On the side of "Nature" we have had, first of all, that remarkable

discourse on Self-Limited Diseases, [On Self-Limited Diseases. A

Discourse delivered before the Massachusetts Medical Society, at their

Annual Meeting, May 27, 1835. By Jacob Bigelow, M. D.] which has given

the key-note to the prevailing medical tendency of this neighborhood, at

least, for the quarter of a century since it was delivered. Nor have we

forgotten the address delivered at Springfield twenty years later,

[Search out the Secrets, of Nature. By Augustus A. Gould, M. D. Read

at the Annual Meeting, June 27, 1855.] full of good sense and useful

suggestions, to one of which suggestions we owe the learned, impartial,

judicious, well-written Prize Essay of Dr. Worthington Hooker. [Rational

Therapeutics. A Prize Essay. By Worthington Hooker, M. D., of New

Haven. Boston. 1857.] We should not omit from the list the important

address of another of our colleagues, [On the Treatment of Compound and

Complicated Fractures. By William J. Walker, M. D. Read at the Annual

Meeting, May 29, 1845.] showing by numerous cases the power of Nature in

healing compound fractures to be much greater than is frequently

supposed,--affording, indeed, more striking illustrations than can be

obtained from the history of visceral disease, of the supreme wisdom,

forethought, and adaptive dexterity of that divine Architect, as shown in

repairing the shattered columns which support the living temple of the

body.

We who are on the side of "Nature" please ourselves with the idea that we

are in the great current in which the true intelligence of the time is

moving. We believe that some who oppose, or fear, or denounce our

movement are themselves caught in various eddies that set back against

the truth. And we do most earnestly desire and most actively strive,

that Medicine, which, it is painful to remember, has been spoken of as

"the withered branch of science" at a meeting of the British Association,

shall be at length brought fully to share, if not to lead, the great wave

of knowledge which rolls with the tides that circle the globe.

If there is any State or city which might claim to be the American

headquarters of the nature-trusting heresy, provided it be one, that

State is Massachusetts, and that city is its capital. The effect which

these doctrines have upon the confidence reposed in the profession is a

matter of opinion. For myself, I do not believe this confidence can be

impaired by any investigations which tend to limit the application of

troublesome, painful, uncertain, or dangerous remedies. Nay, I will

venture to say this, that if every specific were to fail utterly, if the

cinchona trees all died out, and the arsenic mines were exhausted, and

the sulphur regions were burned up, if every drug from the vegetable,

animal, and mineral kingdom were to disappear from the market, a body of

enlightened men, organized as a distinct profession, would be required

just as much as now, and respected and trusted as now, whose province

should be to guard against the causes of disease, to eliminate them if

possible when still present, to order all the conditions of the patient

so as to favor the efforts of the system to right itself, and to give

those predictions of the course of disease which only experience can

warrant, and which in so many cases relieve the exaggerated fears of

sufferers and their friends, or warn them in season of impending danger.

Great as the loss would be if certain active remedies could no longer be

obtained, it would leave the medical profession the most essential part

of it's duties, and all, and more than all, its present share of honors;

for it would be the death-blow to charlatanism, which depends for its

success almost entirely on drugs, or at least on a nomenclature that

suggests them.

There is no offence, then, or danger in expressing the opinion, that,

after all which has been said, the community is still overdosed: The best

proof of it is, that "no families take so little medicine as those of

doctors, except those of apothecaries, and that old practitioners are

more sparing of active medicines than younger ones." [Dr. James Jackson

has kindly permitted me to make the following extract from a letter just

received by him from Sir James Clark, and dated May 26, 1860: "As a

physician advances in age, he generally, I think, places less confidence

in the ordinary medical treatment than he did, not only during his early,

but even his middle period of life."] The conclusion from these facts is

one which the least promising of Dr. Howe's pupils in the mental

department could hardly help drawing.

Part of the blame of over-medication must, I fear, rest with the

profession, for yielding to the tendency to self-delusion, which seems

inseparable from the practice of the art of healing. I need only touch

on the common modes of misunderstanding or misapplying the evidence of

nature.

First, there is the natural incapacity for sound observation, which is

like a faulty ear in music. We see this in many persons who know a good

deal about books, but who are not sharp-sighted enough to buy a horse or

deal with human diseases.

Secondly, there is in some persons a singular inability to weigh the

value of testimony; of which, I think, from a pretty careful examination

of his books, Hahnemann affords the best specimen outside the walls of

Bedlam.

The inveterate logical errors to which physicians have always been

subject are chiefly these:

The mode of inference per enumerationem simplicem, in scholastic phrase;

that is, counting only their favorable cases. This is the old trick

illustrated in Lord Bacon's story of the gifts of the shipwrecked people,

hung up in the temple.--Behold! they vowed these gifts to the altar, and

the gods saved them. Ay, said a doubting bystander, but how many made

vows of gifts and were shipwrecked notwithstanding? The numerical system

is the best corrective of this and similar errors. The arguments

commonly brought against its application to all matters of medical

observation, treatment included, seem to apply rather to the tabulation

of facts ill observed, or improperly classified, than to the method

itself.

The post hoc ergo propter hoc error: he got well after taking my

medicine; therefore in consequence of taking it.

The false induction from genuine facts of observation, leading to the

construction of theories which are then deductively applied in the face

of the results of direct observation. The school of Broussais has

furnished us with a good example of this error.

And lastly, the error which Sir Thomas Browne calls giving "a reason of

the golden tooth;" that is, assuming a falsehood as a fact, and giving

reasons for it, commonly fanciful ones, as is constantly done by that

class of incompetent observers who find their "golden tooth" in the

fabulous effects of the homoeopathie materia medica,--which consists of

sugar of milk and a nomenclature.

Another portion of the blame rests with the public itself, which insists

on being poisoned. Somebody buys all the quack medicines that build

palaces for the mushroom, say rather, the toadstool millionaires. Who is

it? These people have a constituency of millions. The popular belief is

all but universal that sick persons should feed on noxious substances.

One of our members was called not long since to a man with a terribly

sore mouth. On inquiry he found that the man had picked up a box of

unknown pills, in Howard Street, and had proceeded to take them, on

general principles, pills being good for people. They happened to

contain mercury, and hence the trouble for which he consulted our

associate.

The outside pressure, therefore, is immense upon the physician, tending

to force him to active treatment of some kind. Certain old

superstitions, still lingering in the mind of the public, and not yet

utterly expelled from that of the profession, are at the bottom of this,

or contribute to it largely. One of the most ancient is, that disease is

a malignant agency, or entity, to be driven out of the body by offensive

substances, as the smoke of the fish's heart and liver drove the devil

out of Tobit's bridal chamber, according to the Apochrypha. Epileptics

used to suck the blood from the wounds of dying gladiators. [Plinii Hist.

Mundi. lib. xxviii. c. 4.] The Hon. Robert Boyle's little book was

published some twenty or thirty years before our late President, Dr.

Holyoke, was born. [A Collection of Choice and Safe Remedies. The Fifth

Edition, corrected. London, 1712. Dr. Holyoke was born in 1728.] In it

he recommends, as internal medicines, most of the substances commonly

used as fertilizers of the soil. His "Album Graecum" is best left

untranslated, and his "Zebethum Occidentale" is still more

transcendentally unmentionable except in a strange dialect. It sounds

odiously to us to hear him recommend for dysentery a powder made from

"the sole of an old shoe worn by some man that walks much." Perhaps

nobody here ever heard of tying a stocking, which had been worn during

the day, round the neck at night for a sore throat. The same idea of

virtue in unlovely secretions! [The idea is very ancient. "Sordes

hominis" "Sudore et oleo medicinam facientibus."--Plin. xxviii. 4.]

Even now the Homoeopathists have been introducing the venom of serpents,

under the learned title of Lachesis, and outraging human nature with

infusions of the pediculus capitis; that is, of course, as we understand

their dilutions, the names of these things; for if a fine-tooth-comb

insect were drowned in Lake Superior, we cannot agree with them in

thinking that every drop of its waters would be impregnated with all the

pedicular virtues they so highly value. They know what they are doing.

They are appealing to the detestable old superstitious presumption in

favor of whatever is nauseous and noxious as being good for the sick.

Again, we all occasionally meet persons stained with nitrate of silver,

given for epilepsy. Read what Dr. Martin says, about the way in which it

came to be used, in his excellent address before the Norfolk County

Medical Society, and the evidence I can show, but have not time for now,

and then say what you think of the practice which on such presumptions

turns a white man as blue as the double-tattooed King of the Cannibal

Islands! [Note A.]

If medical superstitions have fought their way down through all the

rationalism and scepticism of the nineteenth century, of course the

theories of the schools, supported by great names, adopted into the

popular belief and incorporated with the general mass of misapprehension

with reference to disease, must be expected to meet us at every turn in

the shape of bad practice founded on false doctrine. A French patient

complains that his blood heats him, and expects his doctor to bleed him.

An English or American one says he is bilious, and will not be easy

without a dose of calomel. A doctor looks at a patient's tongue, sees it

coated, and says the stomach is foul; his head full of the old saburral

notion which the extreme inflammation-doctrine of Broussais did so much

to root out, but which still leads, probably, to much needless and

injurious wrong of the stomach and bowels by evacuants, when all they

want is to be let alone. It is so hard to get anything out of the dead

hand of medical tradition! The mortmain of theorists extinct in science

clings as close as that of ecclesiastics defunct in law.

One practical hint may not be out of place here. It seems to be

sometimes forgotten, by those who must know the fact, that the tongue is

very different, anatomically and physiologically, from the stomach. Its

condition does not in the least imply a similar one of the stomach, which

is a very different structure, covered with a different kind of

epithelium, and furnished with entirely different secretions. A

silversmith will, for a dollar, make a small hoe, of solid silver, which

will last for centuries, and will give a patient more comfort, used for

the removal of the accumulated epithelium and fungous growths which

constitute the "fur," than many a prescription with a split-footed Rx

before it, addressed to the parts out of reach.

I think more of this little implement on account of its agency in saving

the Colony at Plymouth in the year 1623. Edward Winslow heard that

Massasoit was sick and like to die. He found him with a houseful of

people about him, women rubbing his arms and legs, and friends "making

such a hellish noise" as they probably thought would scare away the devil

of sickness. Winslow gave him some conserve, washed his mouth, scraped

his tongue, which was in a horrid state, got down some drink, made him

some broth, dosed him with an infusion of strawberry leaves and sassafras

root, and had the satisfaction of seeing him rapidly recover. Massasoit,

full of gratitude, revealed the plot which had been formed to destroy the

colonists, whereupon the Governor ordered Captain Miles Standish to see

to them; who thereupon, as everybody remembers, stabbed Pecksuot with his

own knife, broke up the plot, saved the colony, and thus rendered

Massachusetts and the Massachusetts Medical Society a possibility, as

they now are a fact before us. So much for this parenthesis of the

tongue-scraper, which helped to save the young colony from a much more

serious scrape, and may save the Union yet, if a Presidential candidate

should happen to be taken sick as Massasoit was, and his tongue wanted

cleaning,--which process would not hurt a good many politicians, with or

without a typhoid fever.

Again, see how the "bilious" theory works in every-day life here and now,

illustrated by a case from actual life. A youthful practitioner, whose

last molars have not been a great while cut, meets an experienced and

noted physician in consultation. This is the case. A slender, lymphatic

young woman is suckling two lusty twins, the intervals of suction being

occupied on her part with palpitations, headaches, giddiness, throbbing

in the head, and various nervous symptoms, her cheeks meantime getting

bloodless, and her strength running away in company with her milk. The

old experienced physician, seeing the yellowish waxy look which is common

in anaemic patients, considers it a "bilious" case, and is for giving a

rousing emetic. Of course, he has to be wheedled out of this, a recipe

is written for beefsteaks and porter, the twins are ignominiously

expelled from the anaemic bosom, and forced to take prematurely to the

bottle, and this prolific mother is saved for future usefulness in the

line of maternity.

The practice of making a profit on the medicine ordered has been held up

to reprobation by one at least of the orators who have preceded me. That

the effect of this has been ruinous in English practice I cannot doubt,

and that in this country the standard of practice was in former

generations lowered through the same agency is not unlikely. I have seen

an old account-book in which the physician charged an extra price for

gilding his rich patients' pills. If all medicine were very costly, and

the expense of it always came out of the physician's fee, it would really

be a less objectionable arrangement than this other most pernicious one.

He would naturally think twice before he gave an emetic or cathartic

which evacuated his own pocket, and be sparing of the cholagogues that

emptied the biliary ducts of his own wallet, unless he were sure they

were needed. If there is any temptation, it should not be in favor of

giving noxious agents, as it clearly must be in the case of English

druggists and "General Practitioners." The complaint against the other

course is a very old one. Pliny, inspired with as truly Roman horror of

quackery as the elder Cato,--who declared that the Greek doctors had

sworn to exterminate all barbarians, including the Romans, with their

drugs, but is said to have physicked his own wife to death,

notwithstanding,--Pliny says, in so many words, that the cerates and

cataplasms, plasters, collyria, and antidotes, so abundant in his time,

as in more recent days, were mere tricks to make money.

A pretty strong eddy, then, or rather many eddies, setting constantly

back from the current of sober observation of nature, in the direction of

old superstitions and fancies, of exploded theories, of old ways of

making money, which are very slow to pass out of fashion.

But there are other special American influences which we are bound to

take cognizance of. If I wished to show a student the difficulties of

getting at truth from medical experience, I would give him the history of

epilepsy to read. If I wished him to understand the tendencies of the

American medical mind, its sanguine enterprise, its self-confidence, its

audacious handling of Nature, its impatience with her old-fashioned ways

of taking time to get a sick man well, I would make him read the life and

writings of Benjamin Rush. Dr. Rush thought and said that there were

twenty times more intellect and a hundred times more knowledge in the

country in 1799 than before the Revolution. His own mind was in a

perpetual state of exaltation produced by the stirring scenes in which he

had taken a part, and the quickened life of the time in which he lived.

It was not the state to favor sound, calm observation. He was impatient,

and Nature is profoundly imperturbable. We may adjust the beating of our

hearts to her pendulum if we will and can, but we may be very sure that

she will not change the pendulum's rate of going because our hearts are

palpitating. He thought he had mastered yellow-fever. "Thank God," he

said, "out of one hundred patients whom I have visited or prescribed for

this day, I have lost none." Where was all his legacy of knowledge when

Norfolk was decimated? Where was it when the blue flies were buzzing

over the coffins of the unburied dead piled up in the cemetery of New

Orleans, at the edge of the huge trenches yawning to receive them?

One such instance will do as well as twenty. Dr. Rush must have been a

charming teacher, as he was an admirable man. He was observing, rather

than a sound observer; eminently observing, curious, even, about all

manner of things. But he could not help feeling as if Nature had been a

good deal shaken by the Declaration of Independence, and that American

art was getting to be rather too much for her,--especially as illustrated

in his own practice. He taught thousands of American students, he gave a

direction to the medical mind of the country more than any other one man;

perhaps he typifies it better than any other. It has clearly tended to

extravagance in remedies and trust in remedies, as in everything else.

How could a people which has a revolution once in four years, which has

contrived the Bowie-knife and the revolver, which has chewed the juice

out of all the superlatives in the language in Fourth of July orations,

and so used up its epithets in the rhetoric of abuse that it takes two

great quarto dictionaries to supply the demand; which insists in sending

out yachts and horses and boys to out-sail, out-run, out-fight, and

checkmate all the rest of creation; how could such a people be content

with any but "heroic" practice? What wonder that the stars and stripes

wave over doses of ninety grains of sulphate of quinine, [More strictly,

ninety-six grains in two hours. Dunglison's Practice, 1842, vol. ii. p.

520. Eighty grains in one dose. Ibid. p. 536. Ninety-six grains of

sulphate of quinine are equal to eight ounces of good bark.--Wood &

Bache.] and that the American eagle screams with delight to see three

drachms of calomel given at a single mouthful?

Add to this the great number of Medical Journals, all useful, we hope,

most of them necessary, we trust, many of them excellently well

conducted, but which must find something to fill their columns, and so

print all the new plans of treatment and new remedies they can get hold

of, as the newspapers, from a similar necessity, print the shocking

catastrophes and terrible murders.

Besides all this, here are we, the great body of teachers in the

numberless medical schools of the Union, some of us lecturing to crowds

who clap and stamp in the cities, some of us wandering over the country,

like other professional fertilizers, to fecundate the minds of less

demonstrative audiences at various scientific stations; all of us talking

habitually to those supposed to know less than ourselves, and loving to

claim as much for our art as we can, not to say for our own schools, and

possibly indirectly for our own practical skill. Hence that annual crop

of introductory lectures; the useful blossoming into the ornamental, as

the cabbage becomes glorified in the cauliflower; that lecture-room

literature of adjectives, that declamatory exaggeration, that splendid

show of erudition borrowed from D'Israeli, and credited to Lord Bacon and

the rest, which have suggested to our friends of the Medical Journals an

occasional epigram at our expense. Hence the tendency in these

productions, and in medical lectures generally, to overstate the efficacy

of favorite methods of cure, and hence the premium offered for showy

talkers rather than sagacious observers, for the men of adjectives rather

than of nouns substantive in the more ambitious of these institutions.

Such are some of the eddies in which we are liable to become involved and

carried back out of the broad stream of philosophical, or, in other

words, truth-loving, investigations. The causes of disease, in the mean

time, have been less earnestly studied in the eagerness of the search for

remedies. Speak softly! Women have been borne out from an old-world

hospital, two in one coffin, that the horrors of their prison-house might

not be known, while the very men who were discussing the treatment of the

disease were stupidly conveying the infection from bed to bed, as

rat-killers carry their poisons from one household to another. Do not

some of you remember that I have had to fight this private-pestilence

question against a scepticism which sneered in the face of a mass of

evidence such as the calm statisticians of the Insurance office could not

listen to without horror and indignation? ["The Contagiousness of

Puerperal Fever."--N. E. Quar. Jour. of Medicine and Surgery, April,

1843. Reprinted, with Additions. Boston: Ticknor & Fields. 1855.] Have

we forgotten what is told in one of the books published under our own

sanction, that a simple measure of ventilation, proposed by Dr. John

Clark, had saved more than sixteen thousand children's lives in a single

hospital? How long would it have taken small doses of calomel and

rhubarb to save as many children? These may be useful in prudent hands,

but how insignificant compared to the great hygienic conditions! Causes,

causes, and again causes,--more and more we fall back on these as the

chief objects of our attention. The shortest system of medical practice

that I know of is the oldest, but not the worst. It is older than

Hippocrates, older than Chiron the Centaur. Nature taught it to the first

mother when she saw her first-born child putting some ugly pebble or

lurid berry into its mouth. I know not in what language it was spoken,

but I know that in English it would sound thus: Spit it out!

Art can do something more than say this. It can sometimes reach the

pebble or berry after it has been swallowed. But the great thing is to

keep these things out of children's mouths, and as soon as they are

beyond our reach, to be reasonable and patient with Nature, who means

well, but does not like to hurry, and who took nine calendar months, more

or less, to every mother's son among us, before she thought he was fit to

be shown to the public.

Suffer me now to lay down a few propositions, whether old or new it

matters little, not for your immediate acceptance, nor yet for your hasty

rejection, but for your calm consideration.

But first, there are a number of terms which we are in the habit of using

in a vague though not unintelligible way, and which it is as well now to

define. These terms are the tools with which we are to work, and the

first thing is to sharpen them. It is nothing to us that they have been

sharpened a thousand times before; they always get dull in the using, and

every new workman has a right to carry them to the grindstone and sharpen

them to suit himself.

Nature, in medical language, as opposed to Art, means trust in the

reactions of the living system against, ordinary normal impressions.

Art, in the same language, as opposed to Nature, means an intentional

resort to extraordinary abnormal impressions for the relief of disease.

The reaction of the living system is the essence of both. Food is

nothing, if there is no digestive act to respond to it. We cannot raise

a blister on a dead man, or hope that a carminative forced between his

lips will produce its ordinary happy effect.

Disease, dis-ease,--disturbed quiet, uncomfortableness,--means imperfect

or abnormal reaction of the living system, and its more or less permanent

results.

Food, in its largest sense, is whatever helps to build up the normal

structures, or to maintain their natural actions.

Medicine, in distinction from food, is every unnatural or noxious agent

applied for the relief of disease.

Physic means properly the Natural art, and Physician is only the Greek

synonyme of Naturalist.

With these few explanations I proceed to unfold the propositions I have

mentioned.

Disease and death, if we may judge by the records of creation, are

inherently and essentially necessary in the present order of things. A

perfect intelligence, trained by a perfect education, could do no more

than keep the laws of the physical and spiritual universe. An imperfect

intelligence, imperfectly taught,--and this is the condition of our

finite humanity,--will certainly fail to keep all these laws perfectly.

Disease is one of the penalties of one of the forms of such failure. It

is prefigured in the perturbations of the planets, in the disintegration

of the elemental masses; it has left its traces in the fossil organisms

of extinct creations. [Professor Agassiz has kindly handed me the

following note: "There are abnormal structures in animals of all ages

anterior to the creation of mankind. Malformed specimens of Crinoids are

known from the Triassic and Jurassic deposits. Malformed and diseased

bones of tertiary mammalia have been collected in the caverns of

Gailenreuth with traces of healing."]

But it is especially the prerogative, I had almost said privilege, of

educated and domesticated beings, from man down to the potato, serving to

teach them, and such as train them, the laws of life, and to get rid of

those who will not mind or cannot be kept subject to these laws.

Disease, being always an effect, is always in exact proportion to the sum

of its causes, as much in the case of Spigelius, who dies of a scratch,

as in that of the man who recovers after an iron bar has been shot

through his brain. The one prevalent failing of the medical art is to

neglect the causes and quarrel with the effect.

There are certain general facts which include a good deal of what is

called and treated as disease. Thus, there are two opposite movements of

life to be seen in cities and elsewhere, belonging to races which, from

various persistent causes, are breeding down and tending to run out, and

to races which are breeding up, or accumulating vital capital,--a

descending and an ascending series. Let me give an example of each; and

that I may incidentally remove a common impression about this country as

compared with the Old World, an impression which got tipsy with conceit

and staggered into the attitude of a formal proposition in the work of

Dr. Robert Knox, I will illustrate the downward movement from English

experience, and the upward movement from a family history belonging to

this immediate neighborhood.

Miss Nightingale speaks of "the fact so often seen of a

great-grandmother, who was a tower of physical vigor, descending into a

grandmother perhaps a little less vigorous, but still sound as a bell,

and healthy to the core, into a mother languid and confined to her

carriage and house; and lastly into a daughter sickly and confined to her

bed." So much for the descending English series; now for the ascending

American series.

Something more than one hundred and thirty years ago there graduated at

Harvard College a delicate youth, who lived an invalid life and died at

the age of about fifty. His two children were both of moderate physical

power, and one of them diminutive in stature. The next generation rose

in physical development, and reached eighty years of age and more in some

of its members. The fourth generation was of fair average endowment.

The fifth generation, great-great-grandchildren of the slender invalid,

are several of, them of extraordinary bodily and mental power; large in

stature, formidable alike with their brains and their arms, organized on

a more extensive scale than either of their parents.

This brief account illustrates incidentally the fallacy of the

universal-degeneration theory applied to American life; the same on which

one of our countrymen has lately brought some very forcible facts to bear

in a muscular discussion of which we have heard rather more than is good

for us. But the two series, American and English, ascending and

descending, were adduced with the main purpose of showing the immense

difference of vital endowments in different strains of blood; a

difference to which all ordinary medication is in all probability a

matter of comparatively trivial purport. Many affections which art has

to strive against might be easily shown to be vital to the well-being of

society. Hydrocephalus, tabes mesenterica, and other similar maladies,

are natural agencies which cut off the children of races that are sinking

below the decent minimum which nature has established as the condition of

viability, before they reach the age of reproduction. They are really

not so much diseases, as manifestations of congenital incapacity for

life; the race would be ruined if art could ever learn always to preserve

the individuals subject to them. We must do the best we can for them,

but we ought also to know what these "diseases" mean.

Again, invalidism is the normal state of many organizations. It can be

changed to disease, but never to absolute health by medicinal appliances.

There are many ladies, ancient and recent, who are perpetually taking

remedies for irremediable pains and aches. They ought to have headaches

and back-aches and stomach-aches; they are not well if they do not have

them. To expect them to live without frequent twinges is like expecting

a doctor's old chaise to go without creaking; if it did, we might be sure

the springs were broken. There is no doubt that the constant demand for

medicinal remedies from patients of this class leads to their over-use;

often in the case of cathartics, sometimes in that of opiates. I have

been told by an intelligent practitioner in a Western town, that the

constant prescription of opiates by certain physicians in his vicinity

has rendered the habitual use of that drug in all that region very

prevalent; more common, I should think, than alcoholic drunkenness in the

most intemperate localities of which I have known anything. A frightful

endemic demoralization betrays itself in the frequency with which the

haggard features and drooping shoulders of the opium-drunkards are met

with in the streets.

The next proposition I would ask you to consider is this: The presumption

always is that every noxious agent, including medicines proper, which

hurts a well man, hurts a sick one. [ Note B.]

Let me illustrate this proposition before you decide upon it. If it were

known that a prize-fighter were to have a drastic purgative administered

two or three days before a contest, or a large blister applied to his

back, no one will question that it would affect the betting on his side

unfavorably; we will say to the amount of five per cent. Now the drain

upon the resources of the system produced in such a case must be at its

minimum, for the subject is a powerful man, in the prime of life, and in

admirable condition. If the drug or the blister takes five per cent.

from his force of resistance, it will take at least as large a fraction

from any invalid. But this invalid has to fight a champion who strikes

hard but cannot be hit in return, who will press him sharply for breath,

but will never pant himself while the wind can whistle through his

fleshless ribs. The suffering combatant is liable to want all his

stamina, and five per cent. may lose him the battle.

All noxious agents, all appliances which are not natural food or stimuli,

all medicines proper, cost a patient, on the average, five per cent. of

his vital force, let us say. Twenty times as much waste of force

produced by any of them, that is, would exactly kill him, nothing less

than kill him, and nothing more. If this, or something like this, is

true, then all these medications are, prima facie, injurious.

In the game of Life-or-Death, Rouge et Noir, as played between the Doctor

and the Sexton, this five per cent., this certain small injury entering

into the chances is clearly the sexton's perquisite for keeping the green

table, over which the game is played, and where he hoards up his gains.

Suppose a blister to diminish a man's pain, effusion or dyspnoea to the

saving of twenty per cent. in vital force; his profit from it is fifteen,

in that case, for it always hurts him five to begin with, according to

our previous assumption.

Presumptions are of vast importance in medicine, as in law. A man is

presumed innocent until he is proved guilty. A medicine--that is, a

noxious agent, like a blister, a seton, an emetic, or a cathartic

--should always be presumed to be hurtful. It always is directly

hurtful; it may sometimes be indirectly beneficial. If this presumption

were established, and disease always assumed to be the innocent victim of

circumstances, and not punishable by medicines, that is, noxious agents,

or poisons, until the contrary was shown, we should not so frequently

hear the remark commonly, perhaps erroneously, attributed to Sir Astley

Cooper, but often repeated by sensible persons, that, on the whole, more

harm than good is done by medication. Throw out opium, which the Creator

himself seems to prescribe, for we often see the scarlet poppy growing in

the cornfields, as if it were foreseen that wherever there is hunger to

be fed there must also be pain to be soothed; throw out a few specifics

which our art did not discover, and is hardly needed to apply [ Note C.];

throw out wine, which is a food, and the vapors which produce the miracle

of anaesthesia, and I firmly believe that if the whole materia medica, as

now used, could be sunk to the bottom of the sea, it would be all the

better for mankind,--and all the worse for the fishes.

But to justify this proposition, I must add that the injuries inflicted

by over-medication are to a great extent masked by disease. Dr. Hooker

believes that the typhus syncopatia of a preceding generation in New

England "was often in fact a brandy and opium disease." How is a

physician to distinguish the irritation produced by his blister from that

caused by the inflammation it was meant to cure? How can he tell the

exhaustion produced by his evacuants from the collapse belonging to the

disease they were meant to remove?

Lastly, medication without insuring favorable hygienic conditions is like

amputation without ligatures. I had a chance to learn this well of old,

when physician to the Broad Street district of the Boston Dispensary.

There, there was no help for the utter want of wholesome conditions, and

if anybody got well under my care, it must have been in virtue of the

rough-and-tumble constitution which emerges from the struggle for life in

the street gutters, rather than by the aid of my prescriptions.

But if the materia medica were lost overboard, how much more pains would

be taken in ordering all the circumstances surrounding the patient (as

can be done everywhere out of the crowded pauper districts), than are

taken now by too many who think they do their duty and earn their money

when they write a recipe for a patient left in an atmosphere of domestic

malaria, or to the most negligent kind of nursing! I confess that I

should think my chance of recovery from illness less with Hippocrates for

my physician and Mrs. Gamp for my nurse, than if I were in the hands of

Hahnemann himself, with Florence Nightingale or good Rebecca Taylor to

care for me.

If I am right in maintaining that the presumption is always against the

use of noxious agents in disease, and if any whom I might influence

should adopt this as a principle of practice, they will often find

themselves embarrassed by the imperative demand of patients and their

friends for such agents where a case is not made out against this

standing presumption. I must be permitted to say, that I think the

French, a not wholly uncivilized people, are in advance of the English

and ourselves in the art of prescribing for the sick without hurting

them. And I do confess that I think their varied ptisans and syrups are

as much preferable to the mineral regimen of bug-poison and ratsbane, so

long in favor on the other side of the Channel, as their art of preparing

food for the table to the rude cookery of those hard-feeding and

much-dosing islanders. We want a reorganized cuisine of invalidism

perhaps as much as the culinary, reform, for which our lyceum lecturers,

and others who live much at hotels and taverns, are so urgent. Will you

think I am disrespectful if I ask whether, even in Massachusetts, a dose

of calomel is not sometimes given by a physician on the same principle as

that upon which a landlord occasionally prescribes bacon and

eggs,--because he cannot think of anything else quite so handy? I leave

my suggestion of borrowing a hint from French practice to your mature

consideration.

I may, however, call your attention, briefly, to the singular fact, that

English and American practitioners are apt to accuse French medical

practice of inertness, and French surgical practice of unnecessary

activity. Thus, Dr. Bostock considers French medical treatment, with

certain exceptions, as "decidedly less effective" than that of his own

country. Mr. S. Cooper, again, defends the simple British practice of

procuring union by the first intention against the attacks of M. Roux and

Baron Larrey. [Cooper's Surg. Diet. art. "Wounds." Yet Mr. John Bell

gives the French surgeons credit for introducing this doctrine of

adhesion, and accuses O'Halloran of "rudeness and ignorance," and "bold,

uncivil language," in disputing their teaching. Princ. of Surgery, vol.

i. p. 42. Mr. Hunter succeeded at last in naturalizing the doctrine and

practice, but even he had to struggle against the perpetual jealousy of

rivals, and died at length assassinated by an insult.] We have often

heard similar opinions maintained by our own countrymen. While

Anglo-American criticism blows hot or cold on the two departments of

French practice, it is not, I hope, indecent to question whether all the

wisdom is necessarily with us in both cases.

Our art has had two or three lessons which have a deep meaning to those

who are willing to read them honestly. The use of water-dressings in

surgery completed the series of reforms by which was abolished the

"coarse and cruel practice" of the older surgeons, who with their

dressings and acrid balsams, their tents and leaden tubes, "absolutely

delayed the cure." The doctrine of Broussais, transient as was its

empire, reversed the practice of half of Christendom for a season, and

taught its hasty disciples to shun their old favorite remedies as mortal

poisons. This was not enough permanently to shift the presumption about

drugs where it belonged, and so at last, just as the sympathetic powder

and the Unguentum Armarium came in a superstitious age to kill out the

abuses of external over-medication, the solemn farce of Homoeopathy was

enacted in the face of our own too credulous civilization, that under

shelter of its pretences the "inward bruises" of over-drugged viscera

might be allowed to heal by the first intention. Its lesson we must

accept, whether we will or not; its follies we are tired of talking

about. The security of the medical profession against this and all

similar fancies is in the average constitution of the human mind with

regard to the laws of evidence.

My friends and brothers in Art! There is nothing to be feared from the

utterance of any seeming heresy to which you may have listened. I cannot

compromise your collective wisdom. If I have strained the truth one

hair's breadth for the sake of an epigram or an antithesis, you are

accustomed to count the normal pulse-beats of sound judgment, and know

full well how to recognize the fever-throbs of conceit and the nervous

palpitations of rhetoric.

The freedom with which each of us speaks his thought in this presence,

belongs in part to the assured position of the Profession in our

Commonwealth, to the attitude of Science, which is always fearless, and

to the genius of the soil on which we stand, from which Nature withheld

the fatal gift of malaria only to fill it with exhalations that breed the

fever of inquiry in our blood and in our brain. But mainly we owe the

large license of speech we enjoy to those influences and privileges

common to us all as self-governing Americans.

This Republic is the chosen home of minorities, of the less power in the

presence of the greater. It is a common error to speak of our

distinction as consisting in the rule of the majority. Majorities, the

greater material powers, have always ruled before. The history of most

countries has been that of majorities, mounted majorities, clad in iron,

armed with death treading down the tenfold more numerous minorities. In

the old civilizations they root themselves like oaks in the soil; men

must live in their shadow or cut them down. With us the majority is only

the flower of the passing noon, and the minority is the bud which may

open in the next morning's sun. We must be tolerant, for the thought

which stammers on a single tongue today may organize itself in the

growing consciousness of the time, and come back to us like the voice of

the multitudinous waves of the ocean on the morrow.

Twenty-five years have passed since one of your honored Presidents spoke

to this Society of certain limitations to the power of our Art, now very

generally conceded. Some were troubled, some were almost angry, thinking

the Profession might suffer from such concessions. It has certainly not

suffered here; if, as some affirm, it has lost respect anywhere, it was

probably for other, and no doubt sufficient reasons.

Since that time the civilization of this planet has changed hands. Strike

out of existence at this moment every person who was breathing on that

day, May 27, 1835, and every institution of society, every art and every

science would remain intact and complete in the living that would be

left. Every idea the world then held has been since dissolved and

recrystallized.

We are repeating the same process. Not to make silver shrines for our

old divinities, even though by this craft we should have our wealth, was

this Society organized and carried on by the good men and true who went

before us. Not for this, but to melt the gold out of the past, though

its dross should fly in dust to all the winds of heaven, to save all our

old treasures of knowledge and mine deeply for new, to cultivate that

mutual respect of which outward courtesy is the sign, to work together,

to feel together, to take counsel together, and to stand together for the

truth, now, always, here, everywhere; for this our fathers instituted,

and we accept, the offices and duties of this time-honored Society.

BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.

An Introductory Lecture delivered before the Medical Class of Harvard

University, November 6, 1861.

[This Lecture appears as it would have been delivered had the time

allowed been less strictly, limited. Passages necessarily omitted have

been restored, and points briefly touched have been more fully

considered. A few notes have been added for the benefit of that limited

class of students who care to track an author through the highways and

by-ways of his reading. I owe my thanks to several of my professional

brethren who have communicated with me on subjects with which they are

familiar; especially to Dr. John Dean, for the opportunity of profiting

by his unpublished labors, and to Dr. Hasket Derby, for information and

references to recent authorities relating to the anatomy and physiology

of the eye.]

The entrance upon a new course of Lectures is always a period of interest

to instructors and pupils. As the birth of a child to a parent, so is

the advent of a new class to a teacher. As the light of the untried

world to the infant, so is the dawning of the light resting over the

unexplored realms of science to the student. In the name of the Faculty

I welcome you, Gentlemen of the Medical Class, new-born babes of science,

or lustier nurslings, to this morning of your medical life, and to the

arms and the bosom of this ancient University. Fourteen years ago I

stood in this place for the first time to address those who occupied

these benches. As I recall these past seasons of our joint labors, I

feel that they have been on the whole prosperous, and not undeserving of

their prosperity.

For it has been my privilege to be associated with a body of true and

faithful workers; I cannot praise them freely to their faces, or I should

be proud to discourse of the harmonious diligence and the noble spirit in

which they have toiled together, not merely to teach their several

branches, but to elevate the whole standard of teaching.

I may speak with less restraint of those gentlemen who have aided me in

the most laborious part of my daily duties, the Demonstrators, to whom

the successive classes have owed so much of their instruction. They rise

before me, the dead and the living, in the midst of the most grateful

recollections. The fair, manly face and stately figure of my friend, Dr.

Samuel Parkman, himself fit for the highest offices of teaching, yet

willing to be my faithful assistant in the time of need, come back to me

with the long sigh of regret for his early loss to our earthly

companionship. Every year I speak the eulogy of Dr. Ainsworth's patient

toil as I show his elaborate preparations: When I take down my "American

Cyclopaedia" and borrow instruction from the learned articles of Dr.

Kneeland, I cease to regret that his indefatigable and intelligent

industry was turned into a broader channel. And what can I say too

cordial of my long associated companion and friend, Dr. Hodges, whose

admirable skill, working through the swiftest and surest fingers that

ever held a scalpel among us, has delighted class after class, and filled

our Museum with monuments which will convey his name to unborn

generations?

This day belongs, however, not to myself and my recollections, but to all

of us who teach and all of you who listen, whether experts in our

specialties or aliens to their mysteries, or timid neophytes just

entering the portals of the hall of science. Look in with me, then,

while I attempt to throw some rays into its interior, which shall

illuminate a few of its pillars and cornices, and show at the same time

how many niches and alcoves remain in darkness.

SCIENCE is the topography of ignorance. From a few elevated points we

triangulate vast spaces, inclosing infinite unknown details. We cast the

lead, and draw up a little sand from abysses we may never reach with our

dredges.

The best part of our knowledge is that which teaches us where knowledge

leaves off and ignorance begins. Nothing more clearly separates a vulgar

from a superior mind, than the confusion in the first between the little

that it truly knows, on the one hand, and what it half knows and what it

thinks it knows on the other.

That which is true of every subject is especially true of the branch of

knowledge which deals with living beings. Their existence is a perpetual

death and reanimation. Their identity is only an idea, for we put off

our bodies many times during our lives, and dress in new suits of bones

and muscles.

"Thou art not thyself;

For thou exist'st on many a thousand grains

That issue out of dust."

If it is true that we understand ourselves but imperfectly in health,

this truth is more signally manifested in disease, where natural actions

imperfectly understood, disturbed in an obscure way by half-seen causes,

are creeping and winding along in the dark toward their destined issue,

sometimes using our remedies as safe stepping-stones, occasionally, it

may be, stumbling over them as obstacles.

I propose in this lecture to show you some points of contact between our

ignorance and our knowledge in several of the branches upon the study of

which you are entering. I may teach you a very little directly, but I

hope much more from the trains of thought I shall suggest. Do not expect

too much ground to be covered in this rapid survey. Our task is only

that of sending out a few pickets under the starry flag of science to the

edge of that dark domain where the ensigns of the obstinate rebel,

Ignorance, are flying undisputed. We are not making a reconnoissance in

force, still less advancing with the main column. But here are a few

roads along which we have to march together, and we wish to see clearly

how far our lines extend, and where the enemy's outposts begin.

Before touching the branches of knowledge that deal with organization and

vital functions, let us glance at that science which meets you at the

threshold of your study, and prepares you in some measure to deal with

the more complex problems of the living laboratory.

CHEMISTRY. includes the art of separating and combining the elements of

matter, and the study of the changes produced by these operations. We can

hardly say too much of what it has contributed to our knowledge of the

universe and our power of dealing with its materials. It has given us a

catalogue raisonne of the substances found upon our planet, and shown how

everything living and dead is put together from them. It is

accomplishing wonders before us every day, such as Arabian story-tellers

used to string together in their fables. It spreads the, sensitive film

on the artificial retina which looks upon us through the optician's lens

for a few seconds, and fixes an image that will outlive its original. It

questions the light of the sun, and detects the vaporized metals floating

around the great luminary,--iron, sodium, lithium, and the rest,--as if

the chemist of our remote planet could fill his bell-glasses from its

fiery atmosphere. It lends the power which flashes our messages in

thrills that leave the lazy chariot of day behind them. It seals up a

few dark grains in iron vases, and lo! at the touch of a single spark,

rises in smoke and flame a mighty Afrit with a voice like thunder and an

arm that shatters like an earthquake. The dreams of Oriental fancy have

become the sober facts of our every-day life, and the chemist is the

magician to whom we owe them.

To return to the colder scientific aspect of chemistry. It has shown us

how bodies stand affected to each other through an almost boundless range

of combinations. It has given us a most ingenious theory to account for

certain fixed relations in these combinations. It has successfully

eliminated a great number of proximate compounds, more or less stable,

from organic structures. It has invented others which form the basis of

long series of well-known composite substances. In fact, we are perhaps

becoming overburdened with our list of proximate principles, demonstrated

and hypothetical.

How much nearer have we come to the secret of force than Lully and Geber

and the whole crew of juggling alchemists? We have learned a great deal

about the how, what have we learned about the why?

Why does iron rust, while gold remains untarnished, and gold amalgamate,

while iron refuses the alliance of mercury?

The alchemists called gold Sol, the sun, and iron Mars, and pleased

themselves with fancied relations between these substances and the

heavenly bodies, by which they pretended to explain the facts they

observed. Some of their superstitions have lingered in practical

medicine to the present day, but chemistry has grown wise enough to

confess the fact of absolute ignorance.

What is it that makes common salt crystallize in the form of cubes, and

saltpetre in the shape of six-sided prisms? We see no reason why it

should not have been just the other way, salt in prisms and saltpetre in

cubes, or why either should take an exact geometrical outline, any more

than coagulating albumen.

But although we had given up attempting to explain the essential nature

of affinities and of crystalline types, we might have supposed that we

had at least fixed the identity of the substances with which we deal, and

determined the laws of their combination. All at once we find that a

simple substance changes face, puts off its characteristic qualities and

resumes them at will;--not merely when we liquefy or vaporize a solid, or

reverse the process; but that a solid is literally transformed into

another solid under our own eyes. We thought we knew phosphorus. We warm

a portion of it sealed in an empty tube, for about a week. It has become

a brown infusible substance, which does not shine in the dark nor oxidate

in the air. We heat it to 500 F., and it becomes common phosphorus again.

We transmute sulphur in the same singular way. Nature, you know, gives

us carbon in the shape of coal and in that of the diamond. It is easy to

call these changes by the name allotropism, but not the less do they

confound our hasty generalizations.

These facts of allotropism have some corollaries connected with them

rather startling to us of the nineteenth century. There may be other

transmutations possible besides those of phosphorus and sulphur. When Dr.

Prout, in 1840, talked about azote and carbon being "formed" in the

living system, it was looked upon as one of those freaks of fancy to

which philosophers, like other men, are subject. But when Professor

Faraday, in 1851, says, at a meeting of the British Association, that

"his hopes are in the direction of proving that bodies called simple were

really compounds, and may be formed artificially as soon as we are

masters of the laws influencing their combinations,"--when he comes

forward and says that he has tried experiments at transmutation, and

means, if his life is spared, to try them again,--how can we be surprised

at the popular story of 1861, that Louis Napoleon has established a

gold-factory and is glutting the mints of Europe with bullion of his own

making?

And so with reference to the law of combinations. The old maxim was,

Corpora non agunt nisi soluta. If two substances, a and b, are inclosed

in a glass vessel, c, we do not expect the glass to change them, unless a

or b or the compound a b has the power of dissolving the glass. But if

for a I take oxygen, for b hydrogen, and for c a piece of spongy

platinum, I find the first two combine with the common signs of

combustion and form water, the third in the mean time undergoing no

perceptible change. It has played the part of the unwedded priest, who

marries a pair without taking a fee or having any further relation with

the parties. We call this catalysis, catalytic action, the action of

presence, or by what learned name we choose. Give what name to it we

will, it is a manifestation of power which crosses our established laws

of combination at a very open angle of intersection. I think we may find

an analogy for it in electrical induction, the disturbance of the

equilibrium of the electricity of a body by the approach of a charged

body to it, without interchange of electrical conditions between the two

bodies. But an analogy is not an explanation, and why a few drops of

yeast should change a saccharine mixture to carbonic acid and alcohol,--a

little leaven leavening the whole lump,--not by combining with it, but by

setting a movement at work, we not only cannot explain, but the fact is

such an exception to the recognized laws of combination that Liebig is

unwilling to admit the new force at all to which Berzelius had given the

name so generally accepted.

The phenomena of isomerism, or identity of composition and proportions of

constituents with difference of qualities, and of isomorphism, or

identity of form in crystals which have one element substituted for

another, were equally surprises to science; and although the mechanism by

which they are brought about can be to a certain extent explained by a

reference to the hypothetical atoms of which the elements are

constituted, yet this is only turning the difficulty into a fraction with

an infinitesimal denominator and an infinite numerator.

So far we have studied the working of force and its seeming anomalies in

purely chemical phenomena. But we soon find that chemical force is

developed by various other physical agencies,--by heat, by light, by

electricity, by magnetism, by mechanical agencies; and, vice versa, that

chemical action develops heat, light, electricity, magnetism, mechanical

force, as we see in our matches, galvanic batteries, and explosive

compounds. Proceeding with our experiments, we find that every kind of

force is capable of producing all other kinds, or, in Mr. Faraday's

language, that "the various forms under which the forces of matter are

made manifest have a common origin, or, in other words, are so directly

related and mutually dependent that they are convertible one into

another."

Out of this doctrine naturally springs that of the conservation of force,

so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr. Faraday. This

idea is no novelty, though it seems so at first sight. It was maintained

and disputed among the giants of philosophy. Des Cartes and Leibnitz

denied that any new motion originated in nature, or that any ever ceased

to exist; all motion being in a circle, passing from one body to another,

one losing what the other gained. Newton, on the other hand, believed

that new motions were generated and existing ones destroyed. On the

first supposition, there is a fixed amount of force always circulating in

the universe. On the second, the total amount may be increasing or

diminishing. You will find in the "Annual of Scientific Discovery" for

1858 a very interesting lecture by Professor Helmholtz of Bonn, in which

it is maintained that a certain portion of force is lost in every natural

process, being converted into unchangeable heat, so that the universe

will come to a stand-still at last, all force passing into heat, and all

heat into a state of equilibrium.

The doctrines of the convertibility or specific equivalence of the

various forms of force, and of its conservation, which is its logical

consequence, are very generally accepted, as I believe, at the present

time, among physicists. We are naturally led to the question, What is

the nature of force? The three illustrious philosophers just referred to

agree in attributing the general movements of the universe to the

immediate Divine action. The doctrine of "preestablished harmony" was an

especial contrivance of Leibnitz to remove the Creator from unworthy

association with the less divine acts of living beings. Obsolete as this

expression sounds to our ears, the phrase laws of the universe, which we

use so constantly with a wider application, appears to me essentially

identical with it.

Force does not admit of explanation, nor of proper definition, any more

than the hypothetical substratum of matter. If we assume the Infinite as

omnipresent, omniscient, omnipotent, we cannot suppose Him excluded from

any part of His creation, except from rebellious souls which voluntarily

exclude Him by the exercise of their fatal prerogative of free-will.

Force, then, is the act of immanent Divinity. I find no meaning in

mechanical explanations. Newton's hypothesis of an ether filling the

heavenly spaces does not, I confess, help my conceptions. I will, and

the muscles of my vocal organs shape my speech. God wills, and the

universe articulates His power, wisdom, and goodness. That is all I

know. There is no bridge my mind can throw from the "immaterial" cause

to the "material" effect.

The problem of force meets us everywhere, and I prefer to encounter it in

the world of physical phenomena before reaching that of living actions.

It is only the name for the incomprehensible cause of certain changes

known to our consciousness, and assumed to be outside of it. For me it

is the Deity Himself in action.

I can therefore see a large significance in the somewhat bold language of

Burdach: "There is for me but one miracle, that of infinite existence,

and but one mystery, the manner in which the finite proceeds from the

infinite. So soon as we recognize this incomprehensible act as the

general and primordial miracle, of which our reason perceives the

necessity, but the manner of which our intelligence cannot grasp, so soon

as we contemplate the nature known to us by experience in this light,

there is for us no other impenetrable miracle or mystery."

Let us turn to a branch of knowledge which deals with certainties up to

the limit of the senses, and is involved in no speculations beyond them.

In certain points of view, HUMAN ANATOMY may be considered an almost

exhausted science. From time to time some small organ which had escaped

earlier observers has been pointed out,--such parts as the tensor tarsi,

the otic ganglion, or the Pacinian bodies; but some of our best

anatomical works are those which have been classic for many generations.

The plates of the bones in Vesalius, three centuries old, are still

masterpieces of accuracy, as of art. The magnificent work of Albinus on

the muscles, published in 1747, is still supreme in its department, as

the constant references of the most thorough recent treatise on the

subject, that of Theile, sufficiently show. More has been done in

unravelling the mysteries of the fasciae, but there has been a tendency

to overdo this kind of material analysis. Alexander Thomson split them

up into cobwebs, as you may see in the plates to Velpeau's Surgical

Anatomy. I well remember how he used to shake his head over the coarse

work of Scarpa and Astley Cooper,--as if Denner, who painted the separate

hairs of the beard and pores of the skin in his portraits, had spoken

lightly of the pictures of Rubens and Vandyk.

Not only has little been added to the catalogue of parts, but some things

long known had become half-forgotten. Louis and others confounded the

solitary glands of the lower part of the small intestine with those which

"the great Brunner," as Haller calls him, described in 1687 as being

found in the duodenum. The display of the fibrous structure of the brain

seemed a novelty as shown by Spurzheim. One is startled to find the

method anticipated by Raymond Vieussens nearly two centuries ago. I can

hardly think Gordon had ever looked at his figures, though he names their

author, when he wrote the captious and sneering article which attracted

so much attention in the pages of the "Edinburgh Review."

This is the place, if anywhere, to mention any observations I could

pretend to have made in the course of my teaching the structure of the

human body. I can make no better show than most of my predecessors in

this well-reaped field. The nucleated cells found connected with the

cancellated structure of the bones, which I first pointed out and had

figured in 1847, and have shown yearly from that time to the present, and

the fossa masseterica, a shallow concavity on the ramus of the lower jaw,

for the lodgment of the masseter muscle, which acquires significance when

examined by the side of the deep cavity on the corresponding part in some

carnivora to which it answers, may perhaps be claimed as deserving

attention. I have also pleased myself by making a special group of the

six radiating muscles which diverge from the spine of the axis, or second

cervical vertebra, and by giving to it the name stella musculosa nuchaee.

But this scanty catalogue is only an evidence that one may teach long and

see little that has not been noted by those who have gone before him. Of

course I do not think it necessary to include rare, but already described

anomalies, such as the episternal bones, the rectus sternalis, and other

interesting exceptional formations I have encountered, which have shown a

curious tendency to present themselves several times in the same season,

perhaps because the first specimen found calls our attention to any we

may subsequently meet with.

The anatomy of the scalpel and the amphitheatre was, then, becoming an

exhausted branch of investigation. But during the present century the

study of the human body has changed its old aspect, and become fertile in

new observations. This rejuvenescence was effected by means of two

principal agencies,--new methods and a new instrument.

Descriptive anatomy, as known from an early date, is to the body what

geography is to the planet. Now geography was pretty well known so long

ago as when Arrowsmith, who was born in 1750, published his admirable

maps. But in that same year was born Werner, who taught a new way of

studying the earth, since become familiar to us all under the name of

Geology.

What geology has done for our knowledge of the earth, has been done for

our knowledge of the body by that method of study to which is given the

name of General Anatomy. It studies, not the organs as such, but the

elements out of which the organs are constructed. It is the geology of

the body, as that is the general anatomy of the earth. The extraordinary

genius of Bichat, to whom more than any other we owe this new method of

study, does not require Mr. Buckle's testimony to impress the

practitioner with the importance of its achievements. I have heard a

very wise physician question whether any important result had accrued to

practical medicine from Harvey's discovery of the circulation. But

Anatomy, Physiology, and Pathology have received a new light from this

novel method of contemplating the living structures, which has had a vast

influence in enabling the practitioner at least to distinguish and

predict the course of disease. We know as well what differences to

expect in the habits of a mucous and of a serous membrane, as what

mineral substances to look for in the chalk or the coal measures. You

have only to read Cullen's description of inflammation of the lungs or of

the bowels, and compare it with such as you may find in Laennec or

Watson, to see the immense gain which diagnosis and prognosis have

derived from general anatomy.

The second new method of studying the human structure, beginning with the

labors of Scarpa, Burns, and Colles, grew up principally during the first

third of this century. It does not deal with organs, as did the earlier

anatomists, nor with tissues, after the manner of Bichat. It maps the

whole surface of the body into an arbitrary number of regions, and

studies each region successively from the surface to the bone, or beneath

it. This hardly deserves the name of a science, although Velpeau has

dignified it with that title, but it furnishes an admirable practical way

for the surgeon who has to operate on a particular region of the body to

study that region. If we are buying a farm, we are not content with the

State map or a geological chart including the estate in question. We

demand an exact survey of that particular property, so that we may know

what we are dealing with. This is just what regional, or, as it is

sometimes called, surgical anatomy, does for the surgeon with reference

to the part on which his skill is to be exercised. It enables him to see

with the mind's eye through the opaque tissues down to the bone on which

they lie, as if the skin were transparent as the cornea, and the organs

it covers translucent as the gelatinous pulp of a medusa.

It is curious that the Japanese should have anticipated Europe in a kind

of rude regional anatomy. I have seen a manikin of Japanese make traced

all over with lines, and points marking their intersection. By this

their doctors are guided in the performance of acupuncture, marking the

safe places to thrust in needles, as we buoy out our ship-channels, and

doubtless indicating to learned eyes the spots where incautious meddling

had led to those little accidents of shipwreck to which patients are

unfortunately liable.

A change of method, then, has given us General and Regional Anatomy.

These, too, have been worked so thoroughly, that, if not exhausted, they

have at least become to a great extent fixed and positive branches of

knowledge. But the first of them, General Anatomy, would never, have

reached this positive condition but for the introduction of that,

instrument which I have mentioned as the second great aid to modern

progress.

This instrument is the achromatic microscope. For the history of the

successive steps by which it became the effective scientific implement we

now possess, I must refer you to the work of Mr. Quekett, to an excellent

article in the "Penny Cyclopaedia," or to that of Sir David Brewster in

the "Encyclopaedia Britannica." It is a most interesting piece of

scientific history, which shows how the problem which Biot in 1821

pronounced insolvable was in the course of a few years practically

solved, with a success equal to that which Dollond had long before

obtained with the telescope. It is enough for our purpose that we are

now in possession of an instrument freed from all confusions and

illusions, which magnifies a thousand diameters,--a million times in

surface,--without serious distortion or discoloration of its object.

A quarter of a century ago, or a little more, an instructor would not

have hesitated to put John Bell's "Anatomy" and Bostock's "Physiology"

into a student's hands, as good authority on their respective subjects.

Let us not be unjust to either of these authors. John Bell is the

liveliest medical writer that I can remember who has written since the

days of delightful old Ambroise Pare. His picturesque descriptions and

bold figures are as good now as they ever were, and his book can never

become obsolete. But listen to what John Bell says of the microscope:

"Philosophers of the last age had been at infinite pains to find the

ultimate fibre of muscles, thinking to discover its properties in its

form; but they saw just in proportion to the glasses which they used, or

to their practice and skill in that art, which is now almost forsaken."

Dr. Bostock's work, neglected as it is, is one which I value very highly

as a really learned compilation, full of original references. But Dr.

Bostock says: "Much as the naturalist has been indebted to the

microscope, by bringing into view many beings of which he could not

otherwise have ascertained the existence, the physiologist has not yet

derived any great benefit from the instrument."

These are only specimens of the manner in which the microscope and its

results were generally regarded by the generation just preceding our own.

I have referred you to the proper authorities for the account of those

improvements which about the year 1830 rendered the compound microscope

an efficient and trustworthy instrument. It was now for the first time

that a true general anatomy became possible. As early as 1816 Treviranus

had attempted to resolve the tissues, of which Bichat had admitted no

less than twenty-one, into their simple microscopic elements. How could

such an attempt succeed, Henle well asks, at a time when the most

extensively diffused of all the tissues, the areolar, was not at all

understood? All that method could do had been accomplished by Bichat and

his followers. It was for the optician to take the next step. The

future of anatomy and physiology, as an enthusiastic micrologist of the

time said, was in the hands of Messrs. Schieck and Pistor, famous

opticians of Berlin.

In those earlier days of which I am speaking, all the points of minute

anatomy were involved in obscurity. Some found globules everywhere, some

fibres. Students disputed whether the conjunctiva extended over the

cornea or not, and worried themselves over Gaultier de Claubry's

stratified layers of the skin, or Breschet's blennogenous and

chromatogenous organs. The dartos was a puzzle, the central spinal canal

a myth, the decidua clothed in fable as much as the golden fleece. The

structure of bone, now so beautifully made out,--even that of the teeth,

in which old Leeuwenhoek, peeping with his octogenarian eyes through the

minute lenses wrought with his own hands, had long ago seen the "pipes,"

as he called them,--was hardly known at all. The minute structure of the

viscera lay in the mists of an uncertain microscopic vision. The

intimate recesses of the animal system were to the students of anatomy

what the anterior of Africa long was to geographers, and the stories of

microscopic explorers were as much sneered at as those of Bruce or Du

Chailly, and with better reason.

Now what have we come to in our own day? In the first place, the minute

structure of all the organs has been made out in the most satisfactory

way. The special arrangements of the vessels and the ducts of all the

glands, of the air-tubes and vesicles of the lungs, of the parts which

make up the skin and other membranes, all the details of those complex

parenchymatous organs which had confounded investigation so long, have

been lifted out of the invisible into the sight of all observers. It is

fair to mention here, that we owe a great deal to the art of minute

injection, by which we are enabled to trace the smallest vessels in the

midst of the tissues where they are distributed. This is an old artifice

of anatomists. The famous Ruysch, who died a hundred and thirty years

ago, showed that each of the viscera has its terminal vessels arranged in

its own peculiar way; the same fact which you may see illustrated in

Gerber's figures after the minute injections of Berres. I hope to show

you many specimens of this kind in the microscope, the work of English

and American hands. Professor Agassiz allows me also to make use of a

very rich collection of injected preparations sent him by Professor

Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition of

which I had a number of microscopes made expressly, by Mr. Grunow, during

the past season. All this illustrates what has been done for the

elucidation of the intimate details of formation of the organs.

But the great triumph of the microscope as applied to anatomy has been in

the resolution of the organs and the tissues into their simple

constituent anatomical elements. It has taken up general anatomy where

Bichat left it. He had succeeded in reducing the structural language of

nature to syllables, if you will permit me to use so bold an image. The

microscopic observers who have come after him have analyzed these into

letters, as we may call them,--the simple elements by the combination of

which Nature spells out successively tissues, which are her syllables,

organs which are her words, systems which are her chapters, and so goes

on from the simple to the complex, until she binds up in one living whole

that wondrous volume of power and wisdom which we call the human body.

The alphabet of the organization is so short and simple, that I will risk

fatiguing your attention by repeating it, according to the plan I have

long adopted.

A. Cells, either floating, as in the blood, or fixed, like those in the

cancellated structure of bone, already referred to. Very commonly they

have undergone a change of figure, most frequently a flattening which

reduces them to scales, as in the epidermis and the epithelium.

B. Simple, translucent, homogeneous solid, such as is found at the back

of the cornea, or forming the intercellular substance of cartilage.

C. The white fibrous element, consisting of very delicate, tenacious

threads. This is the long staple textile substance of the body. It is

to the organism what cotton is pretended to be to our Southern States.

It pervades the whole animal fabric as areolar tissue, which is the

universal packing and wrapping material. It forms the ligaments which

bind the whole frame-work together. It furnishes the sinews, which are

the channels of power. It enfolds every muscle. It wraps the brain in

its hard, insensible folds, and the heart itself beats in a purse that is

made of it.

D. The yellow elastic, fibrous element, the caoutchouc of the animal

mechanism, which pulls things back into place, as the India-rubber band

shuts the door we have opened.

E. The striped muscular fibre,--the red flesh, which shortens itself in

obedience to the will, and thus produces all voluntary active motion.

F. The unstriped muscular fibre, more properly the fusiform-cell fibre,

which carries on the involuntary internal movements.

G. The nerve-cylinder, a glassy tube, with a pith of some firmness,

which conveys sensation to the brain and the principle which induces

motion from it.

H. The nerve-corpuscle, the centre of nervous power.

I. The mucous tissue, as Virchow calls it, common in embryonic

structures, seen in the vitreous humor of the adult.

To these add X, granules, of indeterminate shape and size, Y, for

inorganic matters, such as the salts of bone and teeth, and Z, to stand

as a symbol of the fluids, and you have the letters of what I have

ventured to call the alphabet of the body.

But just as in language certain diphthongs and syllables are frequently

recurring, so we have in the body certain secondary and tertiary

combinations, which we meet more frequently than the solitary elements of

which they are composed.

Thus A B, or a collection of cells united by simple structureless solid,

is seen to be extensively employed in the body under the name of

cartilage. Out of this the surfaces of the articulations and the springs

of the breathing apparatus are formed. But when Nature came to the

buffers of the spinal column (intervertebral disks) and the washers of

the joints (semilunar fibrocartilages of the knee, etc.), she required

more tenacity than common cartilage possessed. What did she do? What

does man do in a similar case of need? I need hardly tell you. The

mason lays his bricks in simple mortar. But the plasterer works some

hair into the mortar which he is going to lay in large sheets on the

walls. The children of Israel complained that they had no straw to make

their bricks with, though portions of it may still be seen in the

crumbling pyramid of Darshour, which they are said to have built. I

visited the old house on Witch Hill in Salem a year or two ago, and there

I found the walls coated with clay in which straw was abundantly

mingled;--the old Judaizing witch-hangers copied the Israelites in a good

many things. The Chinese and the Corsicans blend the fibres of amianthus

in their pottery to give it tenacity. Now to return to Nature. To make

her buffers and washers hold together in the shocks to which they would

be subjected, she took common cartilage and mingled the white fibrous

tissue with it, to serve the same purpose as the hair in the mortar, the

straw in the bricks and in the plaster of the old wall, and the amianthus

in the earthen vessels. Thus we have the combination A B C, or

fibro-cartilage. Again, the bones were once only gristle or cartilage, A

B. To give them solidity they were infiltrated with stone, in the form

of salts of lime, an inorganic element, so that bone would be spelt out

by the letters A, B, and Y.

If from these organic syllables we proceed to form organic words, we

shall find that Nature employs three principal forms; namely, Vessels,

Membranes, and Parenchyma, or visceral tissue. The most complex of them

can be resolved into a combination of these few simple anatomical

constituents.

Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find the

same elements in morbid growths that we have met with in normal

structures. The pus-corpuscle and the white blood-corpuscle can only be

distinguished by tracing them to their origin. A frequent form of

so-called malignant disease proves to be only a collection of altered

epithelium-cells. Even cancer itself has no specific anatomical element,

and the diagnosis of a cancerous tumor by the microscope, though

tolerably sure under the eye of an expert, is based upon accidental, and

not essential points,--the crowding together of the elements, the size of

the cell-nuclei, and similar variable characters.

Let us turn to PHYSIOLOGY. The microscope, which has made a new science

of the intimate structure of the organs, has at the same time cleared up

many uncertainties concerning the mechanism of the special functions. Up

to the time of the living generation of observers, Nature had kept over

all her inner workshops the forbidding inscription, No Admittance! If

any prying observer ventured to spy through his magnifying tubes into the

mysteries of her glands and canals and fluids, she covered up her work in

blinding mists and bewildering halos, as the deities of old concealed

their favored heroes in the moment of danger.

Science has at length sifted the turbid light of her lenses, and blanched

their delusive rainbows.

Anatomy studies the organism in space. Physiology studies it also in

time. After the study of form and composition follows close that of

action, and this leads us along back to the first moment of the germ, and

forward to the resolution of the living frame into its lifeless elements.

In this way Anatomy, or rather that branch of it which we call Histology,

has become inseparably blended with the study of function. The

connection between the science of life and that of intimate structure on

the one hand, and composition on the other, is illustrated in the titles

of two recent works of remarkable excellence,--"the Physiological

Anatomy" of Todd and Bowman, and the "Physiological Chemistry" of

Lehmann.

Let me briefly recapitulate a few of our acquisitions in Physiology, due

in large measure to our new instruments and methods of research, and at

the same time indicate the limits which form the permanent or the

temporary boundaries of our knowledge. I will begin with the largest

fact and with the most absolute and universally encountered limitation.

The "largest truth in Physiology" Mr. Paget considers to be "the

development of ova through multiplication and division of their cells."

I would state it more broadly as the agency of the cell in all living

processes. It seems at present necessary to abandon the original idea of

Schwann, that we can observe the building up of a cell from the simple

granules of a blastema, or formative fluid. The evidence points rather

towards the axiom, Omnis cellula a cellula; that is, the germ of a new

cell is always derived from a preexisting cell. The doctrine of Schwann,

as I remarked long ago (1844), runs parallel with the nebular theory in

astronomy, and they may yet stand or fall together.

As we have seen Nature anticipating the plasterer in fibro-cartilage, so

we see her beforehand with the glassblower in her dealings with the cell.

The artisan blows his vitreous bubbles, large or small, to be used

afterwards as may be wanted. So Nature shapes her hyaline vesicles and

modifies them to serve the needs of the part where they are found. The

artisan whirls his rod, and his glass bubble becomes a flattened disk,

with its bull's-eye for a nucleus. These lips of ours are all glazed

with microscopic tiles formed of flattened cells, each one of them with

its nucleus still as plain and relatively as prominent, to the eye of the

microscopist, as the bull's-eye in the old-fashioned windowpane.

Everywhere we find cells, modified or unchanged. They roll in

inconceivable multitudes (five millions and more to the cubic millimetre,

according to Vierordt) as blood-disks through our vessels. A

close-fitting mail of flattened cells coats our surface with a panoply of

imbricated scales (more than twelve thousand millions), as Harting has

computed, as true a defence against our enemies as the buckler of the

armadillo or the carapace of the tortoise against theirs. The same

little protecting organs pave all the great highways of the interior

system. Cells, again, preside over the chemical processes which

elaborate the living fluids; they change their form to become the agents

of voluntary and involuntary motion; the soul itself sits on a throne of

nucleated cells, and flashes its mandates through skeins of glassy

filaments which once were simple chains of vesicles. And, as if to

reduce the problem of living force to its simplest expression, we see the

yolk of a transparent egg dividing itself in whole or in part, and again

dividing and subdividing, until it becomes a mass of cells, out of which

the harmonious diversity of the organs arranges itself, worm or man, as

God has willed from the beginning.

This differentiation having been effected, each several part assumes its

special office, having a life of its own adjusted to that of other parts

and the whole. "Just as a tree constitutes a mass arranged in a definite

manner, in which, in every single part, in the leaves as in the root, in

the trunk as in the blossom, cells are discovered to be the ultimate

elements, so is it also with the forms of animal life. Every animal

presents itself as a sum of vital unities, every one of which manifests

all the characteristics of life."

The mechanism is as clear, as unquestionable, as absolutely settled and

universally accepted, as the order of movement of the heavenly bodies,

which we compute backward to the days of the observatories on the plains

of Shinar, and on the faith of which we regulate the movements of war and

trade by the predictions of our ephemeris.

The mechanism, and that is all. We see the workman and the tools, but

the skill that guides the work and the power that performs it are as

invisible as ever. I fear that not every listener took the significance

of those pregnant words in the passage I quoted from John

Bell,--"thinking to discover its properties in its form." We have

discovered the working bee in this great hive of organization. We have

detected the cell in the very act of forming itself from a nucleus, of

transforming itself into various tissues, of selecting the elements of

various secretions. But why one cell becomes nerve and another muscle,

why one selects bile and another fat, we can no more pretend to tell,

than why one grape sucks out of the soil the generous juice which princes

hoard in their cellars, and another the wine which it takes three men to

drink,--one to pour it down, another to swallow it, and a third to hold

him while it is going down. Certain analogies between this selecting

power and the phenomena of endosmosis in the elective affinities of

chemistry we can find, but the problem of force remains here, as

everywhere, unsolved and insolvable.

Do we gain anything by attempting to get rid of the idea of a special

vital force because we find certain mutually convertible relations

between forces in the body and out of it? I think not, any more than we

should gain by getting rid of the idea and expression Magnetism because

of its correlation with electricity. We may concede the unity of all

forms of force, but we cannot overlook the fixed differences of its

manifestations according to the conditions under which it acts. It is a

mistake, however, to think the mystery is greater in an organized body

than in any other. We see a stone fall or a crystal form, and there is

nothing stranger left to wonder at, for we have seen the Infinite in

action.

Just so far as we can recognize the ordinary modes of operation of the

common forces of nature,--gravity, cohesion, elasticity, transudation,

chemical action, and the rest,--we see the so-called vital acts in the

light of a larger range of known facts and familiar analogies.

Matteuecci's well-remembered lectures contain many and striking examples

of the working of physical forces in physiological processes. Wherever

rigid experiment carries us, we are safe in following this lead; but the

moment we begin to theorize beyond our strict observation, we are in

danger of falling into those mechanical follies which true science has

long outgrown.

Recognizing the fact, then, that we have learned nothing but the

machinery of life, and are no nearer to its essence, what is it that we

have gained by this great discovery of the cell formation and function?

It would have been reward enough to learn the method Nature pursues for

its own sake. If the sovereign Artificer lets us into his own

laboratories and workshops, we need not ask more than the privilege of

looking on at his work. We do not know where we now stand in the

hierarchy of created intelligences. We were made a little lower than the

angels. I speak it not irreverently; as the lower animals surpass man in

some of their attributes, so it may be that not every angel's eye can see

as broadly and as deeply into the material works of God as man himself,

looking at the firmament through an equatorial of fifteen inches'

aperture, and searching into the tissues with a twelfth of an inch

objective.

But there are other positive gains of a more practical character. Thus we

are no longer permitted to place the seat of the living actions in the

extreme vessels, which are only the carriers from which each part takes

what it wants by the divine right of the omnipotent nucleated cell. The

organism has become, in the words already borrowed from Virchow, "a sum

of vital unities." The strictum and laxum, the increased and diminished

action of the vessels, out of which medical theories and methods of

treatment have grown up, have yielded to the doctrine of local

cell-communities, belonging to this or that vascular district, from which

they help themselves, as contractors are wont to do from the national

treasury.

I cannot promise to do more than to select a few of the points of contact

between our ignorance and our knowledge which present particular interest

in the existing state of our physiological acquisitions. Some of them

involve the microscopic discoveries of which I have been speaking, some

belong to the domain of chemistry, and some have relations with other

departments of physical science.

If we should begin with the digestive function, we should find that the

long-agitated question of the nature of the acid of the gastric juice is

becoming settled in favor of the lactic. But the whole solvent agency of

the digestive fluid enters into the category of that exceptional mode of

action already familiar to us in chemistry as catalysis. It is therefore

doubly difficult of explanation; first, as being, like all reactions, a

fact not to be accounted for except by the imaginative appeal to

"affinity," and secondly, as being one of those peculiar reactions

provoked by an element which stands outside and looks on without

compromising itself.

The doctrine of Mulder, so widely diffused in popular and scientific

belief, of the existence of a common base of all albuminous substances,

the so-called protein, has not stood the test of rigorous analysis. The

division of food into azotized and non-azotized is no doubt important,

but the attempt to show that the first only is plastic or nutritive,

while the second is simply calorifacient, or heat-producing, fails

entirely in the face of the facts revealed by the study of man in

different climates, and of numerous experiments in the feeding of

animals. I must return to this subject in connection with the

respiratory function.

The sugar-making faculty of the liver is another "catalytic" mystery, as

great as the rest of them, and no greater. Liver-tissue brings sugar out

of the blood, or out of its own substance;--why?

Quia est in eo

Virtus saccharitiva.

Just what becomes of the sugar beyond the fact of its disappearance

before it can get into the general circulation and sweeten our tempers,

it is hard to say.

The pancreatic fluid makes an emulsion of the fat contained in our food,

but just how the fatty particles get into the villi we must leave Brucke

and Kolliker to settle if they can.

No one has shown satisfactorily the process by which the blood-corpuscles

are formed out of the lymph-corpuscles, nor what becomes of them. These

two questions are like those famous household puzzles,--Where do the

flies come from? and, Where do the pins go to?

There is a series of organs in the body which has long puzzled

physiologists,--organs of glandular aspect, but having no ducts,--the

spleen, the thyroid and thymus bodies, and the suprarenal capsules. We

call them vascular glands, and we believe that they elaborate colored and

uncolored blood-cells; but just what changes they effect, and just how

they effect them, it has proved a very difficult matter to determine. So

of the noted glandules which form Peyer's patches, their precise office,

though seemingly like those of the lymphatic glands, cannot be positively

assigned, so far as I know, at the present time. It is of obvious

interest to learn it with reference to the pathology of typhoid fever.

It will be remarked that the coincidence of their changes in this disease

with enlargement of the spleen suggests the idea of a similarity of

function in these two organs.

The theories of the production of animal heat, from the times of Black,

Lavoisier, and Crawford to those of Liebig, are familiar to all who have

paid any attention to physiological studies. The simplicity of Liebig's

views, and the popular form in which they have been presented, have given

them wide currency, and incorporated them in the common belief and

language of our text-books. Direct oxidation or combustion of the carbon

and hydrogen contained in the food, or in the tissues themselves; the

division of alimentary substances into respiratory, or non-azotized, and

azotized,--these doctrines are familiar even to the classes in our

high-schools. But this simple statement is boldly questioned. Nothing

proves that oxygen combines (in the system) with hydrogen and carbon in

particular, rather than with sulphur and azote. Such is the

well-grounded statement of Robin and Verdeil. "It is very probable that

animal heat is entirely produced by the chemical actions which take place

in the organism, but the phenomenon is too complex to admit of our

calculating it according to the quality of oxygen consumed." These last

are the words of Regnault, as cited by Mr. Lewes, whose intelligent

discussion of this and many of the most interesting physiological

problems I strongly recommend to your attention.

This single illustration covers a wider ground than the special function

to which it belongs. We are learning that the chemistry of the body must

be studied, not simply by its ingesta and egesta, but that there is a

long intermediate series of changes which must be investigated in their

own light, under their own special conditions. The expression "sum of

vital unities" applies to the chemical actions, as well as to other

actions localized in special parts; and when the distinguished chemists

whom I have just cited entitle their work a treatise on the immediate

principles of the body, they only indicate the nature of that profound

and subtile analysis which must take the place of all hasty

generalizations founded on a comparison of the food with residual

products.

I will only call your attention to the fact, that the exceptional

phenomenon of the laboratory is the prevailing law of the organism.

Nutrition itself is but one great catalytic process. As the blood

travels its rounds, each part selects its appropriate element and

transforms it to its own likeness. Whether the appropriating agent be

cell or nucleus, or a structureless solid like the intercellular

substance of cartilage, the fact of its presence determines the

separation of its proper constituents from the circulating fluid, so that

even when we are wounded bone is replaced by bone, skin by skin, and

nerve by nerve.

It is hardly without a smile that we resuscitate the old question of the

'vis insita' of the muscular fibre, so famous in the discussions of

Haller and his contemporaries. Speaking generally, I think we may say

that Haller's doctrine is the one now commonly received; namely, that the

muscles contract in virtue of their own inherent endowments. It is true

that Kolliker says no perfectly decisive fact has been brought forward to

prove that the striated muscles contract without having been acted on

by nerves. Yet Mr. Bowman's observations on the contraction of isolated

fibres appear decisive enough (unless we consider them invalidated by Dr.

Lionel Beale's recent researches), tending to show that each elementary

fibre is supplied with nerves; and as to the smooth muscular fibres, we

have Virchow's statement respecting the contractility of those of the

umbilical cord, where there is not a trace of any nerves.

In the investigation of the nervous system, anatomy and physiology have

gone hand in hand. It is very singular that so important, and seemingly

simple, a fact as the connection of the nerve-tubes, at their origin or

in their course, with the nerve-cells, should have so long remained open

to doubt, as you may see that it did by referring to the very complete

work of Sharpey and Quain (edition of 1849), the histological portion of

which is cordially approved by Kolliker himself.

Several most interesting points of the minute anatomy of the nervous

centres have been laboriously and skilfully worked out by a recent

graduate of this Medical School, in a monograph worthy to stand in line

with those of Lockhart Clarke, Stilling, and Schroder van der Kolk. I

have had the privilege of examining and of showing some of you a number

of Dr. Dean's skilful preparations. I have no space to give even an

abstract of his conclusions. I can only refer to his proof of the fact,

that a single cell may send its processes into several different bundles

of nerve-roots, and to his demonstration of the curved ascending and

descending fibres from the posterior nerveroots, to reach what he has

called the longitudinal columns of the cornea. I must also mention Dr.

Dean's exquisite microscopic photographs from sections of the medulla

oblongata, which appear to me to promise a new development, if not a new

epoch, in anatomical art.

It having been settled that the nerve-tubes can very commonly be traced

directly to the nerve-cells, the object of all the observers in this

department of anatomy is to follow these tubes to their origin. We have

an infinite snarl of telegraph wires, and we may be reasonably sure,

that, if we can follow them up, we shall find each of them ends in a

battery somewhere. One of the most interesting problems is to find the

ganglionic origin of the great nerves of the medulla oblongata, and this

is the end to which, by the aid of the most delicate sections, colored so

as to bring out their details, mounted so as to be imperishable,

magnified by the best instruments, and now self-recorded in the light of

the truth-telling sunbeam, our fellow-student is making a steady progress

in a labor which I think bids fair to rank with the most valuable

contributions to histology that we have had from this side of the

Atlantic.

It is interesting to see how old questions are incidentally settled in

the course of these new investigations. Thus, Mr. Clarke's dissections,

confirmed by preparations of Mr. Dean's which I have myself examined,

placed the fact of the decussation of the pyramids--denied by Haller, by

Morgagni, and even by Stilling--beyond doubt. So the spinal canal, the

existence of which, at least in the adult, has been so often disputed,

appears as a coarse and unequivocal anatomical fact in many of the

preparations referred to.

While these studies of the structure of the cord have been going on, the

ingenious and indefatigable Brown-Sequard has been investigating the

functions of its different parts with equal diligence. The microscopic

anatomists had shown that the ganglionic corpuscles of the gray matter of

the cord are connected with each other by their processes, as well as

with the nerve-roots. M. Brown-Sequard has proved by numerous

experiments that the gray substance transmits sensitive impressions and

muscular stimulation. The oblique ascending and descending fibres from

the posterior nerve-roots, joining the "longitudinal columns of the

cornua," account for the results of Brown-Sequard's sections of the

posterior columns. The physiological experimenter has also made it

evident that the decussation of the conductors of sensitive impressions

has its seat in the spinal core, and not in the encephalon, as had been

supposed. Not less remarkable than these results are the facts, which I

with others of my audience have had the opportunity of observing, as

shown by M. Brown-Sequard, of the artificial production of epilepsy in

animals by injuring the spinal cord, and the induction of the paroxysm by

pinching a certain portion of the skin. I would also call the student's

attention to his account of the relations of the nervous centres to

nutrition and secretion, the last of which relations has been made the

subject of an extended essay by our fellow countryman, Dr. H. F. Campbell

of Georgia.

The physiology of the spinal cord seems a simple matter as you study it

in Longet. The experiments of Brown-Sequard have shown the problem to be

a complex one, and raised almost as many doubts as they have solved

questions; at any rate, I believe all lecturers on physiology agree that

there is no part of their task they dread so much as the analysis of the

evidence relating to the special offices of the different portions of the

medulla spinalis. In the brain we are sure that we do not know how to

localize functions; in the spinal cord, we think we do know something;

but there are so many anomalies, and seeming contradictions, and sources

of fallacy, that beyond the facts of crossed paralysis of sensation, and

the conducting agency of the gray substance, I am afraid we retain no

cardinal principles discovered since the development of the reflex

function took its place by Sir Charles Bell's great discovery.

By the manner in which I spoke of the brain, you will see that I am

obliged to leave phrenology sub Jove,--out in the cold,--as not one of

the household of science. I am not one of its haters; on the contrary, I

am grateful for the incidental good it has done. I love to amuse myself

in its plaster Golgothas, and listen to the glib professor, as he

discovers by his manipulations

"All that disgraced my betters met in me."

I loved of old to see square-headed, heavy-jawed Spurzheim make a brain

flower out into a corolla of marrowy filaments, as Vieussens had done

before him, and to hear the dry-fibred but human-hearted George Combe

teach good sense under the disguise of his equivocal system. But the

pseudo-sciences, phrenology and the rest, seem to me only appeals to weak

minds and the weak points of strong ones. There is a pica or false

appetite in many intelligences; they take to odd fancies in place of

wholesome truth, as girls gnaw at chalk and charcoal. Phrenology juggles

with nature. It is so adjusted as to soak up all evidence that helps it,

and shed all that harms it. It crawls forward in all weathers, like

Richard Edgeworth's hygrometer. It does not stand at the boundary of our

ignorance, it seems to me, but is one of the will-o'-the-wisps of its

undisputed central domain of bog and quicksand. Yet I should not have

devoted so many words to it, did I not recognize the light it has thrown

on human actions by its study of congenital organic tendencies. Its maps

of the surface of the head are, I feel sure, founded on a delusion, but

its studies of individual character are always interesting and

instructive.

The "snapping-turtle" strikes after its natural fashion when it first

comes out of the egg. Children betray their tendencies in their way of

dealing with the breasts that nourish them; nay, lean venture to affirm,

that long before they are born they teach their mothers something of

their turbulent or quiet tempers.

"Castor gaudet equis, ovo proanatus eodem

Pugnis."

Strike out the false pretensions of phrenology; call it anthropology; let

it study man the individual in distinction from man the abstraction, the

metaphysical or theological lay-figure; and it becomes "the proper study

of mankind," one of the noblest and most interesting of pursuits.

The whole physiology of the nervous system, from the simplest

manifestation of its power in an insect up to the supreme act of the

human intelligence working through the brain, is full of the most

difficult yet profoundly interesting questions. The singular relations

between electricity and nerve-force, relations which it has been

attempted to interpret as meaning identity, in the face of palpable

differences, require still more extended studies. You may be interested

by Professor Faraday's statement of his opinion on the matter. "Though I

am not satisfied that the nervous fluid is only electricity, still I

think that the agent in the nervous system maybe an inorganic force; and

if there be reason for supposing that magnetism is a higher relation of

force than electricity, so it may well be imagined that the nervous power

may be of a still more exalted character, and yet within the reach of

experiment."

In connection with this statement, it is interesting to refer to the

experiments of Helmholtz on the rapidity of transmission of the nervous

actions. The rate is given differently in Valentin's report of these

experiments and in that found in the "Scientific Annual" for 1858. One

hundred and eighty to three hundred feet per second is the rate of

movement assigned for sensation, but all such results must be very

vaguely approximative. Boxers, fencers, players at the Italian game of

morn, "prestidigitators," and all who depend for their success on

rapidity of motion, know what differences there are in the personal

equation of movement.

Reflex action, the mechanical sympathy, if I may so call it, of distant

parts; Instinct, which is crystallized intelligence,--an absolute law

with its invariable planes and angles introduced into the sphere of

consciousness, as raphides are inclosed in the living cells of plants;

Intellect,--the operation of the thinking principle through material

organs, with an appreciable waste of tissue in every act of thought, so

that our clergymen's blood has more phosphates to get rid of on Monday

than on any other day of the week; Will,--theoretically the absolute

determining power, practically limited in different degrees by the

varying organization of races and individuals, annulled or perverted by

different ill-understood organic changes; on all these subjects our

knowledge is in its infancy, and from the study of some of them the

interdict of the Vatican is hardly yet removed.

I must allude to one or two points in the histology and physiology of the

organs of sense. The anterior continuation of the retina beyond the ora

serrata has been a subject of much discussion. If H. Muller and Kolliker

can be relied upon, this question is settled by recognizing that a layer

of cells, continued from the retina, passes over the surface of the

zonula Zinnii, but that no proper nervous element is so prolonged

forward.

I observe that Kolliker calls the true nervous elements of the retina

"the layer of gray cerebral substance." In fact, the ganglionic

corpuscles of each eye may be considered as constituting a little brain,

connected with the masses behind by the commissure, commonly called the

optic nerve. We are prepared, therefore, to find these two little brains

in the most intimate relations with each other, as we find the cerebral

hemispheres. We know that they are directly connected by fibres that

arch round through the chiasma.

I mention these anatomical facts to introduce a physiological observation

of my own, first announced in one of the lectures before the Medical

Class, subsequently communicated to the American Academy of Arts and

Sciences, and printed in its "Transactions" for February 14, 1860. I

refer to the apparent transfer of impressions from one retina to the

other, to which I have given the name reflex vision. The idea was

suggested to me in consequence of certain effects noticed in employing

the stereoscope. Professor William B. Rodgers has since called the

attention of the American Scientific Association to some facts bearing on

the subject, and to a very curious experiment of Leonardo da Vinci's,

which enables the observer to look through the palm of his hand (or seem

to), as if it had a hole bored through it. As he and others hesitated to

accept my explanation, I was not sorry to find recently the following

words in the "Observations on Man" of that acute observer and thinker,

David Hartley. "An impression made on the right eye alone by a single

object may propagate itself into the left, and there raise up an image

almost equal in vividness to itself; and consequently when we see with

one eye only, we may, however, have pictures in both eyes." Hartley, in

1784, had anticipated many of the doctrines which have since been

systematized into the theory of reflex actions, and with which I have

attempted to associate this act of reflex vision. My sixth experiment,

however, in the communication referred to, appears to me to be a crucial

one, proving the correctness of my explanation, and I am not aware that

it has been before instituted.

Another point of great interest connected with the physiology of vision,

and involved for a long time in great obscurity, is that of the

adjustment of the eye to different distances. Dr. Clay Wallace of New

York, who published a very ingenious little book on the eye about twenty

years ago, with vignettes reminding one of Bewick, was among the first,

if not the first, to describe the ciliary muscle, to which the power of

adjustment is generally ascribed. It is ascertained, by exact experiment

with the phacueidoscope, that accommodation depends on change of form of

the crystalline lens. Where the crystalline is wanting, as Mr. Ware long

ago taught, no power of accommodation remains. The ciliary muscle is

generally thought to effect the change of form of the crystalline. The

power of accommodation is lost after the application of atropine, in

consequence, as is supposed, of the paralysis of this muscle. This, I

believe, is the nearest approach to a demonstration we have on this

point.

I have only time briefly to refer to Professor Draper's most ingenious

theory as to the photographic nature of vision, for an account of which I

must refer to his original and interesting Treatise on Physiology.

It were to be wished that the elaborate and very interesting researches

of the Marquis Corti, which have revealed such singular complexity of

structure in the cochlea of the ear, had done more to clear up its

doubtful physiology; but I am afraid we have nothing but hypotheses for

the special part it plays in the act of hearing, and that we must say the

same respecting the office of the semicircular canals.

The microscope has achieved some of its greatest triumphs in teaching us

the changes which occur in the development of the embryo. No more

interesting discovery stands recorded in the voluminous literature of

this subject than the one originally announced by Martin Barry,

afterwards discredited, and still later confirmed by Mr. Newport and

others; namely the fact that the fertilizing filament reaches the

interior of the ovum in various animals;--a striking parallel to the

action of the pollen-tube in the vegetable. But beyond the mechanical

facts all is mystery in the movements of organization, as profound as in

the fall of a stone or the formation of a crystal.

To the chemist and the microscopist the living body presents the same

difficulties, arising from the fact that everything is in perpetual

change in the organism. The fibrine of the blood puzzles the one as much

as its globules puzzle the other. The difference between the branches of

science which deal with space only, and those which deal with space and

time, is this: we have no glasses that can magnify time. The figure I

here show you a was photographed from an object (pleurosigma angulatum)

magnified a thousand diameters, or presenting a million times its natural

surface. This other figure of the same object, enlarged from the one

just shown, is magnified seven thousand diameters, or forty-nine million

times in surface. When we can make the forty-nine millionth of a second

as long as its integer, physiology and chemistry will approach nearer the

completeness of anatomy.

Our reverence becomes more worthy, or, if you will, less unworthy of its

Infinite Object in proportion as our intelligence is lifted and expanded

to a higher and broader understanding of the Divine methods of action.

If Galen called his heathen readers to admire, the power, the wisdom, the

providence, the goodness of the "Framer of the animal body,"--if Mr.

Boyle, the student of nature, as Addison and that friend of his who had

known him for forty years tell us, never uttered the name of the Supreme

Being without making a distinct pause in his speech, in token of his

devout recognition of its awful meaning,--surely we, who inherit the

accumulated wisdom of nearly two hundred years since the time of the

British philosopher, and of almost two thousand since the Greek

physician, may well lift our thoughts from the works we study to their

great Artificer. These wonderful discoveries which we owe to that mighty

little instrument, the telescope of the inner firmament with all its

included worlds; these simple formulae by which we condense the

observations of a generation in a single axiom; these logical analyses by

which we fence out the ignorance we cannot reclaim, and fix the limits of

our knowledge,--all lead us up to the inspiration of the Almighty, which

gives understanding to the world's great teachers. To fear science or

knowledge, lest it disturb our old beliefs, is to fear the influx of the

Divine wisdom into the souls of our fellow-men; for what is science but

the piecemeal revelation,--uncovering,--of the plan of creation, by the

agency of those chosen prophets of nature whom God has illuminated from

the central light of truth for that single purpose?

The studies which we have glanced at are preliminary in your education to

the practical arts which make use of them,--the arts of healing,--surgery

and medicine. The more you examine the structure of the organs and the

laws of life, the more you will find how resolutely each of the

cell-republics which make up the E pluribus unum of the body maintains

its independence. Guard it, feed it, air it, warm it, exercise or rest

it properly, and the working elements will do their best to keep well or

to get well. What do we do with ailing vegetables? Dr. Warren, my

honored predecessor in this chair, bought a country-place, including half

of an old orchard. A few years afterwards I saw the trees on his side of

the fence looking in good health, while those on the other side were

scraggy and miserable. How do you suppose this change was brought about?

By watering them with Fowler's solution? By digging in calomel freely

about their roots? Not at all; but by loosening the soil round them, and

supplying them with the right kind of food in fitting quantities.

Now a man is not a plant, or, at least, he is a very curious one, for he

carries his soil in his stomach, which is a kind--of portable flower-pot,

and he grows round it, instead of out of it. He has, besides, a

singularly complex nutritive apparatus and a nervous system. But

recollect the doctrine already enunciated in the language of Virchow,

that an animal, like a tree, is a sum of vital unities, of which the cell

is the ultimate element. Every healthy cell, whether in a vegetable or

an animal, necessarily performs its function properly so long as it is

supplied with its proper materials and stimuli. A cell may, it is true,

be congenitally defective, in which case disease is, so to speak, its

normal state. But if originally sound and subsequently diseased, there

has certainly been some excess, deficiency, or wrong quality in the

materials or stimuli applied to it. You remove this injurious influence

and substitute a normal one; remove the baked coal-ashes, for instance,

from the roots of a tree, and replace them with loam; take away the salt

meat from the patient's table, and replace it with fresh meat and

vegetables, and the cells of the tree or the man return to their duty.

I do not know that we ever apply to a plant any element which is not a

natural constituent of the vegetable structure, except perhaps

externally, for the accidental purpose of killing parasites. The whole

art of cultivation consists in learning the proper food and conditions of

plants, and supplying them. We give them water, earths, salts of various

kinds such as they are made of, with a chance to help themselves to air

and light. The farmer would be laughed at who undertook to manure his

fields or his trees with a salt of lead or of arsenic. These elements

are not constituents of healthy plants. The gardener uses the waste of

the arsenic furnaces to kill the weeds in his walks.

If the law of the animal cell, and of the animal organism, which is built

up of such cells, is like that of the vegetable, we might expect that we

should treat all morbid conditions of any of the vital unities belonging

to an animal in the same way, by increasing, diminishing, or changing its

natural food or stimuli.

That is an aliment which nourishes; whatever we find in the organism, as

a constant and integral element, either forming part of its structure, or

one of the conditions of vital processes, that and that only deserves the

name of aliment. I see no reason, therefore, why iron, phosphate of

lime, sulphur, should not be considered food for man, as much as guano or

poudrette for vegetables. Whether one or another of them is best in any

given case,--whether they shall be taken alone or in combination, in

large or small quantities, are separate questions. But they are elements

belonging to the body, and even in moderate excess will produce little

disturbance. There is no presumption against any of this class of

substances, any more than against water or salt, provided they are used

in fitting combinations, proportions, and forms.

But when it comes to substances alien to the healthy system, which never

belong to it as normal constituents, the case is very different. There

is a presumption against putting lead or arsenic into the human body, as

against putting them into plants, because they do not belong there, any

more than pounded glass, which, it is said, used to be given as a poison.

The same thing is true of mercury and silver. What becomes of these

alien substances after they get into the system we cannot always tell.

But in the case of silver, from the accident of its changing color under

the influence of light, we do know what happens. It is thrown out, in

part at least, under the epidermis, and there it remains to the patient's

dying day. This is a striking illustration of the difficulty which the

system finds in dealing with non-assimilable elements, and justifies in

some measure the vulgar prejudice against mineral poisons.

I trust the youngest student on these benches will not commit the

childish error of confounding a presumption against a particular class of

agents with a condemnation of them. Mercury, for instance, is alien to

the system, and eminently disturbing in its influence. Yet its efficacy

in certain forms of specific disease is acknowledged by all but the most

sceptical theorists. Even the esprit moqueur of Ricord, the Voltaire of

pelvic literature, submits to the time-honored constitutional authority

of this great panacea in the class of cases to which he has devoted his

brilliant intelligence. Still, there is no telling what evils have

arisen from the abuse of this mineral. Dr. Armstrong long ago pointed

out some of them, and they have become matters of common notoriety. I am

pleased, therefore, when I find so able and experienced a practitioner as

Dr. Williams of this city proving that iritis is best treated without

mercury, and Dr. Vanderpoel showing the same thing to be true for

pericarditis.

Whatever elements nature does not introduce into vegetables, the natural

food of all animal life,--directly of herbivorous, indirectly of

carnivorous animals,--are to be regarded with suspicion. Arsenic-eating

may seem to improve the condition of horses for a time,--and even of

human beings, if Tschudi's stories can be trusted,--but it soon appears

that its alien qualities are at war with the animal organization. So of

copper, antimony, and other non-alimentary simple substances; everyone of

them is an intruder in the living system, as much as a constable would

be, quartered in our household. This does not mean that they may not, any

of them, be called in for a special need, as we send for the constable

when we have good reason to think we have a thief under our roof; but a

man's body is his castle, as well as his house, and the presumption is

that we are to keep our alimentary doors bolted against these perturbing

agents.

Now the feeling is very apt to be just contrary to this. The habit has

been very general with well-taught practitioners, to have recourse to the

introduction of these alien elements into the system on the occasion of

any slight disturbance. The tongue was a little coated, and mercury must

be given; the skin was a little dry, and the patient must take antimony.

It was like sending for the constable and the posse comitatus when there

is only a carpet to shake or a refuse-barrel to empty. [Dr. James Johnson

advises persons not ailing to take five grains of blue pill with one or

two of aloes twice a week for three or four months in the year, with half

a pint of compound decoction of sarsaparilla every day for the same

period, to preserve health and prolong life. Pract. Treatise on Dis.

of Liver, etc. p. 272.] The constitution bears slow poisoning a great

deal better than might be expected; yet the most intelligent men in the

profession have gradually got out of the habit of prescribing these

powerful alien substances in the old routine way. Mr. Metcalf will tell

you how much more sparingly they are given by our practitioners at the

present time, than when he first inaugurated the new era of pharmacy

among us. Still, the presumption in favor of poisoning out every

spontaneous reaction of outraged nature is not extinct in those who are

trusted with the lives of their fellow-citizens. "On examining the file

of prescriptions at the hospital, I discovered that they were rudely

written, and indicated a treatment, as they consisted chiefly of tartar

emetic, ipecacuanha, and epsom salts, hardly favorable to the cure of the

prevailing diarrhoea and dysenteries." In a report of a poisoning case

now on trial, where we are told that arsenic enough was found in the

stomach to produce death in twenty-four hours, the patient is said to

have been treated by arsenic, phosphorus, bryonia, aconite, nux vomica,

and muriatic acid,--by a practitioner of what school it may be imagined.

The traditional idea of always poisoning out disease, as we smoke out

vermin, is now seeking its last refuge behind the wooden cannon and

painted port-holes of that unblushing system of false scientific

pretences which I do not care to name in a discourse addressed to an

audience devoted to the study of the laws of nature in the light of the

laws of evidence. It is extraordinary to observe that the system which,

by its reducing medicine to a name and a farce, has accustomed all who

have sense enough to see through its thin artifices to the idea that

diseases get well without being "cured," should now be the main support

of the tottering poison-cure doctrine. It has unquestionably helped to

teach wise people that nature heals most diseases without help from

pharmaceutic art, but it continues to persuade fools that art can arrest

them all with its specifics.

It is worse than useless to attempt in any way to check the freest

expression of opinion as to the efficacy of any or all of the "heroic"

means of treatment employed by practitioners of different schools and

periods. Medical experience is a great thing, but we must not forget

that there is a higher experience, which tries its results in a court of

a still larger jurisdiction; that, namely, in which the laws of human

belief are summoned to the witness-box, and obliged to testify to the

sources of error which beset the medical practitioner. The verdict is as

old as the father of medicine, who announces it in the words, "judgment

is difficult." Physicians differed so in his time, that some denied that

there was any such thing as an art of medicine.

One man's best remedies were held as mischievous by another. The art of

healing was like soothsaying, so the common people said; "the same bird

was lucky or unlucky, according as he flew to the right or left."

The practice of medicine has undergone great changes within the period of

my own observation. Venesection, for instance, has so far gone out of

fashion, that, as I am told by residents of the New York Bellevue and the

Massachusetts General Hospitals, it is almost obsolete in these

institutions, at least in medical practice. The old Brunonian

stimulating treatment has come into vogue again in the practice of Dr.

Todd and his followers. The compounds of mercury have yielded their

place as drugs of all work, and specifics for that very frequent

subjective complaint, nescio quid faciam,--to compounds of iodine. [Sir

Astley Cooper has the boldness,--or honesty,--to speak of medicines which

"are given as much to assist the medical man as his patient." Lectures

(London, 1832), p. 14.] Opium is believed in, and quinine, and "rum,"

using that expressive monosyllable to mean all alcoholic cordials. If

Moliere were writing now, instead of saignare, purgare, and the other, he

would be more like to say, Stimulare, opium dare et potassio-iodizare.

I have been in relation successively with the English and American

evacuant and alterative practice, in which calomel and antimony figured

so largely that, as you may see in Dr. Jackson's last "Letter," Dr.

Holyoke, a good representative of sterling old-fashioned medical art,

counted them with opium and Peruvian bark as his chief remedies; with the

moderately expectant practice of Louis; the blood-letting "coup sur coup"

of Bouillaud; the contra-stimulant method of Rasori and his followers;

the anti-irritant system of Broussais, with its leeching and gum-water; I

have heard from our own students of the simple opium practice of the

renowned German teacher, Oppolzer; and now I find the medical community

brought round by the revolving cycle of opinion to that same old plan of

treatment which John Brown taught in Edinburgh in the last quarter of the

last century, and Miner and Tully fiercely advocated among ourselves in

the early years of the present. The worthy physicians last mentioned,

and their antagonist Dr. Gallup, used stronger language than we of these

degenerate days permit ourselves. "The lancet is a weapon which annually

slays more than the sword," says Dr. Tully. "It is probable that, for

forty years past, opium and its preparations have done seven times the

injury they have rendered benefit, on the great scale of the world," says

Dr. Gallup.

What is the meaning of these perpetual changes and conflicts of medical

opinion and practice, from an early antiquity to our own time? Simply

this: all "methods" of treatment end in disappointment of those

extravagant expectations which men are wont to entertain of medical art.

The bills of mortality are more obviously affected by drainage, than by

this or that method of practice. The insurance companies do not commonly

charge a different percentage on the lives of the patients of this or

that physician. In the course of a generation, more or less, physicians

themselves are liable to get tired of a practice which has so little

effect upon the average movement of vital decomposition. Then they are

ready for a change, even if it were back again to a method which has

already been tried, and found wanting.

Our practitioners, or many of them, have got back to the ways of old Dr.

Samuel Danforth, who, as it is well known, had strong objections to the

use of the lancet. By and by a new reputation will be made by some

discontented practitioner, who, tired of seeing patients die with their

skins full of whiskey and their brains muddy with opium, returns to a

bold antiphlogistic treatment, and has the luck to see a few patients of

note get well under it. So of the remedies which have gone out of

fashion and been superseded by others. It can hardly be doubted that

they will come into vogue again, more or less extensively, under the

influence of that irresistible demand for change just referred to.

Then will come the usual talk about a change in the character of disease,

which has about as much meaning as that concerning "old-fashioned

snow-storms." "Epidemic constitutions" of disease mean something, no

doubt; a great deal as applied to malarious affections; but that the

whole type of diseases undergoes such changes that the practice must be

reversed from depleting to stimulating, and vice versa, is much less

likely than that methods of treatment go out of fashion and come in

again. If there is any disease which claims its percentage with

reasonable uniformity, it is phthisis. Yet I remember that the reverend

and venerable Dr. Prince of Salem told me one Commencement day, as I was

jogging along towards Cambridge with him, that he recollected the time

when that disease was hardly hardly known; and in confirmation of his

statement mentioned a case in which it was told as a great event, that

somebody down on "the Cape" had died of "a consumption." This story does

not sound probable to myself, as I repeat it, yet I assure you it is

true, and it shows how cautiously we must receive all popular stories of

great changes in the habits of disease.

Is there no progress, then, but do we return to the same beliefs and

practices which our forefathers wore out and threw away? I trust and

believe that there is a real progress. We may, for instance, return in a

measure to the Brunonian stimulating system, but it must be in a modified

way, for we cannot go back to the simple Brunonian pathology, since we

have learned too much of diseased action to accept its convenient

dualism. So of other doctrines, each new Avatar strips them of some of

their old pretensions, until they take their fitting place at last, if

they have any truth in them, or disappear, if they were mere phantasms of

the imagination.