THEORY AND OBSERVATION.
All real knowledge is based upon observation; and it is the facts
discovered by observation, which, accumulating from age to age,
constitute the _store_ of human knowledge. Not a single grain has
ever been added to this store, in all the ages of the world, through
the instrumentality of theory alone. Theory, or hypothesis, has often
suggested the existence of facts, and has directed in the pursuit
after them, but observation after all is the only agent that has
discovered them.
Facts are of two kinds—particular and general. General facts are
discovered by a careful observation of a great number of particular
facts. Thus Newton, by observing many particular or individual facts,
established the general fact, which is called gravitation, viz., that
all bodies are attracted towards each other, or have a tendency to
come together. So in medical science, by an observation of many facts
in individual cases, it has been discovered, that there is a tendency
in the human system to restoration to health, whenever it is attacked
with disease—a tendency, existing as a general fact, to which has
been given the name, _vis medicatrix naturæ_.
These general facts are sometimes termed principles or laws, and
are sometimes spoken of as the relationships of facts. A theory, or
hypothesis, consists in a supposition of relationships which have
not yet been ascertained. Thus Newton, after discovering the great
general fact of gravitation, supposed that there might be a sort of
ether connecting bodies together, and acting as the medium of their
attraction. This supposition of a relationship, or general fact, not
yet ascertained, is a theory or hypothesis. So when Stahl supposed
the principle called the _vis medicatrix naturæ_ to be in the soul,
and when Cullen supposed that it exists in the nerves and produces
in fever a spasm of the extreme vessels, they both put forth a mere
theory. Cullen speaks of Stahl’s theory as being fanciful. It is so.
But Cullen’s is just as fanciful, if by this word it is meant that it
is unsubstantiated by fact. Cullen’s supposition is more plausible,
it is true, than Stahl’s; but it is no nearer being a proved fact.
There is often much indefiniteness in the use of the word _theory_.
Thus the doctrine, or law of gravitation, as discovered by Newton is
sometimes spoken of as his _theory_ of gravitation. It was _once_
his theory; that is, when it was a mere supposition in his mind. But
when, by a series of observations it came to be a proved fact, it
was no longer a theory. So the laws of the circulation of the blood,
as discovered by Harvey, are sometimes erroneously spoken of as his
theory of the circulation.
Some theories are said to be founded on facts, while others are
deemed to be very fanciful. But theory can never be said, strictly
speaking, to be founded on facts. It has relation to facts, it is
true, but in the attempt to explain their nature, it goes _beyond_
them over into the domain of conjecture.
Every one who puts forth a theory, is apt to think that all previous
theories are false, while his is proved to be conformable to facts.
Dr. Cullen, in announcing his theory, or doctrine (as he styles
it) of fever, which is from beginning to end a series of unproved
assertions, says, “I flatter myself that I have avoided hypothesis,
and what have been called theories.” So Dr. Rush, after framing a
theory even more palpably fanciful, says, that he conceives the
doctrine of fever that he has aimed to establish rests upon facts
only.
There is no science, in which there has been so much theorizing, as
there has been in that of medicine. Its history seems to be almost
altogether a history of untenable theories. These theories are at
least the prominent objects that present themselves to view. Every
period has had its favorite theory, which has exerted its influence
upon the general medical mind. Almost every great name in medical
history is associated with some celebrated hypothesis. And it would
seem that sometimes the attention of the whole profession has been
almost exclusively directed to the strife between the advocates of
opposing theories. This overweening attachment to theories has been
a very great obstacle to the advancement of medicine as a science.
It has turned the medical mind away from the legitimate pathway of
discovery, and the strict observation of facts has been neglected in
the contemplation of mere fancies.
It is true of medicine, as it is of every other science, that every
advance which has been made has been effected by observation,
and by observation alone. It is the good observer, and not the
mere ingenious theorizer, who has made these advances. And if the
theorizer has added anything to the store of knowledge, it is only
when he has come down from his airy flight of fancy to the drudgery
of humble common observation. He has for the time forgotten
his favorite theory, and has subjected hypothesis to its proper
subserviency to observation, in suggesting the points to which that
observation may be directed. It is in this way, and in this alone,
that many of the authors of theories, escaping occasionally from
the domination of a theorizing spirit, have added rich treasures
to the storehouse of medical science. Even before the discovery of
the circulation of the blood, though medical theories necessarily
contained many absurdities, yet many of their advocates were acute
and accurate observers; and their facts are valuable, though the
theories, which they framed to account for these facts, may appear to
us even ridiculous. They collected a great amount of good materials;
but instead of erecting with them a structure full of beauty and
symmetry, capable of resisting the commotions of ages, they reared
a motley pile which easily tumbled into ruins. They were men of the
most persevering industry. They seemed to forget entirely that “of
making many books there is no end; and much study is a weariness of
the flesh.” Quartos and folios were produced in abundance, full of
mixtures of wisdom and folly, as incongruous as were some of the
old prescriptions with their hundred or more ingredients. And as
some of the articles, which composed these hundred-headed enemies
of disease, are now among our most valuable remedies, so there are
portions of those strange compounds of fact and speculation, which
will always stand as monuments of genius and industry. They are among
the principles which form the basis of medicine. The student, as he
now reads the older works in medical science, regards but as matters
of curiosity the theories of lentor and viscosity, acrimony, &c.; and
picks out from the mass of rubbish the pearls and precious stones,
which are almost concealed beneath it.
The reader cannot fail to have seen, in the course of my remarks,
what I deem to be the province of theory, or hypothesis. It is simply
suggestive. This is its true vocation. It _establishes_ no fact, and
no principle. It should be the mere handmaid of observation, and
should be kept in perfect subjection to her control. It never should
be a rival, much less should it have supremacy, as it has too often
done, in the domains of science.
Thus restricted to its proper sphere, theory is of essential service
in extending the boundaries of science. It often suggests the line
of discovery. It constantly reaches beyond present knowledge. We
theorize, that is, we suppose; then by observation we discover. If
we find our hypothesis or supposition to be correct, we discover a
positive fact. If we find it not to be, we discover a negative fact,
and not valueless because negative—some of our negative facts are
worth quite as much as positive ones.
The abuse of theory consists in the obliteration of the distinction
between what is known, and what is merely supposed. So long as this
distinction is carefully preserved, no harm is done by theory. No
man was ever more thorough, in maintaining this line of separation
between the known and the supposed, than was Newton. “_I shall
not mingle conjectures with certainties_,” a passage in a letter
announcing his great discovery of the compound nature of light, is
a maxim which always governed him, and should govern every searcher
after truth in every branch of science.
This maxim has evidently been little regarded by the great majority
of theorizers in medicine. They have exalted mere conjectures into
the same rank with facts; and so far as they have done this, just so
far have they exerted an influence to retard the progress of medical
science. If all the energy and talent, which have been expended upon
theories, could have been directed to the observation of facts, what
a mass of rubbish, which now encumbers the science of medicine, would
have remained uncollected, and what an amount of pure unadulterated
facts, which as yet are undiscovered, would have been garnered into
the storehouse of knowledge!
As observation then is the only source of improvement in medical
science, it is important to inquire what influences are adverse to
_skill_ in the observer. The influence of an overweening fondness
for theory has already been sufficiently pointed out. I will pass
therefore to the consideration of some other circumstances which tend
to impair skill in observation.
Every physician can add much to his stock of knowledge by a proper
review of cases which have come under his care. But a faulty mode
of doing this will lead him into error. For example, one physician
is so exceedingly fearful that in those cases, in which death has
occurred, something which he did or left undone was the cause of the
fatal event that he sees nothing clearly, and arrives at no definite
and available conclusions; and he ends every review with nothing but
unavailing regrets. Another, on the contrary, is too self-confident,
scarcely harboring the idea that he could have ever committed any
error. This notion of infallibility, though not distinctly avowed,
is indulged to a greater or less extent by many physicians. If they
do not think that they _never_ err, they at least think that it is
very uncommon for them to do so. To such the past is worth nothing as
corrective. They add from it nothing to their stock of ascertained
facts, though they may add to their medley of true and false
inferences. Both of these extremes should be avoided. The physician,
in reviewing his cases, should not fear to find errors; for if he
investigated them properly at the time with the best lights which he
could command, and acted in good faith, he is not to be blamed if he
did err. But, on the other hand, he should not pronounce any measure
which he has adopted to be an error without substantial evidence.
The disposition to form conclusions from a limited number of facts is
a fertile source of error in medical observation. This has already
been alluded to in previous chapters.
This disposition is very common among young physicians. A small
number of cases is often sufficient to lead them to adopt
conclusions, which a larger number of cases would show to be false.
The fact that their experience has been limited should teach them
to be cautious in their inferences; but very often this caution is
never learned, till a larger experience has revealed to them their
errors. The disposition under consideration is often increased, and
sometimes rendered inveterate, by the practice, so common especially
among young aspirants for medical fame, of speaking quite freely in
non-professional circles of the results of their experience. This
practice is not only disgusting, but it contributes essentially to
the establishment of a habit of loose observation and reasoning.
But the disposition to adopt conclusions from a limited observation
is by no means confined to young practitioners. It is a very
common error in the profession at large; and the annals of medical
experience are loaded down with errors, which come from this source.
A few illustrations will suffice.
A few years ago a pamphlet appeared from the pen of Dr. Sewall of
Washington, on the pathology of drunkenness, with plates exhibiting
the state of the drunkard’s stomach in different stages of disease.
Among others is a plate representing the appearance of the stomach of
a man who died of delirium tremens; and Dr. Sewall says, that it is
a true representation of the state of the stomach in all these who
die of this malady. This sweeping assertion is based upon nothing
but his personal observation, which, it seems from his own account,
was very limited. He speaks of having had _several_ opportunities of
inspecting the stomach after death in such cases, and says that the
appearances on dissection have been extremely uniform. How many he
meant by the word ‘several’ I know not; but one thing is certain—that
nothing short of _many_ observations could establish the fact, that
the plate in question exhibits the true state of the stomach in _all_
cases of death by delirium tremens.
Now what is the truth on this point? This question is not to be
answered by what any _one_ man has found in ‘several,’ or even
in many cases. It can be properly answered, only by taking the
observations of many different physicians, who have had extensive
opportunities of making examinations after death in this disease. The
uniformity of appearances, spoken of by Dr. Sewall, we find, has not
been observed by others; but the stomach has been found in various
states in the different cases.
Dr. Sewall infers from the appearances in his cases, that the
opinion advocated by some, that delirium tremens has its seat in the
stomach is correct. Even if such appearances were competent proof in
regard to this point, which is by no means true, it would require
a larger number of cases than can properly be included under the
term ‘several,’ to establish the correctness of such a conclusion.
It is worthy of remark here, that others, taking, like Dr. Sewall,
the partial view of facts presented by a limited experience, but
having their attention directed to another quarter, have located this
disease in some other organ. Thus some have supposed its seat to be
in the brain, and have based this opinion, as Dr. Sewall did his,
upon what they found in examinations after death. The truth is that
all the phenomena of this disease show, that is a peculiar affection
of the nervous system, and not a local disease of any one organ. Now
in the general disordered condition of the drunkard’s organs, this
affection is of course liable to be complicated with various local
diseases. And delirium tremens of itself alone is not apt to end
fatally; but when death occurs, it is ordinarily the result of some
local complaint united with this disease. Wherever this complaint
happens to be,—in the stomach, or the liver, or the brain, or some
other organ,—_there_ will be found on examination after death the
greatest amount of disease. And a partial view of facts has often led
physicians to mistake these local complications of delirium tremens
for the disease itself.
Another error, of a more directly practical character, which existed
for a long time in relation to this same disease, will serve as
another illustration of the influence of a partial view of facts, in
leading to wrong conclusions. Dr. Sutton, one of the early authors
on delirium tremens, asserted as the result of his observation, that
the patient must sleep or die, and that opium in _large_ doses was
the proper remedy to produce the sleep. This opinion was for a long
time almost universally adopted, and practised upon. But the compared
experience of _many_ observers has demonstrated this practice to be
erroneous, and it is now very commonly given up by the profession.
In examining disease, whether in a single case, or in groups of
cases, it is essential to the formation of correct conclusions, that
_all_ the symptoms be observed, and that their relative importance be
duly estimated. Much error has arisen from a disregard of this plain
truth. Take for example the observations of different individuals in
regard to fever. Boerhaave, looking mainly at one class of symptoms,
taught that fever was caused by a bad state of the blood; Cullen
looking at another class of symptoms, considered fever to be an
affection of the nervous system; Clutterbuck, fixing his eye upon
another class of facts, was very sure that the cause of fever is
always to be found in the brain; Broussais, directing his attention
to the symptoms developed in another quarter of the system, asserted,
that all fever arises from an inflammation of the mucous membrane of
the stomach and of the upper portion of the intestines; Dr. Cooke of
this country, narrowing his vision down to a certain set of symptoms,
proclaimed that the primary cause of fever is a weakened action of
the heart, producing an accumulation of blood in the venous system;
and Samuel Thompson, following in his rude way the example of all
previous theorizers on this subject, in taking into view but a part
of the facts in the case, declared that fever is a battle between the
cold and the heat, and that, if the cold conquer, the patient dies,
and if the heat gain the victory, the patient lives.[29]
It is thus that a disposition to form conclusions from a limited
experience, and to take partial views of facts, leads to errors of
opinion, and consequently errors of practice. I might multiply
illustrations on this point, but it is not necessary.
Allied to the influence just mentioned is another, to which I
will give a passing notice. I refer to the hobby-riding which is
so common in the medical profession. Every good thing seems to be
destined to this use till it loses its novelty; and therefore its
real value can never be accurately ascertained, till it has passed
what may be called the _hobby-period_ of its existence. No careful
discriminations are made to any extent until this period is finished.
Even the experience, which is recorded in journals of medicine during
its continuance, needs to be thoroughly sifted by after observation.
The influence of this hobby-riding is therefore a great hindrance to
the progress of medical science. And this influence is not confined
to the particular subjects to which it is applied. It does not merely
throw obstacles in the way of _their_ investigation. It is not thus
limited and evanescent, for it is counter to the true _spirit of
observation_, and impairs its hold upon the profession as a whole.
The riding of hobbies is very much regulated by fashion. For there
is a fashion in medicine as well as in everything else; and it not
only bears rule in the community at large, but it exercises no
inconsiderable authority in the medical profession itself. Some
particular diseases and modes of treatment, are ever, sometimes one,
and sometimes another, uppermost in the popular mind.
When anything new comes up in regard to disease or its treatment,
which attracts considerable attention, there is a strong temptation
to make a hobby of it. Multitudes suppose that they have the
disease, and need the treatment. This may be really true of but
few of them, but such is their belief. There is no time for
accurate discrimination if the object be to make fame and money.
If a physician honestly undertakes to decide what cases need the
treatment, and what do not, he will not be as successful in gaining
eclat, and in getting the people’s money, as his neighbor will be,
who catches the popular breeze with all his sails, knowing that it is
not wont to blow in one direction for any length of time.
A few years ago dyspepsia was very fashionable; but now it is so
old-fashioned, that we hear but little about it, and no hobby-rider
thinks at the present day of setting up any pretensions to great
skill in the treatment of this complaint. Diseases of the throat have
taken its place in the public mind, and multitudes are running to
those, who are reputed to have peculiar skill in clipping off tonsils
and palates, and swabbing out windpipes. The new treatment, as it is
called, is good practice in some cases; but the almost indiscriminate
application which some hobby-doctors make of it is ridiculous and
contemptible. The confirmed consumptive, who has his palate clipped,
or his throat or windpipe swabbed, and because he fancies that he
feels better, revives for a time the delusive hope of recovery, and
cheerfully pays the doctor his fee, has a most unjustifiable cheat
practised upon him. And such fees! From five to twenty dollars,
according to the circumstances of the patient, is asked by some of
these doctors for clipping the palate, one of the most trifling
operations in surgery.[30]
When this fashion shall have passed by, as pass it will, like all
other fashions before it, and this hobby shall have ceased to be
ridden, how little will be the actual knowledge of diseases of the
throat and windpipe, which will be found to be added to the stock
of information in the possession of the profession by those, who
have now the reputation in the community of being very skilful in
the treatment of these complaints! Some, who have had less eclat,
and have therefore reaped less pecuniary benefit, will have made the
proper discriminations; and to them will the profession be indebted
for all that has been really discovered in relation to the nature and
treatment of these diseases.
A habit of making loose and exaggerated statements has become
so common in the medical profession, that it is really no small
obstacle in the way of the accumulation of accurate observations in
medicine. The credulity of the public tempts to an indulgence in such
statements, in the common intercourse of physicians with those who
are around them, and to whom they relate their cases, and state the
results of their experience. If they yield to the temptation, the
habit grows, and it inevitably begets and fosters another habit—that
of loose observation. The statements of such physicians are not to
be relied upon, even when they appear on the pages of some medical
journal. Much of the recorded experience of the profession is
undoubtedly from this cause worse than valueless.
I mention as another very common cause of inaccurate observation
in medicine, an easy credulity, and a consequent fondness for
novelty and change. It is a very prevalent opinion that the medical
profession is opposed, as a general thing, to anything which is
new, and that it really thus stands in the way of the march of
improvement. This may have been true once, when the authority of
antiquity held an almost undisputed supremacy over all the votaries
of learning and science. But it is far from being true now. One of
the prominent faults of the medical profession in the nineteenth
century is, on the other hand, that it is as a body too fond of
new things, and too much disposed to receive them upon doubtful
evidence. There is a great disposition to hail every new remedy with
enthusiasm. The annals of medicine are therefore burdened with false
statements in regard to the effects of remedies. Though the public
think that there have been of late many discoveries of new medicines
of great value, there really have been but few. There have been many
improvements in the _forms_ of medicines. I mention as examples,
quinine and morphine, the active principles of bark and opium. But
there have been but few absolutely new medicines introduced which are
of any importance. Many have been announced with much flourish, and
have been extensively used for a time, but the confidence which has
been put in them has in most cases been found to be misplaced. And
it may be remarked, that physicians, who try all the new remedies
recommended from time to time in medical journals, do not add so much
to their stock of available experience, as those do who are more
cautious, and less ready to adopt everything which is new.
The science of medicine, in all its departments, is in a very
changeable state. The discoveries, which are made from time to
time in anatomy, physiology, and pathology, the theories which
are put forth, and the new remedies, and modes of treatment which
are continually proposed, keep up a constant excitement in the
profession. In this unsettled state of things, with so many novelties
to attract the attention, the temptation is so strong to act as a
mere gazer, and, setting aside the labor of investigation, to adopt
what is asserted upon deficient evidence, that there is the more
need of maintaining that cautious observation, which is the only
preventive of error.
I cannot forbear to notice here one circumstance, which exerts a
great influence in favoring the unsettled state of medicine, and
consequently in encouraging the fondness for new things. I refer
to the fact, that there are no authorities, properly so called in
medicine. The theologian has his standard authors, who are a kind of
authority to which he appeals, and above all, he has the Bible as an
unerring standard, and every opinion which is advanced he can bring
to this test. The lawyer also has his standard works, in which are
embodied the principles of law, and they are settled authorities to
which he can appeal. In medicine, on the other hand, though there are
works which contain the principles of the science, they have none of
that fixed and undisputed authority, which standard works on other
subjects are apt to have. There is therefore a contempt of authority
in matters of opinion in medicine tolerated by the community, and
even by the profession, which is not tolerated in regard to any
other subject. While the lawyer appeals to ‘the law,’ and the divine
to ‘the law and the testimony,’ the doctor often assumes the right
of disputing all authorities from Hippocrates down to the present
time. If a lawyer should, with bold and thoughtless assurance,
call in question a decision of Chief Justice Marshall, he would be
treated with contempt by both the bar and the community. But the most
ignorant pretender in medicine may even gain credit, and what is of
more importance to him, money too, by setting up a bold front against
the whole faculty, and declaring, as Hahneman and Thompson each has
done, that the medical world was in total darkness till he arose
to enlighten it. So in theology, such gross delusions as Mormonism
and Millerism are looked upon with mingled pity and contempt by the
public, and yet that same public will patronize delusions in medicine
which are not a whit less fanciful and ridiculous.[31]
One more cause of inaccurate observation remains to be noticed. It is
one, however, which, at the present time at least, is so uncommon,
that it cannot have any extensive influence. I refer to scepticism.
When it does exist, it not only narrows the limits of knowledge, but
actually leads to positive error. The sceptic, in his demand for
stern, fixed facts, rejects some facts, which are established by
evidence that is sufficient to satisfy any mind possessed of candor
and common sense; and the rejection of a well-proved fact, being
itself an error, must necessarily lead to other errors. The sceptic
too, with all his doubting, is always, to some extent, and on some
points, a credulous man. As he doubts on some points against clear
evidence, so he will assuredly believe on others against evidence
just as clear. His beliefs are no more worthy of confidence than his
doubts. The sceptic is therefore disqualified by his scepticism for
accurate observation. This is especially true in the practice of
medicine, because, as you have seen, there is so much uncertainty in
it, and the physician is obliged to base so much of his treatment
upon probabilities. Some one has said, that the best guesser is the
best practitioner. There is some truth in this remark, though it is
of course by no means strictly true. It is well for the physician to
guess when facts are wanting, but he must be careful not to esteem
his guesses to be facts, as is too often done.
In medicine, as well as in every other science, but little mental
effort is required to frame theories. All the hard work which is
done—the work by which all knowledge is accumulated—is the work of
_observation_. It therefore needs a higher order of mind to ascertain
facts and their relationships, than it does to theorize. “Any man,”
says Pott, an eminent English surgeon, “may give an opinion, but it
is not every mind that is qualified to collect and arrange important
facts.”
It is important that the physician should have at the outset good
habits of observation. If he does, every day’s experience will add
to his store of facts, and at the same time relieve it from some of
the chaff of error which has been brought in unawares. _He will be
all the time becoming a better practitioner._ But, on the other hand,
if he start with a loose habit of observation, experience will be
to him a source of error. He will have no _clean store_ of facts,
but he will garner in a strange mixture of facts, and suppositions,
and errors; and every day’s experience will add to the difficulty of
separating the good grain from the mass of refuse, with which it is
mingled. _He will be all the time becoming a poorer practitioner._
The idea then that experience will _at any rate_ confer knowledge is
a false idea. It is not true, that the old physician, _as a matter of
course_, knows more than he did when he was young. If he has observed
well, he does know more; but if he has not observed well, he not only
does not know more, but he knows less. In the latter case, he may
indeed have more ideas and opinions than he had when he began his
practice, but he does not know as many real ascertained facts, and
those which he does know are so encumbered with the long accumulating
rubbish of error, that they are of little use to him.
It is easier to adopt a theory with a corresponding system of
remedial means, or even to originate one, than it is to encounter
the labor of strict daily observation at the bedside of the sick.
Many physicians pursue the former course, and go through with a
routine of practice from year to year. If they have some tact in
managing the capricious credulity of the public, they succeed
in attaining the object at which they aim. These followers of a
_system_ are generally considered by the community as very rational
and scientific men. Some of them, though they live on the opinions
advanced, and the facts discovered by others, contrive to get up
quite a reputation for originality, by making so much account of
these opinions and facts, that the public awards to them, in part at
least, the credit of their discovery. It gives them a sort of eclat
to stand out from their medical brethren, as the advocates of some
peculiarity of doctrine or practice.
The medical profession has had too much to do with theories, and
modes, and systems. Every prominent theory can be shown to be
unsubstantiated by facts, and is therefore valueless. Every mode, or
system of practice, however numerous are the facts which are adduced
for its support, can be shown to exclude many facts of a valuable
character; and being thus exclusive, it must lead to practical error.
_All these systems therefore should be discarded._ A true eclecticism
should be introduced into medicine, and it should have relation not
to opinions and theories, but to facts only. Whenever a fact is
really ascertained, it should be treasured up in the storehouse,
ready for practical use. If it be apparently inconsistent with other
facts, this is no reason for rejecting it. If it be really proved,
it should be received, and its consistency with other facts may
afterward be discovered. Indeed, quite a large proportion of the
facts practically applied in medicine, are _independent_ facts,
neither explained themselves, nor capable as yet of being used in
the explanation of other facts. I have alluded to this point before.
A single example here will suffice. No fact in medicine is better
established than that arsenic in almost all cases cures hemicrania,
or periodical neuralgia on one side of the head. How or why it does
this no one knows. The bare fact is known.
In this connexion I will make a remark or two upon a subject which
is often the topic of conversation in common as well as professional
circles, viz., the modus operandi of medicines, or the mode by which
they cure disease. It is a common, but a very erroneous idea, that
this subject is easily understood, and much reproach is cast upon
physicians for their differences of opinion in relation to it. The
modus operandi of many remedies is, as I have already said, wholly
unknown, and the knowledge which we have of it in any case is more
or less imperfect. And after all, though it may gratify curiosity to
know _how_ a medicine cures disease, it is comparatively a matter of
little importance. The fact that it does so is the material fact. The
knowledge, which it is practically important to obtain in relation to
any remedy, is a knowledge of its effects, and of the circumstances
which modify them. And physicians, however much they may speculate
about the modus operandi of medicines, commonly view this subject in
this practical light at the bedside of the sick. The question whether
opium is essentially a sedative or a stimulant is forgotten, when a
patient suffering the tortures of spasmodic colic is to be relieved.
The material fact is, that it can relieve the pain—_how_ it will do
it is not just then a subject of consideration.
A reform is now in progress in the medical profession. The struggle
to break loose from theory is fairly begun. A deep consciousness,
that the science of medicine is cumbered by a mass of rubbish, has
awakened a disposition to a more careful and rigid observation. The
_Materia Medica_ of the profession is especially burdened in this
way. The virtues which are attributed to a large portion of the
remedies in use require to be tested in order to strip the statements
which are made in regard to them of all that is inaccurate and false.
Much of the positive medication of the present day will probably be
proved by the tests of a rigid observation to be _aimless_, but by
no means harmless. The over-dosing, which has been so much in vogue
both with the community and the profession, is already fast losing
its popularity. Heretofore the great object of the physician has
been to do _positive good_ to the patient—to overcome disease by a
well-directed onset of _heroic_ remedies—and it has been a secondary
object altogether to guard against doing him harm. But medical
practice is becoming reversed in this respect. It may at the present
time be said of quite a large proportion of the profession, that it
is the principal object of the physician to avoid doing harm to the
patient, and to prevent harm from being done to him by himself and
by his friends: and then, after looking well to this object, he is
ready to do whatever positive good he sees can be done in the case.
Accordingly, cautionary and quieting measures, intended to remove
the obstacles which may hinder the operation of the curative power
of nature, are getting to predominate in medical treatment over the
more active and direct measures for overcoming disease. ‘The golden
axiom of Chomel, that it is only the _second_ law of therapeutics _to
do good_, its _first_ law being this—_not to do harm_—is gradually
finding its way into the medical mind, preventing an incalculable
amount of positive ill.’ So remarks Dr. Bartlett in a work,[32] which
I deem to be one of the best and most effectual efforts, which have
been made in promoting the revolution, which is now taking place in
the practice of medicine. It is a work which, if I mistake not, is
to exert a thorough and extensive influence upon the interests of
medical science.
I cannot conclude this chapter without paying a passing tribute
to the memory of one, my preceptor and friend, who stood among
the foremost in the work of reform now going on in the medical
profession. I refer to the late Dr. Hale,[33] of Boston. He was
eminently a man of accurate observation. His enquiry always was
after the _facts_. He asked not what a man _supposed_, but what he
had _observed_—not what he _thought_, but what he had _found to be
true_. His valuable contributions to the recorded experience, and
the literature of the profession, bear him witness on this point.
His labors, so deservedly prized by his brethren, are ended, but we
have reason to rejoice, that he has left behind him so many of a like
spirit, who are endeavoring to redeem our science from the dominion
of fanciful theory and loose reasoning, and to place it under the
control of a true and rigid OBSERVATION.
FOOTNOTES:
[29] Hunter in one of his lectures thus speaks playfully, but most
truthfully of the various _theories_ of digestion, which have arisen
from exclusive views of different sets of facts. “Some physiologists
will have it that the stomach is a mill;—others, that it is a
fermenting vat;—others again, that it is a stew-pan; but in my
view of the matter, it is neither a mill, a fermenting vat, nor a
stew-pan—but a _Stomach_, gentleman, a _stomach_.”
[30] If this be a suitable charge for this operation, it would be
proper to ask at least an hundred dollars for extracting a tooth, if
the prices of operations are to be regulated by their magnitude, or
by the amount of skill required in performing them.
[31] ‘Have you ever looked into Homœopathy,—have you ever read
Hahneman’s Organon?’ said an eminent divine to an equally eminent
physician. ‘No,’ replied the physician, ‘and let me ask you, in
return, if you have read the Mormon Bible?’ The clergyman of course
answered in the negative, and his medical friend said to him very
properly, ‘when you take the trouble to examine Joe Smith’s Bible, I
will take the trouble to examine Hahneman’s Organon.’
[32] An Essay on the Philosophy of Medical Science.
[33] The reader will permit the author to gratify his own feelings of
regard for Dr. Hale as a _man_, as well as a physician, by inserting
here the following extract from the memoir of him, from the pen of
Dr. Channing. “Dr. Hale was an honest man. He was honest in sentiment
and in purpose. He had little or no tolerance for what he thought
unfair; and any believed misuse or abuse of trusts he resolutely
opposed, however active or however strong was the agency by which the
wrong was attempted to be consummated. These were not the elements
of popularity. You could hardly make a very popular man out of such.
But for the honor and exceeding praise of humanity, there are men
who have found something better worth living for than the present
fame—men who are happy and satisfied to do that which may live after
them, and the memory and the use of which can only be for good. Dr.
Hale enjoyed life—the best thank-offering for living. He was social
and hospitable, for he would contribute to the pleasure of others,
as well as his own. He was always cheerful, because he was truly
hopeful. He looked on the bright side of disease in himself and
in others; and if he labored so well for their recovery, he never
questioned his own.
Dr. Hale was a religious man. In the development of the religious
sentiment was his power. It was kept active by habitual, daily
devotion. It influenced his whole life, making him an earnest student
and a faithful practitioner—giving him strong interest in all wise
effort to extend Christianity in distant lands, and by his example
recommending to others the religious life. In his religion was his
benevolence, which with very narrow fortune led him to attempt and to
accomplish most important objects. In this was his cheerfulness in
suffering and all trial; and out of his religion came the peace and
the hope of his death hour.”