THE MAN OF SCIENCE.
"What decided me," says Doctor Holmes, "to give up Law and apply myself
to Medicine, I can hardly say, but I had from the first looked upon my
law studies as an experiment. At any rate, I made the change, and soon
found myself introduced to new scenes and new companionships.
"I can scarcely credit my memory when I recall the first impressions
produced upon me by sights afterwards become so familiar that they could
no more disturb a pulse-beat than the commonest of every-day
experiences. The skeleton, hung aloft like a gibbeted criminal, looked
grimly at me as I entered the room devoted to the students of the school
I had joined, just as the fleshless figure of Time, with the hour-glass
and scythe, used to glare upon me in my childhood from the _New England
Primer_. The white faces in the beds at the Hospital found their
reflection in my own cheeks which lost their color as I looked upon
them. All this had to pass away in a little time; I had chosen my
profession, and must meet all its aspects until they lost their power
over my sensibility....
"After attending two courses of lectures in the School of the
University, I went to Europe to continue my studies. I can hardly
believe my own memory when I recall the old practitioners and professors
who were still going round the hospitals when I mingled with the train
of students in the Ecole de Medicine."
Of the famous Baron Boyer, author of a nine-volumed book on surgery,
Doctor Holmes says, "I never saw him do more than look as if he wanted
to cut a good collop out of a patient he was examining." Baron Larrey,
the favorite surgeon of Napoleon, he describes as a short, square,
substantial man, with iron-gray hair, red face, and white apron. To go
round the Hotel des Invalides with Larrey was to live over the campaign
of Napoleon, to look on the sun of Austerlitz, to hear the cannon of
Marengo, to struggle through the icy waters of the Beresina, to shiver
in the snows of the Russian retreat, and to gaze through the battle
smoke upon the last charge of the red lancers on the redder field of
Waterloo.
Then there was Baron Dupuytren, "_ce grand homme de lautre cote de la
riviere_,--with his high, full-doomed head and oracular utterances;
Lisfrance, the great drawer of blood and hewer of members; Velpeau, who,
coming to Paris in wooden shoes, and starving, almost, at first, raised
himself to great eminence as surgeon and author; Broussais, the
knotty-featured, savage old man who reminded one of a volcano, which had
well-nigh used up its fire and brimstone, and Gabriel Audral, the rapid,
fluent, fervid and imaginative speaker.
"The object of our reverence, however, I might almost say idolatry,"
adds Doctor Holmes, "was Pierre Charles Alexandre Louis, a tall, rather
spare, dignified personage, of serene and grave aspect, but with a
pleasant smile and kindly voice for the student with whom he came into
personal relations.
"If I summed up the lessons of Louis in two expressions, they would be
these: First, always make sure that you form a distinct and clear idea
of the matter you are considering. Second, always avoid vague
approximations where exact estimates are possible....
"Yes, as I say, I look back on the long hours of the many days I spent
in the wards and in the autopsy room of La Pitie, where Louis was one
of the attending physicians--yes, Louis did a great work for practical
medicine. Modest in the presence of nature, fearless in the face of
authority, unwearying in the pursuit of truth, he was a man whom any
student might be happy and proud to claim as his teacher and his friend.
And yet, as I look back on the days when I followed his teachings, I
feel that I gave myself up too exclusively to his methods of thought and
study. There is one part of their business that certain medical
practitioners are too apt to forget; namely, that what they should most
of all try to do is to ward off disease, to alleviate suffering, to
preserve life, or at least to prolong it if possible. It is not of the
slightest interest to the patient to know whether three or three and a
quarter inches of his lungs are hepatized. His mind is not occupied with
thinking of the curious problems which are to be solved by his own
autopsy, whether this or that strand of the spinal marrow is the seat of
this or that form of degeneration. He wants something to relieve his
pain, to mitigate the anguish of dyspnaea, to bring back motion and
sensibility to the dead limb, to still the tortures of neuralgia. What
is it to him that you can localize and name by some uncouth term, the
disease which you could not prevent and which you can not cure? an old
woman who knows how to make a poultice and how to put it on, and does it
_tuto_, _cito_, _jucunde_, just when and where it is wanted, is
better--a thousand times better in many cases--than a staring
pathologist who explores and thumps and doubts and guesses and tells his
patient he will be better to-morrow, and so goes home to tumble his
books over and make out a diagnosis.
"But in those days I, like most of my fellow students, was thinking much
more of 'science' than of practical medicine, and I believe if we had
not clung so closely to the skirts of Louis, and had followed some of
the courses of men like Rousseau,--therapeutists, who gave special
attention to curative methods, and not chiefly to diagnosis--it would
have been better for me and others. One thing, at any rate, we did learn
in the wards of Louis. We learned that a very large proportion of
diseases get well of themselves, without any special medication--the
great fact formulated, enforced and popularized by Doctor Jacob
Bigelow."
It is well known that Doctor Holmes detests the habit of drugging
practised by so many physicians of the "old school," and in his address
before the Massachusetts Medical Society, entitled Currents and Counter
Currents in Medical Science, he makes a severe attack upon the
inordinate use of medicines.
"What is the honest truth," he says at another time, "about the medical
art? By far the largest number of diseases which physicians are called
to treat will get well at any rate, even in spite of reasonably bad
treatment. Of the other fraction, a certain number will inevitably die,
whatever is done: there remains a small margin of cases where the life
of the patient depends on the skill of the physician. Drugs now and then
save life; they often shorten disease and remove symptoms; but they are
second in importance to food, air, temperature, and the other hygienic
influences. That was a shrewd trick of Alexander's physician on the
occasion of his attack after bathing. He asked three days to prepare his
medicine. Time is the great physician as well as the great consoler.
Sensible men in all ages have trusted most to nature."
Of quacks and other humbugs, Doctor Holmes had an undisguised, wholesome
contempt.
"Shall we try," he says, "the medicines advertised with the certificates
of justices of the peace, of clergymen, or even members of Congress?
Certainly, it may be answered, any one of them which makes a good case
for itself. But the difficulty is, that the whole class of commercial
remedies are shown by long experience, with the rarest exceptions, to be
very sovereign cures for empty pockets, and of no peculiar efficacy for
anything else. You may be well assured that if any really convincing
evidence was brought forward in behalf of the most vulgar nostrum, the
chemists would go at once to work to analyze it, the physiologists to
experiment with it, and the young doctors would all be trying it on
their own bodies, if not on their patients. But we do not think it worth
while, as a general rule, to send a Cheap Jack's gilt chains and lockets
to be tested for gold. We know they are made to sell, and so with the
pills and potions.... Think how rapidly any real discovery is
appropriated and comes into universal use. Take anaesthetics, take the
use of bromide of potassium, and see how easily they obtained
acceptance. If you are disposed to think any of the fancy systems has
brought forward any new remedy of value which the medical profession has
been slow to accept, ask any fancy practitioner to name it. Let him
name one,--the best his system claims,--not a hundred, but one. A single
new, efficient, trustworthy remedy which the medical profession can test
as they are ready to test before any scientific tribunal, opium,
quinine, ether, the bromide of potassium. There is no such remedy on
which any of the fancy practitioners dare stake his reputation. If there
were, it would long ago have been accepted, though it had been flowers
of brimstone from the borders of Styx or Cocytus."
Homoeopathy is classed by Doctor Holmes among such "Kindred Delusions"
as the Royal Cure for the King's Evil, the Weapon Ointment, the
Sympathetic Powder, the Tar-water mania of Bishop Berkeley, and the
Metallic Tractors, or Perkinsism.
In making a direct attack upon the pretentions of Homoeopathy, Doctor
Holmes declares at the outset that he shall treat it not by ridicule,
but by argument; with great freedom, but with good temper and in
peaceable language.
_Similia similibus curantur._ Like cures like, is one of the fundamental
principles of Homoeopathy, and "improbable though it may seem to
some," says Doctor Holmes with his usual impartial fairness, "there is
no essential absurdity involved in the proposition that diseases yield
to remedies capable of producing like symptoms. There are, on the other
hand, some analogies which lend a degree of plausibility to the
statement. There are well-ascertained facts, known from the earliest
periods of medicine, showing that under certain circumstances, the very
medicine which from its known effects, one would expect to aggravate the
disease, may contribute to its relief. I may be permitted to allude, in
the most general way, to the case in which the spontaneous efforts of an
over-tasked stomach are quieted by the agency of a drug which that organ
refuses to entertain upon any terms. But that _every_ cure ever
performed by medicine should have been founded upon this principle,
although without the knowledge of a physician, that the Homoeopathy
axiom is, as Hahnemann asserts, "the _sole_ law of nature in
therapeutics," a law of which nothing more than a transient glimpse ever
presented itself to the innumerable host of medical observers, is a
dogma of such sweeping extent and pregnant novelty, that it demands a
corresponding breath and depth of unquestionable facts to cover its vast
pretensions."
Among the many facts of which great use has been made by the
Homoeopathists, is that found in the precept given for the treatment
of parts which have been frozen, by friction with snow, etc.
"But," says Doctor Holmes, "we deceive ourselves by names, if we suppose
the frozen part to be treated by cold, and not by heat. The snow may
even be actually _warmer_ than the part to which it is applied. But even
if it were at the same temperature when applied, it never did and never
could do the least good to a frozen part, except as a mode of regulating
the application of what? of _heat_. But the heat must be applied
_gradually_, just as food must be given a little at a time to those
perishing with hunger. If the patient were brought into a warm room,
heat would be applied _very rapidly_, were not something interposed to
prevent this, and allow its gradual admission. Snow or iced water is
exactly what is wanted; it is not cold to the part; it is very possibly
warm, on the contrary, for these terms are relative, and if it does not
melt and let the heat in, or is not taken away, the part will remain
frozen up until doomsday. Now the treatment of a frozen limb by heat, in
large or small quantities, is not Homoeopathy."
Another supposed illustration of the Homoeopathic law is the alleged
successful management of burns, by holding them to the fire. "This is a
popular mode of treating those burns which are of too little consequence
to require any more efficacious remedy, and would inevitably get well of
themselves, without any trouble being bestowed upon them. It produces a
most acute pain in the part, which is followed by some loss of
sensibility, as happens with the eye after exposure to strong light, and
the ear after being subjected to very intense sounds. This is all it is
capable of doing, and all further notions of its efficacy must be
attributed merely to the vulgar love of paradox. If this example affords
any comfort to the Homoeopathist, it seems as cruel to deprive him of
it as it would be to convince the mistress of the smoke-jack or the
flatiron that the fire does not literally draw the fire out, which is
her hypothesis.
"But if it were true that frost-bites were cured by cold and burns by
heat, it would be subversive, so far as it went, of the great principle
of Homoeopathy. For you will remember that this principle is that
_Like_ cures _Like_, and not that _Same_ cures _Same_; that there is
_resemblance_ and not _identity_ between the symptoms of the disease and
those produced by the drug which cures it, and none have been readier to
insist upon this distinction than the Homoeopathists themselves. For
if _Same_ cures _Same_, then every poison must be its own
antidote,--which is neither a part of their theory nor their so-called
experience. They have been asked often enough, why it was that arsenic
could not cure the mischief which arsenic had caused, and why the
infectious cause of small-pox did not remedy the disease it had
produced, and then they were ready enough to see the distinction I have
pointed out. "O no! it was not the hair of the same dog, but only of one
very much like him!"
The belief in and employment of the "Infinitesimal doses," Doctor Holmes
handles with the same fairness and acumen; but the absurd idea affirmed
by Hahnemann that Psora is the cause of the great majority of chronic
diseases, he treats as it deserves, with unqualified contempt.
In conclusion, he says, "As one humble member of a profession which for
more than two thousand years has devoted itself to the pursuit of the
best earthly interests of mankind always assailed and insulted from
without by such as are ignorant of its infinite perplexities and labors,
always striving in unequal contest with the hundred armed giants who
walk in the noonday and sleep not in the midnight, yet still toiling not
merely for itself and the present moment, but for the race and the
future, I have lifted up my voice against this lifeless delusion,
rolling its shapeless bulk into the path of a noble science it is too
weak to strike or to injure."
Upon the contagiousness of Puerperal Fever, Doctor Holmes wrote an able
treatise some forty years ago. This was reprinted with some additions,
in 1855, and in an introductory note which accompanies the still later
addition (1883), Doctor Holmes says, "The subject of this Paper has the
same profound interest for me at the present moment as it had when I
was first collecting the terrible evidence out of which, as it seems to
me, the commonest exercise of reason could not help shaping the truth it
involved. It is not merely on account of the bearing of the question--if
there is a question--on all that is most sacred in human life and
happiness that the subject cannot lose its interest. It is because it
seems evident that a fair statement of the facts must produce its
proportion of well-constituted and unprejudiced minds."
The essay, a most valuable one, is republished without the change of a
word or syllable, as the author upon reviewing finds that it anticipates
and eliminates those secondary questions which cannot be for a moment
entertained until the one great point of fact is peremptorily settled.
There are but very few subjects, indeed, in medical science, that Doctor
Holmes has not investigated, and investigated, too, most thoroughly....
In his article on "Reflex Vision," published in Volume IV. of the
Proceedings of the American Academy, will be found a very interesting
account of his experiments in optics. One, indeed, that will both
interest and instruct.
To him, as is well known, we are indebted for numerous improvements in
the stereoscope; and in microscopes also, he has done some original and
important work.
Said an admirer of Doctor Holmes in referring to his career as a medical
professor:
"He always makes people attentive, and I have been told that there is no
professor whom the students so much like to listen to. In one of his
books he says that every one of us is three persons, and I think that if
the statement is true in regard to ordinary men and women, Doctor Holmes
himself is at least half a dozen persons. He lectures so well on anatomy
that his students never suspect him to be a poet, and he writes verses
so well that most people do not suspect him of being an authority among
scientific men. Though he illustrates his medical lectures by quotations
of the most appropriate and interesting sort, from a wonderful variety
of authors, he has never been known to refer to his own writings in that
way."
In celebrating the silver anniversary year of his wedding with the Muse
of the monthlies--meaning his reappearance in the _Atlantic_--he
observed that during the larger part of his absence, his time had been
in a great measure occupied with other duties. "I never forgot the
advice of Coleridge," he said, "that a literary man should have a
regular calling. I may say, in passing, that I have often given the
advice to others, and too often wished that I could supplement it with
the words, "And confine himself to it.'"