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.”