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's Medical Essays, by Oliver Wendell Holmes, Sr.