the day before them, doing it according to the rules of their craft, and
asking no questions of the past or of the future, or of the aim and end
to which their special labor is contributing. These often consider and
call themselves practical men. They pull the oars of society, and have
no leisure to watch the currents running this or that way; let theorists
and philosophers attend to them. In the mean time, however, these
currents are carrying the practical men, too, and all their work may be
thrown away, and worse than thrown away, if they do not take knowledge
of them and get out of the wrong ones and into the right ones as soon as
they may. Sir Edward Parry and his party were going straight towards the
pole in one of their arctic expeditions, travelling at the rate of ten
miles a day. But the ice over which they travelled was drifting straight
towards the equator, at the rate of twelve miles a day, and yet no
man among them would have known that he was travelling two miles a day
backward unless he had lifted his eyes from the track in which he was
plodding. It is not only going backward that the plain practical workman
is liable to, if he will not look up and look around; he may go forward
to ends he little dreams of. It is a simple business for a mason to
build up a niche in a wall; but what if, a hundred years afterwards when
the wall is torn down, the skeleton of a murdered man drop out of the
niche? It was a plain practical piece of carpentry for a Jewish artisan
to fit two pieces of timber together according to the legal pattern in
the time of Pontius Pilate; he asked no questions, perhaps, but we know
what burden the cross bore on the morrow! And so, with subtler tools
than trowels or axes, the statesman who works in policy without
principle, the theologian who works in forms without a soul, the
physician who, calling himself a practical man, refuses to recognize the
larger laws which govern his changing practice, may all find that they
have been building truth into the wall, and hanging humanity upon the
cross.
The truth is, that medicine, professedly founded on observation, is as
sensitive to outside influences, political, religious, philosophical,
imaginative, as is the barometer to the changes of atmospheric density.
Theoretically it ought to go on its own straightforward inductive path,
without regard to changes of government or to fluctuations of public
opinion. But look a moment while I clash a few facts together, and see
if some sparks do not reveal by their light a closer relation between
the Medical Sciences and the conditions of Society and the general
thought of the time, than would at first be suspected.
Observe the coincidences between certain great political and
intellectual periods and the appearance of illustrious medical reformers
and teachers. It was in the age of Pericles, of Socrates, of Plato, of
Phidias, that Hippocrates gave to medical knowledge the form which it
retained for twenty centuries. With the world-conquering Alexander, the
world-embracing Aristotle, appropriating anatomy and physiology, among
his manifold spoils of study, marched abreast of his royal pupil to
wider conquests. Under the same Ptolemies who founded the Alexandrian
Library and Museum, and ordered the Septuagint version of the Hebrew
Scriptures, the infallible Herophilus [“Contradicere Herophilo in
anatomicis, est contradicere evangelium,” was a saying of Fallopius.]
made those six hundred dissections of which Tertullian accused him, and
the sagacious Erasistratus introduced his mild antiphlogistic treatment
in opposition to the polypharmacy and antidotal practice of his time.
It is significant that the large-minded Galen should have been the
physician and friend of the imperial philosopher Marcus Aurelius. The
Arabs gave laws in various branches of knowledge to those whom their
arms had invaded, or the terror of their spreading dominion had reached,
and the point from which they started was, as Humboldt acknowledges,
“the study of medicine, by which they long ruled the Christian Schools,”
and to which they added the department of chemical pharmacy.
Look at Vesalius, the contemporary of Luther. Who can fail to see
one common spirit in the radical ecclesiastic and the reforming
court-physician? Both still to some extent under the dominion of the
letter: Luther holding to the real presence; Vesalius actually causing
to be drawn and engraved two muscles which he knew were not found in
the human subject, because they had been described by Galen, from
dissections of the lower animals. Both breaking through old traditions
in the search of truth; one, knife in hand, at the risk of life and
reputation, the other at the risk of fire and fagot, with that mightier
weapon which all the devils could not silence, though they had been
thicker than the tiles on the house-tops. How much the physician of the
Catholic Charles V. had in common with the great religious destructive,
may be guessed by the relish with which he tells the story how certain
Pavian students exhumed the body of an “elegans scortum,” or lovely dame
of ill repute, the favorite of a monk of the order of St. Anthony, who
does not seem to have resisted temptation so well as the founder of
his order. We have always ranked the physician Rabelais among the early
reformers, but I do not know that Vesalius has ever been thanked for his
hit at the morals of the religious orders, or for turning to the good of
science what was intended for the “benefit of clergy.”
Our unfortunate medical brother, Michael Servetus, the spiritual patient
to whom the theological moxa was applied over the entire surface for
the cure of his heresy, came very near anticipating Harvey. The same
quickened thought of the time which led him to dispute the dogma of the
Church, opened his mind to the facts which contradicted the dogmas of
the Faculty.
Harvey himself was but the posthumous child of the great Elizabethan
period. Bacon was at once his teacher and his patient. The founder
of the new inductive philosophy had only been dead two years when the
treatise on the Circulation, the first-fruit of the Restoration of
Science, was given to the world.
And is it to be looked at as a mere accidental coincidence, that while
Napoleon was modernizing the political world, Bichat was revolutionizing
the science of life and the art that is based upon it; that while the
young general was scaling the Alps, the young surgeon was climbing
the steeper summits of unexplored nature; that the same year read the
announcement of those admirable “Researches on Life and Death,” and the
bulletins of the battle of Marengo?
If we come to our own country, who can fail to recognize that Benjamin
Rush, the most conspicuous of American physicians, was the intellectual
offspring of the movement which produced the Revolution? “The same
hand,” says one of his biographers, “which subscribed the declaration
of the political independence of these States, accomplished their
emancipation from medical systems formed in foreign countries, and
wholly unsuitable to the state of diseases in America.”
Following this general course of remark, I propose to indicate in a few
words the direction of the main intellectual current of the time, and
to point out more particularly some of the eddies which tend to keep the
science and art of medicine from moving with it, or even to carry them
backwards.
The two dominant words of our time are law and average, both pointing to
the uniformity of the order of being in which we live. Statistics have
tabulated everything,--population, growth, wealth, crime, disease. We
have shaded maps showing the geographical distribution of larceny and
suicide. Analysis and classification have been at work upon all tangible
and visible objects. The Positive Philosophy of Comte has only given
expression to the observing and computing mind of the nineteenth
century.
In the mean time, the great stronghold of intellectual conservatism,
traditional belief, has been assailed by facts which would have been
indicted as blasphemy but a few generations ago. Those new tables of
the law, placed in the hands of the geologist by the same living God who
spoke from Sinai to the Israelites of old, have remodelled the beliefs
of half the civilized world. The solemn scepticism of science has
replaced the sneering doubts of witty philosophers. The more positive
knowledge we gain, the more we incline to question all that has been
received without absolute proof.
As a matter of course, this movement has its partial reactions. The
province of faith is claimed as a port free of entry to unsupported
individual convictions. The tendency to question is met by the
unanalyzing instinct of reverence. The old church calls back its
frightened truants. Some who have lost their hereditary religious
belief find a resource in the revelations of Spiritualism. By a parallel
movement, some of those who have become medical infidels pass over to
the mystic band of believers in the fancied miracles of Homoeopathy.
Under these influences transmitted to, or at least shared by, the
medical profession, the old question between “Nature,” so called, and
“Art,” or professional tradition, has reappeared with new interest. I
say the old question, for Hippocrates stated the case on the side
of “Nature” more than two thousand years ago. Miss Florence
Nightingale,--and if I name her next to the august Father of the Healing
Art, its noblest daughter well deserves that place of honor,--Miss
Florence Nightingale begins her late volume with a paraphrase of his
statement. But from a very early time to this there has always been
a strong party against “Nature.” Themison called the practice of
Hippocrates “a meditation upon death.” Dr. Rush says: “It is impossible
to calculate the mischief which Hippocrates has done, by first marking
Nature with his name and afterwards letting her loose upon sick people.
Millions have perished by her hands in all ages and countries.” Sir John
Forbes, whose defence of “Nature” in disease you all know, and to the
testimonial in whose honor four of your Presidents have contributed, has
been recently greeted, on retiring from the profession, with a wish that
his retirement had been twenty years sooner, and the opinion that no man
had done so much to destroy the confidence of the public in the medical
profession.
In this Society we have had the Hippocratic and the Themisonic side
fairly represented. The treatise of one of your early Presidents on the
Mercurial Treatment is familiar to my older listeners. Others who have
held the same office have been noted for the boldness of their practice,
and even for partiality to the use of complex medication.
On the side of “Nature” we have had, first of all, that remarkable
discourse on Self-Limited Diseases, [On Self-Limited Diseases. A
Discourse delivered before the Massachusetts Medical Society, at their
Annual Meeting, May 27, 1835. By Jacob Bigelow, M. D.] which has given
the key-note to the prevailing medical tendency of this neighborhood, at
least, for the quarter of a century since it was delivered. Nor have
we forgotten the address delivered at Springfield twenty years later,
[Search out the Secrets, of Nature. By Augustus A. Gould, M. D. Read
at the Annual Meeting, June 27, 1855.] full of good sense and useful
suggestions, to one of which suggestions we owe the learned, impartial,
judicious, well-written Prize Essay of Dr. Worthington Hooker. [Rational
Therapeutics. A Prize Essay. By Worthington Hooker, M. D., of New Haven.
Boston. 1857.] We should not omit from the list the important address of
another of our colleagues, [On the Treatment of Compound and Complicated
Fractures. By William J. Walker, M. D. Read at the Annual Meeting, May
29, 1845.] showing by numerous cases the power of Nature in
healing compound fractures to be much greater than is frequently
supposed,--affording, indeed, more striking illustrations than can be
obtained from the history of visceral disease, of the supreme wisdom,
forethought, and adaptive dexterity of that divine Architect, as shown
in repairing the shattered columns which support the living temple of
the body.
We who are on the side of “Nature” please ourselves with the idea that
we are in the great current in which the true intelligence of the time
is moving. We believe that some who oppose, or fear, or denounce our
movement are themselves caught in various eddies that set back against
the truth. And we do most earnestly desire and most actively strive,
that Medicine, which, it is painful to remember, has been spoken of
as “the withered branch of science” at a meeting of the British
Association, shall be at length brought fully to share, if not to lead,
the great wave of knowledge which rolls with the tides that circle the
globe.
If there is any State or city which might claim to be the American
headquarters of the nature-trusting heresy, provided it be one, that
State is Massachusetts, and that city is its capital. The effect which
these doctrines have upon the confidence reposed in the profession is a
matter of opinion. For myself, I do not believe this confidence can be
impaired by any investigations which tend to limit the application of
troublesome, painful, uncertain, or dangerous remedies. Nay, I will
venture to say this, that if every specific were to fail utterly, if the
cinchona trees all died out, and the arsenic mines were exhausted, and
the sulphur regions were burned up, if every drug from the vegetable,
animal, and mineral kingdom were to disappear from the market, a body of
enlightened men, organized as a distinct profession, would be required
just as much as now, and respected and trusted as now, whose province
should be to guard against the causes of disease, to eliminate them if
possible when still present, to order all the conditions of the patient
so as to favor the efforts of the system to right itself, and to give
those predictions of the course of disease which only experience can
warrant, and which in so many cases relieve the exaggerated fears of
sufferers and their friends, or warn them in season of impending danger.
Great as the loss would be if certain active remedies could no longer be
obtained, it would leave the medical profession the most essential part
of its duties, and all, and more than all, its present share of honors;
for it would be the death-blow to charlatanism, which depends for its
success almost entirely on drugs, or at least on a nomenclature that
suggests them.
There is no offence, then, or danger in expressing the opinion, that,
after all which has been said, the community is still overdosed: The
best proof of it is, that “no families take so little medicine as those
of doctors, except those of apothecaries, and that old practitioners are
more sparing of active medicines than younger ones.” [Dr. James Jackson
has kindly permitted me to make the following extract from a letter
just received by him from Sir James Clark, and dated May 26, 1860: “As a
physician advances in age, he generally, I think, places less confidence
in the ordinary medical treatment than he did, not only during his
early, but even his middle period of life.”] The conclusion from these
facts is one which the least promising of Dr. Howe's pupils in the
mental department could hardly help drawing.
Part of the blame of over-medication must, I fear, rest with the
profession, for yielding to the tendency to self-delusion, which seems
inseparable from the practice of the art of healing. I need only touch
on the common modes of misunderstanding or misapplying the evidence of
nature.
First, there is the natural incapacity for sound observation, which is
like a faulty ear in music. We see this in many persons who know a good
deal about books, but who are not sharp-sighted enough to buy a horse or
deal with human diseases.
Secondly, there is in some persons a singular inability to weigh the
value of testimony; of which, I think, from a pretty careful examination
of his books, Hahnemann affords the best specimen outside the walls of
Bedlam.
The inveterate logical errors to which physicians have always been
subject are chiefly these:
The mode of inference per enumerationem simplicem, in scholastic phrase;
that is, counting only their favorable cases. This is the old trick
illustrated in Lord Bacon's story of the gifts of the shipwrecked
people, hung up in the temple.--Behold! they vowed these gifts to the
altar, and the gods saved them. Ay, said a doubting bystander, but
how many made vows of gifts and were shipwrecked notwithstanding? The
numerical system is the best corrective of this and similar errors. The
arguments commonly brought against its application to all matters of
medical observation, treatment included, seem to apply rather to the
tabulation of facts ill observed, or improperly classified, than to the
method itself.
The post hoc ergo propter hoc error: he got well after taking my
medicine; therefore in consequence of taking it.
The false induction from genuine facts of observation, leading to the
construction of theories which are then deductively applied in the
face of the results of direct observation. The school of Broussais has
furnished us with a good example of this error.
And lastly, the error which Sir Thomas Browne calls giving “a reason of
the golden tooth;” that is, assuming a falsehood as a fact, and giving
reasons for it, commonly fanciful ones, as is constantly done by that
class of incompetent observers who find their “golden tooth” in the
fabulous effects of the homoeopathie materia medica,--which consists of
sugar of milk and a nomenclature.
Another portion of the blame rests with the public itself, which insists
on being poisoned. Somebody buys all the quack medicines that build
palaces for the mushroom, say rather, the toadstool millionaires. Who is
it? These people have a constituency of millions. The popular belief is
all but universal that sick persons should feed on noxious substances.
One of our members was called not long since to a man with a terribly
sore mouth. On inquiry he found that the man had picked up a box of
unknown pills, in Howard Street, and had proceeded to take them, on
general principles, pills being good for people. They happened to
contain mercury, and hence the trouble for which he consulted our
associate.
The outside pressure, therefore, is immense upon the physician,
tending to force him to active treatment of some kind. Certain old
superstitions, still lingering in the mind of the public, and not yet
utterly expelled from that of the profession, are at the bottom of this,
or contribute to it largely. One of the most ancient is, that disease is
a malignant agency, or entity, to be driven out of the body by offensive
substances, as the smoke of the fish's heart and liver drove the devil
out of Tobit's bridal chamber, according to the Apochrypha. Epileptics
used to suck the blood from the wounds of dying gladiators. [Plinii
Hist. Mundi. lib. xxviii. c. 4.] The Hon. Robert Boyle's little book
was published some twenty or thirty years before our late President, Dr.
Holyoke, was born. [A Collection of Choice and Safe Remedies. The Fifth
Edition, corrected. London, 1712. Dr. Holyoke was born in 1728.] In it
he recommends, as internal medicines, most of the substances commonly
used as fertilizers of the soil. His “Album Graecum” is best
left untranslated, and his “Zebethum Occidentale” is still more
transcendentally unmentionable except in a strange dialect. It sounds
odiously to us to hear him recommend for dysentery a powder made from
“the sole of an old shoe worn by some man that walks much.” Perhaps
nobody here ever heard of tying a stocking, which had been worn during
the day, round the neck at night for a sore throat. The same idea
of virtue in unlovely secretions! [The idea is very ancient. “Sordes
hominis” “Sudore et oleo medicinam facientibus.”--Plin. xxviii. 4.]
Even now the Homoeopathists have been introducing the venom of serpents,
under the learned title of Lachesis, and outraging human nature with
infusions of the pediculus capitis; that is, of course, as we understand
their dilutions, the names of these things; for if a fine-tooth-comb
insect were drowned in Lake Superior, we cannot agree with them in
thinking that every drop of its waters would be impregnated with all the
pedicular virtues they so highly value. They know what they are doing.
They are appealing to the detestable old superstitious presumption in
favor of whatever is nauseous and noxious as being good for the sick.
Again, we all occasionally meet persons stained with nitrate of silver,
given for epilepsy. Read what Dr. Martin says, about the way in which
it came to be used, in his excellent address before the Norfolk County
Medical Society, and the evidence I can show, but have not time for now,
and then say what you think of the practice which on such presumptions
turns a white man as blue as the double-tattooed King of the Cannibal
Islands! [Note A.]
If medical superstitions have fought their way down through all the
rationalism and scepticism of the nineteenth century, of course the
theories of the schools, supported by great names, adopted into the
popular belief and incorporated with the general mass of misapprehension
with reference to disease, must be expected to meet us at every turn in
the shape of bad practice founded on false doctrine. A French patient
complains that his blood heats him, and expects his doctor to bleed
him. An English or American one says he is bilious, and will not be easy
without a dose of calomel. A doctor looks at a patient's tongue, sees it
coated, and says the stomach is foul; his head full of the old saburral
notion which the extreme inflammation-doctrine of Broussais did so
much to root out, but which still leads, probably, to much needless and
injurious wrong of the stomach and bowels by evacuants, when all they
want is to be let alone. It is so hard to get anything out of the dead
hand of medical tradition! The mortmain of theorists extinct in science
clings as close as that of ecclesiastics defunct in law.
One practical hint may not be out of place here. It seems to be
sometimes forgotten, by those who must know the fact, that the tongue is
very different, anatomically and physiologically, from the stomach.
Its condition does not in the least imply a similar one of the stomach,
which is a very different structure, covered with a different kind
of epithelium, and furnished with entirely different secretions. A
silversmith will, for a dollar, make a small hoe, of solid silver, which
will last for centuries, and will give a patient more comfort, used
for the removal of the accumulated epithelium and fungous growths which
constitute the “fur,” than many a prescription with a split-footed Rx
before it, addressed to the parts out of reach.
I think more of this little implement on account of its agency in saving
the Colony at Plymouth in the year 1623. Edward Winslow heard that
Massasoit was sick and like to die. He found him with a houseful of
people about him, women rubbing his arms and legs, and friends “making
such a hellish noise” as they probably thought would scare away the
devil of sickness. Winslow gave him some conserve, washed his mouth,
scraped his tongue, which was in a horrid state, got down some drink,
made him some broth, dosed him with an infusion of strawberry leaves and
sassafras root, and had the satisfaction of seeing him rapidly recover.
Massasoit, full of gratitude, revealed the plot which had been formed
to destroy the colonists, whereupon the Governor ordered Captain Miles
Standish to see to them; who thereupon, as everybody remembers, stabbed
Pecksuot with his own knife, broke up the plot, saved the colony, and
thus rendered Massachusetts and the Massachusetts Medical Society
a possibility, as they now are a fact before us. So much for this
parenthesis of the tongue-scraper, which helped to save the young
colony from a much more serious scrape, and may save the Union yet, if a
Presidential candidate should happen to be taken sick as Massasoit was,
and his tongue wanted cleaning,--which process would not hurt a good
many politicians, with or without a typhoid fever.