stock not worth being perpetuated.
The young man feels uneasy if he is not continually doing something
to stir up his patient's internal arrangements. The old man takes
things more quietly, and is much more willing to let well enough
alone: All these superiorities, if such they are,'you must wait for
time to bring you. In the meanwhile (if we will let the lion be
uppermost for a moment), the young man's senses are quicker than
those of his older rival. His education in all the accessory
branches is more recent, and therefore nearer the existing condition
of knowledge. He finds it easier than his seniors to accept the
improvements which every year is bringing forward. New ideas build
their nests in young men's brains. "Revolutions are not made by men
in spectacles," as I once heard it remarked, and the first whispers
of a new truth are not caught by those who begin to feel the need of
an ear-trumpet. Granting all these advantages to the young man, he
ought, nevertheless, to go on improving, on the whole, as a medical
practitioner, with every year, until he has ripened into a well-
mellowed maturity. But, to improve, he must be good for something at
the start. If you ship a poor cask of wine to India and back, if you
keep it a half a century, it only grows thinner and sharper.
You are soon to enter into relations with the public, to expend your
skill and knowledge for its benefit, and find your support in the
rewards of your labor. What kind of a constituency is this which is
to look to you as its authorized champions in the struggle of life
against its numerous enemies?
In the first place, the persons who seek the aid of the physician are
very honest and sincere in their wish to get rid of their complaints,
and, generally speaking, to live as long as they can. However
attractively the future is painted to them, they are attached to the
planet with which they are already acquainted. They are addicted to
the daily use of this empirical and unchemical mixture which we call
air; and would hold on to it as a tippler does to his alcoholic
drinks. There is nothing men will not do, there is nothing they have
not done, to recover their health and save their lives. They have
submitted to be half-drowned in water, and half-choked with gases, to
be buried up to their chins in earth, to be seared with hot irons
like galley-slaves, to be crimped with knives, like cod-fish, to have
needles thrust into their flesh, and bonfires kindled on their skin,
to swallow all sorts of abominations, and to pay for all this, as if
to be singed and scalded were a costly privilege, as if blisters were
a blessing, and leeches were a luxury. What more can be asked to
prove their honesty and sincerity?
This same community is very intelligent with respect to a great many
subjects-commerce, mechanics, manufactures, politics. But with
regard to medicine it is hopelessly ignorant and never finds it out.
I do not know that it is any worse in this country than in Great
Britain, where Mr. Huxley speaks very freely of "the utter ignorance
of the simplest laws of their own animal life, which prevails among
even the most highly educated persons." And Cullen said before him
"Neither the acutest genius nor the soundest judgment will avail in
judging of a particular science, in regard to which they have not
been exercised. I have been obliged to please my patients sometimes
with reasons, and I have found that any will pass, even with able
divines and acute lawyers; the same will pass with the husbands as
with the wives." If the community could only be made aware of its
own utter ignorance, and incompetence to form opinions on medical
subjects, difficult enough to those who give their lives to the study
of them, the practitioner would have an easier task. But it will
form opinions of its own, it cannot help it, and we cannot blame it,
even though we know how slight and deceptive are their foundations.
This is the way it happens: Every grown-up person has either been ill
himself or had a friend suffer from illness, from which he has
recovered. Every sick person has done something or other by
somebody's advice, or of his own accord, a little before getting
better. There is an irresistible tendency to associate the thing
done, and the improvement which followed it, as cause and effect.
This is the great source of fallacy in medical practice. But the
physician has some chance of correcting his hasty inference. He
thinks his prescription cured a single case of a particular
complaint; he tries it in twenty similar cases without effect, and
sets down the first as probably nothing more than a coincidence. The
unprofessional experimenter or observer has no large experience to
correct his hasty generalization. He wants to believe that the means
he employed effected his cure. He feels grateful to the person who
advised it, he loves to praise the pill or potion which helped him,
and he has a kind of monumental pride in himself as a living
testimony to its efficacy. So it is that you will find the community
in which you live, be it in town or country, full of brands plucked
from the burning, as they believe, by some agency which, with your
better training, you feel reasonably confident had nothing to do with
it. Their disease went out of itself, and the stream from the
medical fire-annihilator had never even touched it.
You cannot and need not expect to disturb the public in the
possession of its medical superstitions. A man's ignorance is as
much his private property, and as precious in his own eyes, as his
family Bible. You have only to open your own Bible at the ninth
chapter of St. John's Gospel, and you will find that the logic of a
restored patient was very simple then, as it is now, and very hard to
deal with. My clerical friends will forgive me for poaching on their
sacred territory, in return for an occasional raid upon the medical
domain of which they have now and then been accused.
A blind man was said to have been restored to sight by a young person
whom the learned doctors of the Jewish law considered a sinner, and,
as such, very unlikely to have been endowed with a divine gift of
healing. They visited the patient repeatedly, and evidently teased
him with their questions about the treatment, and their insinuations
about the young man, until he lost his temper. At last he turned
sharply upon them: "Whether he be a sinner or no, I know not: one
thing I know, that, whereas I was blind, now I see."
This is the answer that always has been and always will be given by
most persons when they find themselves getting well after doing
anything, no matter what,--recommended by anybody, no matter whom.
Lord Bacon, Robert Boyle, Bishop Berkeley, all put their faith in
panaceas which we should laugh to scorn. They had seen people get
well after using them. Are we any wiser than those great men? Two
years ago, in a lecture before the Massachusetts Historical Society,
I mentioned this recipe of Sir Kenelm Digby for fever and ague: Pare
the patient's nails; put the parings in a little bag, and hang the
bag round the neck of a live eel, and place him in a tub of water.
The eel will die, and the patient will recover.
Referring to this prescription in the course of the same lecture, I
said: "You smiled when I related Sir Kenehn Digby's prescription,
with the live eel in it; but if each of you were to empty his or her
pockets, would there not roll out, from more than one of them, a
horse-chestnut, carried about as a cure for rheumatism?" Nobody saw
fit to empty his or her pockets, and my question brought no response.
But two months ago I was in a company of educated persons, college
graduates every one of them, when a gentleman, well known in our
community, a man of superior ability and strong common-sense, on the
occasion of some talk arising about rheumatism, took a couple of very
shiny horse-chestnuts from his breeches-pocket, and laid them on the
table, telling us how, having suffered from the complaint in
question, he had, by the advice of a friend, procured these two
horse-chestnuts on a certain time a year or more ago, and carried
them about him ever since; from which very day he had been entirely
free from rheumatism.
This argument, from what looks like cause and effect, whether it be
so or not, is what you will have to meet wherever you go, and you
need not think you can answer it. In the natural course of things
some thousands of persons must be getting well or better of slight
attacks of colds, of rheumatic pains, every week, in this city alone.
Hundreds of them do something or other in the way of remedy, by
medical or other advice, or of their own motion, and the last thing
they do gets the credit of the recovery. Think what a crop of
remedies this must furnish, if it were all harvested!
Experience has taught, or will teach you, that most of the wonderful
stories patients and others tell of sudden and signal cures are like
Owen Glendower's story of the portents that announced his birth. The
earth shook at your nativity, did it? Very likely, and
"So it would have done,
At the same season, if your mother's cat
Had kittened, though yourself had ne'er been born."
You must listen more meekly than Hotspur did to the babbling
Welshman, for ignorance is a solemn and sacred fact, and, like
infancy, which it resembles, should be respected. Once in a while
you will have a patient of sense, born with the gift of observation,
from whom you may learn something. When you find yourself in the
presence of one who is fertile of medical opinions, and affluent in
stories of marvellous cures,--of a member of Congress whose name
figures in certificates to the value of patent medicines, of a
voluble dame who discourses on the miracles she has wrought or seen
wrought with the little jokers of the sugar-of-milk globule-box, take
out your watch and count the pulse; also note the time of day, and
charge the price of a visit for every extra fifteen, or, if you are
not very busy, every twenty minutes. In this way you will turn what
seems a serious dispensation into a double blessing, for this class
of patients loves dearly to talk, and it does them a deal of good,
and you feel as if you had earned your money by the dose you have
taken, quite as honestly as by any dose you may have ordered.
You must take the community just as it is, and make the best of it.
You wish to obtain its confidence; there is a short rule for doing
this which you will find useful,--deserve it. But, to deserve it in
full measure, you must unite many excellences, natural and acquired.
As the basis of all the rest, you must have all those traits of
character which fit you to enter into the most intimate and
confidential relations with the families of which you are the
privileged friend and counsellor. Medical Christianity, if I may use
such a term, is of very early date. By the oath of Hippocrates, the
practitioner of ancient times bound himself to enter his patient's
house with the sole purpose of doing him good, and so to conduct
himself as to avoid the very appearance of evil. Let the physician
of to-day begin by coming up to this standard, and add to it all the
more recently discovered virtues and graces.
A certain amount of natural ability is requisite to make you a good
physician, but by no means that disproportionate development of some
special faculty which goes by the name of genius. A just balance of
the mental powers is a great deal more likely to be useful than any
single talent, even were it the power of observation; in excess. For
a mere observer is liable to be too fond of facts for their own sake,
so that, if he told the real truth, he would confess that he takes
more pleasure in a post-mortem examination which shows him what was
the matter with a patient, than in a case which insists on getting
well and leaving him in the dark as to its nature. Far more likely
to interfere with the sound practical balance of the mind is that
speculative, theoretical tendency which has made so many men noted in
their day, whose fame has passed away with their dissolving theories.
Read Dr. Bartlett's comparison of the famous Benjamin Rush with his
modest fellow-townsman Dr. William Currie, and see the dangers into
which a passion for grandiose generalizations betrayed a man of many
admirable qualities.
I warn you against all ambitious aspirations outside of your
profession. Medicine is the most difficult of sciences and the most
laborious of arts. It will task all your powers of body and mind if
you are faithful to it. Do not dabble in the muddy sewer of
politics, nor linger by the enchanted streams of literature, nor dig
in far-off fields for the hidden waters of alien sciences. The great
practitioners are generally those who concentrate all their powers on
their business. If there are here and there brilliant exceptions, it
is only in virtue of extraordinary gifts, and industry to which very
few are equal.
To get business a man mast really want it; and do you suppose that
when you are in the middle of a heated caucus, or half-way through a
delicate analysis, or in the spasm of an unfinished ode, your eyes
rolling in the fine frenzy of poetical composition, you want to be
called to a teething infant, or an ancient person groaning under the
griefs of a lumbago? I think I have known more than one young man
whose doctor's sign proclaimed his readiness to serve mankind in that
capacity, but who hated the sound of a patient's knock, and as he sat
with his book or his microscope, felt exactly as the old party
expressed himself in my friend Mr. Brownell's poem
"All I axes is, let me alone."
The community soon finds out whether you are in earnest, and really
mean business, or whether you are one of those diplomaed dilettanti
who like the amusement of quasi medical studies, but have no idea of
wasting their precious time in putting their knowledge in practice
for the benefit of their suffering fellow-creatures.
The public is a very incompetent judge of your skill and knowledge,
but it gives its confidence most readily to those who stand well with
their professional brethren, whom they call upon when they themselves
or their families are sick, whom they choose to honorable offices,
whose writings and teachings they hold in esteem. A man may be much
valued by the profession and yet have defects which prevent his
becoming a favorite practitioner, but no popularity can be depended
upon as permanent which is not sanctioned by the judgment of
professional experts, and with these you will always stand on your
substantial merits.
What shall I say of the personal habits you must form if you wish for
success? Temperance is first upon the list. Intemperance in a
physician partakes of the guilt of homicide, for the muddled brain
may easily make a fatal blunder in a prescription and the unsteady
hand transfix an artery in an operation. Tippling doctors have been
too common in the history of medicine. Paracelsus was a sot,
Radcliffe was much too fond of his glass, and Dr. James Hurlbut of
Wethersfield, Connecticut, a famous man in his time, used to drink a
square bottle of rum a day, with a corresponding allowance of opium
to help steady his nerves. We commonly speak of a man as being the
worse for liquor, but I was asking an Irish laborer one day about his
doctor, who, as he said, was somewhat given to drink. "I like him
best when he's a little that way," he said; "then I can spake to
him." I pitied the poor patient who could not venture to allude to
his colic or his pleurisy until his physician was tipsy.
There are personal habits of less gravity than the one I have
mentioned which it is well to guard against, or, if they are formed,
to relinquish. A man who may be called at a moment's warning into
the fragrant boudoir of suffering loveliness should not unsweeten its
atmosphere with reminiscences of extinguished meerschaums. He should
remember that the sick are sensitive and fastidious, that they love
the sweet odors and the pure tints of flowers, and if his presence is
not like the breath of the rose, if his hands are not like the leaf
of the lily, his visit may be unwelcome, and if he looks behind him
he may see a window thrown open after he has left the sick-chamber.
I remember too well the old doctor who sometimes came to help me
through those inward griefs to which childhood is liable. "Far off
his coming "--shall I say "shone," and finish the Miltonic phrase, or
leave the verb to the happy conjectures of my audience? Before him
came a soul-subduing whiff of ipecacuanha, and after him lingered a
shuddering consciousness of rhubarb. He had lived so much among his
medicaments that he had at last become himself a drug, and to have
him pass through a sick-chamber was a stronger dose than a
conscientious disciple of Hahnemann would think it safe to
administer.
Need I remind yon of the importance of punctuality in your
engagements, and of the worry and distress to patients and their
friends which the want of it occasions? One of my old teachers
always carried two watches, to make quite sure of being exact, and
not only kept his appointments with the regularity of a chronometer,
but took great pains to be at his patient's house at the time when he
had reason to believe he was expected, even if no express appointment
was made. It is a good rule; if you call too early, my lady's hair
may not be so smooth as could be wished, and, if you keep her waiting
too long, her hair may be smooth, but her temper otherwise.
You will remember, of course, always to get the weather-gage of your
patient. I mean, to place him so that the light falls on his face
and not on yours. It is a kind of, ocular duel that is about to take
place between you; you are going to look through his features into
his pulmonary and hepatic and other internal machinery, and he is
going to look into yours quite as sharply to see what you think about
his probabilities for time or eternity.
No matter how hard he stares at your countenance, he should never be
able to read his fate in it. It should be cheerful as long as there
is hope, and serene in its gravity when nothing is left but
resignation. The face of a physician, like that of a diplomatist,
should be impenetrable. Nature is a benevolent old hypocrite; she
cheats the sick and the dying with illusions better than any
anodynes. If there are cogent reasons why a patient should be
undeceived, do it deliberately and advisedly, but do not betray your
apprehensions through your tell-tale features.
We had a physician in our city whose smile was commonly reckoned as
being worth five thousand dollars a year to him, in the days, too, of
moderate incomes. You cannot put on such a smile as that any more
than you can get sunshine without sun; there was a tranquil and
kindly nature under it that irradiated the pleasant face it made one
happier to meet on his daily rounds. But you can cultivate the
disposition, and it will work its way through to the surface, nay,
more,--you can try to wear a quiet and encouraging look, and it will
react on your disposition and make you like what you seem to be, or
at least bring you nearer to its own likeness.
Your patient has no more right to all the truth you know than he has
to all the medicine in your saddlebags, if you carry that kind of
cartridge-box for the ammunition that slays disease. He should get
only just so much as is good for him. I have seen a physician
examining a patient's chest stop all at once, as he brought out a
particular sound with a tap on the collarbone, in the attitude of a
pointer who has just come on the scent or sight of a woodcock. You
remember the Spartan boy, who, with unmoved countenance, hid the fox
that was tearing his vitals beneath his mantle. What he could do in
his own suffering you must learn to do for others on whose vital
organs disease has fastened its devouring teeth. It is a terrible
thing to take away hope, even earthly hope, from a fellow-creature.
Be very careful what names you let fall before your patient. He
knows what it means when you tell him he has tubercles or Bright's
disease, and, if he hears the word carcinoma, he will certainly look
it out in a medical dictionary, if he does not interpret its dread
significance on the instant. Tell him he has asthmatic symptoms, or
a tendency to the gouty diathesis, and he will at once think of all
the asthmatic and gouty old patriarchs he has ever heard of, and be
comforted. You need not be so cautious in speaking of the health of
rich and remote relatives, if he is in the line of succession.
Some shrewd old doctors have a few phrases always on hand for
patients that will insist on knowing the pathology of their
complaints without the slightest capacity of understanding the
scientific explanation. I have known the term "spinal irritation"
serve well on such occasions, but I think nothing on the whole has
covered so much ground, and meant so little, and given such profound
satisfaction to all parties, as the magnificent phrase "congestion of
the portal system."
Once more, let me recommend you, as far as possible, to keep your
doubts to yourself, and give the patient the benefit of your
decision. Firmness, gentle firmness, is absolutely necessary in this
and certain other relations. Mr. Rarey with Cruiser, Richard with
Lady Ann, Pinel with his crazy people, show what steady nerves can do
with the most intractable of animals, the most irresistible of
despots, and the most unmanageable of invalids.
If you cannot acquire and keep the confidence of your patient, it is
time for you to give place to some other practitioner who can. If
you are wise and diligent, you can establish relations with the best
of them which they will find it very hard to break. But, if they
wish to employ another person, who, as they think, knows more than
you do, do not take it as a personal wrong. A patient believes
another man can save his life, can restore him to health, which, as
he thinks, you have not the skill to do. No matter whether the
patient is right or wrong, it is a great impertinence to think you
have any property in him. Your estimate of your own ability is not
the question, it is what the patient thinks of it. All your wisdom
is to him like the lady's virtue in Raleigh's song:
"If she seem not chaste to me,
What care I how chaste she be?"
What I call a good patient is one who, having found a good physician,
sticks to him till he dies. But there are many very good people who
are not what I call good patients. I was once requested to call on a
lady suffering from nervous and other symptoms. It came out in the
preliminary conversational skirmish, half medical, half social, that
I was the twenty-sixth member of the faculty into whose arms,
professionally speaking, she had successively thrown herself. Not
being a believer in such a rapid rotation of scientific crops, I
gently deposited the burden, commending it to the care of number
twenty-seven, and, him, whoever he might be, to the care of Heaven.
If there happened to be among my audience any person who wished to
know on what principles the patient should choose his physician, I
should give him these few precepts to think over:
Choose a man who is personally agreeable, for a daily visit from an
intelligent, amiable, pleasant, sympathetic person will cost you no
more than one from a sloven or a boor, and his presence will do more
for you than any prescription the other will order.
Let him be a man of recognized good sense in other matters, and the
chance is that he will be sensible as a practitioner.
Let him be a man who stands well with his professional brethren, whom
they approve as honest, able, courteous.
Let him be one whose patients are willing to die in his hands, not
one whom they go to for trifles, and leave as soon as they are in
danger, and who can say, therefore, that he never loses a patient.
Do not leave the ranks of what is called the regular profession,
unless you wish to go farther and fare worse, for you may be assured
that its members recognize no principle which hinders their accepting
any remedial agent proved to be useful, no matter from what quarter
it comes. The difficulty is that the stragglers, organized under
fantastic names in pretentious associations, or lurking in solitary
dens behind doors left ajar, make no real contributions to the art of
healing. When they bring forward a remedial agent like chloral, like
the bromide of potassium, like ether, used as an anesthetic, they
will find no difficulty in procuring its recognition.
Some of you will probably be more or less troubled by the pretensions
of that parody of mediaeval theology which finds its dogma of
hereditary depravity in the doctrine of psora, its miracle of
transubstantiation in the mystery of its triturations and dilutions,
its church in the people who have mistaken their century, and its
priests in those who have mistaken their calling. You can do little
with persons who are disposed to accept these curious medical
superstitions. The saturation-point of individual minds with
reference to evidence, and especially medical evidence, differs, and
must always continue to differ, very widely. There are those whose
minds are satisfied with the decillionth dilution of a scientific
proof. No wonder they believe in the efficacy of a similar
attenuation of bryony or pulsatilla. You have no fulcrum you can
rest upon to lift an error out of such minds as these, often highly
endowed with knowledge and talent, sometimes with genius, but
commonly richer in the imaginative than the observing and reasoning
faculties.
Let me return once more to the young graduate. Your relations to
your professional brethren may be a source of lifelong happiness and
growth in knowledge and character, or they may make you wretched and
end by leaving you isolated from those who should be your friends and
counsellors. The life of a physician becomes ignoble when he suffers
himself to feed on petty jealousies and sours his temper in perpetual
quarrels. You will be liable to meet an uncomfortable man here and
there in the profession,--one who is so fond of being in hot water
that it is a wonder all the albumen in his body is not coagulated.
There are common barrators among doctors as there are among lawyers,
--stirrers up of strife under one pretext and another, but in reality
because they like it. They are their own worst enemies, and do
themselves a mischief each time they assail their neighbors. In my
student days I remember a good deal of this Donnybrook-Fair style of
quarrelling, more especially in Paris, where some of the noted
surgeons were always at loggerheads, and in one of our lively Western
cities. Soon after I had set up an office, I had a trifling
experience which may serve to point a moral in this direction. I had
placed a lamp behind the glass in the entry to indicate to the
passer-by where relief from all curable infirmities was to be sought
and found. Its brilliancy attracted the attention of a devious
youth, who dashed his fist through the glass and upset my modest
luminary. All he got by his vivacious assault was that he left
portions of integument from his knuckles upon the glass, had a lame
hand, was very easily identified, and had to pay the glazier's bill.
The moral is that, if the brilliancy of another's reputation excites
your belligerent instincts, it is not worth your while to strike at
it, without calculating which of you is likely to suffer most, if you
do.
You may be assured that when an ill-conditioned neighbor is always
complaining of a bad taste in his mouth and an evil atmosphere about
him, there is something wrong about his own secretions. In such
cases there is an alterative regimen of remarkable efficacy: it is a
starvation-diet of letting alone. The great majority of the
profession are peacefully inclined. Their pursuits are eminently
humanizing, and they look with disgust on the personalities which
intrude themselves into the placid domain of an art whose province it
is to heal and not to wound.
The intercourse of teacher and student in a large school is
necessarily limited, but it should be, and, so far as my experience
goes, it is, eminently cordial and kindly. You will leave with
regret, and hold in tender remembrance, those who have taken you by
the hand at your entrance on your chosen path, and led you patiently
and faithfully, until the great gates at its end have swung upon
their hinges, and the world lies open before you. That venerable
oath to which I have before referred bound the student to regard his
instructor in the light of a parent, to treat his children like
brothers, to succor him in his day of need. I trust the spirit of
the oath of Hippocrates is not dead in the hearts of the students of
to-day. They will remember with gratitude every earnest effort,
every encouraging word, which has helped them in their difficult and
laborious career of study. The names they read on their diplomas
will recall faces that are like family-portraits in their memory, and
the echo of voices they have listened to so long will linger in their
memories far into the still evening of their lives.
One voice will be heard no more which has been familiar to many among
you. It is not for me, a stranger to these scenes, to speak his
eulogy. I have no right to sadden this hour by dwelling on the deep
regrets of friendship, or to bid the bitter tears of sorrow flow
afresh. Yet I cannot help remembering what a void the death of such
a practitioner as your late instructor must leave in the wide circle
of those who leaned upon his counsel and assistance in their hour of
need, in a community where he was so widely known and esteemed, in a
school where he bore so important a part. There is no exemption from
the common doom for him who holds the shield to protect others. The
student is called from his bench, the professor from his chair, the
practitioner in his busiest period hears a knock more peremptory than
any patient's midnight summons, and goes on that unreturning visit
which admits of no excuse, and suffers no delay. The call of such a
man away from us is the bereavement of a great family. Nor can we
help regretting the loss for him of a bright and cheerful earthly
future; for the old age of a physician is one of the happiest periods
of his life. He is loved and cherished for what he has been, and
even in the decline of his faculties there are occasions when his
experience is still appealed to, and his trembling hands are looked
to with renewing hope and trust, as being yet able to stay the arm of
the destroyer.
But if there is so much left for age, how beautiful, how inspiring is
the hope of youth! I see among those whom I count as listeners one
by whose side I have sat as a fellow-teacher, and by whose
instructions I have felt myself not too old to profit. As we
borrowed him from your city, I must take this opportunity of telling
you that his zeal, intelligence, and admirable faculty as an
instructor were heartily and universally recognized among us. We
return him, as we trust, uninjured, to the fellow-citizens who have
the privilege of claiming him as their own.
And now, gentlemen of the graduating class, nothing remains but for
me to bid you, in the name of those for whom I am commissioned and
privileged to speak, farewell as students, and welcome as
practitioners. I pronounce the two benedictions in the same breath,
as the late king's demise and the new king's accession are proclaimed
by the same voice at the same moment. You would hardly excuse me if
I stooped to any meaner dialect than the classical and familiar
language of your prescriptions, the same in which your title to the
name of physician is, if, like our own institution, you follow the
ancient usage, engraved upon your diplomas.
Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete,
filii!
Salvete, VIRI, artis medicae magister; Salvete amici; salvete
fratres!
MEDICAL LIBRARIES.
[Dedicatory Address at the opening of the Medical Library in Boston,
December 3, 1878.]
It is my appointed task, my honorable privilege, this evening, to
speak of what has been done by others. No one can bring his tribute
of words into the presence of great deeds, or try with them to
embellish the memory of any inspiring achievement, without feeling
and leaving with others a sense of their insufficiency. So felt
Alexander when he compared even his adored Homer with the hero the
poet had sung. So felt Webster when he contrasted the phrases of
rhetoric with the eloquence of patriotism and of self-devotion. So
felt Lincoln when on the field of Gettysburg he spoke those immortal
words which Pericles could not nave bettered, which Aristotle could
not have criticised. So felt he who wrote the epitaph of the builder
of the dome which looks down on the crosses and weathercocks that
glitter over London.
We are not met upon a battle-field, except so far as every laborious
achievement means a victory over opposition, indifference,
selfishness, faintheartedness, and that great property of mind as
well as matter,--inertia. We are not met in a cathedral, except so
far as every building whose walls are lined with the products of
useful and ennobling thought is a temple of the Almighty, whose
inspiration has given us understanding. But we have gathered within
walls which bear testimony to the self-sacrificing, persevering
efforts of a few young men, to whom we owe the origin and development
of all that excites our admiration in this completed enterprise; and
I might consider my task as finished if I contented myself with
borrowing the last word of the architect's epitaph and only saying,
Look around you!
The reports of the librarian have told or will tell you, in some
detail, what has been accomplished since the 21st of December, 1874,
when six gentlemen met at the house of Dr. Henry Ingersoll Bowditch
to discuss different projects for a medical library. In less than
four years from that time, by the liberality of associations and of
individuals, this collection of nearly ten thousand volumes, of five
thousand pamphlets, and of one hundred and twenty-five journals,
regularly received,--all worthily sheltered beneath this lofty roof,
--has come into being under our eyes. It has sprung up, as it were;
in the night like a mushroom; it stands before us in full daylight as
lusty as an oak, and promising to grow and flourish in the perennial
freshness of an evergreen.
To whom does our profession owe this already large collection of
books, exceeded in numbers only by four or five of the most extensive
medical libraries in the country, and lodged in a building so well
adapted to its present needs? We will not point out individually all
those younger members of the profession who have accomplished what
their fathers and elder brethren had attempted and partially
achieved. We need not write their names on these walls, after the
fashion of those civic dignitaries who immortalize themselves on
tablets of marble and gates of iron. But their contemporaries know
them well, and their descendants will not forget them,--the men who
first met together, the men who have given their time and their
money, the faithful workers, worthy associates of the strenuous
agitator who gave no sleep to his eyes, no slumber to his eyelids,
until he had gained his ends; the untiring, imperturbable, tenacious,
irrepressible, all-subduing agitator who neither rested nor let
others rest until the success of the project was assured. If,
against his injunctions, I name Dr. James Read Chadwick, it is only
my revenge for his having kept me awake so often and so long while he
was urging on the undertaking in which he has been preeminently
active and triumphantly successful.
We must not forget the various medical libraries which preceded this:
that of an earlier period, when Boston contained about seventy
regular practitioners, the collection afterwards transferred to the
Boston Athenaeum; the two collections belonging to the University;
the Treadwell Library at the Massachusetts General Hospital; the
collections of the two societies, that for Medical Improvement and
that for Medical Observation; and more especially the ten thousand
volumes relating to medicine belonging to our noble public city
library,--too many blossoms on the tree of knowledge, perhaps, for
the best fruit to ripen. But the Massachusetts Medical Society now
numbers nearly four hundred members in the city of Boston. The time
had arrived for a new and larger movement. There was needed a place
to which every respectable member of the medical profession could
obtain easy access; where, under one roof, all might find the special
information they were seeking; where the latest medical intelligence
should be spread out daily as the shipping news is posted on the
bulletins of the exchange; where men engaged in a common pursuit
could meet, surrounded by the mute oracles of science and art; where
the whole atmosphere should be as full of professional knowledge as
the apothecary's shop is of the odor of his medicaments. This was
what the old men longed for,--the prophets and kings of the
profession, who
"Desired it long,
But died without the sight."
This is what the young men and those who worked under their guidance
undertook to give us. And now such a library, such a reading-room,
such an exchange, such an intellectual and social meeting place, we
be hold a fact, plain before us. The medical profession of our city,
and, let us add, of all those neighboring places which it can reach
with its iron arms, is united as never before by the commune
vinculum, the common bond of a large, enduring, ennobling, unselfish
interest. It breathes a new air of awakened intelligence. It
marches abreast of the other learned professions, which have long had
their extensive and valuable centralized libraries; abreast of them,
but not promising to be content with that position. What glorifies a
town like a cathedral? What dignifies a province like a university?
What illuminates a country like its scholarship, and what is the nest
that hatches scholars but a library?
The physician, some may say, is a practical man and has little use
for all this book-learning. Every student has heard Sydenham's reply
to Sir Richard Blackmore's question as to what books he should read,
--meaning medical books. "Read Don Quixote," was his famous answer.
But Sydenham himself made medical books and may be presumed to have
thought those at least worth reading. Descartes was asked where was
his library, and in reply held up the dissected body of an animal.
But Descartes made books, great books, and a great many of them. A
physician of common sense without erudition is better than a learned
one without common sense, but the thorough master of his profession
must have learning added to his natural gifts.
It is not necessary to maintain the direct practical utility of all
kinds of learning. Our shelves contain many books which only a
certain class of medical scholars will be likely to consult. There
is a dead medical literature, and there is a live one. The dead is
not all ancient, the live is not all modern. There is none, modern
or ancient, which, if it has no living value for the student, will
not teach him something by its autopsy. But it is with the live
literature of his profession that the medical practitioner is first
of all concerned.
Now there has come a great change in our time over the form in which
living thought presents itself. The first printed books,--the
incunabula,--were inclosed in boards of solid oak, with brazen clasps
and corners; the boards by and by were replaced by pasteboard covered
with calf or sheepskin; then cloth came in and took the place of
leather; then the pasteboard was covered with paper instead of cloth;
and at this day the quarterly, the monthly, the weekly periodical in
its flimsy unsupported dress of paper, and the daily journal, naked
as it came from the womb of the press, hold the larger part of the
fresh reading we live upon. We must have the latest thought in its
latest expression; the page must be newly turned like the morning
bannock; the pamphlet must be newly opened like the ante-prandial
oyster.
Thus a library, to meet the need of our time, must take, and must
spread out in a convenient form, a great array of periodicals. Our
active practitioners read these by preference over almost everything
else. Our specialists, more particularly, depend on the month's
product, on the yearly crop of new facts, new suggestions, new
contrivances, as much as the farmer on the annual yield of his acres.
One of the first wants, then, of the profession is supplied by our
library in its great array of periodicals from many lands, in many
languages. Such a number of medical periodicals no private library
would have room for, no private person would pay for, or flood his
tables with if they were sent him for nothing. These, I think, with
the reports of medical societies and the papers contributed to them,
will form the most attractive part of our accumulated medical
treasures. They will be also one of our chief expenses, for these
journals must be bound in volumes and they require a great amount of
shelf-room; all this, in addition to the cost of subscription for
those which are not furnished us gratuitously.
It is true that the value of old scientific periodicals is, other
things being equal, in the inverse ratio of their age, for the
obvious reason that what is most valuable in the earlier volumes of a
series is drained off into the standard works with which the
intelligent practitioner is supposed to be familiar. But no extended
record of facts grows too old to be useful, provided only that we
have a ready and sure way of getting at the particular fact or facts
we are in search of.
And this leads me to speak of what I conceive to be one of the
principal tasks to be performed by the present and the coming
generation of scholars, not only in the medical, but in every
department of knowledge. I mean the formation of indexes, and more
especially of indexes to periodical literature.
This idea has long been working in the minds of scholars, and all who
have had occasion to follow out any special subject. I have a right
to speak of it, for I long ago attempted to supply the want of
indexes in some small measure for my own need. I had a very complete
set of the "American Journal of the Medical Sciences;" an entire set
of the "North American Review," and many volumes of the reprints of
the three leading British quarterlies. Of what use were they to me
without general indexes? I looked them all through carefully and
made classified lists of all the articles I thought I should most
care to read. But they soon outgrew my lists. The "North American
Review" kept filling up shelf after shelf, rich in articles which I
often wanted to consult, but what a labor to find them, until the
index of Mr. Gushing, published a few months since, made the contents
of these hundred and twenty volumes as easily accessible as the words
in a dictionary! I had a, copy of good Dr. Abraham Rees's
Cyclopaedia, a treasure-house to my boyhood which has not lost its
value for me in later years. But where to look for what I wanted? I
wished to know, for instance, what Dr. Burney had to say about
singing. Who would have looked for it under the Italian word
cantare? I was curious to learn something of the etchings of
Rembrandt, and where should I find it but under the head "Low
Countries, Engravers of the,"--an elaborate and most valuable article
of a hundred double-columned close-printed quarto pages, to which no
reference, even, is made under the title Rembrandt.
There was nothing to be done, if I wanted to know where that which I
specially cared for was to be found in my Rees's Cyclopaedia, but to
look over every page of its forty-one quarto volumes and make out a
brief list of matters of interest which I could not find by their
titles, and this I did, at no small expense of time and trouble.
Nothing, therefore, could be more pleasing to me than to see the
attention which has been given of late years to the great work of
indexing. It is a quarter of a century since Mr. Poole published his
"Index to Periodical Literature," which it is much to be hoped is
soon to appear in a new edition, grown as it must be to formidable
dimensions by the additions of so long a period. The "British and
Foreign Medical Review," edited by the late Sir John Forties,
contributed to by Huxley, Carpenter, Laycock, and others of the most
distinguished scientific men of Great Britain, has an index to its
twenty-four volumes, and by its aid I find this valuable series as
manageable as a lexicon. The last edition of the "Encyclopaedia
Britannica" had a complete index in a separate volume, and the
publishers of Appletons' "American Cyclopaedia" have recently issued
an index to their useful work, which must greatly add to its value.
I have already referred to the index to the "North American Review,"
which to an American, and especially to a New Englander, is the most
interesting and most valuable addition of its kind to our literary
apparatus since the publication of Mr. Allibone's "Dictionary of
Authors." I might almost dare to parody Mr. Webster's words in
speaking of Hamilton, to describe what Mr. Gushing did for the solemn
rows of back volumes of our honored old Review which had been long
fossilizing on our shelves: "He touched the dead corpse of the 'North
American,' and it sprang to its feet." A library of the best
thought of the best American scholars during the greater portion of
the century was brought to light by the work of the indexmaker as
truly as were the Assyrian tablets by the labors of Layard.
A great portion of the best writing and reading literary, scientific,
professional, miscellaneous--comes to us now, at stated intervals, in
paper covers. The writer appears, as it were, in his shirt-sleeves.
As soon as he has delivered his message the book-binder puts a coat
on his back, and he joins the forlorn brotherhood of "back volumes,"
than which, so long as they are unindexed, nothing can be more
exasperating. Who wants a lock without a key, a ship without a
rudder, a binnacle without a compass, a check without a signature, a
greenback without a goldback behind it?
I have referred chiefly to the medical journals, but I would include
with these the reports of medical associations, and those separate
publications which, coming in the form of pamphlets, heap themselves
into chaotic piles and bundles which are worse than useless, taking
up a great deal of room, and frightening everything away but mice and
mousing antiquarians, or possibly at long intervals some terebrating
specialist.
Arranged, bound, indexed, all these at once become accessible and
valuable. I will take the first instance which happens to suggest
itself. How many who know all about osteoblasts and the experiments
of Ollier, and all that has grown out of them, know where to go for a
paper by the late Dr. A. L. Peirson of Salem, published in the year
1840, under the modest title, Remarks on Fractures? And if any
practitioner who has to deal with broken bones does not know that
most excellent and practical essay, it is a great pity, for it
answers very numerous questions which will be sure to suggest
themselves to the surgeon and the patient as no one of the recent
treatises, on my own shelves, at least, can do.
But if indexing is the special need of our time in medical
literature, as in every department of knowledge, it must be
remembered that it is not only an immense labor, but one that never
ends. It requires, therefore, the cooperation of a large number of
individuals to do the work, and a large amount of money to pay for
making its results public through the press. When it is remembered
that the catalogue of the library of the British Museum is contained
in nearly three thousand large folios of manuscript, and not all its
books are yet included, the task of indexing any considerable branch
of science or literature looks as if it were well nigh impossible.
But many hands make light work. An "Index Society" has been formed
in England, already numbering about one hundred and seventy members.
It aims at "supplying thorough indexes to valuable works and
collections which have hitherto lacked them; at issuing indexes to
the literature of special subjects; and at gathering materials for a
general reference index." This society has published a little
treatise setting forth the history and the art of indexing, which I
trust is in the hands of some of our members, if not upon our
shelves.
Something has been done in the same direction by individuals in our
own country, as we have already seen. The need of it in the
department of medicine is beginning to be clearly felt. Our library
has already an admirable catalogue with cross references, the work of
a number of its younger members cooperating in the task. A very
intelligent medical student, Mr. William D. Chapin, whose excellent
project is indorsed by well-known New York physicians and professors,
proposes to publish a yearly index to original communications in the
medical journals of the United States, classified by authors and
subjects. But it is from the National Medical Library at Washington
that we have the best promise and the largest expectations. That
great and growing collection of fifty thousand volumes is under the
eye and hand of a librarian who knows books and how to manage them.
For libraries are the standing armies of civilization, and an army is
but a mob without a general who can organize and marshal it so as to
make it effective. The "Specimen Fasciculus of a Catalogue of the
National Medical Library," prepared under the direction of Dr.
Billings, the librarian, would have excited the admiration of Haller,
the master scholar in medical science of the last century, or rather
of the profession in all centuries, and if carried out as it is begun
will be to the nineteenth all and more than all that the three
Bibliothecae--Anatomica, Chirurgica, and Medicinae-Practicae--were to
the eighteenth century. I cannot forget the story that Agassiz was
so fond of telling of the king of Prussia and Fichte. It was after
the humiliation and spoliation of the kingdom by Napoleon that the
monarch asked the philosopher what could be done to regain the lost
position of the nation. "Found a great university, Sire," was the
answer, and so it was that in the year 1810 the world-renowned
University of Berlin came into being. I believe that we in this
country can do better than found a national university, whose
professors shall be nominated in caucuses, go in and out, perhaps,
like postmasters, with every change of administration, and deal with
science in the face of their constituency as the courtier did with
time when his sovereign asked him what o'clock it was: "Whatever hour
your majesty pleases." But when we have a noble library like that at
Washington, and a librarian of exceptional qualifications like the
gentleman who now holds that office, I believe that a liberal
appropriation by Congress to carry out a conscientious work for the
advancement of sound knowledge and the bettering of human conditions,
like this which Dr. Billings has so well begun, would redound greatly
to the honor of the nation. It ought to be willing to be at some
charge to make its treasures useful to its citizens, and, for its own
sake, especially to that class which has charge of health, public and
private. This country abounds in what are called "self-made men,"
and is justly proud of many whom it thus designates. In one sense no
man is self-made who breathes the air of a civilized community. In
another sense every man who is anything other than a phonograph on
legs is self-made. But if we award his just praise to the man who
has attained any kind of excellence without having had the same
advantages as others whom, nevertheless, he has equalled or
surpassed, let us not be betrayed into undervaluing the mechanic's
careful training to his business, the thorough and laborious
education of the scholar and the professional man.
Our American atmosphere is vocal with the flippant loquacity of half
knowledge. We must accept whatever good can be got out of it, and
keep it under as we do sorrel and mullein and witchgrass, by
enriching the soil, and sowing good seed in plenty; by good teaching
and good books, rather than by wasting our time in talking against
it. Half knowledge dreads nothing but whole knowledge.
I have spoken of the importance and the predominance of periodical
literature, and have attempted to do justice to its value. But the
almost exclusive reading of it is not without its dangers. The
journals contain much that is crude and unsound; the presumption; it
might be maintained, is against their novelties, unless they come
from observers of established credit. Yet I have known a
practitioner,--perhaps more than one,--who was as much under the
dominant influence of the last article he had read in his favorite
medical journal as a milliner under the sway of the last fashion-
plate. The difference between green and seasoned knowledge is very
great, and such practitioners never hold long enough to any of their
knowledge to have it get seasoned.
It is needless to say, then, that all the substantial and permanent
literature of the profession should be represented upon our shelves.
Much of it is there already, and as one private library after another
falls into this by the natural law of gravitation, it will gradually
acquire all that is most valuable almost without effort. A scholar
should not be in a hurry to part with his books. They are probably
more valuable to him than they can be to any other individual. What
Swedenborg called "correspondence" has established itself between his
intelligence and the volumes which wall him within their sacred
inclosure. Napoleon said that his mind was as if furnished with
drawers,--he drew out each as he wanted its contents, and closed it
at will when done with them. The scholar's mind, to use a similar
comparison, is furnished with shelves, like his library. Each book
knows its place in the brain as well as against the wall or in the
alcove. His consciousness is doubled by the books which encircle
him, as the trees that surround a lake repeat themselves in its
unruffled waters. Men talk of the nerve that runs to the pocket, but
one who loves his books, and has lived long with them, has a nervous
filament which runs from his sensorium to every one of them. Or, if
I may still let my fancy draw its pictures, a scholar's library is to
him what a temple is to the worshipper who frequents it. There is
the altar sacred to his holiest experiences. There is the font where
his new-born thought was baptized and first had a name in his
consciousness. There is the monumental tablet of a dead belief,
sacred still in the memory of what it was while yet alive. No
visitor can read all this on the lettered backs of the books that
have gathered around the scholar, but for him, from the Aldus on the
lowest shelf to the Elzevir on the highest, every volume has a
language which none but be can interpret. Be patient with the book-
collector who loves his companions too well to let them go. Books
are not buried with their owners, and the veriest book-miser that
ever lived was probably doing far more for his successors than his
more liberal neighbor who despised his learned or unlearned avarice.
Let the fruit fall with the leaves still clinging round it. Who
would have stripped Southey's walls of the books that filled them,
when, his mind no longer capable of taking in their meaning, he would
still pat and fondle them with the vague loving sense of what they
had once been to him,--to him, the great scholar, now like a little
child among his playthings?
We need in this country not only the scholar, but the virtuoso, who
hoards the treasures which he loves, it may be chiefly for their
rarity and because others who know more than he does of their value
set a high price upon them. As the wine of old vintages is gently
decanted out of its cobwebbed bottles with their rotten corks into
clean new receptacles, so the wealth of the New World is quietly
emptying many of the libraries and galleries of the Old World into
its newly formed collections and newly raised edifices. And this
process must go on in an accelerating ratio. No Englishman will be
offended if I say that before the New Zealander takes his stand on a
broken arch of London Bridge to sketch the ruins of St. Paul's in the
midst of a vast solitude, the treasures of the British Museum will
have found a new shelter in the halls of New York or Boston. No
Catholic will think hardly of my saying that before the Coliseum
falls, and with it the imperial city, whose doom prophecy has linked
with that of the almost eternal amphitheatre, the marbles, the
bronzes, the paintings, the manuscripts of the Vatican will have left
the shores of the Tiber for those of the Potomac, the Hudson, the
Mississippi, or the Sacramento. And what a delight in the pursuit of
the rarities which the eager book-hunter follows with the scent of a
beagle!
Shall I ever forget that rainy day in Lyons, that dingy bookshop,
where I found the Aetius, long missing from my Artis bledicae
Principes, and where I bought for a small pecuniary consideration,
though it was marked rare, and was really tres rare, the Aphorisms of
Hippocrates, edited by and with a preface from the hand of Francis
Rabelais? And the vellum-bound Tulpius, which I came upon in Venice,
afterwards my only reading when imprisoned in quarantine at
Marseilles, so that the two hundred and twenty-eight cases he has
recorded are, many of them, to this day still fresh in my memory.
And the Schenckius,--the folio filled with casus rariores, which had
strayed in among the rubbish of the bookstall on the boulevard,--and
the noble old Vesalius with its grand frontispiece not unworthy of
Titian, and the fine old Ambroise Pare, long waited for even in Paris
and long ago, and the colossal Spigelius with his eviscerated
beauties, and Dutch Bidloo with its miracles of fine engraving and
bad dissection, and Italian Mascagni, the despair of all would-be
imitators, and pre-Adamite John de Ketam, and antediluvian
Berengarius Carpensis,--but why multiply names, every one of which
brings back the accession of a book which was an event almost like
the birth of an infant?
A library like ours must exercise the largest hospitality. A great
many books may be found in every large collection which remind us of
those apostolic looking old men who figure on the platform at our
political and other assemblages. Some of them have spoken words of
wisdom in their day, but they have ceased to be oracles; some of them
never had any particularly important message for humanity, but they
add dignity to the meeting by their presence; they look wise, whether
they are so or not, and no one grudges them their places of honor.
Venerable figure-heads, what would our platforms be without you?
Just so with our libraries. Without their rows of folios in creamy
vellum, or showing their black backs with antique lettering of
tarnished gold, our shelves would look as insufficient and unbalanced
as a column without its base, as a statue without its pedestal. And
do not think they are kept only to be spanked and dusted during that
dreadful period when their owner is but too thankful to become an
exile and a wanderer from the scene of single combats between dead
authors and living housemaids. Men were not all cowards before
Agamemnon or all fools before the days of Virchow and Billroth. And
apart from any practical use to be derived from the older medical
authors, is there not a true pleasure in reading the accounts of
great discoverers in their own words? I do not pretend to hoist up
the Bibliotheca Anatomica of Mangetus and spread it on my table every
day. I do not get out my great Albinus before every lecture on the
muscles, nor disturb the majestic repose of Vesalius every time I
speak of the bones he has so admirably described and figured. But it
does please me to read the first descriptions of parts to which the
names of their discoverers or those who have first described them
have become so joined that not even modern science can part them; to
listen to the talk of my old volume as Willis describes his circle
and Fallopius his aqueduct and Varolius his bridge and Eustachius his
tube and Monro his foramen,--all so well known to us in the human
body; it does please me to know the very words in which Winslow
described the opening which bears his name, and Glisson his capsule
and De Graaf his vesicle; I am not content until I know in what
language Harvey announced his discovery of the circulation, and how
Spigelius made the liver his perpetual memorial, and Malpighi found a
monument more enduring than brass in the corpuscles of the spleen and
the kidney.
But after all, the readers who care most for the early records of
medical science and art are the specialists who are dividing up the
practice of medicine and surgery as they were parcelled out,
according to Herodotus, by the Egyptians. For them nothing is too
old, nothing is too new, for to their books of ail others is
applicable the saying of D'Alembert that the author kills himself in
lengthening out what the reader kills himself in trying to shorten.
There are practical books among these ancient volumes which can never
grow old. Would you know how to recognize "male hysteria" and to
treat it, take down your Sydenham; would you read the experience of a
physician who was himself the subject of asthma, and who,
notwithstanding that, in the words of Dr. Johnson, "panted on till
ninety," you will find it in the venerable treatise of Sir John
Floyer; would you listen to the story of the King's Evil cured by the
royal touch, as told by a famous chirurgeon who fully believed in it,
go to Wiseman; would you get at first hand the description of the
spinal disease which long bore his name, do not be startled if I tell
you to go to Pott,--to Percival Pott, the great surgeon of the last
century.
There comes a time for every book in a library when it is wanted by
somebody. It is but a few weeks since one of the most celebrated
physicians in the country wrote to me from a great centre of medical
education to know if I had the works of Sanctorius, which he had
tried in vain to find. I could have lent him the "Medicina Statica,"
with its frontispiece showing Sanctorius with his dinner on the table
before him, in his balanced chair which sunk with him below the level
of his banquet-board when he had swallowed a certain number of
ounces,--an early foreshadowing of Pettenkofer's chamber and
quantitative physiology,--but the "Opera Omnia" of Sanctorius I had
never met with, and I fear he had to do without it.
I would extend the hospitality of these shelves to a class of works
which we are in the habit of considering as being outside of the pale
of medical science, properly so called, and sometimes of coupling
with a disrespectful name. Such has always been my own practice. I
have welcomed Culpeper and Salmon to my bookcase as willingly as
Dioscorides or Quincy, or Paris or Wood and Bache. I have found a
place for St. John Long, and read the story of his trial for
manslaughter with as much interest as the laurel-water case in which
John Hunter figured as a witness. I would give Samuel Hahnemann a
place by the side of Samuel Thomson. Am I not afraid that some
student of imaginative turn and not provided with the needful
cerebral strainers without which all the refuse of gimcrack
intelligences gets into the mental drains and chokes them up,--am I
not afraid that some such student will get hold of the "Organon" or
the "Maladies Chroniques" and be won over by their delusions, and so
be lost to those that love him as a man of common sense and a brother
in their high calling? Not in the least. If he showed any symptoms
of infection I would for once have recourse to the principle of
similia similibus. To cure him of Hahnemann I would prescribe my
favorite homoeopathic antidote, Okie's Bonninghausen. If that
failed, I would order Grauvogl as a heroic remedy, and if he survived
that uncured, I would give him my blessing, if I thought him honest,
and bid him depart in peace. For me he is no longer an individual.
He belongs to a class of minds which we are bound to be patient with
if their Maker sees fit to indulge them with existence. We must
accept the conjuring ultra-ritualist, the dreamy second adventist,
the erratic spiritualist, the fantastic homoeopathist, as not
unworthy of philosophic study; not more unworthy of it than the
squarers of the circle and the inventors of perpetual motion, and the
other whimsical visionaries to whom De Morgan has devoted his most
instructive and entertaining "Budget of Paradoxes." I hope,
therefore, that our library will admit the works of the so-called
Eclectics, of the Thomsonians, if any are in existence, of the
Clairvoyants, if they have a literature, and especially of the
Homoeopathists. This country seems to be the place for such a
collection, which will by and by be curious and of more value than at
present, for Homoeopathy seems to be following the pathological law
of erysipelas, fading out where it originated as it spreads to new
regions. At least I judge so by the following translated extract
from a criticism of an American work in the "Homoeopatische
Rundschau" of Leipzig for October, 1878, which I find in the
"Homoeopathic Bulletin" for the month of November just passed:
"While we feel proud of the spread and rise of Homoeopathy across the
ocean, and while the Homoeopathic works reaching us from there, and
published in a style such as is unknown in Germany, bear eloquent
testimony to the eminent activity of our transatlantic colleagues, we
are overcome by sorrowful regrets at the position Homoeopathy
occupies in Germany. Such a work [as the American one referred to]
with us would be impossible; it would lack the necessary support."
By all means let our library secure a good representation of the
literature of Homoeopathy before it leaves us its "sorrowful regrets"
and migrates with its sugar of milk pellets, which have taken the
place of the old pilulae micae panis, to Alaska, to "Nova Zembla, or
the Lord knows where."
What shall I say in this presence of the duties of a Librarian?
Where have they ever been better performed than in our own public
city library, where the late Mr. Jewett and the living Mr. Winsor
have shown us what a librarian ought to be,--the organizing head, the
vigilant guardian, the seeker's index, the scholar's counsellor? His
work is not merely that of administration, manifold and laborious as
its duties are. He must have a quick intelligence and a retentive
memory. He is a public carrier of knowledge in its germs. His
office is like that which naturalists attribute to the bumble-bee,--
he lays up little honey for himself, but he conveys the fertilizing
pollen from flower to flower.
Our undertaking, just completed,--and just begun--has come at the
right time, not a day too soon. Our practitioners need a library
like this, for with all their skill and devotion there is too little
genuine erudition, such as a liberal profession ought to be able to
claim for many of its members. In reading the recent obituary
notices of the late Dr. Geddings of South Carolina, I recalled what
our lamented friend Dr. Coale used to tell me of his learning and
accomplishments, and I could not help reflecting how few such medical
scholars we had to show in Boston or New England. We must clear up
this unilluminated atmosphere, and here,--here is the true electric
light which will irradiate its darkness.
The public will catch the rays reflected from the same source of
light, and it needs instruction on the great subjects of health and
disease,--needs it sadly. It is preyed upon by every kind of
imposition almost without hindrance. Its ignorance and prejudices
react upon the profession to the great injury of both. The jealous
feeling, for instance, with regard to such provisions for the study
of anatomy as are sanctioned by the laws in this State and carried
out with strict regard to those laws, threatens the welfare, if not
the existence of institutions for medical instruction wherever it is
not held in check by enlightened intelligence. And on the other hand
the profession has just been startled by a verdict against a
physician, ruinous in its amount,--enough to drive many a hard-
working young practitioner out of house and home,--a verdict which
leads to the fear that suits for malpractice may take the place of
the panel game and child-stealing as a means of extorting money. If
the profession in this State, which claims a high standard of
civilization, is to be crushed and ground beneath the upper millstone
of the dearth of educational advantages and the lower millstone of
ruinous penalties for what the ignorant ignorantly shall decide to be
ignorance, all I can say is
God save the Commonhealth of Massachusetts!
Once more, we cannot fail to see that just as astrology has given
place to astronomy, so theology, the science of Him whom by searching
no man can find out, is fast being replaced by what we may not
improperly call theonomy, or the science of the laws according to
which the Creator acts. And since these laws find their fullest
manifestations for us, at least, in rational human natures, the study
of anthropology is largely replacing that of scholastic divinity. We
must contemplate our Maker indirectly in human attributes as we talk
of Him in human parts of speech. And this gives a sacredness to the
study of man in his physical, mental, moral, social, and religious
nature which elevates the faithful students of anthropology to the
dignity of a priesthood, and sheds a holy light on the recorded
results of their labors, brought together as they are in such a
collection as this which is now spread out before us.
Thus, then, our library is a temple as truly as the dome-crowned
cathedral hallowed by the breath of prayer and praise, where the dead
repose and the living worship. May it, with all its treasures, be
consecrated like that to the glory of God, through the contributions
it shall make to the advancement of sound knowledge, to the relief of
human suffering, to the promotion of harmonious relations between the
members of the two noble professions which deal with the diseases of
the soul and with those of the body, and to the common cause in which
all good men are working, the furtherance of the well-being of their
fellow-creatures!
NOTE.--As an illustration of the statement in the last paragraph but
one, I take the following notice from the "Boston Daily Advertiser,"
of December 4th, the day after the delivery of the address:
"Prince Lucien Bonaparte is now living in London, and is devoting
himself to the work of collecting the creeds of all religions and
sects, with a view to their classification,--his object being simply
scientific or anthropological."
Since delivering the address, also, I find a leading article in the
"Cincinnati Lancet and Clinic" of November 30th, headed "The
Decadence of Homoeopathy," abundantly illustrated by extracts from
the "Homoeopathic Times," the leading American organ of that sect.
In the New York "Medical Record" of the same date, which I had not
seen before the delivery of my address, is an account of the action
of the Homoeopathic Medical Society of Northern New York, in which
Hahnemann's theory of "dynamization" is characterized in a formal
resolve as "unworthy the confidence of the Homoeopathic profession."
It will be a disappointment to the German Homoeopathists to read in
the "Homoeopathic Times" such a statement as the following:
"Whatever the influences have been which have checked the outward
development of Homoeopathy, it is plainly evident that the
Homoeopathic school, as regards the number of its openly avowed
representatives, has attained its majority, and has begun to decline
both in this country and in England."
All which is an additional reason for making a collection of the
incredibly curious literature of Homoeopathy before that
pseudological inanity has faded out like so many other delusions.
SOME OF MY EARLY TEACHERS
[A Farewell Address to the Medical School of Harvard University,
November 28, 1882.]
I had intended that the recitation of Friday last should be followed
by a few parting words to my class and any friends who might happen
to be in the lecture-room. But I learned on the preceding evening
that there was an expectation, a desire, that my farewell should take
a somewhat different form; and not to disappoint the wishes of those
whom I was anxious to gratify, I made up my mind to appear before you
with such hasty preparation as the scanty time admitted.
There are three occasions upon which a human being has a right to
consider himself as a centre of interest to those about him: when he
is christened, when he is married, and when he is buried. Every one
is the chief personage, the hero, of his own baptism, his own
wedding, and his own funeral.
There are other occasions, less momentous, in which one may make more
of himself than under ordinary circumstances he would think it proper
to do; when he may talk about himself, and tell his own experiences,
in fact, indulge in a more or less egotistic monologue without fear
or reproach.
I think I may claim that this is one of those occasions. I have
delivered my last anatomical lecture and heard my class recite for
the last time. They wish to hear from me again in a less scholastic
mood than that in which they have known me. Will you not indulge me
in telling you something of my own story?
This is the thirty-sixth Course of Lectures in which I have taken my
place and performed my duties as Professor of Anatomy. For more than
half of my term of office I gave instruction in Physiology, after the
fashion of my predecessors and in the manner then generally prevalent
in our schools, where the physiological laboratory was not a
necessary part of the apparatus of instruction. It was with my
hearty approval that the teaching of Physiology was constituted a
separate department and made an independent Professorship. Before my
time, Dr. Warren had taught Anatomy, Physiology, and Surgery in the
same course of Lectures, lasting only three or four months. As the
boundaries of science are enlarged, new divisions and subdivisions of
its territories become necessary. In the place of six Professors in
1847, when I first became a member of the Faculty, I count twelve
upon the Catalogue before me, and I find the whole number engaged in
the work of instruction in the Medical School amounts to no less than
fifty.
Since I began teaching in this school, the aspect of many branches of
science has undergone a very remarkable transformation. Chemistry
and Physiology are no longer what they were, as taught by the
instructors of that time. We are looking forward to the synthesis of
new organic compounds; our artificial madder is already in the
market, and the indigo-raisers are now fearing that their crop will
be supplanted by the manufactured article. In the living body we
talk of fuel supplied and work done, in movement, in heat, just as if
we were dealing with a machine of our own contrivance.
A physiological laboratory of to-day is equipped with instruments of
research of such ingenious contrivance, such elaborate construction,
that one might suppose himself in a workshop where some exquisite
fabric was to be wrought, such as Queens love to wear, and Kings do
not always love to pay for. They are, indeed, weaving a charmed web,
for these are the looms from which comes the knowledge that clothes
the nakedness of the intellect. Here are the mills that grind food
for its hunger, and "is not the life more than meat, and the body
than raiment?"
But while many of the sciences have so changed that the teachers of
the past would hardly know them, it has not been so with the branch I
teach, or, rather, with that division of it which is chiefly taught
in this amphitheatre. General anatomy, or histology, on the other
hand, is almost all new; it has grown up, mainly, since I began my
medical studies. I never saw a compound microscope during my years
of study in Paris. Individuals had begun to use the instrument, but
I never heard it alluded to by either Professors or students. In
descriptive anatomy I have found little to unlearn, and not a great
deal that was both new and important to learn. Trifling additions
are made from year to year, not to be despised and not to be
overvalued. Some of the older anatomical works are still admirable,
some of the newer ones very much the contrary. I have had recent
anatomical plates brought me for inspection, and I have actually
button-holed the book-agent, a being commonly as hard to get rid of
as the tar-baby in the negro legend, that I might put him to shame
with the imperial illustrations of the bones and muscles in the great
folio of Albinus, published in 1747, and the unapproached figures of
the lymphatic system of Mascagni, now within a very few years of a
century old, and still copied, or, rather, pretended to be copied, in
the most recent works on anatomy.
I am afraid that it is a good plan to get rid of old Professors, and
I am thankful to hear that there is a movement for making provision
for those who are left in need when they lose their offices and their
salaries. I remember one of our ancient Cambridge Doctors once asked
me to get into his rickety chaise, and said to me, half humorously,
half sadly, that he was like an old horse,--they had taken off his
saddle and turned him out to pasture. I fear the grass was pretty
short where that old servant of the public found himself grazing. If
I myself needed an apology for holding my office so long, I should
find it in the fact that human anatomy is much the same study that it
was in the days of Vesalius and Fallopius, and that the greater part
of my teaching was of such a nature that it could never become
antiquated.
Let me begin with my first experience as a medical student. I had
come from the lessons of Judge Story and Mr. Ashmun in the Law School
at Cambridge. I had been busy, more or less, with the pages of
Blackstone and Chitty, and other text-books of the first year of
legal study. More or less, I say, but I am afraid it was less rather
than more. For during that year I first tasted the intoxicating
pleasure of authorship. A college periodical, conducted by friends
of mine, still undergraduates, tempted me into print, and there is no
form of lead-poisoning which more rapidly and thoroughly pervades the
blood and bones and marrow than that which reaches the young author
through mental contact with type-metal. Qui a bu, boira,--he who has
once been a drinker will drink again, says the French proverb. So
the man or woman who has tasted type is sure to return to his old
indulgence sooner or later. In that fatal year I had my first attack
of authors' lead-poisoning, and I have never got quite rid of it from
that day to this. But for that I might have applied myself more
diligently to my legal studies, and carried a green bag in place of a
stethoscope and a thermometer up to the present day.
What determined me to give up Law and apply myself to Medicine I can
hardly say, but I had from the first looked upon that year's study as
an experiment. At any rate, I made the change, and soon found myself
introduced to new scenes and new companionships.
I can scarcely credit my memory when I recall the first impressions
produced upon me by sights afterwards become so familiar that they
could no more disturb a pulse-beat than the commonest of every-day
experiences. The skeleton, hung aloft like a gibbeted criminal,
looked grimly at me as I entered the room devoted to the students of
the school I had joined, just as the fleshless figure of Time, with
the hour-glass and scythe, used to glare upon me in my childhood from
the "New England Primer." The white faces in the beds at the
Hospital found their reflection in my own cheeks, which lost their
color as I looked upon them. All this had to pass away in a little
time; I had chosen my profession, and must meet its painful and
repulsive aspects until they lost their power over my sensibilities.
The private medical school which I had joined was one established by
Dr. James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow
Lewis, and Dr. George W. Otis. Of the first three gentlemen I have
either spoken elsewhere or may find occasion to speak hereafter. The
two younger members of this association of teachers were both
graduates of our University, one of the year 1819, the other of 1818.
Dr. Lewis was a great favorite with students. He was a man of very
lively temperament, fond of old books and young people, open-hearted,
free-spoken, an enthusiast in teaching, and especially at home in
that apartment of the temple of science where nature is seen in
undress, the anthropotomic laboratory, known to common speech as the
dissecting-room. He had that quality which is the special gift of
the man born for a teacher,--the power of exciting an interest in
that which he taught. While he was present the apartment I speak of
was the sunniest of studios in spite of its mortuary spectacles. Of
the students I met there I best remember James Jackson, Junior, full
of zeal and playful as a boy, a young man whose early death was a
calamity to the profession of which he promised to be a chief
ornament; the late Reverend J. S. C. Greene, who, as the prefix to
his name signifies, afterwards changed his profession, but one of
whose dissections I remember looking upon with admiration; and my
friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is
entitled to be called, then, as now and always, a favorite with all
about him. He had come to us from the schools of Germany, and
brought with him recollections of the teachings of Blumenbach and the
elder Langenbeck, father of him whose portrait hangs in our Museum.
Dr. Lewis was our companion as well as our teacher. A good
demonstrator is,--I will not say as important as a good Professor in
the teaching of Anatomy, because I am not sure that he is not more
important. He comes into direct personal relations with the
students,--he is one of them, in fact, as the Professor cannot be
from the nature of his duties. The Professor's chair is an
insulating stool, so to speak; his age, his knowledge, real or
supposed, his official station, are like the glass legs which support
the electrician's piece of furniture, and cut it off from the common
currents of the floor upon which it stands. Dr. Lewis enjoyed
teaching and made his students enjoy being taught. He delighted in
those anatomical conundrums to answer which keeps the student's eyes
open and his wits awake. He was happy as he dexterously performed
the tour de maitre of the old barber-surgeons, or applied the spica
bandage and taught his scholars to do it, so neatly and symmetrically
that the aesthetic missionary from the older centre of civilization
would bend over it in blissful contemplation, as if it were a
sunflower. Dr. Lewis had many other tastes, and was a favorite, not
only with students, but in a wide circle, professional, antiquarian,
masonic, and social.
Dr. Otis was less widely known, but was a fluent and agreeable
lecturer, and esteemed as a good surgeon.
I must content myself with this glimpse at myself and a few of my
fellow-students in Boston. After attending two courses of Lectures
in the school of the University, I went to Europe to continue my
studies.
You may like to hear something of the famous Professors of Paris in
the days when I was a student in the Ecole de Medicine, and following
the great Hospital teachers.
I can hardly believe my own memory when I recall the old
practitioners and Professors who were still going round the hospitals
when I mingled with the train of students that attended the morning
visits. See that bent old man who is groping his way through the
wards of La Charity. That is the famous Baron Boyer, author of the
great work on surgery in nine volumes, a writer whose clearness of
style commends his treatise to general admiration, and makes it a
kind of classic. He slashes away at a terrible rate, they say, when
he gets hold of the subject of fistula in its most frequent habitat,
--but I never saw him do more than look as if he wanted to cut a good
dollop out of a patient he was examining. The short, square,
substantial man with iron-gray hair, ruddy face, and white apron is
Baron Larrey, Napoleon's favorite surgeon, the most honest man he
ever saw,--it is reputed that he called him. To go round the Hotel
des Invalides with Larrey was to live over the campaigns of Napoleon,
to look on the sun of Austerlitz, to hear the cannons of Marengo, to
struggle through the icy waters of the Beresina, to shiver in the
snows of the Russian retreat, and to gaze through the battle smoke
upon the last charge of the red lancers on the redder field of
Waterloo. Larrey was still strong and sturdy as I saw him, and few
portraits remain printed in livelier colors on the tablet of my
memory.
Leave the little group of students which gathers about Larrey beneath
the gilded dome of the Invalides and follow me to the Hotel Dieu,
where rules and reigns the master-surgeon of his day, at least so far
as Paris and France are concerned,--the illustrious Baron Dupuytren.
No man disputed his reign, some envied his supremacy. Lisfranc
shrugged his shoulders as he spoke of "ce grand homme de l'autre cots
de la riviere," that great man on the other side of the river, but
the great man he remained, until he bowed before the mandate which
none may disobey. "Three times," said Bouillaud, "did the apoplectic
thunderbolt fall on that robust brain,"--it yielded at last as the
old bald cliff that is riven and crashes down into the valley. I saw
him before the first thunderbolt had descended: a square, solid man,
with a high and full-domed head, oracular in his utterances,
indifferent to those around him, sometimes, it was said, very rough
with them. He spoke in low, even tones, with quiet fluency, and was
listened to with that hush of rapt attention which I have hardly seen
in any circle of listeners unless when such men as ex-President John
Quincy Adams or Daniel Webster were the speakers. I do not think
that Dupuytren has left a record which explains his influence, but in
point of fact he dominated those around him in a remarkable manner.
You must have all witnessed something of the same kind. The personal
presence of some men carries command with it, and their accents
silence the crowd around them, when the same words from other lips
might fall comparatively unheeded.
As for Lisfranc, I can say little more of him than that he was a
great drawer of blood and hewer of members. I remember his ordering
a wholesale bleeding of his patients, right and left, whatever might
be the matter with them, one morning when a phlebotomizing fit was on
him. I recollect his regretting the splendid guardsmen of the old
Empire,--for what? because they had such magnificent thighs to
amputate. I got along about as far as that with him, when I ceased
to be a follower of M. Lisfranc.
The name of Velpeau must have reached many of you, for he died in
1867, and his many works made his name widely known. Coming to Paris
in wooden shoes, starving, almost, at first, he raised himself to
great eminence as a surgeon and as an author, and at last obtained
the Professorship to which his talents and learning entitled him.
His example may be an encouragement to some of my younger hearers who
are born, not with the silver spoon in their mouths, but with the
two-tined iron fork in their hands. It is a poor thing to take up
their milk porridge with in their young days, but in after years it
will often transfix the solid dumplings that roll out of the silver
spoon. So Velpeau found it. He had not what is called genius, he
was far from prepossessing in aspect, looking as if he might have
wielded the sledge-hammer (as I think he had done in early life)
rather than the lancet, but he had industry, determination,
intelligence, character, and he made his way to distinction and
prosperity, as some of you sitting on these benches and wondering
anxiously what is to become of you in the struggle for life will have
done before the twentieth century has got halfway through its first
quarter. A good sound head over a pair of wooden shoes is a great
deal better than a wooden head belonging to an owner who cases his
feet in calf-skin, but a good brain is not enough without a stout
heart to fill the four great conduits which carry at once fuel and
fire to that mightiest of engines.
How many of you who are before me are familiarly acquainted with the
name of Broussais, or even with that of Andral? Both were lecturing
at the Ecole de Medicine, and I often heard them. Broussais was in
those days like an old volcano, which has pretty nearly used up its
fire and brimstone, but is still boiling and bubbling in its
interior, and now and then sends up a spirt of lava and a volley of
pebbles. His theories of gastro-enteritis, of irritation and
inflammation as the cause of disease, and the practice which sprang
from them, ran over the fields of medicine for a time like flame over
the grass of the prairies. The way in which that knotty-featured,
savage old man would bring out the word irritation--with rattling and
rolling reduplication of the resonant letter r--might have taught a
lesson in articulation to Salvini. But Broussais's theory was
languishing and well-nigh become obsolete, and this, no doubt, added
vehemence to his defence of his cherished dogmas.
Old theories, and old men who cling to them, must take themselves out
of the way as the new generation with its fresh thoughts and altered
habits of mind comes forward to take the place of that which is dying
out. This was a truth which the fiery old theorist found it very hard
to learn, and harder to bear, as it was forced upon him. For the
hour of his lecture was succeeded by that of a younger and far more
popular professor. As his lecture drew towards its close, the
benches, thinly sprinkled with students, began to fill up; the doors
creaked open and banged back oftener and oftener, until at last the
sound grew almost continuous, and the voice of the lecturer became a
leonine growl as he strove in vain to be heard over the noise of
doors and footsteps.
Broussais was now sixty-two years old. The new generation had
outgrown his doctrines, and the Professor for whose hour the benches
had filled themselves belonged to that new generation. Gabriel
Andral was little more than half the age of Broussais, in the full
prime and vigor of manhood at thirty-seven years. He was a rapid,
fluent, fervid, and imaginative speaker, pleasing in aspect and
manner,--a strong contrast to the harsh, vituperative old man who had
just preceded him. His Clinique Medicale is still valuable as a
collection of cases, and his researches on the blood, conducted in
association with Gavarret, contributed new and valuable facts to
science. But I remember him chiefly as one of those instructors
whose natural eloquence made it delightful to listen to him. I doubt
if I or my fellow-students did full justice either to him or to the
famous physician of Hotel Dieu, Chomel. We had addicted ourselves
almost too closely to the words of another master, by whom we were
ready to swear as against all teachers that ever were or ever would
be.
This object of our reverence, I might almost say idolatry, was one
whose name is well known to most of the young men before me, even to
those who may know comparatively little of his works and teachings.
Pierre Charles Alexandre Louis, at the age of forty-seven, as I
recall him, was a tall, rather spare, dignified personage, of serene
and grave aspect, but with a pleasant smile and kindly voice for the
student with whom he came into personal relations. If I summed up
the lessons of Louis in two expressions, they would be these; I do
not hold him answerable for the words, but I will condense them after
my own fashion in French, and then give them to you, expanded
somewhat, in English:
Formez toujours des idees nettes.
Fuyez toujours les a peu pres.
Always make sure that you form a distinct and clear idea of the
matter you are considering.
Always avoid vague approximations where exact estimates are possible;
about so many,--about so much, instead of the precise number and
quantity.
Now, if there is anything on which the biological sciences have
prided themselves in these latter years it is the substitution of
quantitative for qualitative formulae. The "numerical system," of
which Louis was the great advocate, if not the absolute originator,
was an attempt to substitute series of carefully recorded facts,
rigidly counted and closely compared, for those never-ending records
of vague, unverifiable conclusions with which the classics of the
healing art were overloaded. The history of practical medicine had
been like the story of the Danaides. "Experience" had been, from
time immemorial, pouring its flowing treasures into buckets full of
holes. At the existing rate of supply and leakage they would never
be filled; nothing would ever be settled in medicine. But cases
thoroughly recorded and mathematically analyzed would always be
available for future use, and when accumulated in sufficient number
would lead to results which would be trustworthy, and belong to
science.
You young men who are following the hospitals hardly know how much
you are indebted to Louis. I say nothing of his Researches on
Phthisis or his great work on Typhoid Fever. But I consider his
modest and brief Essay on Bleeding in some Inflammatory Diseases,
based on cases carefully observed and numerically analyzed, one of
the most important written contributions to practical medicine, to
the treatment of internal disease, of this century, if not since the
days of Sydenham. The lancet was the magician's wand of the dark
ages of medicine. The old physicians not only believed in its
general efficacy as a wonder-worker in disease, but they believed
that each malady could be successfully attacked from some special
part of the body,--the strategic point which commanded the seat of
the morbid affection. On a figure given in the curious old work of
John de Ketam, no less than thirty-eight separate places are marked
as the proper ones to bleed from, in different diseases. Even Louis,
who had not wholly given up venesection, used now and then to order
that a patient suffering from headache should be bled in the foot, in
preference to any other part.
But what Louis did was this: he showed by a strict analysis of
numerous cases that bleeding did not strangle,--jugulate was the word
then used,--acute diseases, more especially pneumonia. This was not
a reform,--it was a revolution. It was followed up in this country
by the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited
Diseases, which has, I believe, done more than any other work or
essay in our own language to rescue the practice of medicine from the
slavery to the drugging system which was a part of the inheritance of
the profession.
Yes, I say, as I look back on the long hours of the many days I spent
in the wards and in the autopsy room of La Pitie, where Louis was one
of the attending physicians,--yes, Louis did a great work for
practical medicine. Modest in the presence of nature, fearless in
the face of authority, unwearying in the pursuit of truth, he was a
man whom any student might be happy and proud to claim as his teacher
and his friend, and yet, as I look back on the days when I followed
his teachings, I feel that I gave myself up too exclusively to his
methods of thought and study.
There is one part of their business which certain medical
practitioners are too apt to forget; namely, that what they should
most of all try to do is to ward off disease, to alleviate suffering,
to preserve life, or at least to prolong it if possible. It is not
of the slightest interest to the patient to know whether three or
three and a quarter cubic inches of his lung are hepatized. His mind
is not occupied with thinking of the curious problems which are to be
solved by his own autopsy,--whether this or that strand of the spinal
marrow is the seat of this or that form of degeneration. He wants
something to relieve his pain, to mitigate the anguish of dyspnea, to
bring back motion and sensibility to the dead limb, to still the
tortures of neuralgia. What is it to him that you can localize and
name by some uncouth term the disease which you could not prevent and
which you cannot cure? An old woman who knows how to make a poultice
and how to put it on, and does it tuto, eito, jucunde, just when and
where it is wanted, is better,--a thousand times better in many
cases,--than a staring pathologist, who explores and thumps and
doubts and guesses, and tells his patient be will be better tomorrow,
and so goes home to tumble his books over and make out a diagnosis.
But in those days, I, like most of my fellow students, was thinking
much more of "science" than of practical medicine, and I believe if
we had not clung so closely to the skirts of Louis and had followed
some of the courses of men like Trousseau,--therapeutists, who gave
special attention to curative methods, and not chiefly to diagnosis,
--it would have been better for me and others. One thing, at any
rate, we did learn in the wards of Louis. We learned that a very
large proportion of diseases get well of themselves, without any
special medication,--the great fact formulated, enforced, and
popularized by Dr. Jacob Bigelow in the Discourse referred to. We
unlearned the habit of drugging for its own sake. This detestable
practice, which I was almost proscribed for condemning somewhat too
epigrammatically a little more than twenty years ago, came to us, I
suspect, in a considerable measure from the English "general
practitioners," a sort of prescribing apothecaries. You remember
how, when the city was besieged, each artisan who was called upon in
council to suggest the best means of defence recommended the articles
he dealt in: the carpenter, wood; the blacksmith, iron; the mason,
brick; until it came to be a puzzle to know which to adopt. Then the
shoemaker said, "Hang your walls with new boots," and gave good
reasons why these should be the best of all possible defences. Now
the "general practitioner" charged, as I understand, for his
medicine, and in that way got paid for his visit. Wherever this is
the practice, medicine is sure to become a trade, and the people
learn to expect drugging, and to consider it necessary, because drugs
are so universally given to the patients of the man who gets his
living by them.
It was something to have unlearned the pernicious habit of constantly
giving poisons to a patient, as if they were good in themselves, of
drawing off the blood which he would want in his struggle with
disease, of making him sore and wretched with needless blisters, of
turning his stomach with unnecessary nauseous draught and mixtures,
--only because he was sick and something must be done. But there
were positive as well as negative facts to be learned, and some of
us, I fear, came home rich in the negatives of the expectant
practice, poor in the resources which many a plain country
practitioner had ready in abundance for the relief and the cure of
disease. No one instructor can be expected to do all for a student
which he requires. Louis taught us who followed him the love of
truth, the habit of passionless listening to the teachings of nature,
the most careful and searching methods of observation, and the sure
means of getting at the results to be obtained from them in the
constant employment of accurate tabulation. He was not a showy, or
eloquent, or, I should say, a very generally popular man, though the
favorite, almost the idol, of many students, especially Genevese and
Bostonians. But he was a man of lofty and admirable scientific
character, and his work will endure in its influences long after his
name is lost sight of save to the faded eyes of the student of
medical literature.
Many other names of men more or less famous in their day, and who
were teaching while I was in Paris, come up before me. They are but
empty sounds for the most part in the ears of persons of not more
than middle age. Who of you knows anything of Richerand, author of a
very popular work on Physiology, commonly put into the student's
hands when I first began to ask for medical text-books? I heard him
lecture once, and have had his image with me ever since as that of an
old, worn-out man,--a venerable but dilapidated relic of an effete
antiquity. To verify this impression I have just looked out the
dates of his birth and death, and find that he was eighteen years
younger than the speaker who is now addressing you. There is a
terrible parallax between the period before thirty and that after
threescore and ten, as two men of those ages look, one with naked
eyes, one through his spectacles, at the man of fifty and thereabout.
Magendie, I doubt not you have all heard of. I attended but one of
his lectures. I question if one here, unless some contemporary of my
own has strayed into the amphitheatre,--knows anything about
Marjolin. I remember two things about his lectures on surgery, the
deep tones of his voice as he referred to his oracle,--the earlier
writer, Jean Louis Petit,--and his formidable snuffbox. What he
taught me lies far down, I doubt not, among the roots of my
knowledge, but it does not flower out in any noticeable blossoms, or
offer me any very obvious fruits. Where now is the fame of
Bouillaud, Professor and Deputy, the Sangrado of his time? Where is
the renown of Piorry, percussionist and poet, expert alike in the
resonances of the thoracic cavity and those of the rhyming
vocabulary?--I think life has not yet done with the vivacious
Ricord, whom I remember calling the Voltaire of pelvic literature,--a
sceptic as to the morality of the race in general, who would have
submitted Diana to treatment with his mineral specifics, and ordered
a course of blue pills for the vestal virgins.
Ricord was born at the beginning of the century, and Piorry some
years earlier. Cruveilhier, who died in 1874, is still remembered by
his great work on pathological anatomy; his work on descriptive
anatomy has some things which I look in vain for elsewhere. But
where is Civiale,--where are Orfila, Gendrin, Rostan, Biett, Alibert,
--jolly old Baron Alibert, whom I remember so well in his broad-
brimmed hat, worn a little jauntily on one side, calling out to the
students in the court-yard of the Hospital St. Louis, "Enfans de la
methode naturelle, etes-vous tous ici?" "Children of the natural
method [his own method of classification of skin diseases,] are you
all here? "All here, then, perhaps; all where, now?
My show of ghosts is over. It is always the same story that old men
tell to younger ones, some few of whom will in their turn repeat the
tale, only with altered names, to their children's children.
Like phantoms painted on the magic slide,
Forth from the darkness of the past we glide,
As living shadows for a moment seen
In airy pageant on the eternal screen,
Traced by a ray from one unchanging flame,
Then seek the dust and stillness whence we came.
Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden,
where he had written his Latin graduating thesis, talking of the
learned Gaubius and the late illustrious Boerhaave and other dead
Dutchmen, of whom you know as much, most of you, as you do of Noah's
apothecary and the family physician of Methuselah, whose
prescriptions seem to have been lost to posterity. Dr. Lloyd came
back to Boston full of the teachings of Cheselden and Sharpe, William
Hunter, Smellie, and Warner; Dr. James Jackson loved to tell of Mr.
Cline and to talk of Mr. John Hunter; Dr. Reynolds would give you his
recollections of Sir Astley Cooper and Mr. Abernethy; I have named
the famous Frenchmen of my student days; Leyden, Edinburgh, London,
Paris, were each in turn the Mecca of medical students, just as at
the present day Vienna and Berlin are the centres where our young men
crowd for instruction. These also must sooner or later yield their
precedence and pass the torch they hold to other hands. Where shall
it next flame at the head of the long procession? Shall it find its
old place on the shores of the Gulf of Salerno, or shall it mingle
its rays with the northern aurora up among the fiords of Norway,--or
shall it be borne across the Atlantic and reach the banks of the
Charles, where Agassiz and Wyman have taught, where Hagen still
teaches, glowing like his own Lampyris splendidula, with enthusiasm,
where the first of American botanists and the ablest of American
surgeons are still counted in the roll of honor of our great
University?
Let me add a few words which shall not be other than cheerful, as I
bid farewell to this edifice which I have known so long. I am
grateful to the roof which has sheltered me, to the floors which have
sustained me, though I have thought it safest always to abstain from
anything like eloquence, lest a burst of too emphatic applause might
land my class and myself in the cellar of the collapsing structure,
and bury us in the fate of Korah, Dathan, and Abiram. I have helped
to wear these stairs into hollows,--stairs which I trod when they
were smooth and level, fresh from the plane. There are just thirty-
two of them, as there were five and thirty years ago, but they are
steeper and harder to climb, it seems to me, than they were then. I
remember that in the early youth of this building, the late Dr. John
K. Mitchell, father of our famous Dr. Weir Mitchell, said to me as
we came out of the Demonstrator's room, that some day or other a
whole class would go heels over head down this graded precipice, like
the herd told of in Scripture story. This has never happened as yet;
I trust it never will. I have never been proud of the apartment
beneath the seats, in which my preparations for lecture were made.
But I chose it because I could have it to myself, and I resign it,
with a wish that it were more worthy of regret, into the hands of my
successor, with my parting benediction. Within its twilight
precincts I have often prayed for light, like Ajax, for the daylight
found scanty entrance, and the gaslight never illuminated its dark
recesses. May it prove to him who comes after me like the cave of
the Sibyl, out of the gloomy depths of which came the oracles which
shone with the rays of truth and wisdom!
This temple of learning is not surrounded by the mansions of the
great and the wealthy. No stately avenues lead up to its facades and
porticoes. I have sometimes felt, when convoying a distinguished
stranger through its precincts to its door, that he might question
whether star-eyed Science had not missed her way when she found
herself in this not too attractive locality. I cannot regret that
we--you, I should say--are soon to migrate to a more favored region,
and carry on your work as teachers and as learners in ampler halls
and under far more favorable conditions.
I hope that I may have the privilege of meeting you there, possibly
may be allowed to add my words of welcome to those of my former
colleagues, and in that pleasing anticipation I bid good-by to this
scene of my long labors, and, for the present at least, to the
friends with whom I have been associated.
APPENDUM
NOTES TO THE ADDRESS ON CURRENTS AND COUNTER
CURRENTS IN MEDICAL SCIENCE.
Some passages contained in the original manuscript of the Address,
and omitted in the delivery on account of its length, are restored in
the text or incorporated with these Notes.
NOTE A.--
There is good reason to doubt whether the nitrate of silver has any
real efficacy in epilepsy. It has seemed to cure many cases, but
epilepsy is a very uncertain disease, and there is hardly anything
which has not been supposed to cure it. Dr. Copland cites many
authorities in its favor, most especially Lombard's cases. But De la
Berge and Monneret (Comp. de Med. Paris), 1839, analyze these same
cases, eleven in number, and can only draw the inference of a very
questionable value in the supposed remedy. Dr. James Jackson says
that relief of epilepsy is not to be attained by any medicine with
which he is acquainted, but by diet. (Letters to a Young Physician,
p. 67.) Guy Patin, Dean of the Faculty of Paris, Professor at the
Royal College, Author of the Antimonial Martyrology, a wit and a man
of sense and learning, who died almost two hundred years ago, had
come to the same conclusion, though the chemists of his time boasted
of their remedies. "Did, you ever see a case of epilepsy cured by
nitrate of silver?" I said to one of the oldest and most experienced
surgeons in this country. "Never," was his instant reply. Dr.
Twitchell's experience was very similar. How, then, did nitrate of
silver come to be given for epilepsy? Because, as Dr. Martin has so
well reminded us, lunatics were considered formerly to be under the
special influence of Luna, the moon (which Esquirol, be it observed,
utterly denies), and lunar caustic, or nitrate of silver, is a salt
of that metal which was called luna from its whiteness, and of course
must be in the closest relations with the moon. It follows beyond
all reasonable question that the moon's metal, silver, and its
preparations, must be the specific remedy for moonblasted maniacs and
epileptics!
Yet the practitioner who prescribes the nitrate of silver supposes he
is guided by the solemn experience of the past, instead of by its
idle fancies. He laughs at those old physicians who placed such
confidence in the right hind hoof of an elk as a remedy for the same
disease, and leaves the record of his own belief in a treatment quite
as fanciful and far more objectionable, written in indelible ink upon
a living tablet where he who runs may read it for a whole generation,
if nature spares his walking advertisement so long.
NOTE B.--
The presumption that a man is innocent until he is proved guilty,
does not mean that there are no rogues, but lays the onus probandi on
the party to which it properly belongs. So with this proposition.
A noxious agent should never be employed in sickness unless there is
ample evidence in the particular case to overcome the general
presumption against all such agents, and the evidence is very apt to
be defective.
The miserable delusion of Homoeopathy builds itself upon an axiom
directly the opposite of this; namely, that the sick are to be cured
by poisons. Similia similibus curantur means exactly this. It is
simply a theory of universal poisoning, nullified in practice by the
infinitesimal contrivance. The only way to kill it and all similar
fancies, and to throw every quack nostrum into discredit, is to root
out completely the suckers of the old rotten superstition that
whatever is odious or noxious is likely to be good for disease. The
current of sound practice with ourselves is, I believe, setting fast
in the direction I have indicated in the above proposition. To
uphold the exhibition of noxious agents in disease, as the rule,
instead of admitting them cautiously and reluctantly as the
exception, is, as I think, an eddy of opinion in the direction of the
barbarism out of which we believe our art is escaping. It is only
through the enlightened sentiment and action of the Medical
Profession that the community can be brought to acknowledge that
drugs should always be regarded as evils.
It is true that some suppose, and our scientific and thoughtful
associate, Dr. Gould, has half countenanced the opinion, that there
may yet be discovered a specific for every disease. Let us not
despair of the future, but let us be moderate in our expectations.
When an oil is discovered that will make a bad watch keep good time;
when a recipe is given which will turn an acephalous foetus into a
promising child; when a man can enter the second time into his
mother's womb and give her back the infirmities which twenty
generations have stirred into her blood, and infused into his own
through hers, we may be prepared to enlarge the National
Pharmacopoeia with a list of specifies for everything but old age,
--and possibly for that also.
NOTE C.--
The term specific is used here in its ordinary sense, without raising
the question of the propriety of its application to these or other
remedies.
The credit of introducing Cinchona rests between the Jesuits, the
Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor,
who employed it as a secret remedy. (Pereira.) Mercury as an
internal specific remedy was brought into use by that impudent and
presumptuous quack, as he was considered, Paracelsus. (Encyc. Brit.
art. "Paracelsus.") Arsenic was introduced into England as a remedy
for intermittents by Dr. Fowler, in consequence of the success of a
patent medicine, the Tasteless Ague Drops, which were supposed,
"probably with reason," to be a preparation of that mineral. (Rees's
Cyc. art. "Arsenic.") Colchicum came into notice in a similar way,
from the success of the Eau Medicinale of M. Husson, a French
military officer. (Pereira.) Iodine was discovered by a saltpetre
manufacturer, but applied by a physician in place of the old remedy,
burnt sponge, which seems to owe its efficacy to it. (Dunglison, New
Remedies.) As for Sulphur, "the common people have long used it as an
ointment" for scabies. (Rees's Cyc. art. "Scabies.") The modern
cantiscorbutic regimen is credited to Captain Cook. "To his sagacity
we are indebted for the first impulse to those regulations by which
scorbutus is so successfully prevented in our navy." (Lond. Cyc.
Prac. Med. art. "Scorbutus.") Iron and various salts which enter
into the normal composition of the human body do not belong to the
materia medica by our definition, but to the materia alimentaria.
For the first introduction of iron as a remedy, see Pereira, who
gives a very curious old story.
The statement in the text concerning a portion of the materia medica
stands exactly as delivered, and is meant exactly as it stands. No
denunciation of drugs, as sparingly employed by a wise physician, was
or is intended. If, however, as Dr. Gould stated in his "valuable
and practical discourse" to which the Massachusetts Medical Society
"listened with profit as well as interest," "Drugs, in themselves
considered, may always be regarded as evils,"--any one who chooses
may question whether the evils from their abuse are, on the whole,
greater or less than the undoubted benefits obtained from their
proper use. The large exception of opium, wine, specifics, and
anaesthetics, made in the text, takes off enough from the useful
side, as I fully believe, to turn the balance; so that a vessel
containing none of these, but loaded with antimony, strychnine,
acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus
diaboli, tormentilla, and other approved, and, in skilful hands,
really useful remedies, brings, on the whole, more harm than good to
the port it enters.
It is a very narrow and unjust view of the practice of medicine, to
suppose it to consist altogether in the use of powerful drugs, or of
drugs of any kind. Far from it. "The physician may do very much for
the welfare of the sick, more than others can do, although he does
not, even in the major part of cases, undertake to control and
overcome the disease by art. It was with these views that I never
reported any patient cured at our hospital. Those who recovered
their health were reported as well; not implying that they were made
so by the active treatment they had received there. But it was to be
understood that all patients received in that house were to be cured,
that is, taken care of." (Letters to a Young Physician, by James
Jackson, M. D., Boston, 1855.)
"Hygienic rules, properly enforced, fresh air, change of air, travel,
attention to diet, good and appropriate food judiciously regulated,
together with the administration of our tonics, porter, ale, wine,
iron, etc., supply the diseased or impoverished system with what Mr.
Gull, of St. Bartholomew's Hospital, aptly calls the 'raw material of
the blood;' and we believe that if any real improvement has taken
place in medical practice, independently of those truly valuable
contributions we have before described, it is in the substitution of
tonics, stimulants, and general management, for drastic cathartics,
for bleeding, depressing agents, including mercury, tartar emetics,
etc., so much in vogue during the early part even of this century."
(F. P. Porcher, in Charleston Med. Journal and Review for January,
1860.)
End of Project Gutenberg Etext Medical Essays, by Oliver Wendell Holmes