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 he could possibly help it, until eleven,
and so keep a nervous patient and an anxious family waiting for him
through a long, weary hour.
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 mussels, and very fat and full of
sea-pearl.” Sailors and passengers indulged in the treacherous delicacy;
which seems to have been the sea-clam; and found that these mollusks,
like the shell the poet tells of, remembered their august abode, and
treated the way-worn adventurers to a gastric reminiscence of the
heaving billows. In the mean time it blew and snowed and froze. The
water turned to ice on their clothes, and made them many times like
coats of iron. Edward Tilley had like to have “sounded” with cold. The
gunner, too, was sick unto death, but “hope of trucking” kept him on his
feet,--a Yankee, it should seem, when he first touched the shore of New
England. Most, if not all, got colds and coughs, which afterwards turned
to scurvy, whereof many died.
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, in 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.