4- THE GIFT OF A.^^&3vfe^ ... ■..:... '^m^ 97*4 Cornell University Library R 117.H75C9 Currents and counter-currents In medical 3 1924 011 939 075 Cornell University Library The original of tliis bool< is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924011939075 CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE. OTHER ADDRESSES AND ESSAYS. BY OLIVIE WENDELL HOLMES, FAKEMAN PBOFB880R OF ANATOMY AND PHYSIOLOGY IN HABVARD UNIVEESITY, LATB PHYSICIAN IN THE UASSACHUSETTS GENERAL HOSPITAL, UBMBEB OF THE SOCIETY FOE MEDICAL OBSERVATION AT PARIS, FELLOW OF THE MASSACHUSETTS MEDICAL SOCIETY, FELLOW OF THE AMERICAN ACADEMY OF ARTS AND SCIENCES. BOSTON: TIOKNOB AND FIELDS. M DCCC I/XI. Enteied according to Act of Congress, in the year 1861, by OLIVER WENDELL HOLMES, in the Clerk's Office of the District Court of the District of Massachusetts. ITniverBity Frcse, Cambridge : Stereotyped and Printed by Welch, Blgolow, & Co. JAMES JACKSON, M.D., MY EARLIEST MEDICAL TEACHES, WHOSE FKIENDSHIP AND COUNSEL HAVE BEEN AMONQ THE CHIEF PLEASCEES AND PRIVILEGES OP MY LIFE, ARE AFFECTIONATELY AND RESPECTFULLY DEDICATED. PRErACE. The character of the opposition which some of these papers have met with suggests the inference that they contain really important, but unwelcome truths. Nega- tives .multiplied into each other change their sign and become positives. Hostile criticisms meeting together are often equivalent to praise, and the square of fault-finding turns out to be the same thing as eulogy. But a writer has rarely so many enemies as it pleases him to believe. Self-love leads us to overrate the num- bers of our negative constituency. The larger portion of my limited circle of readers must be quite indifferent to, if not ignorant of, the adverse opinions which have been expressed or recorded concerning any of these Addresses or Essays now submitted to their own judgment. It is proper, however, to inform them, that some of the posi- tions maintained in these pages have been unsparingly attacked, with various degrees of ability, scholarship, and good-breeding. The tone of criticism naturally changes with local conditions in different parts of a country extend- ed like our own, so that it is one of the most convenient gauges of the partial movements in the direction of civili- iv PREFACK. zation. It is satisfactoiy to add, that the views assailed have also been unflinchingly defended by unsought cham- pions, among the ablest of whom it is pleasant to mention, at this moment of political alienation, the Editor of the Charleston Medical Journal. " Currents and Counter-Currents " was written and de- livered as an Oration, a florid rhetorical composition, expressly intended to secure the attention of an audience not easy to hold as listeners. It succeeded in doing this, and also in being as curiously misunderstood and misrep- resented as if it iad been a political harangue. This gave it more local notoriety than it might otherwise have attained, so that, as I learn, one ingenious person made use of its title as an advertisement to a production of his own. The commonest mode of misrepresentation was this : qualified propositions, the whole meaning of which depend- ed on the qualifications, were stripped of these and taken as absolute. Thus, the attempt to establish a presumption against giving poisons to sick persons was considered as equivalent to condemning the use of these* substances. The only important inference the writer has been able to draw from the greater number of the refutations of his opinions which have been kindly sent him, is that the preliminary education of the Medical Profession is not always what it ought to be. One concession he is willing to make, whatever sacri- fice of pride it may involve. The story of Massasoit, which has furnished a coral, as it were, for some teething critics, when subjected to a powerful logical analysis, though correct in its essentials, proves to have been told with exceptionable breadth of statement, and therefore PEEFACE. V (to resume the metaphor) has been slightly rounded off at its edges, so as to be smoother for any who may wish to bite upon it hereafter. In other respects the Discourse has hardly been touched. It is only an individual's expression, in his own way, of opinions entertained by hundreds of the Medical Profession in every civilized country, and has nothing in it which on revision the writer sees cause to retract or modify. The superstitions it attacks lie at the very foundation of Homceopathy, and of almost every form of medical charlatanism. Still the mere routinists and unthinking artisans in most callings dislike whatever shakes the dust out of their traditions, and it may be unreasonable to expect that Medicine will always prove an exception to the rule. One half the opposition which the numerical system of Louis has met with, as applied to the results of treatment, has been owing to the fact that it showed the movements of disease to be far more independent of the kind of practice pursued than was agreeable to the pride of those whose self-confidence it abated. The statement, that medicines are more sparingly used in physicians' families than in most others, admits of a very natural explanation, without putting a harsh construc- tion upon it, which it was not intended to admit. Outside pressure is less felt in the physician's own household; that is all. If this does not sometimes influence him to give medicine, or what seems to be medicine, when among those who have more confidence in drugging than his own fam- ily commonly has, the learned Professor Dunglison is hereby requested to apologize for his definition of the word Placebo, or to expunge it from his Medical Dictionary. vi PREFACE. One thing is certain. A loud outcry on a slight touch reveals the weak spot in a profession, as well as in a patient. It is a doubtful poUcy to oppose the freest speech in those of our own number who are trying to show us where they honestly believe our weakness lies. Vast as are the advances of our Science and Art, may it not possibly prove on examination that we retain other old barbarisms beside the use of the astrological sign of Jupiter, with which we endeavor to insure good luck to our prescriptions ? Is it the act of a friend or a foe to try to point them out to our brethren when asked to ad- dress them, and is the speaker to subdue the constitutional habit of his style to a given standard, under penalty of giving offence to a grave assembly ? "Homoeopathy and its Kindred Delusions" was pub- lished nearly twenty years ago, and has been long out of piint, so that the author tried in vain to procure a copy nntU the kindness of a friend supplied him with the only one he has had for years. A foolish story reached his ears that he was attempting to buy up stray copies for the sake of suppressing it. This edition was in the press at that very time. Many of the arguments contained in the Lectures have lost wha,tever novelty they may have possessed. AH its predictions have been submitted to the formidable test of time. They appear to have stood it, so far, about as well as most uninspired prophecies; indeed, some of them require much less accommodation than certain grave commentators employ in their readings of the ancient Prophets. PREFACE. Vll If some statistics recently published* are correct, Ho- moeopathy has made very slow progress in Europe. In all England, as it appears, there are hardly a fifth more Homoeopathic practitioners than there are students attend- ing Lectures at the Massachusetts Medical College at the present time. In America it has undoubtedly proved more popular and lucrative, yet how loose a hold it has on the public confidence is shown by the fact that, when a specially valued life, which has been played with by one of its agents, is seriously threatened, the first thing we expect to hear is that a regular practitioner is by the patient's bed, and the Homoeopathic counsellor over- ruled or discarded. Again, how many of the ardent and capricious persons who embraced Homoeopathy have run the whole round of pretentious novelties ; — have been boarded at water-cure establishments, closeted with uterine and other specialists, and finally wandered over seas to put themselves in charge of foreign celebrities, who dosed them as lustily as they were ever dosed be- fore they took to globules ! It will surprise many to learn to what a shadow of a shade Homoeopathy has dwindled in the hands of many of its noted practitioners. The itch-doctrine is treated with contempt. Infinitesimal doses are replaced by full ones whenever the fancy-prac- titioner chooses. Good Homoeopathic reasons can be found for employing anything that anybody wants to employ. Homoeopathy is now merely a name, an un- proved theory, and a box of pellets pretending to be * Medical Investigator. Devoted to the Advancement of the Homoe- opathic System of Medicine. Chicago, Jan. 1st, 1861. Viii PEEFACE. specifics, which, as all of us know, fail ignominiously in those cases where we would thankfully sacrifice all our prejudices and give the world to have them true to their promises. Homoeopathy has not died out so rapidly as Tractora- tion. Perhaps it was well that it should not, for it has taught us a lesson of the healing faculty of Nature which was needed, and for which many of us have made proper acknowledgments. But it probably does more harm than good to medical science at the present time, by keeping up the delusion of treating everything by specifics, — the old barbarous notion that sick people should feed on poisons,* against which a part of the Discom-se at the beginning of this volume is directed. The infinitesimal globules have not become a curiosity as yet, like Perkins's Tractors. But time is a very elastic element in Geology and Prophecy. If Daniel's seventy weeks mean four hundred and ninety years, as the learned Prideaux and others have settled it that they do, the " not many years " of my prediction may be stretched out a generation or two beyond our time, if ne- cessary, when the prophecy will no doubt prove true. It might be fitting to add a few words with regard to the Essay on the Contagiousness of Puerperal Fever. But the whole question I consider to be now transferred * Lachem, arrow-poison, obtained from a sei'pent (Pulte). Crotahs horridm, rattlesnake's venom (Neidhard). The less dangerous Pedioulus capitis is the favorite remedy of Dr. Mure, the English " Apostle of Ho- moeopathy." These are examsples of the retrograde current setting towards barbarism. PREFACE. IX from the domain of medical inquiry to the consideration of Life Insurance agencies and Grand Juries. For the justification of this somewhat sharply accented language I must refer the reader to the paper itself for details which I regret to have been forced to place on permanent record. The Essay on the Mechanism of Vital Actions was written, it must be remembered, before the recent discus- sions on the Origin of Species. The reader must also notice the difference in the dates of the two Addresses which follow this Essay. Boston, January, 1861. CONTENTS. PAGE Currents and Counter-Currents in Medical Sci- ence 1 An Address, delivered before the Massachusetts Medical So- ciety, at the Annual Meeting, May 30, 1860. HOM(EOPATHY, AND ITS KiNDRED DELUSIONS .... 51 Two Lectures, delivered before the Boston Society for the Difiiision of Useful Knowledge, 1842. Some more Recent Views on Homceopathy . . .179 A Notice of the " Homoeopathic Domestic Physician." From the Atlantic Monthly for December, 1867. Puerperal Fever, as a Private Pestilence . . . 189 An Essay printed in 1843 ; reprinted, with Additions, 1855. The Position and Prospects or the Medical Stu- dent 279 An Address delivered before the Boylston Medical Society of Harvard University, January 12, 1844. Published at the Re- quest of the Society. Mechanism op Vital Actions 323 From the North American Review, for April, 1857. Valedictory Address 383 Delivered to the Medical Graduates of Harvard University, at the Annual Commencement, Wednesday, March 10, 1858. CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE. AN ADDRESS, DELIVERED BEFORE TitE MASSACHTJSETTS MEDICAL SOCIETY, AT THE ANNUAL MEETING, MAY 80, 1860. " tioiirav (jniiries Irfrpoi." " Facilitate magis quam Tiolentia." HlPPOCEATES. CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE. Our Annual Meeting never fails to teach us at least one lesson. The Art whose province it is to heal and to save cannot protect its own ranks from the inroads of disease and the waste of the Destroyer. Seventeen of our associates have been taken from us since our last Anniversary. Most of them fol- lowed their calling in the villages or towns that lie among the hills or along the inland streams. Only those who have lived the kindly, mutually depend- ent life of the country, can tell how near the phy- sician who is the main reliance in sickness of all the fajnilies throughout a thinly settled region comes to the hearts of the people among whom he labors, how they value him while living, how they cherish his memory when dead. For these friends of ours who have gone before, there is now no more toil ; they start from their slumbers no more at the cry of pain ; they sally forth no more into the storms ; they ride no longer over the lonely roads that knew them so well; their wheels are rusting on 4 CUEEENTS AND COUNTER-CURRENTS their axles or rolling with other burdens ; their watchful eyes are closed to all the sorrows they lived to soothe. Not one of these was famous in the great world ; some were almost unknown be- yond their own immediate circle. But they have left behind them that loving remembrance which is better than fame, and if their epitaphs are chis- elled briefly in stone, they are written at full length on Rving tablets in a thousand homes to which they carried their ever-welcome aid and sympatliy. One whom we have lost, very widely known and honored, was a leading practitioner of this city. His image can hardly be dimmed in your recollec- tion, as he stood before you only three years ago, filling the same place with which I am now honored. To speak of him at all worthily, would be to write the history of professional success, won without spe- cial aid at starting, by toil, patience, good sense, pure character, and pleasing manners ; won in a straight uphill ascent, without one breathing-space until he sat down, not to rest, but to die. If pray- ers could have shielded him from the strode, if love could have drawn forth the weapon, and skill could have healed the wound, this passing tribute might have been left to other lips and to another gen- eration. Let us hope that our dead have at last found that rest which neither summer nor winter, nor day nor night, had granted to their unending earthly labors ! IN MEDICAL SCIENCE. 5 And let iis remember that our duties to our brethren do not cease when they become unable to share our toils, or leave behind them in want and woe those whom their labor had supported. It is honorable to the Profession that it has organized an Associa- tion* for the relief of its suffering members and their families ; it owes this tribute to the ill- rewarded industry and sacrifices of its less fortu- nate brothers who wear out health and life in the service of humanity. I have great pleasure in re- ferring to this excellent movement, which gives our liberal profession a chance to show its liberality, and serves to unite us all, the successful and those whom fortune has cast down, in the bonds of a true- brother- hood. A medical man, as he goes about his daily busi- ness after twenty years of practice, is apt to suppose that he treats his patients according to the teachings of his experience. No doubt this is true to some extent ; to what extent depending much on the qualities of the individual. But it is easy to prove that the prescriptions of even wise physicians are very commonly founded on something quite differ- ent from experience. Experience must be based on the permanent facts of nature. But a glance at the prevalent modes of treatment of any two suc- cessive generations will show that there is a change- * The Massachusetts Medical Benevolent Society. 6 CURRENTS AND COUNTER-CURRENTS able as well as a permanent element in the art of healing ; not merely changeable as diseases vary, or as new remedies are introduced, but changeable by the going out of fashion of special remedies, by the decadence of a popular theory from which their fit- ness was deduced, or other cause not more signifi- cant. There is no reason to suppose that the pres- ent time is essentially different in this respect from any other. Much, therefore, which is now very commonly considered to be the result of experience, will be recognized in the next, or in some succeed- ing generation, as no such result at all, but as a fore- gone conclusion, based on some prevalent belief or fasliion of the time. There are, of course, in every calling, those who go about the work of the day before them, doing it according to the rules of their craft, and asking no questions of the past or of the future, or of the aim and end to whicli their special labor is contributing. These often consider and call themselves practical men. They pull the oars of society, and have no leisure to watch the currents running this or that way ; let theorists and philosophers attend to them. In the mean time, however, these currents are carry- ing the practical men, too, and all their work may be thrown away, and worse than thrown away, if they do not take knowledge of them and get out of the wrong ones and into the right ones as soon as they may. Sir Ed-?^ard Parry and his party were m MEDICAL SCIENCE. 7 going straight towards the pole, in one of their arc- tic expeditions, travelling at the rate of ten miles a day. But the ice over which they travelled was drifting straight towards the equator, at the rate of twelve miles a day, and yet no man among them would have known that he was travelling two miles a day backward, unless he had lifted his eyes from the track in which he was plodding. It is not only going backward that the plain practical workman is liable to, if he will not look up and look around ; he may go forward to ends he little dreams of. It is a simple business for a mason to build up a niche in a wall ; but what if, a hundred years afterwards, when the wall is torn down, the skeleton of a mur- dered man drop out of the niche ? It was a plain practical piece of carpentry for a Jewish artisan to fit two pieces of timber together according to the legal pattern in the time of Pontius Pilate ; he asked no questions, perhaps, but we know what burden the cross bore on the morrow ! And so, with subtler tools than trowels or axes, the statesman who works in policy withoixt principle, the theologian who works in forms without a soul, the physician who, calling himself a practical man, refuses to recognize the larger laws which govern his changing practice, may all find that they have been building triith into the wall, and hanging humanity upon the cross. The truth is, that medicine, professedly founded on observation, is as sensitive to outside influences, 8 CUREENTS AND COUNTER-CUEEENTS political, religious, philosophical, imaginative, as is the barometer to the changes of atmospheric density. Theoretically it ought to go on its own straightfor- ward inductive path, without regard to changes of government or to fluctuations of public opinion. But look a moment while I clash a few facts to- gether, and see if some sparks do not reveal by their light a closer relation between the Medical Sciences and the conditions of Society and the general thought of the time, than would at first be suspected. Observe the coincidences between certain great po- litical and intellectual periods and the appearance of illustrious medical reformers and teachers. It was in the age of Pericles, of Socrates, of Plato, of Phidias, that Hippocrates gave to medical knowl- edge the form which it retained for twenty centu- ries. With the world-conquering Alexander, the word-embracing philosopher Aristotle, appropriating anatomy and physiology, among his manifold spoils of study, marched abreast of his royal pupil to wider conquests. Under the same Ptolemies who founded the Alexandrian Library and Museum, and ordered the Septuagint version of the Hebrew Scriptures, the infallible Herophilus* made those six hundred dis- sections of which TertuUian accused him, and the sagacious Erasistratus introduced his mild antiphlo- gistic treatment in opposition to the polypharmacy * " Contradicere Herophilo in anatomicis, est contradicere evange- linm," was a saying of Fallopius. IN MEDICAL SCIENCE. 9 and antidotal practice of his time. It is significant that the large-minded Galen should have been the physician and friend of the imperial philosopher Marcus Aurelius. The Arabs gave laws in various branches of knowledge to those whom their arms had invaded, or the terror of their spreading do- minion had reached, and the point from which they started was, as Humboldt acknowledges, " the study of medicine, by which they long ruled the Christian Schools," * and to which they added the department of chemical pharmacy. Look at VesaUus, the contemporary of Luther. Who can fail to see one common spirit in the radi- cal ecclesiastic and the reforming court-physician ? Both still to some extent under the dominion of the letter : Luther holding to the real presence ; Vesalius actually catising to be drawn and engraved two muscles which he knew were not found in the human subject, because they had been described by Galen, from dissections of the lower animals. f Both breaking through old traditions in the search of truth ; one, knife in hand, at the risk of life and reputation, the other at the risk of fire and fagot, with that mightier weapon which all the devils could not silence, though they had been thicker than the tiles on the house-tops. How much the physician of the Catholic Charles V. had in common with the * Cosmos, II. 587. t Optera Omnia, BasilesB, 155.5. Lib. II., Tab. V. VI. pp. 225, 228. 1* 10 CUEBENTS AND COtJNTEE-CUEEENTS great religious destructive, may be guessed by the relish with which he tells the story how certain Par vian students exhumed the body of an " elegans scortum," or lovely dame of ill repute, the favorite of a monk of the order of St. Anthony, who does not seem to have resisted temptation so well as the founder of his order.* We have always ranked the physician Rabelais among the early reformers, but I do not know that Vesalius has ever been thanked for his hit at the morals of the religious orders, or for turning to the good of science what was intend- ed for the " benefit of clergy." Our unfortunate medical brother, Michael Serve- tus, the spiritual patient to whom the theological moxa was applied over the entire surface for the cure of his heresy, came very near anticipating Harvey. f The same quickened thought of the time which led him to dispute the dogmas of the Church, opened his mind to the facts which contradicted the dogmas of the Faculty. Harvey himself was but the posthumous child of the great Elizabethan period. Bacon was at once his teacher and his patient. The founder of the * Op. cit., Lib. V. Cap. 15, p. 663. t " Non per parietem cojrdis mediam, ut vulgo creditur, Bed magno artificio, a dextro cordis ventriculo, longe per pnlmones tractu, et a vena arteriosa, in arteriam venosam transfunditur." — Bostock's Physi- dogy, note to p. 211. I cite the passage on account of the calling in question of the claims of Servetus by Amed& Pichot. (Life ana Labors of Sir Charles Bell, London, 1860, p. 3.) IN MEDICAL SCIENCE. 11 new inductive philosophy had only been dead two years when the treatise on the Circulation, the first- fruit of the Eestoration of Science, was given to the world. And is it to be looked at as a mere accidental coincidence, that while Napoleon was modernizing the political world, Bichat Was revolutionizing the science of life and the art that is based upon it ; that while the young general was scaling the Alps, the young surgeon was climbing the steeper summits of unexplored nature ; that the same year read the announcement of those admirable Researches on Life and Death, and the bulletins of the battle of Ma- rengo ? If we come to our own country, who can fail to recognize that Benjamin Eush, the most conspicuous of American physicians, was the intellectual offspring of the movement which produced the Revolution ? " The same hand," says one of his biographers, "which subscribed the declaration of the political independence of these States, accomplished their emancipation from medical systems formed in for- eign countries, and wholly unsuitable to the state of diseases in America." Following this general course of remark, I pro- pose to indicate in a few words the direction of the main intellectual current of the time, and to point out more particularly some of the eddies which tend 12 CUEEENTS AND COUNTEE-CUEEENTS to keep the science and art of medicine from mov- ing with it, or even to carry them backwards. The two dominant words of our time are law and average, both pointing to the uniformity of the or- der of being in which we live. Statistics have tab- ulated everything, — population, growth, wealth, ■ crime, disease. We have shaded maps showing the geographical distribution of larceny and suicide. Analysis and classification have been at work upon all tangible and visible objects. The positive Phi- losophy of Comte has only given expression to the observing and computing mind of fhe nineteenth century. In the mean time, the great stronghold of intel- lectual conservatism, traditional belief, has been a? sailed by facts which would have been indicted as blasphemy but a few generations ago. Those new tables of the law, placed in the hands of the geol- gist by the same living God who spoke from Sinai to the Israehtes of old, have remodelled the beliefs of half the civilized world. The solemn scepticism of science has replaced the sneering doubts of witty philosophers. The more positive knowledge we gain, the more we incline to question all that has been received without absolute proof. As a matter of course, this movement has its par- tial reactions. The province of faith is claimed as a port free of entry to unsupported individual con- victions. The tendency to question is met by the IN MEDICAL SCIENCE. 13 unanalyzing instinct of reverence. The old church calls back its frightened truants. Some who have lost their hereditary religious belief find a resource in the revelations of Spiritualism. By a parallel movement, some of those who have become medical infidels pass over to the mystic band of believers in the fancied miracles of Homoeopathy. Under these influences transmitted to, or at least shared by, the medical profession, the old question between " Nature," so called, and " Art," or profes- sional tradition, has reappeared with new interest. I say the old. question, for Hippocrates stated the case on the side of " Nature " more than two thou- sand years ago.* Miss Florence Nightingale, — and if I name her next to the august Father of the Healing Art, its noblest daughter well deserves that place of honor, — Miss Florence Nightingale begins her late volume with a paraphrase of his statement. But from a very early time to this there has always been a strong party against " Nature." Themison called the practice of Hippocrates " a meditation upon death." Dr. Eush says: "It is impossible to calculate the mischief which Hippocrates has done, by first marking nature with his name and after- wards letting her loose upon sick people. Millions have perished by her hands in all ages and coun- tries." Sir John Forbes, whose defence of " Na- ture " in disease you all know, and to the testimonial * Epidemics, Book VI. Sect. 5. 14 CTRKENTS AND COUNTEK-CUEEENTS in whose honor four of your Presidents have contrib- uted, has been recently greeted, on retiring from the profession, with a wisli that his retirement had been twenty years sooner, and the opinion that no man had done so much to destroy the confidence of the public in the medical profession. In this Society we have had the Hippocratic and the Themisonic side fairly represented. The Trea- tise of one of your early Presidents on the Mer- curial Treatment is familiar to my older listeners. Others who have held the same office have been noted for the boldness of their practice, and even for partiality to the use of complex medication. On the side of " Nature " we have had, first of all, that remarkable discourse on Self-Limited Dis- eases,* which has given the key-note to the prevail- ing medical tendency of this neighborhood, at least, for the quarter of a centiiry since it was delivered. Nor have we forgotten the address delivered at Springfield twenty years later,! 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.J We * Ou Self-Limited Diseases. A Discourse delivered before the Massachusetts Medical Society, at their Annual Meeting, May 27th, 1835. By Jacob Bigelow, M. D. t " Search out the Secrets of Nature." By Augustus A. Gould, M. D. Eead at the Annual Meeting, June 27th, 1855. t Kational Therapeutics. A Prize Essay. By Worthington Hooker. M. D., of New Haven. Boston. 1857. m MEDICAL' SCIENCE. 15 should not omit from the list the important address of another of our colleagues,* showing by numer- ous cases the power of- Nature in healing compound fractures. to be much greater than is frequently sup- posed, — affording, indeed, more striking illustrations than can be obtained from the history of visceral dis- ease, of the supreme wisdom, forethought, and adap- tive 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 our- selves 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 de- nounce 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 head-quarters of the nature-trusting heresy, provided it be one, that State is Massachu- * On the Treatment of Compound and Complicated Fraetutes. By William J. Walker, M. D. Read at the Annual Meeting. May 29th, 1845. 16 CUEEENTS AND COUOTEE-CUEKENTS setts, 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 applica- tion of troublesome, painful, uncertain, or dangerous remedies. Nay, 1 wiU venture to say this, that if every specific were -to fail utterly, if the cinchona trees all died out, and the arsenic mines were ex- hausted, and the stdphur 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 profes- sion, 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 elimi- nate them if p6ssible 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 predic- tions 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 its 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. IN MEDICAL SCIENCE. 17 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, arid that old practitioners are more sparing of active medicines than younger" ones.* 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 misapply- ing 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 ina- bility to weigh the value of testimony ; of which, I think, from a pretty careful examination of his books, * Dr. .James Jackson has kindly permitted me to make the following extract from a letter jnst received by him from Sir James Clark, and dated May 26th, 1 860 : — " 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." B 18 CUERENTS AND COUNTEE-CURRENTS. 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 simpii- cem, 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 not- withstanding ? — The numerical system is the best corrective of this and similar errors. The arguments commonly broiight against its application to all mat- ters 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 obser- vation, 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 IN MEDICAL SCIENCE. 19 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 ho- moeopathic materia medica, — which consists of sugar of milk and a nomenclature. Another portion of tiie 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 millionnaires. 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 th^ 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 peo- ple. They happened to contain mercury, and hence the trouble for w'hich he consulted our associate. The outside pressure, therefore, is immense upon the physician, tending to force him to active treat- ment of some kind. Certain old superstitions, still lingering in the mind of the public, and not yet ut- terly 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 agen- cy 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, accord- 20 CURRENTS AND COUNTER-CURRENTS. ing to the Apocrypha. Epileptics used to suck the blood from the wounds of dying gladiators.* The Hon. Robert Boyle's little book was published some twenty or thirty years before our late President, Dr. Holyoke, was born.f In it he recommends, as inter- nal medicines, most of the substances commonly used as fertilizers of the soil. His Album Grcecum 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 shooe 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 ! J Even now, the Homoeopathists have been intro- ducing the venom of serpents, under the learned title of Lachesis, and outraging human nature with infu- sions 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 * Plinii Hist. Mundi, Lib. xxviii., C. 4. t A Collection of Choice and Safe Remedies. The Fifth Edition, corrected. London. 1712. Dr. Holyoke was bom in 1728. t The idea is very ancient. " Sordes hominis " — " Sudore et oleo medicinam facientibus." — Plin., xxviii. 4 IN MEDICAL SCIENCE. 21 impregnated with all the pedicular virtues they so highly value. They know what they are doing. They are appes^ling to the detestable old super- stitious presumption in favor of whatever is nau- seous and noxious as being good for the sick. Again, we all occasionally meet persons stained with nitrate of silver, given for epilepsy. Eead 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 pa- tient'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 Brous- 22 CURRENTS AND COUNTER-CURRENTS sais 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 lot 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 soipetimes 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 difiFerent kind of epithelium, and fur- nished with entirely different secretions. A silver- smith 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 splitfooted R 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 Massa- soit 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 IN MEDICAL SCIENCE. 28 the devil of sickness. Winslow gave him some con- serve, 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 straw- berry leaves and sassafras root, and had the satisfac- tion of seeing him rapidly recover. Massasoit, full of gratitude, revealed the plot which had been formed to destroy the colonists, whereupon the Gov- ernor 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 Presiden- tial candidate should happen to be taken sick as Massasoit was, and his tongue wanted cleaning, — which process would not hurt a good many poli- ticians, 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 lirfe. 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 * Winslow's Good News from New England, or a Relation, &c. Chap. 20, 21. 24 CrOEBENTS AM) COUNTEE-CUEBENTS is suckling two lusty twins, the intervals of suction being occupied on her part with palpitations, head- aches, giddiness, throbbing in the head, and various nervous symptoms, her cheeks meantime getting bloodless, and her strength running away in com- pany 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 beef- steaks and porter, the twins are ignominiously ex- pelled from the anaemic bosom, and forced to take prematurely to the bottle, and this prolific mother is saved for futirre usefalness 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 prac- tice I cannot doubt, and that in this country the standard of practice was in former generations low- ered through the same agency is not imlikely. I have seen an old accoimt-book in which the physician charged an extra price for gilding his rich patients' pills. If all medicine were very costly, and the ex- pense 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 IN MEDICAL SCIENCE. 25 the cholagogues that emptied the bUiary ducts of his own wallet, unless he were siire they were needed. If there is asny temptation, it should not be in favor of giv- • ing noxiojis 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 a horror of quackery as the elder Cato, — who declared that the Greek doctors had sworn to exterminate all bar- barians, including the Romans, with their drugs, but is said to have physicked his own wife to death, not- withstanding, — Pliny says, in so many words, that the cerates and cataplasms, plasters, coUyria, and antidotes, so abundant in his time, as in more re- cent 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 super- stitions and fancies, of exploded theories, of old ways of making mone'y, which are very slow to pass out of fashion ! But there are other special Ameri- can influences which we are bound to take cogni- zance of. If I wished to show a student the difficul- ties 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 26 CUBRENTS AND COUNTER-CURRENTS impatience with lier old-fasliioned 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, pro- duced 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 pro- foundly 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 ceme- tery 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 IN MEDICAL SCIENCE. 27 feeling as if Nature had been a good deal shaken by the Declaration of Independence, and that Ameri- can 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 ex- travagance 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 epi- thets 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,* and that the American eagle screams with delight to see three drachms of calomel given at a single mouthful ? f * More strictly, ninety-six grains in two hours. — Dunglison's Prac- tice, 1842, Vol. II. p. 520. Eighty grains in one dose. — Ibid., p. 536. Ninety-six grains of snlphate of quinine are equal to eight ounces of good bark. — Wood jj- Bache. t Pereira, II. 614. Quoted from Christison's Treatise on Poisons. 28 CUERENTS AND COUNTEE-CUEKENTS 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 rem- edies 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 ia 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 fecun- date the minds of less demonstrative audiences at various scientific stations ; all of us talking habitu- ally 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 indi- rectly for our own practical skill. Hence that annual crop of introductory lectures ; the useful blossoming into the ornamental, as the cabbage be- comes glorified in the cauliflower ; that lecture-room literature of adjectives, that declamiatory exaggera- tion, 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 over-state the efficacy IN MEDICAL SCIENCE. 29 of favorite methods of cure, and hence the premium offered for showy talkers rather than sagacious ob- servers, 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 lia- ble to become involved and carried back out of the broad stream of philosophical, or, in other words, truth-loving, investigations. The causes of disease, iu 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 remem- ber 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 statis- ticians of the Insurance office could not listen to without horror and indignation ? f Have we forgot- * "Ingeniorum Grsecise flata impellimur. Palaraque est, ut quisque inter istos loquendo poUeat, imperatorem iUico vites nostrse necisqne Hen." — {Plin. Hist. Mundi, XXIX. 1.) I hope I may use the old Roman liberty of speech without offence. t The Contagiousness of Puerperal Feyer. — N. E. Quar. Jour, of Medicine and Surgery, April, 1843. Reprinted, with Additions. Boston : Ticknor & Fields. 1855. 30 CURRENTS AND COimXER-CURRENTS ten what is told in one of the hooks published under our own sanction, that a simple measure of ventilar tion, proposed by Dr. John Clark, had saved more than sixteen thousand children's lives in a single hos- pital ? * 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 in- significant 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 Cen- taur. 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 lan- guage it was spoken, but I know that in English it would soimd 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. * CoUins'B Midwifery, p. 312. (In Lib. of Prac. Med.) IN MEDICAL SCIENCE. 31 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 rejec- tion, 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 un- intelligible way, and which it is as well now to de- fine. 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 abnor- mal 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, — distiirbed quiet, uncomforta- bleness, — means imperfect or abnormal reaction of the living system, and its more or less permanent results. 32 CURRENTS AKD COUNTER-CUEEENTS Food, in its largest sense, is whatever helps to buUd up the normal structures, or to maintain their natural actions. Medicine, in distinction from food, is every un- natural or noxious agent applied for the relief of disease. Physic means properly the Natural art, and Phy- sician 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 intelli- gence, trained by a perfect education, could do no more than keep the laws of the physical and spirit- ual universe. Au imperfect intelligence, imperfectly taught, — and this is the condition of our finite hu- manity, — 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 per- turbations of the planets, in the disintegration of the elemental masses ; it has left its traces in the fossil organisms of extinct creations.* But it is especially the prerogt^tive, I had almost said privilege, of edu- cated and domesticated beings, from man down to * 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 m MEDICAL SCIENCE. 33 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 quar- rel 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 atti- bones of tertiary mammalia hare been collected in the caverns of Gailenreuth with traces of healing." Professor Jeffries Wyman has also favored me with an interesting communication, from which I extract this statement : — " Necrosis, caries, anchylosis, and osteophytes have been observed in fossil bones. Zeis (Leipsic, 1856). has written a memoir on the speci- mens of this nature contained in the Eoyal Cabinet of Natural History at Dresden.'' 2* O 34 CUEEENTS AND COUNTEE-OUEEENTS tude of a formal proposition in the work of Dr. Eobert Knox* I will illustrate tlie downward move- ment 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 was graduated at Harvard College a deli- cate 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 di- minutive 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 * " Already the Anglo-Saxon rears with difiBcnlty his offspring in Australia : it is the same in most parts of America. But for the supplies they receive from Europe the race would perish, even in these most healthy climates.'' — The Races of Men. Philadelphia, 1850, p. 317. IN MEDICAL SCIENCE. 35 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 fal- lacy of the universal-degeneration theory applied to American life ; the same on which one of our coun- trymen 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 endow- ments 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 chil- dren of races that are sinking below the decent minimum which nature has established as the con- dition of viability, before they reach the age of re- production. 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. 36 CUBEENTS AND COUNTER-CURRENTS Again, invalidism is tlie 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 rem- edies 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 be- trays itself in the frequency with which the hag- gard features and drooping shoulders of the opium- drunkards are met with in the streets. The next proposition I would ask you to con- sider, is this : — The presumption always is that every noxious agent, including medicines proper, which hurts . a well man, hurts a sick one. [Note B."] m MEDICAL SCIENCE. 37 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 power- ful man, in the prime of life, and in admirable con- dition. K 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 can- not 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 suffer- ing 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 ex- actly kill him, nothing less than kill him, and noth- ing more. If this, or something like this, is true, then all these medications are, prima facie, injurious. In the game of Life-or-Death, Rovg-e et Noir, as played between the Doctor and the Sexton, this five 88 CURRENTS AND COUNTER-CURRENTS per cent, this certain small injury entering into the chances, is clearly the sexton's perquisite for keep- ing the green table, over which the game is played, and where he hoards up his gains. Suppose a Uls- ter 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 ca- thartic — should always be presumed to be hurtful. It always is directly hurtful ; it may sometimes be indirectly beneficial. If this presumption were es- tablished, and disease always assumed to be the inno- cent 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, at- tributed 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 scaiiet 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 dis- IN MEDICAL SCIENCE. , 39 cover, 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 firm- ly 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 be- lieves that the typhus syncopalis of a preceding gen- eration in New England, " was often in fact a brandy and opium disease." How is a physician to distin- guish 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 hygi- enic conditions, is like amputation without ligatures. I had a chance to learn this well of old, when phy- sician to the Broad Street district of the Boston Dis- pensary. There, there was no help for the utter want of wholesome conditions, and if anybody got well iinder 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, 40 CURRENTS AND CODNTER-CURBENTS 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 at- mosphere of domestic malaria, or to the most negli- gent kind of nursing ! I confess that I should think my chance of recovery from illness less with Hippoc- rates 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 dis- ease, and if any whom I might influence should adopt this as a principle of practice, they will often find themselves embarrassed by the imperative de- mand 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 pre- paring food for the table to the rudo cookery of those IN MEDICAL SCIENCE. 41 hard-feeding and much-dosing islanders. We want a reorganized cuisine of invalidism perhaps as much as the cuhnary 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 calo- mel is not sometimes given by a physician on the same principle as that upon which a landlord occa- sionally prescribes bacon and eggs, — because he can- not think of anything else quite so handy ? I leave my suggestion of borrowing a hint from French prac- tice to your mature consideration. I may, however, call your attention, briefly, to the singular fact, that English and American practitioners are apt to acctise French medical practice of inert- ness, and French surgical practice of unnecessary ac- tivity. 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.f We have * Hist, of Med., in Cyc. of Prae. Med., Vol. I. p. 70. t 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. — (Prim, 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. 42 OUREENTS AND OOUNTEE-OUBRENTS often hoard similar opinions maintained by our own countrymen. "While Anglo-American criticism blows hot and cold on the two departments of French prac- tice, 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 sur- gery 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, tran- sient 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 mor- tal 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 vrill 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 aver- m MEDIOAL SCIENCE. 48 age 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 her- esy to which you may have listened. I cannot com- promise your collective wisdom. If I have strained the truth one hair's breadth for the sake of an epi- gram or an antithesis, you are accustomed to count the normal pulse-beats of sound judgment, and know ftiU 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 as- sured position of the Profession in our Common- wealth, 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 con- sisting in the rule of the majority. Majorities, the greater material powers, have always ruled before. The history of most countries has been that of ma- 44 CUEEENTS AND COUNTER-CUEEENTS jorities, — mounted majorities, clad in iron, armed with death, treading down the tenfold more numer- ous 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 ma- jority 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 to-day may or- ganize itself in the growing consciousness of the time, and come back to us like the voice of the mul- titudinous 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 gen- erally 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 mo- ment every person who was breathing on that day, May 27th, 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 recrystallizod. IN MEDICAL SCIENCE. 45 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 Soci- ety 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 togeth- er, to take counsel together, and to stand together for the truth, now, always, here, everywhere ; for this our fathers instituted, and we accept, the ofi&ces and duties of this time-honored Society. NOTES, Some passages contained in the original manuscript of the Address, and omitted in the delivery on account of its length, are restored in the text or incorporated with these Notes. Note A. — (p. 21.) There is good reason to doubt whether the nitrate of silver has any real efficacy in epilepsy. It has seemed to cure many cases, but epilepsy is a very uncertain disease, and there is hardly any- thing which has not been supposed to cure it. Dr. Copland cites many authorities in its favor, most especially Lombard's cases. But De la Berge and Monneret (Comp. de Mdd., Paris), 1889, analyze these same cases, eleven in number, and can only draw the inference of a very questionable value in the supposed rem- edy. Dr. James Jackson says that relief of epilepsy is not to be attained by any medicine with which he is acquainted, but by diet. (Letters to a Young Physician, p. 67.) Guy Fatin, Dean of the Faculty of Paris, Professor at the Royal College, Author of the Antimonial Martyrology, a wit and a man of sense and learning, who died almost two hundred years ago, had come to the same conclusion, though the chemists of his time boasted of their remedies. " Did you ever see a case of epilepsy cured by nitrate of silver ? " I said to one of the oldest and most expe- rienced surgeons in this country. "Never," was his instant reply. Dr. Twitchell's experience was very similar. How, then, did nitrate of silver come to be given for epilepsy ? Because, as NOTES. 47 Dr. Martin has so well reminded us, lunatics were considered formerly to be under the special influence of Luna, the moon, (which Esquirol, be it observed, utterly denies,) and lunar caustic, or nitrate of silver, is a salt of that metal which was called luna from its whiteness, and of course must be in the closest relations with the moon. It follows beyond all reasonable question that the moon's metal, silver, and its preparations, must be the specific remedy for moon-blasted maniacs and epileptics 1 Yet the practitioner who prescribes the nitrate of silver sup- poses he is guided by the solemn experience of the past, instead of by its idle fancies. He laughs at those old physicians who placed such confidence in the right hind hoof of an elk as a rem- edy for the same disease, and leaves the record of his own belief in a treatment quite as fanciful and far more objectionable, writ- ten in indelible ink upon a living tablet where he who runs may read it for a whole generation, if nature spares his walking ad- vertisement so long. Note B. — (p. 36.) The presumption that a man is innocent until he is proved guilty, does not mean that there are no rogues, but lays the onus probandi on the party to which it properly belongs. So with this proposition. A noxious agent should never be employed in sick- ness unless there is ample evidence in the particular case to over- come the general presumption against all such agents, — and the evidence is very apt to be defective. The miserable delusion of Homoeopathy builds itself upon an axiom directly the opposite of this ; namely, that the sick are to be cured by poisons. Similia simUibus curantur means exactly this. It is simply a theory of universal poisoning, nullified in practice by the infinitesimal contrivance. The only way to kill it and all similar fancies, and to throw every quack nostrum into discredit, is to root out completely the suckers of the old rotten 48 NOTES. superstition that whatever is odious or noxious is likely to be good for disease. The current of sound practice with ourselves is, I believe, setting fast in the direction I have indicated in the above proposition. To uphold the exhibition of noxious agents in dis- ease, as the rule, instead of admitting them cautiously and reluc- tantly as the exception, is, as I think, an eddy of opinion in the direction of the barbarism out of which we believe our art is escaping. It is only through the enlightened sentiment and ac- tion of the Medical Profession that the community can be brought to acknowledge that drugs should " always be regarded as evils." It is true that some suppose, and our scientific and thoughtM associate. Dr. Gould, has half countenanced the opinion, that there may yet be discovered a specific for every disease. Let us not despair of the future, but let us be moderate in our expecta- tions. When an oil is discovered that will make a bad watch keep good time ; when a recipe is given which will turn an acephalous fcetus into a promising child ; when a man can enter the second time into his mother's womb and give her back the infirmities which twenty generations have stirred into her blood, and infused into his own through hers, we may be prepared to enlarge the National Pharmacopoeia with a list of specifics for everything but old age, — and possibly for that also. Note C. — (p. 39.) The term specific is used here in its ordinary sense, without raising the question of the propriety of its application to these or , other remedies. The credit of introducing Cinchona rests between the Jesuits, the Countess of Chinchon, the Cardinal de Lugo, and Sir Kobert Talbor, who employed it as a secret remedy. (Pereira.) Mercu- ry as an internal specific remedy was brought into use by that " impudent and presumptuous quack," as he was considered, Par- acelsus. (Encyc. Brit., Art. Paracelsus.') Arsenic was intro- NOTES. 49 dnced into England as a remedy for intermittents by Dr. Fowler, in consequence of the success of a patent medicine, the Tasteless Ague Drops, -which were supposed, " probably with reason," to be a preparation of that mineral. (Kees's Cyc, Art. Arsenic.) Colchicum came into notice in a similar way, from the success of the Eau Medicinale of M. Hnsson, a French military officer. (Pereira.) Iodine was discovered by a saltpetre manufactiu'er, but applied by a physician in place of the old remedy, burnt sponge, which seems to ow-? its efficacy to it. (Dunglison, New Remedies.) As for Sulphur, "the common people have long used it as an ointment" for scabies. (Rees's Cyc, Art. Scabies.') The modern antiscorbutic regimen is credited to Captain Cook. " To his sagacity we are indebted for the first impulse to those regulations by which scorbutus is so successfully prevented in our navy." (Lond. Cyc. Prac. Med., Art. Scorbutus.) Iron and various salts which enter into the normal composition of the human body do not belong to the materia medica by our defi- nition, but to the materia alimentaria. For the first introduction of iron as a remedy, see Pereira, who gives a very curious old story. The statement in the text concerning a portion of the materia medica stands exactly as delivered, and is meant exactly as it stands. No denunciation of drugs as sparingly employed by a wise physician, was or is intended. If, however, as Dr. Gould stated in his "valuable and practical discourse" to which the Massachusetts Medical Society "listened with profit as well as interest," " Drugs, in themselves considered, may always be re- garded as evils," — any one who chooses may question whether the evils from their abuse are, on the whole, greater or less than the undoubted benefits obtained from their proper use. The large exception of opium, wine, specifics, and anaesthetics, made in the text, takes off enough from the useful side, as I fuUy believe, to turn the balance ; so that a vessel containing none of these, but loaded with antimony, strychnine, acetate of lead, aloes, 3 D 50 NOTES. aconite, lobeKa, lapis infernalis, stercus diaboli, tormentilla, and other approved, and, in skilful hands, really useful remedies, brings, on the whole,, more harm than good to the port it enters. " It is a very narrow and unjust view of the practice of medi- cine, to suppose it to consist altogether in the use of powerful drugs, or of drugs of any kind. Far from it." " The physician may do very much for the welfare of the sick, more than others can do, although he does not, even in the major part of cases, undertake to control and overcome the disease by art. It was with these views that I never reported any patient cured at our hospital. Those who recovered their health were reported as well, not implying that they were made so by the active treat- ment they had received there. But it was to be understood that all patients received in that house were to be curedj- that is, taken care of." (Letters to a Young Physician, by Jambs Jackson, M.D., Boston, 1855.) " Hygienic rules, properly enforced, fresh air, change of air, travel, attention to diet, good and appropriate food judiciously regulated, together with the administration of our tonics, porter, ale, wine, iron, etc., supply the diseased or impoverished system with what Mr. Gull, of St. Bartholomew's Hospital, aptly calls ' the raw material of the blood ; ' and we believe that if any real improvement has taken place in medical practice, independently of those truly valuable contributions we have before described, it is in the substitution of tonics, stimulants, and general manage- ment, for drastic cathartics, for bleeding, depressing agents, in- cluding mercury, tartar emetics, &c., so much in vogue during the early part even of this century." — (F. P. Fobcher, in Charleston Med. Journal and Review, for January, 1860.) HOMCEOPATHY, AND ITS KINDRED DELUSIONS: TWO LECTURES X>£LIT£BED BEFOSB T HW BOSTON SOCIETY FOR Tfffi DIFFUSION OF USEFUL KNOWLEDGE. 1842. KaiTVOV (TKias Svap^ PREFACE, When a physician attempts to convince a person, who has fallen into the Homoeopathic delusion, of the emptiness of its pretensions, he is often answered by a statement of cases in which its practitioners are thought to have effected wonderful cures. The main object of the first of these Lectures is to show, by abundant facts, that such statements, made by per- sons unacquainted with the fluctuations of disease and the fallacies of observation, are to be considered in general as of little or no value in establishing the truth of a medical doctrine, or the utility of a method of practice. Those kind friends who suggest to a person suffer- ing from a tedious complaint, that he "had better try Homoeopathy," are apt to enforce their sugges- tion by adding, that " at any rate it can do no harm." This may or may not be true as regards the individ- ual. But it always does very great harm to the community to encourage ignorance, error, or decep- tion, in *a profession which deals with the life and health of our fellow-creatures. Whether or not 64 PREFACE. those who countenance Homoeopathy are guilty of this injustice towards others, the second of these Lectures may afford them some means of deter- mining. To deny that good effects may happen from the observance of diet and regimen when prescribed by Homoeopathists as well as by others, would be very unfair to them. But to suppose that men witla minds so constituted as to accept such staternents and em- brace such doctrines as mate up the so-called science of Homoeopathy, are more competent than others to regulate the circumstances which influence the hu- man body in health and disease, would be judging very harshly the average capacity of ordinary prac- titioners. To deny that some patients may liave been actually benefited through the influence exerted upon their imaginations, would be to refuse to Homoeopathy what all are willing to concede to every one of those numerous modes of practice known to all intelligent persons by an opprobrious title. So long as the body is affected through the mind, no audacious device, even of the most manifestly dishonest character, can fail of producing occasional good to those who yield it an implicit or even a partial faith. The argument founded on this occasional good, would be as applica- ble in justifying the counterfeiter and giving circula- tion to his base coin, on the ground that a^spurious doUar had often relieved a poor man's necessities. PEEFACE. 55 Homoeopathy has come before our public at a period when the growing spirit of eclecticism has prepared many ingenious and honest minds to listen to all new doctrines with a candor , liable to degen- erate into weakness. It is not impossible that the pretended evolution of great and mysterious virtues from infinitely attenuated atoms, may have enticed a few over-refining philosophers, who have slid into a vague belief that matter subdivided grows less mate- rial, and approaches nearer to a spiritual nature as it requires a more powerful microscope for its detection. However this may be, some persons seem disposed to take the ground of Menzel, that the Laity must pass formal judgment between the Physician and the Homoeopathist, as it once did between Luther and the Romanists. The practitioner and the scholar must not therefore smile at the amount of time and labor expended in these Lectures upon this shadowy system ; which, in the calm and serious judgment of many of the wisest members of the medical pro- fession, is not entitled by anything it has ever said or done to the notoriety of a public rebuke, still less to the honors of critical martyrdom. LECTURE I. I HATE selected four topics for this lecture, the first three of which I shall touch but slightly, the last more fully. They are 1. The Eoyal cure of the King's Evil, or Scrofula. 2. The Weapon Ointment, and its twin absurdity, the Sympathetic Powder. 3. The Tar-water mania of Bishop Berkeley. 4. The History of the Metallic Tractors, or Per- kinism. The first two illustrate the ease with which nu- merous facts are accumulated to prove the most fanciful and senseless extravagances. The third exhibits the entire insufficiency of ex- alted wisdom, immaculate honesty, and vast general acquirements to make a good physician of a great bishop. The fourth shows us the intimate machinery of an extinct delusion, which flourished only forty years ago ; drawn in all its details, as being a rich and comparatively recent illustration of the pretensions, the arguments, the patronage, by means of which 58 HOMffiOPATHY windy errors have long been, and will long con- tinue to be, swollen into transient consequence. All display in superfluous abundance the boundless credulity and excitability of mankind upon subjects connected with medicine. Prom the time of Edward the Confessor to Queen Anne, the monarchs of England were in the habit of touching those who were brought to them suffer- ing with the scrofula, for the cure of that distemper. William the Third had good sense enough to discon- tinue the practice, but Anne resumed it, and, among her other patients, performed the royal operation upon a child, who, in spite of his disease, grew up at last into Samuel Johnson. After laying his hand upon the sufferers, it was customary for the monarch to hang a gold piece around the neck of each patient. Very strict precautions were adopted to prevent those who thought more of the golden angel hung round the neck by a white ribbon, than of relief for their bodily infirmities, from making too many calls, as they sometimes attempted to do. " According to the statement of the advocates and contemporaries of this remedy, none ever failed of receiving benefit unlets their little faith and credulity starved their merits. Some are said to have been cured immediately on the very touch, others did not so easily get rid of their swellings, until they were toxiched a second time. AND ITS KINDRED DELUSIONS. 59 Several cases are related, of persons who had been blind for several weeks, and months, and obliged even to be led to Whitehall, yet recovered their sight immediately upon being touched, so as to walk away without any guide." * So widely, at one period, was the belief diffused, that, in the course of twelve years, nearly a hundred thousand persons were touched by Charles the Sec- ond. Catholic divines, in disputes upon the ortho- doxy of their church, did not deny that the power had descended to Protestant princes ; — Dr. Harps- field, in his Ecclesiastical History of England, admit- ted it, and, in Wiseman's words, " when Bishop Tooker would make use of this Argument to prove the Truth of our Church, Smitheus doth not there- upon go about to deny the Matter of fact ; nay, both he and Cope acknowledge it." " I my self," says Wiseman, the best English surgical writer of his day, — "I my self have been a frequent Eye-witness of many hundreds of Cures performed by his Majesties Touch alone, without any assistance of Chirurgery ; and those, many of them such as had tired out the endeavors of able Chirurgeons before they came hither. It were endless to recite what I myself have seen, and what I have received acknowledgments of by Letter, not only from the severall parts of this Na- tion, but also from Ireland, Scotland, Jersey, Garn- * Edinburgh Medical and Surgical Journal, Vol. III. p. 103. 60 HOMffiOPATHY sey. It is needless also to remember what Miracles of this nature were performed by the very Bloud of his late Majesty of Blessed memory, after whose dec- ollation by the inhumane Barbarity of the Regicides, the reliques of that wore gathered on Chips and in Handkerohieffs by the pious Devotes, who could not but think so great a suffering in so honourable and pious a Cause, would be attended by an extraordina- ry assistance of God, and some more then ordinary miracle : nor did their Faith deceive them in this there point, being so many hundred that found the benefit of it."* Obstinate and incredulous men, as he tells us, ac- counted for these cures in three ways : by the journey and change of air the patients obtained in coming to London ; by the influence of imagination ; and the wearing of gold. To these objections he answers, — 1st. That many of those cured were inhabitants of the city. 2d. That the subjects of treatment were frequently infants. 3d. That sometimes silver was given, and sometimes nothing, yet the patients were cured. A superstition resembling this probably exists at the present time in some ignorant districts of Eng- land and this country. A writer in a Medical Jour- nal in the year 1807, speaks of a farmer in Devon- shire, who, being a ninth son of a ninth son, is * Severall Chirurgicall Treatises. London, 1676. p. 246. AND ITS KINDEED DELUSIONS. 61 thought endowed with healing powers like those of ancient royalty, — and who is accustomed one day in every week to strike for the evil. I remember that one of my schoolmates told me, when a boy, of a seventh son of a seventh son, some- where in Essex county, who touched for the scrofula, and who used to hang a silver fourpence halfpenny about the neck of those who came to him, which fourpence halfpenny it was solemnly affirmed became of a remarkably black. color after having been some time worn, and that his own brother had been sub- jected to this extraordinary treatment ; but I must add that my schoolmate drew a bow of remarkable length, strength, and toughness for his tender years. One of the most curious examples of the fallacy of popular belief and the uncertainty of asserted facts in medical .experience is to be found in the history of the Unguentum Armarium, or Weapon Ointment. Fabricius Hildanus, whose name is familiar to ev- ery surgical scholar, and Lord Bacon, who frequently dipped a little into medicine, are my principal au- thorities for the few circumstances I shall mention regarding it. The Weapon Ointment was a prepara- tion used for the healing of wounds, but instead of its being applied to them, the injured part was washed and bandaged, and the weapon with which the wound was inflicted was carefully anointed with the un- 62 HOMCEOPATHY guent. Empirics, ignorant barbers, and men of that sort, are said to have especially employed it. Still there were not wanting some among the more respec- table members of the medical profession who sup- ported its claims. The composition of this ointment was complicated, in the different formulae given by different authorities ; but some substances addressed to the imagination, rather than the wound or weapon, entered into all. Such were portions of mummy, of human blood, and of moss from the skull of a thief hung in chains. Hildanus was a wise and learned man, one of the best surgeons of his time. He was fully aware that a part of the real secret of the Unguentum Armarium consisted in the washing and bandaging the wound and then letting it alone. But he could not resist the solemn assertions respecting its efficacy ; he gave way before the outcry of facts, and therefore, instead of denying all their pretensions, he admitted and tried to account for them upon supernatural grounds. As the virtue of those applications, he says, which are made to the weapon cannot reach the wound, and as they can produce no effect without contact, it fol- lows, of necessity, that the Devil must have a hand in the business; and as he is by far the most long- headed and experienced of practitioners, he cannot find this a matter of any great difficulty. Hildanus himself reports, in detail, the case of a lady who had received a moderate wound, for which the Unguen- AND ITS KINDRED DELUSIONS. 63 turn Armarium was employed without the slightest use. Yet instead of receiving this flat case of failure as any evidence against the- remedy, he accounts for its not succeeding by the devout character of the lady, and her freedom from that superstitious and over-imaginative tendency whicli the Devil requires in those who are to be benefited by his devices. Lord Bacon speaks of the Weapon Ointment, in his Natural History, as having in its favor the testimony of men of credit, though, in his own language, he himself " as yet is not fully inclined to believe it." His remarks upon the asserted facts respecting it show a mixture of wise suspicion and partial belief. He does not like the precise directions given as to the circumstances under which the animals from which some of the materials were obtained were to be kiUed ; for he thought it looked like a provision for an excuse in case of failure, by laying the fault to the omission of some of these circumstances. But he likes well that " they do not observe the confect- iug of the Ointment under any certaui constellation ; which is commonly the excuse of magical medicines, when they fail, that they were not made under a fit figure of heaven." * It was pretended that if the offending weapon could not be had, it would serve the purpose to anoint a wooden one made like it. * This was a mistake, however, since the two recipes given by Hil- danus are both very explicit as to the aspect of the heavens required for different stages of the process. 64 HOMCEOPATHY " This," says Bacon, " I should doubt to be a device to keep this strange form of cure in request and use ; because many times you- cannot come by the weapon itself." And in closing his remarks on the statements of the advocates of the ointment, he says, " Lastly, it will cure a beast as well as a man, which I like best of all the rest, because it subjecteth the matter to an easy trial." It is worth remembering, that more than two hundred years ago, vshen an absurd and fantastic remedy was asserted to possess won- derful power, and when sensible persons ascribed its pretended influence to imagination, it was boldly answered that the cure took place when the wound- ed party did not know of the application made to the weapon, and even when a brute animal was the subject of the experiment, and that this assertion, lie as we all know it was, came in such a shape as to shake the incredulity of the keenest thinker of his time. The very same assertion has been since re- peated in favor of Perkinism, and, since that, of Homoeopathy. The same essential idea as that of the Weapon Ointment reproduced itself in the still more famous Sympathetic Powder. This Powder was said to have the faculty, if applied to the blood-stained garments of a wounded person, to cure his injuries, even though he were at a great distance at the time. A friar, returning from the East, brought the recipe to Europe somewhat before the middle of the seven- AND ITS KINDKED DELUSIONS. 65 teentli century. The Grand Duke of Florence, in wliicli city the friar was residing, heard of his cures, and tried, but without success, to obtain his secret. Sir Kenelm Digby, an Englishman well known to fame, was fortunate enough to do him a faTor, which wrought upon his feelings and induced him to impart to his benefactor the composition of his extraordinary Powder. This English knight was at different periods of his life an admiral, a theologian, a critic, a meta- physician, a politician, and a disciple of Alchemy. As is not unfrequent with versatile and inflamma- ble people, he caught fire at the first spark of a new medical discovery, and no sooner got home to Eng- land than he began to spread the conflagration. " An opportunity soon offered itself to try the powers of the famous Powder. Mr. J. Howel, having been wounded in endeavoring to part two of his friends who were fighting a duel, submitted himself to a trial of the Sympathetic Powder. Four days after he received his wounds, Sir Kenelm dipped one of Mr. Howel's garters in a solution of the Powder, and immediately, it is said, the wounds, which were very painful, grew easy, although the patient, who was conversing in a corner of the chamber, had not the least idea of what was doing with his garter. He then returned home, leaving his garter in the hands of Sir Kenelm, who had hung it up to dry, when Mr. Howel sent his servant in a great hurry to tell him that his wounds were paining him horri- 66 HOMCEOPATHY bly ; the garter was therefore replaced in the solution of the Powder, and the patient got well after five or six days of its continued immersion." " King James First, his son Charles the First, the Duke of Buckingham, then prime minister, and all the principal personages of the time, were cognizant of this fact ; and James himself, being curious to know the secret of this remedy, asked it of Sir Kenelm, who revealed it to him, and his Majesty had the opportunity of making several trials of its effi- cacy, which all succeeded in a surprising manner." * The king's physician, Dr. Mayenne, was made master of the secret, which he carried to France and communicated to the Duke of Mayerne, who performed many cures by means of it, and taught it to his surgeon, who, after the duke's death, sold it to many distinguished persons, by whose agency it soon ceased to be a secret. "What was this won- derful substance which so astonished kings, princes, dukes, knights, and doctors ? Nothing but pow- dered blue vitriol. But it was made to undergo several processes that conferred on it extraordinary virtues. Twice or thrice it was to be dissolved, filtered, and crystallized. The crystals were to be laid in the sun during the months of June, July, and August, taking care to turn them carefully that all should be exposed. Then they were to be powdered, triturated, and again exposed to the sun, * * Diet, des Sciences M^dicales. AND ITS KIKDEED DELUSIONS. 67 again reduced to a very fine powder, and secured in a vessel, while hot, from the sunshine. If there seem anything remarkable in the fact of such as- tonishing properties being developed by this process, it must be from our short-sightedness, for common salt and charcoal develop powers quite as marvel- lous after a certain number of thumps, stirs, and shakes, from the haiids of modern workers of miracles. In fact the Unguentum Armarium and Sympathetic Powder resemble some more recent prescriptions ; the latter consisting in an infinite dilution of the common dose in which remedies are given, and the two former in an infinite dilu- tion of the common distance at which they are applied. Whether philosophers, and more especially meta- physicians, have any peculiar tendency to dabble in drugs and dose themselves with physic, is a question which might suggest itself to the reader of their biographies. When Bishop Berkeley visited the illustrious Male- branche at Paris, he found him in his cell, cooking in a small pipkin a medicine for an inflammation of the lungs, from which he was suffering ; and the disease being unfortunately aggravated by the vehe- mence of their discussion, or the contents of the pipkin, carried him ofi" in the course of a few days. Berkeley himself afforded a remarkable Illustration 68 HOMCEOPATHY of a truth which has long been known to the mem- bers of one of the learned professions, namely, that no amount of talent or of acquirements in other departments, can rescue from lamentable folly those who, without something of the requisite preparation, undertake to experiment with nostrums upon them- selves and their neighbors. The exalted character of Berkeley is thus drawn by Sir James Mackintosh: "Ancient learning, exact science, polished society, modern literature, and the fine arts, contributed to adorn and enrich the mind of this accomplished man. All his contemporaries agreed with the sat- irist in ascribing " ' To Berkeley every virtue under heaven.' " Even the discerning, fastidious, and turbulent Atterbury said, after an interview with him, ' So much understanding, so much knowledge, so much innocence, and such humility, I did not think had been the portion of any but angels, till I saw this gentleman.' " But among the writings of this great and good man is an Essay of the most curious character, illustrating his weakness upon the point in ques- tion, and entitled, " Siris, a Chain of Philosophical Reflections and Inquiries concerning the Virtues of Tar Water, and divers other Subjects," — an essay which begins with a recipe for his favorite fluid, and slides by gentle gradations into an examination AND ITS KINDRED DELUSIONS. 69 of the sublimest doctrines of Plato. To show how far a man of honesty and beneTolence, and with a mind of singular acuteness and depth, inay be run away with by a favorite notion on a subject his habits and education do not fit him to investigate, I shall give a short account of this Essay, merely stating that as all the supposed virtues of Tar Water, made public in successive editions of his treatise by so illustrious an author, have not saved it from neglect and disgrace, it may be fairly as- sumed that they were mainly imaginary. The bishop, as is usual in such cases, speaks of himself as indispensably obliged, by the duty he owes to mankind, to make his experience public. Now this was by no means evident, nor does it follow in general, that because a man has formed a favorable opinion of a person or a thing he has not the proper means of thoroughly understanding, he shall be bound to print it, and thus give currency to his impressions, which may be erroneous, and therefore injurious. He would have done much better to have laid his inipressions before some experienced physicians and surgeons, such as Dr. Mead and Mr. Cheselden, to have asked them to try his experi- ment over again, and have been guided by their answers. But the good bishop got excited ; he pleased himself with the thought that he had dis- covered a great panacea; and having once tasted the bewitching cup of self-quackery, like many be- 70 HOMCEOPATHY fore and since his time, he was so infatuated with the draught, that he would insist on pouring it down the throats of his neighbors and all mankind. The precious fluid was made by stirring a gallon of water with a quart of tar, leaving it forty-eight hours, and pouring off the clear water. Such was the specific which the great metaphysician recom- mended for averting and curing all manner of dis- eases. It was, if he might be believed, a preventive of the small-pox, and of great use in the course of the disease. It was a cure for impurities of the blood, coughs, pleurisy, peripneumony, erysipelas, asthma, indigestion, cachexia, hysterics, dropsy, mor- tification, scurvy, and hypochondria. It was of great use in gout and fevers, and was an excellent pre- servative of the teeth and gums ; answered all the purpose of Elixir Proprietatis, Stoughton's drops, diet drinks, and mineral waters ; was particularly to be recommended to sea-faring persons, ladies, and men of studious and sedentary lives ; could never be taken too long, but, on the contrary, pro- duced advantages which sometimes did not begin to show themselves for two or three mouths. " From my representing Tar Water as good for so many things," says Berkeley, " some perhaps may conclude it is good for nothing. But charity obligeth me to say what I know, and what I think, howsoever it may be taken. Men may censure and object as they please, but I appeal to time and ex- AND ITS KDJDRED DELUSIONS. 71 periment. Effects misimputed, cases ■wrong told, circumstances overlooked, perhaps, too, prejudices and partialities against truth, may for a time pre- vail and keep her at the bottom of her well, from whence nevertheless she emergeth sooner or later, and strikes the eyes of all who do not keep them shut." I cannot resist the temptation of illustrat- ing the bishop's belief in the wonderful powers of his remedy, by a few sentences from different parts of his essay. " The hardness of stubbed vulgar constitutions renders them insensible of a thousand things that fret and gall those delicate people, who, as if their skin was peeled off, feel, to the quick everything that touches them. The tender nerves and low spirits of such poor creatures would be much relieved by the use of Tar "Water, which might prolong and cheer their lives." " It [the Tar Water] may be made stronger for brute beasts, as horses, in whose disorders I have found it very useful." " This same water will also give charitable -relief to the ladies, who often want it more than the parish poor ; being many of them never able to make a good meal, and sitting pale, puny, and forbidden, like ghosts, at their own table, victims of vapors and in- digestion." It does not appear among the virtues of Tar Water that " children cried for it," as for some of our modern remedies, but the bishop says, " I have known children take it for above six months together with great benefit, and without any incon- 72 HOMCEOPATHY venience ; and after long and repeated experience I do esteem it a most excellent diet drink, fitted to all seasons and ages." After mentioning its useful- ness in febrile complaints, he says : " I have had all this confirmed by my own experience in the late sickly season of the year one thousand seven hun- dred and forty-one, having had twenty-five fevers in my own family cured by this medicinal water, drunk copiously." And to finish these extracts with a most important suggestion for the improvement of the British nation : "It is much to be lamented that our Insulars, who act and think so much for themselves, should yet, from grossness of air and diet, grow stupid or doat sooner than other people, who, by virtue of elastic air, water-drinking, and light food, preserve their faculties to extreme old age ; an advantage which may perhaps be approached, if not equalled, even in these regions, by Tar Water, temperance, and early hours." Berkeley died at the age of about seventy; he might have lived longer, but his fatal illness was so sudden that there was not time enough to stir up a quart of the panacea. He was an illustrious man, but he held two very odd opinions ; that tar water was everything, and that the whole material uni- verse was nothing. Most of those present have at some time in their AND ITS KINDEED DELUSIONS. 73 lives heard mention made of the Metallic Tisac- TORS, invented by one Dr. Perkins, an American, and formerly enjoying great repute for the cure of various diseases. Many have seen or heard of a satirical poem, written by one of our own country- men also, about forty years since, and called " Ter- rible Tractoration." The Metallic Tractors are now so utterly abandoned, that I have only by good for- tune fallen upon a single one of a pair, to show for the sake of illustration. For more than thirty years this great discovery, which was to banish at least half the evils which afflict humanity, has been sleeping undisturbed in the grave of oblivion. Not a voice has, for this long period, been raised in its favor ; its noble and learned patrons, its public in- stitutions, its eloquent advocates, its brilliant prom- ises are all covered with the dust of silent neglect ; and of the generation which has sprung up since the period when it flourished, very few know anything of its history, and hardly even the title which in its palmy days it bore of Perkinism. Taking it as settled, then, as no one appears to answer for it, that Perkinism is entirely dead and gone, that both in public and private, officially and individually, its former adherents even allow it to be absolutely defunct, I select it for anatomical examination. If this pretended discovery was made public ; if it was long kept before the public ; if it was addressed to the people of different countries ; if it was formally 74 HOMCEOPATHY investigated by scientific men, and systematically adopted by benevolent persons, who did everything in their power to diffuse the knowledge and practice of it ; if various collateral motives, such as interest and vanity, were embarked in its cause ; if, notwith- Btanding all these things, it gradually sickened and died ; then the conclusion seems a fair one, that it did not deserve to live. Contrasting its failure with its high pretensions, it is fair to call it an imposi- tion; whether an express fraudulent contrivance or not, some might be ready to question. Everything historically shown to have happened concerning the mode of promulgation, the wide diffusion, the ap- parent success of this delusion, the respectability and enthusiasm of its advocates, is of great inter- est in showing to what extent and by what means a considerable part of the community may be led into the belief of that which is to be eventually considered as an idle folly. If there is any existing folly, fraudulent or innocent in its origin, which appeals to certain arguments for its support ; pro- vided that the very same arguments can be shown to have been used for Perkinism -with as good reason, they will at once fall to the ground. Still more, if it shall appear that the general course of any existing delusion bears a strong resemblance to that of Perkinism, that the former is most fre- quently advocated by the same class of persons who were conspicuous in behalf of the latter, and treated AND ITS KINDRED DELUSIONS. 75 with contempt or opposed by the same kind of per- sons who thus treated Perkinism ; if the facts in favor of both have a similar aspect; if the motives of their originators and propagators may be pre- sumed to have been similar ; then there is every reason to suppose that the existing folly will follow in the footsteps of the past, and after displaying a given anaount of cunning and credulity in those deceiving and deceived, will drop from the public view like a fruit which has ripened into spontaneous rottenness, and be succeeded by the fresh bloom of some other delusion required by the same excitable portion of the community. Dr. Elisha Perkins was born at Norwich, Connect- icut, in the year 1740. He had practised his profes- sion with a good local, reputation for many years, when he fell upon a course of experiments, as it is related, which led to his great discovery. He con- ceived the idea that metallic substances might have the effect of removing diseases, if applied in a certain manner ; a notion probably suggested by the then recent experiments of Galvani, in which muscular contractions were found to be produced by the con- tact of two metals with the living fibre. It was in 1796 that his discovery was promulgated in the shape of the Metallic Tractors, two pieces of metal, one apparently iron and the other brass, about three inches long, blunt at one end and pointed at the other. These instruments were applied for the cure 76 HOMffiOPATHY of different complaints, as rheumatism, local pains, inflammations, and even tumors, by drawing them over the affected part very lightly for about twenty minutes. Dr. Perkins took out a patent for his dis- covery, and travelled about the country to difiuse the new practice. He soon found numerous advocates of his discovery, many of them of high standing and influence. In the year 1798, the tractors had crossed the Atlantic, and were publicly employed in the Royal Hospital at Copenhagen. About the same time the son of the inventor, Mr. Benjamin Douglass Perkins, carried them to London, where they soon attracted attention. The Danish physicians published an ac- count of their cases, containing numerous instances of alleged success, in a respectable octavo volume. In the year 1804, an establishment, honored with the name of the Perkinean Institution, was founded in London. The transactions of this institution were pubUshed in pamphlets, the Perkinean Society had public dinners at the Crown and Anchor, and a poet celebrated their medical triumph in strains like these : — " See, painted metals, bleat with power t' appease The ruthless rage of merciless disease, O'er the frail part a subtle fluid pour. Drenched with invisible Galvanic shower, Till the arthritic staff and crutch forego. And leap exulting like the bounding roe ! " While all these things were going on, Mr. Benja- AND ITS KINDRED DELUSIONS. 77 miu Douglass Perkins was calmly pocketing money, so that after some half a dozen years he left the country with more than ten thousand pounds, which had been paid him by the believers in Great Britain. But in spite of all this success, and the number of those interested and committed in its behalf, Perkin- ism soon began to decline, and in 1811 the Tractors are spoken of by an intelligent writer as being almost forgotten. Such was the origin and duration of this doctrine and practice, into the history of which we will now look a little more narrowly. Let us see, then, by whose agency this delusion was established and kept up ; whether it was princi- pally by those who were accustomed to medical piu:- suits, or those whose habits and modes of reasoning were different ; Whether it was with the approbation of those learned bodies usually supposed to take an interest in scientific discoveries, or only of individuals whose claims to distinction were founded upon their position in society, or political station, or literary eminence ; whether the judicious or excitable classes gave most deeply into it ; whether, in short, the scientific men of that time were deceived, or only intruded upon, and shouted down for the moment by persons who had no particular call to invade their precincts. Not much, perhaps, was to be expected of the Medical Profession in the way of encouragement. One Dr. Puller, who wrote in England, himself a 78 BOMCEOPATHT Perkinist, thus expressed his opinion: "It must be an extraordinary exertion of virtue and humanity for a medical man, whose livelihood depends either on the sale of drugs, or on receiving a guinea for writing a prescription, which must relate to those drugs, to say to his patient, ' You had better purchase a set of Tractors to keep in your family ; they will cure you without the expense of my attendance, or the danger of the common medical practice.' For very obvious reasons medical men must never be expected to rec- ommend the ■ use .of Perkinism. The Tractors must trust for their patronage to the enlightened and phil- anthropic out of the profession, or to medical men retired from practice, and who know of no other interest than the luxuiy of relieving the distressed. And I do not despair of seeing the day, when but very few of this description as well as private fam- ilies will be without them." Whether the motives assigned by this medical man to his professional brethren existed or not, it is true that Dr. Perkins did not gain a great deal at their hands. The Connecticut Medical Society expelled him in 1797 for violating their law against the use of nostrums, or secret remedies. The leading English physicians appear to have looked on with singular apathy or contempt at the miracles which it was pre- tended were enacting in the hands of the apostles of the new practice. In looking over the reviews of the time, I have found little beyond brief occasional AND ITS KINDEED DELUSIONS. 79 notices of their pretensions ; the columns of these journals being occupied with subjects of more per- manent interest. The state of things in London is best learned, however, from the satirical poem to which I have already alluded as having been written at the period referred to. This was entitled, " Terri- ble Tractoration ! ! A Poetical Petition against Gal- vanizing Trumpery and the Perkinistic Institution. Most respectfully addressed to the Royal College of Physicians, by Christopher Caustic, M. D., LL. D., A. S. S., Fellow of the Royal College of Physicians, Aberdeen, and Honorary Member of no less than nineteen very learned Societies." Two editions of this work were published in London in the years 1803 and 1804, and one or two have been published in this country. " Terrible Tractoration " is supposed, by those who never read it, to be a satire upon the folli«s of Per- kins and his followers. It is, on the contrary, a most zealous defence of Perkinism, and a fierce attack upon its opponents, most especially upon such of the medical profession as treated the subject with neglect or ridicule. The Royal College of Physicians was the more peculiar object of the attack, but with this body, the editors of some of the leading periodicals, and several physicians distinguished at that time, and even now remembered for their services to science and humanity, were involved in unsparing denun- ciations. The work is by no means of the simply 80 HOMffiOPATHY humorous character it might be supposed, but is overloaded with notes of tlie most seriously polemical nature. Much of the history of the subject, indeed, is to be looked for in this volume. It appears from this work that the principal mem- bers of the medical profession, so far from hailing Mr. Benjamin Douglass Perkins as another Harvey or Jenner, looked very coldly upon him and his Trac- tors ; and it is now evident that, though they were much abused for so doing, they knew very well what they had to deal with, and were altogether in the right. The delusion at last attracted such an amount of attention as to induce Dr. Haygarth and some others of respectable standing to institute some experiments which I shall ipention in their proper place, the result of which might have seemed sufficient to show the emptiness of the whole con- trivance.* The Royal Society, that learned body which for ages has constituted the best tribimal to which Brit- ain can appeal in questions of science, accepted Mr. Perkins's Tractors and the book written about them, passed the customary vote of thanks, and never thought of troubling itself further in the investiga- tion of pretensions of such an aspect. It is not to be denied that a considerable number of physicians did avow themselves advocates of the new practice ; but out of the whole catalogue of those who were publicly proclaimed as such, no one has ever been AND ITS KINDRED DELUSIONS. 81 known, so far as I am aware, to the scientific world, except in connection with the sliort-lived notoriety of Perkinism. Wlio were the people, then, to whose activity, influence, or standing with the community was owing all the temporary excitement produced by the Metallic Tractors ? First, those persons who had been induced to pur- chase a pair of Tractors. These little bits of brass and iron, the intrinsic value of which might, perhaps, amount to ninepence, were sold at five guineas a pair ! A man who has paid twenty-five dollars for his whistle is apt to blow it louder and longer than other people. So it appeared that when the " Per- kinean Society " applied to the possessors of Tractors in the metropolis to concur in the establishment of a public institution for the use of these instruments upon the poor, " it was found that only five out of above a hundred objected to subscribe, on account of their want of confidence in the efi&cacy of the prac- tice ; and these," the committee observes, " there is reason to believe, never gave them a fair trial, proba- bly never used them in more than one case, and that perhaps a case in which the Tractors had never been recommended as serviceable." "Purchasers of the Tractors," said one of their ardent advocates, " would be among the last to approve of them if they had rea- son to suppose themselves defirauded of five guineas." He forgot poor Moses, with his " gross of green spec- tacles, with silver rims and shagreen cases." " Dear 4* !■ 82 HOMffiOPATHY mother," cried the boy, " why won't you listen to reason ? I had them a dead bargain, or I should not have bought them. The silver rims alone will sell for double the money." But it is an undeniable fact, that many persons of considerable standing, and in some instances holding the most elevated positions in society, openly patron- ized the new practice. In a translation of a work entitled " Experiments with the Metallic Tractors," originally published in Danish, thence rendered suc- cessively into German and English, Mr. Benjamin Perkins, who edited the English edition, has given a copious enumeration of the distinguished individuals, both in America and Europe, whose patronage he enjoyed. He goes so far as to signify that Royalty itself was to be included among the number. When the Perkinean Institution was founded, no less a person than Lord Rivers was elected President, and eleven other individuals of distinction, among them Governor Franklin, son of Dr. Franklin, figured as Vice-Presidents. Lord Henniker, a member of the Royal Society, who is spoken of as a man of judgment and talents, condescended to patronize the astonish- ing discovery, and at different times bought three pairs of Tractors. When the Tractors were intro- duced into Europe, a large number of testimonials accompanied them from various distinguished char- acters in America, the list of whom is given in the translation of the Danish work referred to, as follows : AND ITS KINDEED DELUSIONS. 83 " Those who have individually stated cases, or who have presented their names to the public as men who approved of this remedy, and acknowledged them- selves instrumental in circulating the Tractors, are fifty-six in number; thirty-four of whom are phy- sicians and surgeons, and many of them of the first eminence, thirteen clergymen, most of whom are doctors of divinity, and connected with the literary institutions of America ; among the remainder are two members of Congress, one professor of natural philosophy in a college, &c., &o." It seemed, to be taken rather hardly by Mr. Perkins that the transla- tors of the work which he edited^ in citing the names of the advocates of the Metallic Practice, frequently omitted the honorary titles which should have been annexed. The testimonials were obtained by the Danish writer, from a pamphlet published in Amer- ica, in which these titles were giveu in full. Thus one of these testimonials is from "John Tyler, Esq., a magistrate in the county of New London, and late Brigadier-General of the militia in that State." The "omission of the General's title" is the subject of complaint,, as if this title were sufficient evidence of the commanding powers of one of the patrons of tractoration. A similar complaint is made when " Calvin Goddard,, Esq., of Plainfield, Attorney at Law, and a member of the Legislature of the State of Connecticut," is mentioned without his titular honors, and. even on account of the omission of the 84 HOMCEOPATHY proper official titles belonging to " Nathan Pierce, Esq., Governor and Manager of the Almshouse of Newburyport." These instances show the great im- portance to be attached to civil and military dignities, in qualifying their holders to judge of scientific sub- jects, a truth which has not been overlooked by the legitimate successors of the Perkinists. In Great Britain, the Tractors were not less honored than in America, by the learned and the illustrious. The " Perkinistic Committee " made this statement in their report : " Mr. Perkins has annually laid before the public a large collection of new cases communi- cated to him for that purpose by disinterested and intelligent characters, from almost every quarter of Great Britain. In regard to the competency of these vouchers, it will be sufficient simply to state that, amongst others whose names have been attached to their commimications, are eight professors in four different universities, twenty-one regular Physicians, nineteen Surgeons, thirty Clergymen, twelve of whom are Doctors of Divinity, and numerous other charac- ters of equal respectability." It cannot but excite our notice and surprise that the number of clergymen both in America and Great Britain who thrust forward their evidence on this medical topic was singularly large in proportion to that of the members of the medical profession. Whole pages are contributed by such worthies as tlie Rev. Dr. Trotter of Hans Place, the Rev. War- AND ITS KINDRED DELUSIONS. 85 ing Willett, Chaplain to the Earl of Dunmore, the Eev. Dr. Clarke, Chaplain to the Prince of Wales. The style of these theologico-medical communica- tions may be seen in the following from a divine who was also professor in one of the colleges of New England. " I have used the Tractors with success in several other cases in my own family, and al- though, like Naaman the Syrian, I cannot tell why the waters of Jordan should be better than Abana and Pharpar, rivers of Damascus ; yet since expe- rience has proved them so, no reasoning can change the opuiion. Indeed the causes of all common facts are, we think, perfectly well known to us ; and it is very probable, fifty or a hundred years hence, we shall as well know why the Metallic Tractors should in a few minutes remove violent pains, as we now know why cantharides and opium will produce oppo- site effects, namely, we shall know very little about either excepting facts." Fifty or a himdred years hence ! if he could have looked forward forty years, he would have seen the descendants of the " Perkin- istic " philosophers swallowing infinitesimal globules, and knowing and caring as much about the Tractors as the people at Saratoga Springs do about the waters of Abana and Pharpar. I trust it will not be thought in any degree disre- spectful to a profession which we all honor, that I have mentioned the great zeal of many clergymen in the cause of Perkinism. I hope, too, that I may 86 HOMffiOFATHY without offence suggest the causes which have often led them out of their own province into one to which their education has no special reference. The mem- bers of that profession ought to be, and commonly are, persons of benevolent character. Their duties carry them into the midst of families, and particu- larly at times when the members of them are suffer- ing from bodily illness. It is natural enough that a strong desire should be excited to alleviate sufferings which may have defied the efforts of professional skill ; as natural that any remedy which recommends itself to the belief or the fancy of the spiritual phy- sician should be applied with the hope of benefit; and perfectly certain that the weakness of human nature, from which no profession is exempt, wiU lead him to take the most flattering view of its effects upon the patient ; his own sagacity and judgment being staked upon the success of the trial. The inventor of the Tractors was aware of these truths. He therefore sent the Tractors gratuitously to many clergymen, accompanied with a formal certificate that the holder had become entitled to their posses- sion by the payment of five guineas. This was prac- tised in our own neighborhood, and I remember finding one of these certificates, so presented, which proved that among the risks of infancy I had to en- counter Perkins's Tractors. Two clergymen of Bos- ton and the vicinity, both well known to local fame, gave in their testimony to the value of the instru- AND ITS KINDRED DELTJSIOHS. 87 ments thus presented to them ; an unusually moder- ate proportion, when it is remembered that to the common motives of which I have spoken was added the seduction of a gift for which the profane public was expected to pay so largely. It was remarkable, also, that Perkinism, which had so little success with the medical and scientific part of the community, found great favor in the eyes of its more lovely and less obstinate portion. " The lady of Major Oxholm," — I quote from Mr. Perkins's volume, — " having been lately in America, had seen and heard much of the great effects of Perkinism. Influenced by a most benevolent disposition, she brought these Tractors and the pamphlet with her to Europe, with a laudable desire of extending their utility to her suffering countrymen." Such was the channel by which the Tractors were conveyed to Den- mark, where they soon became the ruling passion. The workmen, says a French writer, could not man- ufacture them fast enough. Women carried them about their persons, and delighted in bringing them into general use. To what extent the Tractors were favored with the patronage of English and Americaa ladies, it is of course not easy to say, except on gen- eral principles, as their names were not brought be- fore the public. But one of Dr. Haygarth's stories may lead us to conjecture that there was a class of female practitioners who went, about doing good with the Tractors in England as well as in Denmark. A 88 HOMCEOPATHY certain lady had the misfortune to haye a spot as big as a silver penny at the corner of her eye, caused by a bruise, or some such injury. Another lady, who was a friend of hers, and a strong believer in Per- kinism, was very anxious to try the effects of trac- toration upon this unfortunate blemish. The patient consented ; the lady " produced the instruments, and, after drawing them four or five times over the spot, declared that it changed to a paler color, and on re- peating the use of them a few minutes longer, that it had almost vanished, and was scarcely visible, and departed in high triumph at her success." The lady who underwent the operation assured the narrator "that she looked in the glass immediately after, and that not the least visible alteration had taken place." It would be a very interesting question, what was the intellectual character of those persons most con- spicuous in behalf of the Perkinistic delusion ? Such an inquiry might bring to light some principles which we could hereafter apply to the study of other popular errors. But the obscurity into which nearly aU these enthiisiasts have subsided renders the question easier to ask than to answer. I be- lieve it would have been found that most of these persons were of ardent temperament and of consid- erable imagination, and that their history would show that Perkinism was not the first nor the last hobby-horse they rode furiously. Many of them AND ITS KINDRED DELUSIONS. 89 may very probably have been persons of more than common talent, of active and ingenious minds, of versatile powers and various acquirements. Such, for instance, was the estimable man to whom I have repeatedly referred as &■> warm defender of tractoration, and a bitter assailant of its enemies. The story tells itself in the biographical preface to his poem. He went to London with the view of introducing a hydraulic machine, which he and his Vermont friends regarded as a very important' in- vention. He found, however, that the machine was already in common use in that metropolis. A brother Yankee, then in London, had started the project of a mill, which was to be carried by the water of the Thames. He was sanguine enough to purchase one fifth of this concern, which also proved a failure. At about the same period he wrote the work which proved the great excitement of his mind upon the subject of the transient folly then before the public. Originally a lawyer, he was in succession a mechanician, a poet, and an . editor, meeting with far less success in each of these de- partments than usually attends men of less varied gifts, but of more tranquil and phlegmatic compo- sition. But who is ignorant that there is a class of minds characterized by qtialities like those I have mentioned ; minds with many bright and even beau- tiful traits ; but aimless and fickle as the butterfly ; that settle upon every gayly-colored illusion as it 90 HOMffiOFATHY opens into flower, and flutter away to another when the first has dropped its leaves, and stands naked in the icy air of truth ! Let us now look at the general tenor of the arguments addressed by believers to sceptics and opponents. Foremost of all, emblazoned at the head of every column, loudest shouted by every tri- umphant disputant, held up as paramount to all other considerations, stretched like an impenetrable shield to protect the weakest advocate of the great cause against the weapons of the adversary, was that omnipotent monosyllable, which has been the patrimony of cheats and the currency of dupes from time immemorial, — Facts ! Facts ! Facts ! First came the published cases of the American clergy- men, brigadier-generals, almshouse governors, rep- resentatives, attorneys,, and esquires. Then came the published cases of the surgeons of Copenhagen. Then followed reports of about one hundred and fifty cases published in England, " demonstrating the efficacy of the metallic practice in a variety of complaints both upon the human body and on horses, r a valuable resume oC many of the £icts, and the necessary inferences, relating to this snlgect. Also for another series of cases, Mr. Sidey's, five or six in rapid succession. Dr. Simpson attended the dissaetion of two of Dr. Sidey's cases. OF PUERPERAL FEVEE. 277 and freely handled the diseased parts. His next four child-bed patients were aifected with puerperal fever, and it was the first time he had seen it in practice. As Dr. Simpson is a gentleman (Dr. Meigs, as above), and as " a gentleman's hands are clean " (Dr. Meigs's Sixth Letter), it foUowa that a gentleman with clean hands may carry the disease. Am. Jour. Med. Sc, October, 1851. Peddie. — The five or six cases of Dr. Sidey, followed by the four of Dr. Simpson, did not end the series. A practitioner in Leith having \examined, in Dr. Simpson's house, a portion of the uterus obtained from one of the patients, had immediately after- wards three fatal cases of puerperal fever. Dr. Peddie referred to two distinct series of consecutive cases in his own practice. He had since taken precautions, and not met with any such cases. Am. Jour. Med. Sc, October, 1851. Copland. — Considers it proved that Puerperal f'ever may be propagated by the hands and the clothes, or either, of a third per- son, the bed-clothes or body-clothes of a patient. Mentions a new series of cases, one of which he saw, with the practitioner who had attended them. She was the sixth he had had within a few days. All died. Dr. Copland insisted that contagion had caused these cases ; advised precautionary measures, and the practitioner had no other cases for a considerable time. Considers it criminal, after the evidence adduced, — which he could have quadrupled, — and the weight of authority brought forward, for a practitioner to be the medium of transmitting contagion and death to his patients. Dr. Copland lays down rules similar to those suggested by myself, and is therefore entitled to the same epithet for so doing. Medi- cal Dictionary, New York, 1852. Article, Puerperal States and Diseases. If there is any appetite for facts so craving as to be yet unap- peased, — lassata, necdum satiata, — more can be obtained. Dr. Hodge remarks that " the frequency and importance of this singu- lar circumstance (that the disease is occasionally more prevalent with one practitioner than another) has been exceedingly over- 278 THE CONTAGIOUSNESS OF POEEPEEAL FEVEE. rated." More than thirty strings of cases, more than two hundred and fifty sufferers from puerperal fever, more than one hundred and thirty deaths appear as the results of a sparing estimate of such among the facts I have gleaned as could be numerically valued. These facts constitute, we may take it for granted, but a small fraction of those that have actually occurred. The num- ber of them might be greater, but " 't is enough, 't will serve," in Mercutio's modest phrase, so far as frequency is concerned. For a just estimate of the importance of the singular circumstance, it might be proper to consult the languid survivors, the widowed husbands, and the motherless children, as well as " the unfortu- nate accoucheur." THE POSITION AND PEOSPECTS OF THE MEDICAL STUBENT. AN ADDRESS DEUTEBED BEFORE THE BOYLSTON MEDICAL SOCIETY OF HARVARD UNIVERSITY, JANUAKY 12, 1844. PUBLISHKD AT THE BEQUEST OF THE SOCIETY. THE POSITION AND PROSPECTS OF THE MEDICAL STUDENT. It was not my good fortune, during the period of my studies, to be connected with the Society which I have the honor of addressing. I know enough, how- ever, of its objects and of its history to feel sure that it will take an interest in every effort, however hum- ble, which aims to illustrate the progress and promises of our science, to defend it against senseless clamor, to elevate the standax'd of the young men who have devoted their lives to its pursuit, to encourage them in their honorable toils, to warn them of their dan- gers, and even to point out their faults, withoiit fear, though without any other authority than the call of truth and duty. In making some remarks upon tM Position and Prospects of the Medical Student, I must entreat you to allow me a somewhat wider range than the circle which includes only your own number. I would address myself, through you, to all the young men now in the course of their medical education who surround you, or who may be within the reach of my 282 THE POSITION AND PROSPECTS voice. If, therefore, there should be anything in this address which meets with your approval, be pleased to receive it as my return for the attention you have shown me ; if there should be anything that may sound harsh to your ears, suffer it, not for your own sakes, nor as intended for you, but for the sake of the great body of students of which you constitute a part, and which will furnish its candid interpreters and judges. So wide a subject as I have chosen can only be par- tially treated within the somewhat liberal hour that I shall venture to claim. In speaking of the present position of the medical student, it seems becoming to pass over many comparisons which might prove unfa^ vorable, in some respects, to the past. The existing condition of medical schools, the character of the present race of teachers, the standard of the text- books generally employed, are among these. Leav- ing these out of the question, there is enough to interest us in glancing at the passing phases of each of the branches which make up the usual course of study; and in pointing out certain influences that result from the character of our pursuits. Again, the prospects which open before the medical student in his professional life would require a long roll of canvas for their display, and you must be content with a cabinet picture instead of a panorama. The effect of the cold and slow welcome which the world offers to the young physician upon his mind and OF THE MEDICAL STUDENT. 283 feelings ; the attitude assumed by society towards medical science at the present period ; the true way of meeting the various follies which assail the medi- cal practitioner, — these are the points that I shall briefly illustrate, to the exclusion of many others which the title I have chosen might equally embrace. The branches which unite to form tlie science of medicine never presented themselves to the medical student in a manner more adapted to kindle his zeal and energies than at the present time. In almost every department, the recent impress or the active progress of improvement is most distinctly visible. Anatomy and Physiology have received from the hand of Art an instrument which has enabled them to penetrate, with almost miraculous skill, into the mysteries of living structures and functions. From the days of Malpighi and Leeuwenhoeck, whose ad- mirable observations were made with simple lenses, until those of Prevost and Dumas, or even later, it covdd hardly be said that any great additions were made to the intimate knowledge of animal structure by means of the microscope. That the blood corpus- cles should not have been known to be flattened disks until the time of Hewson, must show the former im- perfection of the means of observation to any one who has seen them rolling over like sixpences in the field of a common modern instrument. The fanciful descriptions of Sir Everard Home and Mr. Bauer, 284 THE POSITION AND PEOSPECTS made only to be contradicted ; the too notorious mys- tification in the matter of the acarus scabiei in the hospitals of Paris, justified in some measure the con- tempt into which investigations of this kind gradually declined. Such insuperable difficulties seemed to attend the construction of compound microscopes, tolerably free from the effects of chromatic and spherical aberration, that about twenty years since men like Biot and WoUaston predicted it would never rival the simple instrument. Soon after the year 1820, by one of those simultaneous impulses so common at the period of great discoveries, the atten- tion of several opticians and mathematicians of the Continent and of England was turned to this impor- tant scientific problem. The result was the achro- matic compound microscope in its present state of wonderful perfection. We are poised midway between two material infi- nites, the infinitely great and'the infinitely little. The confines of the first, strange as it may seem, were thoroughly explored before we had reached the inner borders of the second. Uranus and the asteroids were led in by Science like wild colts from the out- skirts of creation, before the acarus and the cheese- mite had settled the duel concerning their identity. But when at length the microscope was taken with its sudden convulsion of improvement, a new world of wonders opened upon the eye of the observer of nature. The same scrupulous sagacity which had OF THE MEDICAL STUDENT. 285 swept the sparkling floor of the firmament beyond the orbit of Saturn, the same daring which, in the words of the elder Herschel, had " gauged the heavens " with its mighty cylinders, was now to be seen counting the stomachs of once invisible animal- cules and diving into the abysses of an impalpable drop of fluid. At the present time there is scarcely a line in structural or physiological anatomy which is not written over by the hand of recent microscopic discovery. The texture of every organ has been determined with a degree of precision before unap- proached. The fluids have been shown to contain and to evolve regular structures. If the blood- corpusdes are not proved to be " swimming glands," the expression no longer excites the idea of anything improbable or unnatural. A geologist hands to his physiological friend a particle broken from a fossil tooth, and requires the nature, size, habits, food, date, of the behemoth, the megalosaurus, the palseothe- rium, that chewed upon it. The physiologist grinds a speck of it down to a translucent lamina, saturates this shaving with the light from a little concave mirror, screws his inexorable lenses to their focus, and extorts a truth which nature had buried beneath the deluge and blotted with the night of uncounted ages. The form of the branching tubes is manifest ; ex pede Herculem; as the tubes, so the tooth; as the tooth, so the creature ; the perished antediluvian rises out of his fossil sepulchre. The unaccom- 286 THE POSITION AND PROSPECTS plished promise of Archimedes hardly surpasses the performance of modern philosophy ; — give her but a thread from the web of nature, and she will suspend a living universe upon it ; give her but a ray from the luminous fountain of truth, and she will catch a photograph from an extinct creation. But how can we speak in terms of sufficient delight and wonder of that discovery which has lifted the veil between the nibrtal eye and the life-giving en- ergy, at the moment when the flowing atoms of matter are uniting into the mysterious harmony of organized structure ! The recent microscopic dis- coveries concerning the development of living tissues, animal and vegetable, are among the most remark- able truths ever yet reached by observation. By the long, winding path of facts we arrive at the clear summits of general laws. From these, as from celestial observatories, we contemplate more nearly the all-embracing Spirit of the universe. A general law is the expression of wisdom and power not yet concealed by their own incidental manifesta- tions ; it is a circle which surrounds the Deity within the outer wall of phenomena. The discoveries just referred to may be ranked, for their universality of extent, with the loftiest generalizations of the astron- omer and the chemist. The law of gravity reduced to a single principle the varied movements of those great masses which traverse the immensities of space. OF THE MEDICAL STUDENT. 287 The law of combination in definite proportions brought down to a graduated scale the hitherto cha- otic range of chemical compounds, and led by irre- sistible inference to the great primordial truth of the atomic constitution of matter. The most sublime vision that ever dawned upon the eye of discovery is that which reveals the evolu- tion of new worlds from the luminous ether of the nebulae, commencing by the condensation of their particles in a solid nucleus at the centre of gravi- tation. This telescopic phenomenon has at length found its counterpart in the microscopic history of the primi- tive organization of the living tissues. It is now received as an established truth, that every organized structure is developed from a cell, itself evolved from a nucleus, which again is constituted by the sponta- neous aggregation of granules in the midst of a fluid. Thus the tube of the astronomer has carried his vision into illimitable space, and shown him the hand of creative power, as it shapes worlds and systems out of chaos ; while the lens of the microscopic ob- server has lifted the invisible up to the level of his senses, to display the same eternal agency as it fashions a living creature from the elements of a formless fluid. These are some of the results of the application of ^ the microscope to anatomy and physiology. I will* not speak of its employment in the investigation of 288 THE POSITION AND PEOSPEOTS diseased products, and in combination with chemical agents. These fields have but just been opened, and who can tell what mysteries are ready to burst iiito the flame of demonstration with the chance spark of any day of scientific labor ? Look again at the progress of chemistry in its ap- plication to the phenomena of life. The attempt has been made to show, not merely that certain combina- tions and decompositions take place in living bodies, by which new products are evolved, and life kept active in the midst of the shifting organization, but the analyst has taken his balance, his measuring jar, his pound of food, and his maw, and traced the ma- terial of support through the organs of the recipient, with all its successive changes, to its resolution into the elements of the earth or atmosphere, calling every organ to account for its share in exact decimals, as a manufacturer might trace the progress of a bale of cotton through the hands of his various operatives. The strictly medical page of chemistry has but just been fairly laid open. It is true that alkalis have long been given to correct acidity, and gases were respired in the days of Beddoes and mahogany- furnished cow-houses, but the experiments were for the most part obvious and of limited utility, or built upon fanciful speculations. But medical chemistry is beginning to deal with stricter problems. Given, ■ a man in whose joints the insoluble urate of soda is depositing itself in solid masses ; what element shall OF THE MEDICAL STUDENT. 289 we throw in among these fighting atoms, to restore their equilibrium ? The chemist looks over his tables of the elementary constitution of bodies, and finds that the required conditions are answered by the benzoic acid. He drops a certain number of grains of this substance into the mouth of his human alem- bic, and the insoluble concretions are eliminated, as the soluble hippurate of soda. One fact like that just mentioned is like one star in the heavens, the herald of a thousand which will soon be kindled. But let all magnificent promises be left out of sight, you may still be thankful foi- three great sources of knowledge, all bearing upon the history and treatment of disease, and which may be almost said to be peculiar to your time and that of your immediate predecessors. Pathological Anat- omy, Auscultation, Medical Statistics, — these three great implements of knowledge are offered to you in a state of perfection unknown to many, at the period of their medical education, who, though your seniors, wiU occupy the same stage of action as yourselves. Pathological anatomy is, in one sense, old ; bodies have been opened from an early period. There have been men profotmdly skilled in the science of morbid change of structure before this age or the precedilig age was born. But we can scarcely dispute that the general diffusion of knowledge throiigh the medical 13 8 290 THE POSITION AND PROSPECTS world on this subject, and the reduction of pathologi- cal results to simple terms may be dated since the beginning of the present century, and especially be- long to the last half of this period. Pathological anatomy was a chaos to the medical profession in general, until the following points were clearly made out. First, the character of inflamma- tion in its dififerent forms, and aflecting. different tissues, as distinguishable from various appearances long confounded with it. Secondly, the distinction of the tubercle from all other morbid deposits, and the final determination of its invariable characters. Thirdly, the discrimination of malignant growths, and their ultimate reduction to the three forms of scirrhus, encephaloid, and colloid. At the time when Broussais erected his system, the characters of inflammation, especially as affecting the mucous tissues, were so little comprehended, tliat the whole fabric of our science tottered for a time before his audacious statements. A few vascular arborizations, the result of passive congestion, a little redness from cadaveric changes, were enough to de- monstrate the existence of gastritis or gastro-enteritis, and all the dogmas, and all the practical inferences belonging to the so-called physiological system, fol- lowed in the wake of this error in observation. The subtlety of his reasoning, and the hissing vehemence of his style, effervescent as acids upon marble, aided the temporary triumph of his doctrine. Whatever OF THE MEDICAL STUDENT. 291 others have done for its downfall, the death-blow- came from the scalpel of Loiiis. That common con- tinued fever is not gastro-enteritis, that tubercle is not essentially the consequence of inflammation ; these two facts he placed beyond dispute, and from that moment the empire of Broussais began to dis- solve. In vain did the old athlete writhe like Laoco- on in the embrace of the serpents ; his children, his darling doctrines, circled with coil upon coil of their iron antagonist, were slowly choked out of life, while he himself battled vainly to the last, with the whole strength of his Herculean energies. The physiologi cal system, as a whole, passed away, and with it a mode of practice founded upon false principles, and often leading to dangerous practical conclusions. This was the immediate consequence of a more ex- act study of the characters of inflammation, joined to a nicer scrutiny of the individual orgaiis. The self-styled practical men of provincial celebrity sometimes sneer at the labors of the pathologist, as ignorant sailors laugh at the landlubber who com- putes their captain's logarithms ; alike unconscious that thoir path through doubt and danger is traced by the hand which is the object of their stupid laugh- ter. At this very time, during this very day which passes over our heads, a hundred thousand leeches would have been draining the lifeblood from that noble army of martyrs whom the physicians of Amer- ica call their patients, in the vain hope of subduing 292 THE POSITION AND PROSPECTS an imaginary inflammation, had not the great French pathologist wilted down his youth upon the stone floor of the amphitheatre of La Charity, and sent out his new truths upon the winds that turn the weather- cocks of medical Christendom ! The true characters of inflammation having once been fixed with a cer- tain degree of exactness, the first great stumbling- block in the way of the pathological anatomist was removed. The diseases now known as tuberculous were for a long period scattered and concealed under various disguises, which prevented their real identity from being recognized. In the lymphatic glands tubercle was known as scrofula, in the bones as white swell- ing, in ^the lungs as phthisis, in various other internal organs by no distinctive name whatever. Thus, the tuberculous affections were separated at their natural point of union, and became joined to various other diseases, with which their relations were wholly acci- dental. In the year 1810, for instance, when Bayle wrote his work on Phthisis, he recognized pulmonary tubercle only as one of six forms of the disease of which he was treating. Of the other five, one was characterized by what are commonly called gray granulations, another by the calcareous depositions which mark the seat of former tuberculous disease. The three remaining forms, the melanotic, the ulcer- ous, the cancerous, had no relation whatever with tuberculous disease. Here, as you may observe, a OF TKB MEDICAI, STUDENT. 293 Sfit of symptoms, qalled, from the most remarkable one, phthisis, in connection with dififerent changes affecting certain organs, namely, the lungs, was taken as the basis of arrangement for the facts collected by this distinguished observer. It followed am.ong other consequences that the pathologist who trod in his footsteps learned to consider tuberculous consumpr tion, and, what he called cancerous consumption, as two varieties only of the same disease.. No error could be. greater than this ; none more calculated to mislead the inexperienced observer. Tuberclcj and can^cerous or malignant degeneratioa, are not only unlike each other in every circumstance of structure, mode of development, history and pro- gress, but they appear to be actually in some sense the antagonists and almost irreconcilable opposites of each other. A cancerous patient, is less likely? to have tubercle, and a tuberculous patient less likely to have malignant disease, than another person: suffer-^ ing from some different affection. It was not; until all tuberculous: affections, iin what- ever organ tjjey might be found, were brought to- gether as a natural group,, and all other morbid changes separated from them, that their true history became easy to learn. The studsent, is now well aware that the production of a single particle of genuine tuberculous matter in any portion of the system is a formal declaration and warning, om the. part, of nature, of what she has sulfered,, has done, 294 THE POSITION AND PKOSPECTS and is about to do. That hereditary influences, or ill treatment of the body in some form, have de- pressed the living energy below the standard of healthy existence ; that every solid and fluid in the body is more or less imperfect in composition and organization ; that the local manifestations at one or more points of the system are the effects, and not the primary causes, of a general morbid condition ; that by a process of softening, and its destructive inflammatory consequences, the new deposition tends to destroy the texture of the part where it has oc- curred, and in this process to react more or less powerfully, perhaps fatally, on the system ; that this process can only be effectually and certainly arrested by replacing every atom of the imperfectly vitalized organism with new and healthier particles, taken from the soil, the atmosphere, and acted on by the sunbeams; in other words, by causing a complete in- terstitial renovation of the body by proper food, and exercise, in the midst of abundant air and light ; all these facts, in all their numberless applications, fol- low from the discovery that any tuberculous affection has shown itself in the body. In every point of view, therefore, the distinction of tubercle from all other morbid deposits, and its recognition as the essential anatomical element of every disease where it is found, is of vast assistance to the pathologist and the practitioner. Those whose education dates but a few years back OF THE MEDICAL STUDENT. 295 will remember the inextricable cpnfasion wliich reigned upon the subject of malignant growths. What relation was held to each other by such dis- eases as the pancreatic and mammary sarcoma of Abernethy, the lardaceous tissue of the Trench writ- ers, the spongoid inflammation of Burns, the oerebri- form disease of Laennec, the medullary sarcoma, the milt-like tumor of other authors ? To make the ac- quaintance of all these and many more seeming vari- eties, was like shaking hands with Briareus, or bor- rowing the glasses of Argus. Three principal forms have been found enough to include them all ; and the forms of scirrhus and encephaloid to embrace ninety- nine hundredths of the whole. The third species of malignant disease, colloid, though comparatively rare, is yet easily discriminated, with a very little attention, from every other morbid change of structure. The student has only to settle clearly in his mind the distinctive characters of these three kinds of disease _ in their different aspects and stages, and their ten- dencies and future progress, with all the inferences respecting their treatment acquired by past expe- rience, are within his immediate grasp. A just classification, like the lens in an optical instrument, converges and brings into a clear image the scat- tered and refracted rays of individual observation. I have spoken of inflammation, tubercle, and ma- lignant diseases, as having been brought to their respective foci by the labors of comparatively recent. 296 THE POSITION AND PROSPECTS observers. Doubtless morbid anatomy has many, other points requiring study and nice attention, but these lesions, after all, constitute the tripod of organic disease. Of the others, some are rare, and are hardly more than objects of occasional curiosity ; such as melanosis and hydatids ; and many are too obvious to be misunderstood ; such as mechanical injuries, perforations, and hemorrhages. Once more, gentlemen, you may think yourselves singularly happy that at. the period when you are entering into professional life, the value of Auscul- tation, or rather of the physical signs of disease, is permanently established, and the means of acquiring the necessary skill in this branch of our art of easy attainment. Ten years ago it was not uncommon, in this centre of knowledge, to meet with persons of a certain degree of reputation in tlie medical profes- sion, who considered the discoveries of Laennec as leading to little or nothing to be relied upon and of practical utility. I can but too well remember many remarks to this effect which were uttered to me or before me at the period when I was a student ; some- times by my companions, and sometimes by those whose age and standing insured an exaggerated re- spect for their expressions, I sliall never forget the contemptuous air of wisdom with which such remarks were made ; the assumption, on the part of individ- uals, of a degree of sagacity which rendered all the OF THE MEDICAL STUDENT. 297 methods of direct exploration unnecessary ; the buz- zing air of triumph with which every mistake, sup- posed or real, of the as yet inexperienced students of the art in question, was speckled over with the fly-blows of gossiping annotation. The remembrance of my own feelings at such times, listening to these unwise sarcasms, has given me so strong a spirit of rebellion against the authority of all men who talk too loudly of their own " experience," that I fear my sympathies will always be on the school-boy side of every question, until time has driven me too beyond aU equivocation into the ranks of spectacled wisdom, and ex-officio infallibility. It is idle now to expatiate upon all that we owe to the divining-rod of thoracic disease. A few years ago some of us thought it expedient to point out the reality and the extent of its utility to those around us who might have undervalued it. We should feel disposed at the present time rather to suggest some cautions against its excessive use and its substitution for a more enlarged investigation of disease. A physical exploration of a patient by a skilful person is an autopsy performed before death. This expression may convey an idea of its importance in the study of disease. But allow me to add one or two brief hints which may be useful to you hereafter in a class of cases you wUl too often be called to witness. A prolonged examination is often very distressing 13* 298 TELE CONDITION AND PBOSPECTS to a feeble patient. Eemember that your instrument of examination is a probe, feeling among your pa- tient's Titals, with, more or less suffering to him, however interesting it may be to yourself. Do not indulge your curiosity at his expense, any more than you would thrust the exploring instrument of surgery to the bottom of every sinus in a wound beyond the reach of art. Eemember that in most cases of tuberculous dis- ease it is by no means indispensable, so far as the patient is concerned, to make out a topographical estimate of the exact amount and distribution of an undoubted mass of disease. It is sometimes quite as well not to do it, and thus to save the necessity of answering disagreeable questions. When you begin to examine a supposed phthisical patient, settle in your own mind, at least, what you are to tell him in case you find the signs that were feared. Learn how far he wishes to know his state, and form your opinion how far he ought to know it, before your examination has made you master of the secret of his life or death. Eemember that many tuberculous patients are suspicious as jealousy, impressible as hysteria, acute as insanity ; that with aU their supposed unconscious- ness of their state, they are often singularly alive to apprehension ; and be careful that you do not startle them, as is sometimes done, by employing percussion in such a manner as to astonish, even their unaccus- OF THE MEDICAL STUDENT. 299 tomed ears with the ominous character of its sounds, or by any expression of surprise at what you may observe. "Whatever you suppose you have discQvered|, be- ware, beware how you commit yourself in a too oonfi,dent pcognosia! The patient whom you have foimd resounding under the clavicles like the Trojan horse, breathing with the respiratory murmur of a prize-fighter,, may die. in three, months with his lungs devoured by tuberculous, disease,. The patient whom you have condemned on the faith of indispujable physical signs may greet you with a pleasant smile for many years, and, live tOi write your obituary. Remember that the: errors of slsthoscopists spring much oftener from the faults of their brains than of their ears. Mistaking a single sound will rarely lead a man into important, error who duly reflects upon the accompanying signs and symptoms. Observation may trip now and, then without throwing youj foB her gait is a walk ; but, inferenoe always gallops, aii(i if she stumbles, you are gone, Knally, if you are ever called, as I was a few years ago, to visit a patient in consultation with a physician iBUch older than yourself, and your respected friend, as in that case, insists repeatedly, inveterately, and in every instance, on applying tiie wrong end of the ste^oscope to his ear, while he gravely rests the ivory ear-piece upon the patient's thorax, remember th:e scene betiroen Gil Bias and the archbishop, and 300 THE POSITION AND PROSPECTS do not trifle with the wisdom of experience in at- tempting to teach your scientific grandfather. I have said that you have also good cause to be thankful that you were born into the period of Medi- cal Statistics. I would speak briefly in this place respecting one branch of this subdivision of science, namely, the application of the numerical system to the analysis of individual diseases. A great deal has been said and written upon the application of arith- metic to medicine, which there is no need of repeat- ing or disputing here. Much ingenuity has some- times been shown in arguing against the use and practicability of this mode of investigation, or in magnifying its possible abuses and chances of leading into error. A few sentences may despatch the whole of these objections. And JBirst, facts must be settled with accuracy before any attempt, is made to count them. Error in these is fatal ; but no more so when they are counted than when they are reasoned from without counting. This is self-evident. Certainly it is not covMting our spurious coin, but having it, that makes us poorer than we suppose. Secondly and lastly, it should be remembered what the numerical system professes and what it does not profess to do. It professes to furnish us the means of extracting the collective results of a mass of individual facts too long to be analyzed by the unaided memory. It does not profess to be answerable for all the conclusions OF THE MEDICAL STUDENT. 301 we may see fit to draw from these results. I will offer you an illustration in miniature. Given a hundred patients affected with the small- pox between the months of December and February. Of these patients ten die. Given, another hundred patients who had small-pox between the months of June and August. Of these patients five die. The fact of the relative mortality in these cases can only be accurately expressed in numbers, and the numbers can only be obtained by counting. The case is as clear as that of a merchant's balance. But now suppose an attempt to reason from this result. SmalPpox is twice us fatal in winter as in summer. Such a conclusion might be drawn, and yet be entirely erroneous. Perhaps the winter pa- tients were in a poor quarter of a city, and the others in a healthier section, — perhaps they were the sub- jects of a different and more malignant epidemic, — perhaps they were treated in a different manner. Just so the merchant sums up his accounts, strikes his balance, finds that he has gained his ten thousand dollars, draws an erroneous practical conchision, acts upon it, and becomes a bankrupt. Is that any reason why the state of his affairs should not be always as- certained by an exact arithmetical process ? Or shall his clerks read over the- day-book and ledger, and without summing up the columns, write an occasional essay containing their " impressions " as to the con- ditions of his business ; that his operations in sugar 802 THE POSITION AND PROSPECTS have been " frequently " successful, while his dealings in cotton are " probably " attended with a " consider- able " amount of loss ? Enough, and more than enough of argument on so plain a matter. The numerical system is of so ob- vious utility in medicine that it could not have been wholly overlooked by former observers. On, the pages of Bayle lying before me are two tables drawn up from his observation more than thirty years ago, giving the exact proportion in which lesions of the larynx and of the alimentary canal occurred in a hundred cases of phthisis. Numerical analysis in medicine is analogous to quantitative analysis in chemistry. The words of Liebig, applied to the latter, might, with a very slight alteration of words, be applied to the former. " Prom the moment that we begin to look earnestly and con- scientiously for the true answers to our question; that we take the trouble, by means of weight and measure, to fix our observations, and. express them in the form of equations, these answers are obtained without diJficulty." The advance of Medical Statistics in all its braiuohes, as shown, not merely by the works of Louis and his followers, but in the Reports drawn up by the author- ity of different governments, especially those of the Registrar-General of England and the papers founded upon them, and in the investigation of the effects of climate and other hygienic influences, is most obvious. OF THE MEDICAL STUDENT. 303 The accurate statistical laborer is setting a machinery ijj' motion, the results, of •which he can never certainly foresee. But just as the carpet-loom, rightly worked, must produce a given figure, as the barrel-organ must utter a certain, tune, as the calculjating machine must render a precise answer, so his toil& must lead to some definite, harmonious, and absolute results. You are fortunate that such an influence is making itself clearly felt at the period when you are entering the profession. There are. many improvements in several most important departments of medical science to which it is only necessary to allude. First in consequence is the ever-growing convic- tion, in and out of the profession, of the comparative insignificance of ckii^ging in. aU its forms as an an- tagonist to disease. That the body is a changeable compound of particles, which must be properly aired, washed, agitated, rested, protected, and renewed, in order that their changes, may run on in the rhythm called health, and that no drug can take the place of these conditions any more than it can, give music to a piano-string which is loose or broken, is to some extent understood; A vast deal of annoyance and often, positive injury is. spared to the patient, while the physician lias, learned submission to the laws of nature, and grown- less pr^nmptuous in. his. expecta- tions- and promises. 304 THE POSITION AND PROSPECTS Concerning various practical improTcments in the different brandies of our art, it is not my intention to make any particular remarks. The simplification of prescriptions, the isolation of the active principles of many vegetable products, the introduction of new and useful remedies into practice, are matters of in- terest, but these may be considered as a part of the steady growth of knowledge, and hardly as marking an epoch of progress. The same remark may be applied to the improvements in mechanical surgery. Strictly speaking, this art may be susceptible of con- tinual improvement, in the same way as watch- making or printing ; but that each of these pursuits has pretty clearly shown all its essential capabilities, will be generally conceded. We would not under- value the recent achievements of ingenuity in the invention of subcutaneous operations and the revival and improvement of plastic surgery. But that there are distinct and visible limits to this department is so clear that the wildest optimist can hardly look for- ward to the time when such operations as the " total extirpation of the sphenoid," once mentioned in a London journal, shall be performed with impunity upon the living subject. I have little to say respecting the progress of an- other branch of the profession, in which the more extended employment of auscultation and the discov- ery of kiestein are the most conspicuous novelties. I must, however, leave my path a moment for the OF THE MEDICAL STUDENT. 305 sake of calling your most serious attention to a fact not ofteii enough insisted upon, — namely, the con- tagiousness of puerperal fever. Having developed the evidence on this point at some length in a journal recently published in this place,* you will not expect a repetition of it here. Allow me only to repeat my conclusions to you. The offices of an attendant upon the pa^tujAent female, in the vast majority of cases, consist of very little more than the prevention of improper meddling, and the promotion of his patient's comfort. The ac- cidents involving life are mere exceptions in the course of a natural process, and when they occur liis power over them is generally limited, and often nothing, or next to, nothing. I believe that all who will take: the trouble to look over the fifteen thousand cases of Dr. Collins, or any other extensive tables giving the result of a large experience, will not think this an unfair statement. But from the, facts, I havC; exposed elsewhere, it appears that the medical attendant has a power of doing mischief which has sometimes proved enor- mous. He may carry a pestilence about with him from house to house, that shall kill more women in a month than he is like to save in his whole life : there is too great reason to fear that he has done so often. Look over the tremendous series of cases * New England Quarterly Journal of Medicine and Surgery for 1843. (See the preceding- pages.)- 306 THE POSITION AND PROSPECTS proving what I say, and then if a question should ever arise between your private advantage and a score or two of innocent lives, remember that you have been warned against adding your names to the list of those who, with a smile upon their faces, have carried death from bedside to bedside, sometimes ignorantly and innocently, and sometimes negli- gently, if not criminally ; but compared to whom Toffana was a public benefactress, and the Mar- chioness of Brinvilliers a nursing mother ! We have thus glanced over the range of medical sciences as they present themselves to the student of the present day, looking, as we passed them in re- view, at the illuminated points they offer, and here and there presuming to add a word of caution or warning. I should not feel that I was answering their wishes, if, when called to address a body of men younger than myself, about to become members of the profes- sion I have followed, I did not speak freely to them of the peculiar dangers to which they are exposed by the nature of their pursuits. To us of the medical profession, the great calami- ties of life present themselves under a strangely modi- fied aspect. Disease is our playmate, and Death is our familiar acquaintance. In the great tragedies of life the vast multitude of mankind look with tear- ful and throbbing emotion upon scenes to us as little OF THE MEDICAL STUDENT. 307 exciting as the stage machinery to the actors in a drama. The still features of the dead, the white folds of the last robe which covers the body, all the objects and thoughts that hush the gay and worldly into momentary solemnity, are to us but the habitual accompaniment of a stage in human history we are often called upon to witness. By such a discipline even a tender nature loses much of its ready impressibility, but not therefore of its sincere love and sympathy for its fellow-creatures in their anguish and trials. By such training a coarse nature may become brutalized, and forfeit its heavenly birthright, — a share in every human sor- row. In a recent work of fiction, read by unprecedented nimibers in both hemispheres, the author has held up the medical profession, m the, person of an imaginary physician of a Parisian hospital, to the observation of the world at large. The character of Dr. Griffon, as delineated in the Mysteries of Paris, is an indict- ment of the scientific physician at the bar of the novel- reading public. I will not stop to criticise the work in which it is found. Many of you are familiar with its brilliancy of invention and variety of incident, its charming impossibilities, and the talking machinery which plays the parts of its difierent characters. In this book, which is a poem founded on the well- known work of Parent Duchatelet, where bursts of enthusiastic morality are succeeded by the inflamma- 308 THE POSITION AND PROSPECTS tory love-songs of a posturing Creole, and projects of reforming society are skipped by impatient adoles- cents that they may read the chapter devoted to the description of erotic mania, accusations are brought forward that sooner or later many of you will b© destined to hear re-echoed. The first charge is founded on an absurd misrepre- sentation of the mode sometimes adopted in hospitals or elsewhere to determine the true relative value of different modes of treatment. You take a hundred patientsj says M. Eugene Sue, try one experiment upon them, and see how many die; then take an- other hundred, and try another experiment, and see how many die under that treatment. This a/rgumert- turn ad invidiam may hereafter serve a mob as the pretext for tearing down a hospital. But is it n«t clear that more than one mode of treatment, in some diseases, has a positive claim to trial? This is so- manifest that, ten to one, the very declaimer- against trying experiments is clamorous that some notion or other he has taken up should have a fkir trial ; that is, should be experimented with on human beings. The true question for the jury is not, " Do hospital or other physicians try experiments ? " for strictly speaking, every administration of a remedy is an experiment, — but, " Do they study diligently the claims of all new and old methods, and do they know how to select those which oflfer the best chance of proving useful ? " Either the best mode of treating OF THE MEDICAL STUDENT. 309 a disease is positively ascertained or not. If it is ascertained, no man "would think of employing a method known to be a comparatively bad one. If it is a question between two or more methods of treat- ment which is best, and if there is abundant and satisfactory proof that both are good and safe, how absurd to say that the physician is not authorized to try more than one ! Which one shall it be ? Who shall dictate ? What can decide between them but a competent trial ? Why have a medical profession, except to Icnow, first, what remedies are always cer- tain, and, secondly, and ten times oftener, what are jnost deserving of trial where certainty does not exist ? It is cleas", in the next place, that if the physician has a right to try a given mode of treatment once, which will generally decide nothing at all, he has a right to try it repeatedly; perhaps ten times, perhaps a hundred, according to circumstances. It is as clear that he is perfectly justified in counting the days, weeks, or months that each case -may have lasted, the number of times this or that symptom appeared, ,the proportion of cases that recovered or terminated fatally. The dealers in the rag-fair of light literature have •itaken a great fancy, of late, to airing their philan- thropy and morality. Everything must come suc- cessively into fashion, even the virtues ; but when a former " elegant" voluptuary " undertakes to reform 310 THE POSITION AND PROSPECTS abuses, we have a right to regret that he did not give the time to learning the facts concerning these sup- posed abuses, which he wasted on his banquets and his odalisques. Dr. GriflFon may very probably stand for the founder of the numerical system. It is true that Louis, after having employed the more ordinary treatment of fever for some years, and learned its general degree of success, determined to make trial of another method, and that not in one or two cases only, but in a sufficient number to furnish some term of comparison with his former method. Here is one of those heartless experiments that M. Sue holds up to the horror of his slip-shod thousands of readers. But what was this method which Louis thus ventured to subject to trial ? It was the plan proposed and followed for many years by M. Laroque, a physician in a French hospital ; and which had acquired a repu- tation, seemingly not without foundation, of being attended with a truly remarkable degree of success. Hard times for the physician of the nineteenth century ! The philanthropist at his right ear brands him as a murderous bigot, if he will not try a new and vaunted method, and the philanthropist at his left ear calls him an experimenting homicide, if he tries it in the only way that can lead to any definite conclusion as to its value. I pass to another charge contained in the cele- brated romance referred to, and involving, to a greater or less extent, the whole medical profession, OF THE MEDICAL STUDENT. 311 attacked in the person of a fictitious character. I mean the brutal treatment of the sick in charitable institutions ; especially a shameless indifference to the delicacy of females, many of whose infirmities are always revealed with pain, and who are said to be sometimes subjected to public examinations that over- whelm them with confusion and agony. So far as this country is concerned the accusation woiild prove wholly unfounded. I believe that in all civilized coimtries outrages of this sort are only ex- ceptions to a general habit of tenderness and regard for the sick and destitute. Alas, that I should ever have witnessed such an exception ! Yes, I have seen, in a great foreign hospital, in broad daylight, in the midst of a crowd of bearded young men, a young, tender, and sufiering female thus outraged. I have seen a rough hand tear from her figure the only covering of her heaving bosom, and expose her, in the centre of- a trampling and wedging multitude, to a scrutiny that would make a harlot shudder. De- cency and humanity must be violated, that a prse- cordial region might be inspected, a professor might expatiate, and a class admire. If the Genius of Sci- ence smiled as the new fact was inscribed upon his iron tablets, what was the expression of Heaven's recording angel as he wrote down this unmanly in- sult in the pages consecrated to the wrongs of help- less poverty ? The amphitheatre for surgical operations is the scene 812 THE POSITION AND PROSPECTS of tortures which should never be undervalued, how- ever familiar the sight of them may have grown to the seasoned student. That act of frightful violence to a fellow-creature which you call a " brilliant opera- tion," may be the twentieth, or the fiftieth of the kind you have witnessed. You are used to such sights, and it is hard to realize that others are not used to such sufferings. Do you remember that this seeming- ly brief space of mortal anguish has been for months , or years the one waking and sleeping terror of the poor victim of disease before you, — that, like the iron chamber of the story, this dreadful necessity has been narrowing closer and closer about him day by day, at every approach darkening some window of" life and happiness, and now in the midst of fearful sights and sounds is lacerating his convulsed fibres, and pouring out his smoking heart's blood ? Do you remember how long the memory of this little period will blend with all his thoughts, how every kind look he re- ceived will be treasured in his heart, how every care- less word will be recalled, how eveiy thoughtless cruelty will leave its scar deeper than the terrible seams of the knife and the cautery ? I have not left my stated pursuits at your kind request, to come before you either for the sake of bestowing flattery, or receiving applause. To you, and throxigh you to your fellow-students, I must offer a few words, which, as they come from my heart and my conscience, I will not dishonor by introducing with an apology. OF THE MEDICAL STUDENT. 313 In the many operations I have attended in the hospitals of Prance and England, often in the midst of a crowd of students more numerous and less or- derly in their deportment than are ever .found in the hospitals of our own country, I never but once heard the ordinary theatrical expression of applause at the close of an operation, and it was then imme- diately and indignantly silenced. Is it necessary for me to inform you that the same manner of expressing approbation has more than once manifested itself on this side of the Atlantic, and even in one of our own public institutions ? If I should see to-morrow in the journals, or in any popular work, a statement of this fact, and an appeal to the feelings of the public on the point, I should expect a simultaneous expression of surprise and disg\ist to echo through the whole community. Far be it from me to make this appeal to the public ; I had rather speak of the fact directly to the faces of those whose duty it is to support the honor of the medical profession. But were an exposure and pub- lic-denunciation of this truly barbarous practice to appear in any popular publication, I, for one, should be disinclined and "unable to say one word in defence of those who had armed every thinking man, much more every gentle-hearted woman and pitying child> against them. No ! The listeners to this address may receive it with applause, or hisses, or silence, as they please. The spectators of a drama, the audience 14 314 THE POSITION AND PEOSPECTS of a concert, may express their delight by ringing plaudits, if they choose. But there is a limit where decency requires us to refrain from indulging our impulses.. We do not think it necessary to honor the utterer of an impressive prayer with a round from the floor and galleries of the house of worship. Do so, do so a thousand times before you thus violate the peaceful walls devoted to the languishing and dying poor ! Spare your noisy honors to the san- guinary triumphs of the art of mutilation, while the neglected subject lies panting in his blood before you. Do you ask who constituted me a critic or a censor in this matter ? I answer, God, who made me a man ; society, which imposed my duties ; my nature, not palsied to sympathy ; my profession, not yet de- graded beneath that of the gladiator. Better that one of your own number should speak out, than wait for the cheap newspaper and the philanthropic novel- writer ; better humanize our own manners than have our fellow-citizens say of the physician as the early B/omans of Archagathus : transiisse nomen in camifi- cem, — that his name is changed to that of butcher ; better keep a becoming quiet within the asylum of disease, than have the passers-by who hear its floors rattling with tumultuous applause, break in upon us, thinking to enjoy an hour of private theatricals, and start with horror to find that such is the tribute of youthful sympathy to a bleeding wretch, broken upon the wheel of Science, for the crime of a disease she could not master by her remedies ! OF THE MEDICAL STUDENT. 315 Let me devote the few additional moments I may venture to claim, to some remarks respecting, your prospects on entering upon the active duties of the profession. . , • Some plain truths have been recently laid before the student as to the time during which he must, in most cases, be content to live on his future expecta- tions. If fifteen years, as it has been said, are re- quired to obtain a good city practice, of course, where no accidental aid, or peculiar good fortune, conspires with the requisite industry and ability, a long and dreary blank separates many of you from the object of your ambition. What becomes of medical men during this long period ? The answer is not a flattering one. Many of them lose their impulse and ambition, shrink in all their intellectual dimensions, become atrophied and indurated, so that at the period when they have attained success, the sunshine comes too late for their development into their natural proportions. Many are worn out with long waiting, and seek for some other pursuit where their faculties may be called into active exercise. A few only, like the steady oak, add a new aird wider ring to their mental growth with every year that creeps torpidly by them. You cannot wonder that four 6r five years since, I should have said, in a few loose couplets which I still remember, — But thou, poor dreamer, who hast vainly thought To live by knowledge which thy bloom has bought, — 316 THE POSITION AND PROSPECTS Thou who hast waited with thy martyr smile, Hope ever whispering, yet a little while, — Too proud to stoop beneath thy nobler aim. While prostrate meanness crawls to wealth and fame ; Thou all unfriended, as thy blossoms fade In the chill circle of thy senior's shade ; Go, spurn the art that every boon denies Till age sits glassy in thy sunken eyes ; Gro, scorn the treasury that withholds its store Till hope grows cold, and blessings bless no more ! In the calm pursuit of medical truth, ia the de- Ughtful paths of natural science, in the acquisition of that more liberal range of knowledge for which your busy years will offer little opportunity, in form- ing and maintaining useful and dignified relations with the society of which you form a part, these trying years will roll gently over you, and as the first silver arrows of time fall among the locks of your waning youth, the golden promises of fortune will begin their tardy fulfilment. You are to enter upon your professional duties at a time which offers some peculiarities affecting your interests and comfort. Society is congratulating it- self, in all its orations and its periodicals, that the spirit of inquiry has become universal, and will not be repressed ; that all things are summoned before its tribunal for judgment. No authority is allowed to pass current, no opinion to remain unassailed, no profession to be the best judge of its own men and OF THE MEDICAL STUDENT. 817 doctrines. The ultra-radical version of the axiom that all men are born free and equal, which says, " I am as good as you are," and means, " I am a little better," has invaded the regions of science. The dogmas of the learned have lost their usurped authority, but the dogmas of the ignorant rise in luxuriant and ever-renewing growths to take their place. The conceit of philosophy, which at least knew something of its subjects, has found its substi- tute in the conceit of the sterile hybrids who question all they choose to doubt in their capacity of levellers, and believe all that strikes their fancy in their char- acter of reverential mystics. This is the spirit which you will daily meet with applied to your own pro- fession, and which might condense its whole length and breadth into the following formula : A question involving the health and lives of mankind has been investigated by many generations of men, prepared by deep study and long experience, in trials that have lasted for years, and in thousands upon thou- sands of cases ; the collected results of their investi- gations are within my reach ; I, who have neither sought after, reflected upon, nor tested these results, declare them false and dangerous, and zealously main- tain and publish that a certain new method, which I have seen employed once, twice, or several times, in a disease, of the ordinary history, progress, duration, and fatality of which I am profoundly ignorant, with a success which I (not knowing anything about the 318 THE POSITION AND PEOSPECTS matter) affirm to be truly surprising, is to be substi- tuted for the arrogant notions of a set of obsolete dogmatists, heretofore received as medical authorities. What difference does it make, whether the speaker is the apostle of Thomsonism, the " conmion sense " scientific radicalism of the bam -yard, or homoeopa- thy, the mystical scientific radicalism of the drawing- room ? It is the same spirit of ignorant and saucy presumption, with a fractional difference in grammar and elegance of expression. K this is just, it affords you a hint as to the true manner of dealing with such adversaries. Do not think that the special error they utter before you is all that you have to vanqtiish. The splinter of stone at your feet which you would demolish with your logical hammer, runs deeper under the soil of society than you may at first imag- ine ; it is only the edge of a stratum that stretches into the heart of the blue mountains in the far hori- zon. Think not to gain anythiag by arguing against those who are drunken upon the alcohol hot fi-om the stiU of brainless philanthropists ; who are raving with the nitrous oxide fresh fi:om the retort of gaseous reformers. Argument must have a point of resist- ance in a fixed reasoning principle, as the levej" must have its counter-pressure in the fulcrum ; no mariner would hope to take an observation by an ignis fatuus, to steer by a light-house floating unanchored \ipon the tempestuous ocean ! No, your object must not be this or that heretical opinion, but the false philos- OP THE MEDICAL STUDENT. 319 ophy, or tlie shattered iutellectual organization from which it springs ; it is Polly who is masking tinder the liberty-cap of Free Inquiry ; it is Insanity who has wandered from the hospital without his keeper ! After what I have just said, you cannot think I shall waste your time with allusions to>the particular vanities that happen to engross the medical amateurs of our community at this precise mpment. On some occasions, and before some audiences, it may be justi- fiable, and perhaps useful, to show up some extreme and insupportable extravagance as an example, not for the sake of the sharpers who live by it, or the simpletons whom they live upon, but for that of a few sensible listeners who are disturbed by their clamor, and wish to know its meaning. Even then you must expect a shoal of pamphlets to spring upon you with the eagerness of sharks, and the ability of barnacles. You have given a meal to your hungry enemies by merely showing yourself, like an animal that ventures into a meadow during the short empire of the horse-flies. I know too well the character of these assailants to gratify their demand for publicity by throwing a stone into any of their nests. They welcome every cuff of criticism as a gratuitous advertisement ; they grow turgid with delight upon every eminence of exposure which enables them to climb up where they can be seen. Little as they know of anything, they understand the hydrostatic paradox oi contro- 320 THE POSITION AND FEOSPECTS versy ; that it raises the meanest disputant to a seem- ing level with his antagonist ; that the calibre of a pipe-stem is as good as that of a water-spout, when two columns are balanced against each other. They would be but too happy to figure again in the eyes of that fraction of the public which knows enough to keep out of fire and water, and to quote that famous line from the idiot's copy-book, — " Who shall decide when doctors disagree I " As I have given them more prose than they are worth, allow me to toss them a few lines written for a recent anniversary, which, if they are unworthy of your approbation, are quite good enough for them. The feeble sea-birds, blinded in the storms, On some tall light-house dash their little forms ; And the rude granite scatters for their pains Those small deposits which were meant for brains. Tet the proud fabric in the morning sun Stands all unconscious of the mischief done ; Still the red beacon pours its evening rays For the lost pilot with as broad a blaze ; Nay, shines all radiance o'er the scattered fleet Of gulls and boobies, brainless at its feet. I tell their fate, but courtesy disclaims To call our kind by such ungentle names ; Yet if your rashness bid you vainly dare, Think on their doom, ye simple, and beware. See where aloft its hoary forehead rears The towering pride of twice a thousand years ! Far, far below the vast, incumbent pile, Sleeps the broad rock from art's .Xgean isle ; OF THE MEDICAL STUDENT. 321 Its massive courses, circling as they rise. Swell from the waves, and mingle with the skies ; There every quarry lends its marble spoil, And clustering ages blend their common toil ; The Greek, the Roman reared its mighty walls, the silent Arab arched its mystic halls ; In that fair niche, by countless billows laved, Trace the deep lines that Sydenham engraved ; On yon broad front, that breasts the changing swell, Mark where the ponderous sledge of Hunter fell ; By that square buttress look where Louis stands, The stone yet warm from his uplifted hands ; And say, O Science ! shall thy life-blood freeze When fluttering folly flaps on walls like these 1 Go, then, to meet your chosen Science, who waits for you like a bride adorned with her ancestral jewels, and crowned with fresh-gathered garlands ! How checkered with the ever-glancing sunbeams and the ever-flitting shadows of joy and of sorrow is the long path to which she beckons your eager footsteps ! Go forth from these courts of learning, armed with the borrowed wisdom of age, yet ever cherishing the tender sympathies of childhood. The distant murmur which you hear from the trampled fields before you will soon grow louder in your ears, and you will find yourselves swept into the whirlwind of the world's tumultuous conflict. Go. forward in hope and se- rene courage ; Disease is calling you from his bed of anguish. Death is looking for you to smooth his piUow, Posterity is expecting you, impatient to be laid in his cradle ! 14* TT MECHANISM OF VITAL ACTIONS. FBOM THE NORTH AMERICAN REVIEW, FOR APRIL, 1857. MECHANISM OF VITAL ACTIONS. If the reader of this paper live another complete year, his self-conscious principle will have migrated from its present tenement to another, the raw mate- rials, even, of which are not as yet put together. A portion of that body of his which is to be, will ripen in the corn of the next harvest. Another portion of his future person he will purchase, or others will purchase for him, headed up in, the form of certain barrels of potatoes. A third fraction is yet to be gathered in a Southern rice-field. The limbs with which he is then to walk will be clad with flesh borrowed from the tenants of, many stalls and pas- tures, now unconscious of their doom. The very organs of speech with which he is to talk so wisely, or plead so eloquently, or preach so effectively, must first serve his humbler brethren to bleat, to bellow, and for all the varied utterances of bristled or feath- ered barn-yard life. His bones themselves are, to a great extent, in posse, and not in esse. A bag of phosphate of lime which he has ordered from Pro- fessor Mapes, for his grounds, contains a large part 326 MECHANISM OF VITAL ACTIONS. of what is to be his next year's skeleton. And, more than all this, as by far the greater part of his body is nothing, after all, but water, the main sub- stance of his scattered members is to be looked for in the reservoir, in the running streams, at the bottom of the well, in the clouds that float over his head, or diffused among them all. For a certain period, then, the permanent human being is to use the temporary fabric made up of these shifting materials. So long as they are held together in human shape, they manifest certain properties which fit them for the use of a self-conscious and self-determining existence. But it is as absurd to suppose any identification of this existence with the materials which it puts on and off, as to suppose the hand identified with the glove it wears, or the sponge with the various fluids which may in succession fill its pores. Our individual being is in no sense ap- proximated to a potato by living on that esculent for a few months ; and if we study the potato while it forms a part of our bodies under the name of brain or muscle, we shall learn no more of the true nature of our self-determining consciousness than if we studied the same tuber in the hill where it grew. These forms of nutritive matter which pass through our systems in a continual round may be observed, weighed, tested, analyzed, tortured in a thousand ways, without our touching for a moment the higher problem of our human existence. Sooner or later, MECHANISM OF VITAL ACTIONS. 327 according to the perfection of our methods and in- struments, we bring hard up against a deaf, dumb, blind fact. The microscope reaches a granule, and there it stops. Chemistry finds a few bodies which it cannot decompose, and plays with them as with so many dominos, coimting and matching equivalents as our old Mends of the CafS Procope used to count and match the spots on their humbler playthings. But why C4, O2, Hs, have such a tendency to come together, and why, when they have come together, a fluid ounce of the resulting compound will make the small philosopher as great as a king for an hour or two, and give him the usual headache which crowns entail upon their wearers, the next morn- ing, is not written in the pages of Lehmainn, nor treasured in the archives of Poggendorf. Experi- mental physiology teaches how to stop the wheels of the living machinery, and sometimes how to stai-t them when their action is checked ; but no observa- tion from the outside ever did or ever wiU approach the mystery of that most intense of all realities, — our relations, as responsible agents, to right and wrong. It will never answer, by aid of microscope, or balance, or scalpel, that ever-recurring question, — " Whence this pleasing hope, this fond desire, This longing after immortality t " The study of physical and physiological phenom- ena has been thought to lead to what is called ma- 328 MECHANISM OF VITAL ACTIONS. terialism, or something worse. In spite of Galen's lialf-Ohristian religious eloquence, — in spite of Hal- ler's defence of the faith, and of Boerhaave's apos- tolic piety, — we cannot fcrrget the old saying, that where there are three physicians there are two athe- ists. It would be almost as fair to say, that where there are three bank-clerks there are two rogues. Unquestionably, the handling of large sums of money betrays into dishonesty some men who would have resisted slighter temptations. So the exclusive study of the bodily functions may, now and then, lead away a weak mind from the contemplation of the spiritual side of nature. The mind, like the eye, has its ad- justment to near and remote objects. A watchmaker can find the broken tooth in a ship's chronometer quicker thauvthe captain, and the captain wUl detect a sail in the distance long before the artisan can see it. Physiologists and metaphysicians look at the same objects with different' focal adjustments ; but if they deny the truths out of their own immediate range, their eyes have got the better of their judgment. If the mariner will not trust his chronometer to the expert, he loses his reckoning ; if the nice-fingered myope should play sailor, the pirate 'would be sure to catch him. Our old, foolish proverb is not, therefore, wholly without its meaning. Charlatans in physiol- ogy, who are not so likely to be found in any other profession as in the one mentioned, make the mistake of confounding the results derived from their obser- MECHANISM OF VITAL ACTIONS. 329 vation of the working of certain instruments, in health or disease, with those which claim another and a more exalted source. Our convictions, even with- out special divine illumination, reveal us to ourselves, not as machines, but as sub-creative centres of intelli- gence and power. The two ranges of mental vision should never be confounded for good or for bad. The laws of the organism cannot be projected, a priori, on the strength of the profoundest intu- itions. Hunter's maxim, " Don't think, but try," comes down like a pile-driver on the audacious head possessed by the delusion that it can find out how things are, by abstract speculation upon the question how they ought to be. But, on the other hand, the doctrine of an immortal spirit will never come from the dissecting-room or the laboratory, unless it is first carried thither from a higher sphere. Yet there is nothing in these workshops which can efface it, any more than their gases and exhalations can blot out the stars of heaven. Thus what we have to say must be considered as applying solely to the living body, and not to the divine emanation which, in the human form, seems, but only seems, to identify itself for a while with the shape it uses. We shall not even think it necessary to consider the living body in all its attributes. Ani- mals have a life in common with plants : they grow, they keep their condition, they decay ; they reproduce their kind, they perish ; and these acts, apart from 330 MECHANISM OF VITAL ACTIONS. self-consciousness or any voluntary agency, constitute them living creatures. This simplest and broadest aspect of living nature is that which we propose to consider. Life may be contemplated either as a condition, manifested by a group of phenomena, or as the cause of that condition. Looked at as a condition, it is the active state peculiar to an organism, vegetable or ani- mal, which consists in the maintenance of structural integrity by a constant interchange of elements with ' surrounding matter. This interchange is effected under the influence of certain exciting agencies, or stimuli, such as light and heat, which are essential to its due performance. An egg or a seed perishing undeveloped has never been excited into this active state, and therefore cannot be said to have lived. It was only for a time capable of living, if the proper stimuli and surrounding matters had been present. But life may be considered, again, as a cause of the phenomena just referred to, and it is in this as- pect that we mean to regard it ; and before attempt- ing to examine our special question, we must remem- ber the limits of all our inquiries with reference to- causation. We can hope for nothing more, in the way of positive increase of knowledge, than these results, in any such inquiry : — to detect the con- stant antecedents of any condition or change ; to resolve one or more antecedents into consequents of some previous fact ; to show that one or more of the MECHAMSM OF VITAL ACTIONS. 331 causative elements are the same that are productive of other effects ; and, lastly, to reproduce the effect by supplying the causative conditidns, or to prove the nature of the constant antecedent by experiment. As to the essence of causation or of force, in any of its aspects, we are no wiser than Newton, the pro- foundest student of its laws, and the readiest to con- fess his ignorance of its intimate nature. Let us look first at the theological relations of an inquiry into the causes and nature of life. These, if nothing else, may, we think, be satisfactorily ad- justed. Every action, or series of actions, is referred by the mind to a force, and this again to a power. Thus the action of a clock is referred to the force of the spring, and this force is the manifestation of a power stored in the spring by winding it up, and set free by giving the first swing to the pendulum. We may consider action as the specific application of force ; force, as the transfer of power, or power in transitu ; power itself, as the original or delegated source of being, or of change in its condition. Thus life, which appears as a series of actions, is referred to a force commonly called vital, and this to a power, having its centre in the Divine Being ; for all who recognize a Divinity are agreed that all power comes from him. This is what they mean when they call omnipotence one of his attributes. The first manifestations of force are habitually referred to the same original 332 MECHANISM OP VITAL ACTIONS. source. Thus we say that the Creator gave motion to the planets in space, taking it for granted that the Master-hand alone could impart their original im-: pulse. If, however, we are asked why they continue to roll on, we are told that the vis inertice keeps them from stopping. But this is a mere name, and we might as well say that the vis motus starts a planet, as that the vis . inertice keeps it going. A simpler statement is that the Divine agency, once in opera- tion, never changes without cause. We cannot allow force to be self-sustaining any more than self-originat- ing, nor matter itself to be self-subsistent any more than self-creating. " Actualia dependent a Deo turn in existendo, tum in agendo." " Neque male doce- tur conservationem divinam esse continuatam crea- tiouem, ut radius continue a sole prodit." Such are the words of Leibnitz. The apparent uniformity of force, and the seeming independent existence of mat- ter, lead us to speak of them as if their laws, as we term them, were absolutely and eternally inherent. But a law which an omnipotent, omniscient, omni- present Being enforces, is plainly nothing more than the Lawgiver himself at work. This is the meaning of that somewhat startling utterance of Oken, " The universe is God rotating." Transcendental Physiol- ogy is beginning to steal from the hymn-books. " With glory clad, with strength arrayed, The Lord, that o'er all nature reigns, The world's foundations strongly laid, And the vast fabric still sustains." MECHANISM OF VITAL ACTIONS. 333 ■So sang Tate and Brady, paraphrasing the royal David. And Watts, still more expressly, in the hymn made famous by " the harp of thousand strings " : — , " His Spirit mores our hearing lungs, Or they would breathe no more." Once giving in our complete adhesion to the doc- trine of the " immianent Deity," we get rid of many difficulties in the way of speculative inquiry into the nature and origin of things. This may be an impor- tant preliminary. Mr. Newport, the very distin- guished physiological anatomist, communicated a paper to the Linnsean Society, in the year 1845, " On the Natural History of the Oil Beetle, Meloe." It contained the following sentence : " The facts I have now detailed lead me, in conformity with the discov- ery by Faraday of the analogy of light with heat, magnetism, and electricity, to regard light as the primary source of all vital and instinctive power, the degrees and variations of which may, perhaps, be referred to modifications of this influence on the special organization of each animal body." The Council of the Society objected to the publication of the passage from which this is extracted. The So- ciety's Index Bxpurgatorius would have been more complete, if it had included the Invocation of the third book of Paradise Lost, which has hitherto escaped the Anglican censorship. But if the student of nature and the student of di- 334 MECHANISM OF VITAL ACTIONS. vinity can once agree that all the forces of the uni- verse, as well as all its power, are immediately depen- dent upon its Creator, — that He is not only omni- potent, but omnimovent, — we have no longer any fear of nebular theories, or doctrines of equivocal gen- eration, or of progressive development. If we saw a new planet actually formed in the field of the tele- scope, or the imaginary " Acarus Crossii" put togeth- er " de toutes pieces " under the microscope, true to its alleged pedigree, — out of Silex, by Galvanism, — it would no more turn us into atheists, than a sight of the mint would make us doubt tlie national credit. We are ready, therefore, to examine the mystery of life with the same freedom that we should carry into the examination of any other problem ; for it is only a question of what mechanism is employed in its evolution and sustenance. We begin, then, by examining the general rules which the Creator seems to have prescribed to his own operations. We ask, in the first place, whether ho is wont, so far as we know, to employ a great multitude of materials, patterns, and forces, or whether he has seen fit to accomplish many differ- ent ends by the employment of a few of these only. In all our studies of external nature, the tendency of increasing knowledge has uniformly been to show that the rules of creation are simplicity of material, economy of inventive efibrt, and thrift in the expendi- ture of force. All tfie endless forms in which matter MECHANISM OF VITAL ACTIONS. 335 presents itself to us are resolved by chemistry into some threescore supposed simple substances, some of these, perhaps, being only modifications of the same element. The shapes of beasts and birds, of reptiles and fishes, vary in every conceivable degree ; yet a single vertebra is the pattern and representation of the framework of them all, from eels to elephants. The identity reaches still further, — across a mighty gulf of being, — but bridges it over with a hne of logic as straight as a sunbeam, and as indestructible as the scymitar-edge that spanned the chasm in the fable of the Indian Hades. Strange as it may sound, the tail which the serpent trails after him in the dust, and the head of Plato, were struck in the die of the same primitive conception, and difier only in their special adaptation to particular ends. Again, the study of the movements of the universe has led us from their complex phenomena to the few simple forces from which they flow. The falling apple and the rolling planet are shown to obey the same ten- dency. The stick of sealing-wax which draws a feather to it, is animated by the same impulse that convulses the stormy heavens. These generalizations have simplified our view of the grandest material operations, yet we do not feel that creative power and wisdom have been shorn of any single ray by the demonstrations of Newton or of Franklin. On the contrary, the larger the collection of seemingly heterogeneous facts we can bring under 336 MECHANISM OF VITAL ACTIONS. the rule of a single formula, the nearer we feel that we have reached towards the source of knowledge, and the more perfectly we trace the little arc of the immeasurable circle which comes within the range of our hasty observations, at first like the broken frag- ments of a many-sided polygon, but at last as a sim- ple curve which encloses all we know or can know of Nature. To our own intellectual wealth, the gain is like that of the over-burdened traveller, who should exchange hundred-weights of iron for ounces of gold. Evanescent, formless, unstable, impalpable, a fog of uncondensed experiences hovers over our conscious- ness like an atmosphere of uncombined gases. One spark of genius shoots through it, and its elements rush together and glitter before us in a single trans- lucent drop. It would hardly be extravagant to call Science the art of packing knowledge. We are moving in the right direction, therefore, when we summon all the agencies of nature before the tribunal of Science, and try the question of their identity under their various aliases, just so often as a new set of masks or disguises is detected in their possession. The accumulated discoveries of late years have resulted in such a trial. Following the same course that Newton and Franklin followed in their generalizations, living philosophers have attempted to show relations of mutual convertibility, if not of identity, between the series of forces known as light, heat, electricity, magnetism, and chemical MECHANISM OF VITAL ACTIONS. 337 affinity. Some leading facts indicating their intimate relationship may be very briefly recalled. A body heated to a certain point becomes lumi- nous ; its heat seems to pass over partly into the con- dition of light. Thus iron becomes red-hot at about 1,000° Fahrenheit. Light may, perhaps, be changed into, or manifest itself as heat. In Franklin's fa- mous experiment, the black cloth, which absorbs all the luminous rays, sinks deepest into the snow. Light, again, may act chemically, as heat does, as we see in the results of photography. It may be fixed in a body, like heat, as is shown in the Bologna phosphorus, which shines for some minutes after being exposed to sunlight, or to the common light of day. Heat develops electricity, as in the various thermo-electric combinations of different metals. Elec- tricity produces light, and sets fire to combustibles. The highest magnetic powers are developed in iron by the action of galvanic electricity. The magnet, again, is made to give galvanic shocks in a common form of battery, with the usual manifestations of light and heat. Chemical force develops light, heat, and electricity ; and each of these is used constantly in the laboratory as a practical means of inducing chemical action. Heat alone is shown, by an experi- ment of Mr. Grove, to be capable of decomposing wa.ter. Further than this, as all forms of motion are capable of developing heat, or light, or elec- tricity, according to the conditions under which it 15 V 338 MECHANISM OF VITAL ACTIONS. occurs, and as heat and electricity and chemical changes are habitually used to produce motion, it is questioned whether all the apparent varieties of force are not mutually convertible, there being in reality but one kind of force, which manifests itself in each of the different modes just spoken of according to the material substratum through which it is passing, or some other modifying cause. And as there are facts indicating the existence of a system of equivalents as prevailing in these conversions, or of a fixed ratio between the various convertible forms of force, so that a given electrical force wiU produce just so much heat or chemical decomposition, and either of these reproduce the original amount of electricity, it has been maintained that the total force of the inorganic universe is undergoing perpetual transfer, but never changes in amount, any more than the matter of the universe is altered in quantity by change of form. This would be the noblest of generalizations, could we accept it without limit, as an established truth : — a few simple elements ; the material world formed by their innumerable combinations ; — one force, an effluence from the central power of creation, ani- mating all ; binding atoms, guiding systems, illumi- nating, warming, renewing, dissolving, as it passes through the various media of which the unbreathing universe is made up. We may carry the generalization a step further. We know nothing of matter itself except as a collec- MECHANISM OP VITAL ACTIONS. 339 tion of localized forces, points of attraction and re- pulsion, as Boscovich expressed his notion of its ele- ments. Take a quartz crystal as an example. It resists the passage of certain other forces through a limited portion of space. It resists the separation of that sphere of resistance into two or more parts, by means of what we call cohesion. If a ray of light attempts to pass the portion of space within which these circumscribed forces have been found to act, it is thrown back or bent from its course. Here, then, are localized forces, or agencies that produce change ; the existence of anything behind them — substance, or substratum — is a mere hypothesis- But while the fluent forces of the universe have been shown to pass more or less completely into one another, these col- lections of stationary forces which we caU matter have hitherto maintained their ground against every attempt to reduce them to unity, or to render them in any degree mutually convertible. Our threescore groups of fixed forces, known as simple substances, defy all further analysis, so far as our present power and knowledge extend. But we must remember that, even if the hypothesis of the absolute unity of the various imponderable agencies were established as a fact, we should still have to look somewhere between their sources and our organs for the difference in their manifestations. And this could be only in the media through which they act. K electricity becomes magnetic attraction 340 MEOHAMSM OF VITAL ACTIONS. in passing through iron, and iron only, we must look to the metal for the cause of its change of form. Thus we only transfer the differentiating agency from one sphere to another, in consequence of the experi- mental inferences of the physicist and the chemist. If chemistry had reduced matter to some one mother- element, we should have been forced to refer all its different manifestations, such as gold, sulphur, oxy- gen, and the rest, to the influence of external agencies operating through them. The tendency of modern re- search, without claiming for its inferences the charac- ter of demonstration, is in the other direction ; — unity of the fluent forces ; diversity of the fixed forces, or matter. Such are the data derived from the inorganic world with which we approach the consideration of the phe- nomena which belong to organized beings. According to their analogies we should look for the cause of any peculiar manifestation we might meet with, in the fixed forces or material structure of the organism. When we commence the examination of this mate- rial structure, we find it so different from everything that we have met with in lifeless matter, that we are tempted to believe it must differ no less in elemen- tary composition. The substance of these five hun- dred mute slaves which we call muscles, and the cur- rents of this " running flesh " that we call blood, seem unlike anything in earth, air, or waters. But Chemistry meets us witli her all-searching analysis, MECHANISM OF 'VITAL ACTIONS. 341 and tells us that this solid and this fluid, and all the other structures of the body, however varied in as- pect, are but combinations of a few elements which we know well in the laboratories of Nature and Art. A few gallons of water, a few pounds of carbon and of lime, some cubic feet of air, an ounce or two of phosphorus, a few drams of iron, a dash of common salt, a pinch of sulphur, a grain or more of each of several hardly essential ingredients, and we have Man, according to Berzelius and Liebig. We have literally " weighed Hannibal," or his modern repre- sentative, and are ready to answer Juvenal's question. The wisest brain, the fairest face, and the strongest arm before or since Ulysses and Helen and Agamem- non, were, or are, made up of these same elements, not twenty in number, and scarcely a third of the simple substances known to the chemist. The test- tube, and the crucible, and the balance which " cavils on the ninth part of a hair," have settled that ques- tion. Appearances, therefore, have proved deceptive with regard to the composition of the organism. Again, if we looked for the first time at the mode of action of the living structure, we should probably decide that the forces at work to produce the opera- tions we observe must be of an essentially different nature from those which we see manifested in brute matter. Here are solids sustained and fluids lifted against the force of gravity. Here is heat generated without fire. Here is bread turned into flesh. Here 342 MECHANISM OF VITAL ACTIONS. is a glairy and oily fluid shut up in a tight casket, sealed by Nature as carefully as the last will and testament of an heirless monarch ; and lo ! what the casket holds is juggled into blood, bone, marrow, flesh, feathers, by the aid of a little heat, which, in- creased a few degrees, might give us an omelet in- stead of a chicken. Surely, we should say, here must be new forces, unknown to the common forms of matter. Yet appearances may deceive us, as they deceived us respecting the substance of the organism until the chemist set us right. We must try the actions just as he has tried the elements. We are not bound to do for them any more than he has done for the materials he has worked upon. If he has stopped at analysis, and confessed that synthesis was beyond his powers, so may we. He has shown us the carbon, the iron, and the other elements of which blood and muscular fibre are made up. But he has never made a drop of blood or a fibre of muscle. We have done as much for physiological analysis, if we can show that such or such a living action is produced by some form of natural force with which we are acquainted as it appears in inorganic matter, although we cannot re- produce the living action by artificial contrivances. .It is not to be supposed that the laboratory can pre- sent combining elements to one another under all the conditions furnished by the organism, nor that any one living act may be imitated after the mu- MECHANISM OF YITAt ACTIONS. 343 tually interdependent round of movements has been permanently interrupted. Proceeding, then, to our analysis of the living ac- tions, a very superficial examination shows us that many of the physical agencies are manifested in the organism in the same way as in ordinary matter. Thus gravity is always at work to drag us down to the earth. It holds us spread out on the nurse's lap in infancy. We stand up against it for some three or four score years. Then it pulls us slowly down- ward again. The biped is forced to become a triped. The jaw falls by its own weight, and must continually be lifted again ; so that old men, as Haller remarked, seem to be constantly chewing. It stretches us out at last, and flattens the earth over our bones, and so has done with us. Our fluid's obey it during our whole lives. The veins of the legs dilate in tall men who stand much ; the hands blanch if we hold them up; the face reddens if we stoop. The same cohe- sion that gives strength to knife-handles and tenacity to bowstrings serves the purposes of life in bones and sinews. The valves of the heart and vessels, which pointed Harvey to the discovery of the circulation, proclaim the obedience of the fluids to the laws of hydraulics. The tear-passages are filled by the force of capillary attraction. The skin soaks up fluids and allows them to escape through it, as membranes and films of paper and sheets of unglazed porcelain do in our experiments. The chemical reactions between 344 MECHANISM OF VITAL ACTIONS. the blood and the atmosphere, and between the gas- tric juice and the food, may be imitated very success- fully out of the body. The eye and the ear recognize the ordinary laws of light and sound in all their arrangements. Levers, pulleys, and even the wheel and axle, play their nsual part in the passive transfer of the forces which move the living machinery. These facts, and many others of similar character which might be mentioned, point to the following con- clusion. If there is a special force acting in the liv- ing organism, it must exist in addition to the general forces of nature, and not as a substitute for tliem. To know whether such a special force is necessary, or whether the general forces of nature are sufficient, we must know what these last are capable of doing, and what they cannot do, and must compare their ascertained power and its limitations with the living task to be performed. This is the next point to be examined. That form of force which we call chemical affinity is capable of giving an indefinite number of aspects and qualities to matter, by varying the proportions and mode of combination of a few simple elements. Oxygen and nitrogen, which are the breath of our nostrils, become a corrosive fluid when united in certain simple proportions differing from those of atmospheric air. The same elements, in varied com- binations, serve us as food, or form a fluid, one drop of which kills almost like a stroke of lightning. MECHANISM OF VITAL ACTIONS. 345 Thus there is nothing exceptional in the fact, that the compounds of the vegetable or animal structure should present the distinctive characters by which we know them as starch or fat, as fibre or muscle. Neither does there appear to be anything in the mere fact of assimilation, which estabUshes a distinct line of demarcation between the living and the lifeless world. A crystal, from a solution containing several salts, appropriates just the materials adapted to build up its own substance. A lichen does nothing more. The air is a solution of the elements which form it, and it appropriates and fixes them. The penetration of the new materials into the organic structure, and their interstitial distribution among its parts, might seem to draw the line of distinction. But this is very limited in many plants, and depends on their me- chanical arrangement, one division growing upon the outside and another upon the inside. The porosity of organized beings which favors this mode of nutri- tion is nothing but an increase of internal surface ; soluble nutritive matters are difiiised through ttieir textures just as water and other fluids pass into the pores of the Spanish alcarraza ; and there is no rea- son why this internal surface should not appropriate new matter, as well as the external surface of a mineral. The constancy of specific form is not more abso- lute in organized beings than in crystals. The diflFer- ence between diffierent crystalline shapes of the same 15* 346 MECHANISM OF VITAL ACTIONS. mineral is not greater than that of the grub and the butterfly, or of the floating and the fixed Medusa. Nor is a certain limitation of size a distinguishing mark of vitality. Some crystals are microscopic ; some needle-like ; some columnar. No diamond was ever found too heavy for a lady's coronet ; but there are beryls which it would break a man's back to carry. The plant and the animal have been thought to be peculiar in maintaining their integrity by continual waste and renewal. They are a perpetual "whirl- pool," into which new matter is constantly passing, and from which the materials which have been used are always being thrown out. It might at first seem hard to match this condition by any fact from the inorganic world. But from time immemorial, life has been compared to a flame, a spark, a torch, a candle. " Et, quasi cursores, vitai lampada tradant." The inverted flambeau of the ancients is still a fre- quent symbol in our rural cemeteries. Macbeth, Othello, John of Gaunt, have made the image familiar to us in different forms. " My oil-dried lamp, and time-bewasted light. Shall be extinct with age and endless night." The simile is in fact a little fatigued with long use, and the Humane Society is hardly true to its name when it tolerates the expression that " the vital spark MECHANISM OF VITAL ACTIONS. 347 ■was extinct." But this is the very object of compari- son that we here want, not for ornament, but use. Professor Draper has beautifully drawn the parallel between the flame and the plant. The flame is not living, yet it grows ; it is fed by incessant waste and supply ; and it dies at length, exhausted, clogged, or suddenly quenched. The plant must suck up fluid by its wick-like roots, as well as the lamp by its root- like wick. The leaves must let it evaporate, as does the alcohol in an unprotected spirit-lamp. Here, then, is the mechanism of perpetual interstitial change, which we have a right to say may be purely physical in the one case, as in the other. We need not wonder, in view of this perpetual change of material, that the living body, as a whole, resists decomposition. The striking picture drawn by Cuvier in his Introduction to the Comparative Anatomy, in which the living loveliness of youthful beauty is contrasted with the fearful changes which a few hours will make in the lifeless form, loses its apparent significance when we remember the neces- sary consequence of, the arrest of its interior move- ments. The living body is like a city kept sweet by drains running under ground to every house, into which the water which supplies the wants of each household is constantly sweeping its refuse matters. The dead body is the same city, with its drains choked and its aqueducts dry. The individual sys- tem, like the mass of collective life which constitutes 348 MECHANISM OF VITAL ACTIONS. a people, is continually undergoing interstitial de- composition. If we take in a ton every twelvemonth, in the shape of food, drink, and air, and get rid of only a quarter of it unchanged into our own sub- stance, we die ten times a year ; not all of us at any one time, but a portion of us at every moment. It is a curious consequence of this, we may remark, by the way, that, if the refuse of any of our great cities were properly economized, its population would eat itself over and over again in the course of every genera- tion. We consume nothing. Our food is like those everlasting pills that old pharmacopoeias tell of, heir- looms for the dwra ilia of successive generations. But we change what we receive, first into our otv^u substance, then into waste matter, and we have no evidence that any single portion of the body resists decomposition longer during life than after death. Only, all that decays is at once removed while the living state continues. As for our inability, already referred to, to imitate most of the organic compounds, it is no more remark- able than our inability to manufacture precious stones. Some combinations take place readily ; oth- ers require the most delicately adjusted conditions. Potassium and oxygen rush into each other's arms like true lovers. Iron blushes a tardier consent be- fore changing its maiden name for oxide. The " noble metals " are coy to the great elemental wooer ; they must be tampered with by go-betweens MECHANISM OF VITAL ACTIONS. 349 before they mil yield. Chlorine and hydrogen unite with a violent explosion, if exposed to sunlight. Hy- drogen and oxygen resist the mediation of the sun- beams, but come together with sudden vehemence if crossed by the electric spark or touched by a flame. Most bodies must be dissolved before they will form alliances ; " corpora non agunt nisi soluta." Some can combine only in the nascent state ; like princes, they must be betrothed in their cradles. There is nothing strange, then, in the fact, that combinations formed in the vegetable or animal laboratory should be hard to imitate out of the body. Yet the chemist has al- ready succeeded in forming urea ; and artificial diges- tive fluids, borrowing nothing from life but a bit of dried and salted rennet, do their work quite as well as the gastric juice of many dyspeptic professors. These instances show us that, if we can only supply the necessary conditions, the chemical forces are always ready. Nature expects every particle of carbon, and the rest, to do its duty under all circum- stances. The digestive secretions often devour the stomach after death. A drowned man is restored by artificial respiration ; the air forced into the lungs changes the blood in their capillary vessels ; the blood thus changed is enabled to flow more freely ; the heart is unloaded of its stagnant contents, and roused to action ; the round of vital acts is once more set in motion ; and all this because carbon and oxy- gen are always true to each other. ' 350 MECHAMSM OF VITAL ACTIONS. "We are obliged to confess, as the result of this examination, that the inherent and inalienable rela- tions of the elements found in the living organism may be sufficient to account for all the acts of com- position and decomposition observed during life, without invoking that special " chimie vivante " which Broussais and others have supposed to be one of the properties of organization. There is another mode of operation found in ani- mals and vegetables, which has been considered as depending upon special vital, in distinction from physical, causes. This is the process by which cer- tain bodies are selected from others for absorption or secretion ; as when the chyle is taken up by the lacteals, and the bile is separated from the blood by the liver. To account for this, the organs have been supposed to possess a certain " low intelligence," which directs them in this selection. Yet there is evidence that the ordinary physical laws are not idle in these operations, and it is fair to ask if they may not be the only real agencies. The lacteals will not take up oily matters until they have been turned into an emulsion by the pancreatic fluid ; just as a wick wetted with water will not take up oil until this is emulsified, or made a soap of. We may still inquire why each secreting gland forms or transmits its own special product, and no other ; why the liver secretes only bile, and the lach- rymal gland only tears. We can see nothing in the MECHANISM OF AHTAL ACTIONS. 351 anatomical formation of these organs to account for their peculiar modes of action. But there are many phenomena of simple physical transudation equally unexplained. When water and alcohol are separated by a membrane, a current is established between the fluids in both directions, that from the water to the alcohol — the denser to the lighter — being the most rapid. When a similar experiment is performed with sirup and water, the current is from the water to the sirup, — the lighter to the denser. When the same fluids are employed, the nature and position of the membrane used occasion differences which we cannot explain. With the skin of a frog, the current from the water is most rapid when the internal surface is towards the alcohol. But with an eel-skin, the re- Tersed position is most favorable to the flow in the same direction. Again, in the phenomena of precipitation, as seen in the laboratory, we have an illustration of the chemical side of secretion. Two clear fluids are mixed, and one of them immediately separates or secretes one or more of its elements as a distinct product ; or both may be decomposed with entire transformation of aspect and properties. Or a sim- ple solid substance is introduced into a fluid com- pound, and at once seizes upon some constituent, and appropriates it, as when iron is immersed in solutions of salts of copper. StiU more striking is the well-known action of spongy platinum in pro- 852 MECHANISM OF VITAL ACTIONS. ducing the combination of hydrogen and oxygen, without undergoing any chemical change itself. Let us see whether some of these same physical operations may not be manifested in the liver, taking this as the typical secreting organ. Its cell-walls may govern their currents of transudation by laws of their own, as eel-skins and frog-skins govern the currents of alcohol and water. The two kinds of blood which meet in its capillary vessels may react upon each other, and produce mutual decomposition, as well as any other compound fluids. The substance of the liver has as much right to appropriate fat, without a special license from vitality, as the iron, in the ex- periment referred to above, to appropriate copper. It may have as good a title from the Supreme Au- thority to join the elements that form cholesterine, as spongy platinum to unite hydrogen and oxygen. This catalytic agency — the priestly office of chemical nature which gives to one body the power of marry- ing innumerable pairs of loving atoms, itself standing apart in elemental celibacy — is not to be denied its possible place in the living mechanism. Its action may, perhaps, be more extended than in inanimate bodies. The instances furnished by the action of the pancreatic fluid and the gastric juice may belong to a far more numerous series of similar phenomena. We may grant a difference of degree between the separations or secretions efiected by the reactions among the complex elements of the organism, and MECHANISM OF VITAL ACTIONS. 353 those witnessed in unorganized matter ; but the dif- ference of essential nature is less easily demonstrated. But it will be said that the several parts select their special secretions with reference to the general wants of the system. If there is no eYidenee of adaptation of parts to a whole anywhere except in living beings, then we must allow that here is a difference in kind as well as in degree, which it would be hard to recon- cile with the supposition that the same forces are the sole agents in both cases. But it is vain to deny that the macrocosm shows the same adaptation of parts as the microcosm. "When the Resolute was found adrift and boarded by the American sailors, there was no sailvon her masts, and no hand at her helm. Yet there was just as much evidence in her build and equipments that «he was framed and provided for a definite purpose, as if the good ship had been seen with all her men at; the ropes and the steersman at the wheel, following a lead into the ice-fields of the North. So if the earth had been visited by some wandering spirit before a fern had spread its leaves, or a trilobite had clashed his scales, the evidence of adaptation of its several parts to one another, as well as to ulterior ends, would have be^ clear as the sun that shone upon its primeval strata. Its steady cir- cuit through the heavens, exposing it on all sides to light and shade in succession ; the qualities of matter which lead its various forms to arrange themselves as shapeless matrix, or geometrical solid, into ever 354 MECHANISM OF VITAL ACTIONS. downward-sinking waters and ever upward-rising atmospheres ; the self-preserving and self-classifying tendency, constantly at work to educe new harmo- nies out of the destroying conflict of the active powers of nature, — show that the adaptation of parts to the whole is wider than the realm and older than the reign of life. All the physical laws, in and out of the organism, are arranged in harmony with one another. Each organ of a plant or an animal is supported by, and accountable to, the general system. But this system holds the same relations to the surrounding universe. Every creature that is born has an account opened at once with Nature, — debtor by so much of carbon, oxygen, hydrogen, azote ; creditor by so much car- bonic acid and ammonia, or whatever may be the medium of payment. Life is adapted to maintain a certain normal composition of the atmosphere, as much as the atmosphere to maintain life. And as air existed before plant or animal lived to breathe it, and as air is made up of at least three elements, each of these, considered as a part, was adjusted in quality and quantity to the whole with the same fitness that we see in the relation of the amount and quality of the bile as compared with the other secretions and the wants of the system. But the living system protects itself by special pro- visions, it will be said ; look at the thickened cuticle upon the workingman's hand, and see how admirably MECHANISM OK VITAL ACTIONS. 356 it shields the sensitive surface. True ; and see also how delightfully the same thickened cuticle acts in the case of a corn. The avidity with which the most deadly substances are sucked in by the skin, — the suddenness with which a single drop of poison will work its way through the system from the surface of a mucous membrane, — shows us that the same force acts for good or bad indifferently ; that is, it is under the general law of harmony, but not modified to meet accidental conditions. Just so, in the greater universe, the tide rises by one of its beneficent pro- visions, wafting a hundred fleets into their harbors, but not less surely drowning the poor wretches who are caiight on the sands by its advancing waters. " Faugh a ballagh ! " — " Clear the coast ! " — is the word when we get across the track of any natural agency. We must not expect it to turn out for any particular end ; the Creator has imparted no such wisdom to matter. The course of a single ray of light is the eternal illustration of the Divine mode of action. It is always in straight lines. The difference between our utilitarian methods, always looking to special ends, and the Supreme handling of things in their univer- sal aspect, is beautifully shown in the structure of one of our domestic animals. If a watchmaker should insist on putting into a common watch one httle wheel, unseen, and unconnected with the rest of the machinery, because he had made repeaters which 356 MECHANISM OF VITAL ACTIONS. required such a wheel, we should smile at his lost labor. But there is a little collar-bone, too small to be of any use, floating in the midst of the muscles about a cat's shoulder, which is as constant as if the animal's welfare depended on it. Why is it there? It is the vanishing point of a series of models formed on one general plan. The plan, as a whole, is a monument of infinite wisdom, adapted to the various needs of a numerous series of conscious beings. But it is so vast that it includes what we call utility as one of its accidents, and this anatomical fact shows us one of the borders at which the Divine conception overlaps the temporary application. The human arti- san is wise in leaving out the wheel when it is no longer wanted. But the seemingly trivial arrange- ment just mentioned shows that the Deity respects a normal type more than a practical fact. His thoughts and his ways are not as ours. The limited duration of existence might be thought to be characteristic of organic being. But, in the first place, this fact is not so universal and absolute as might be supposed. De Candolle long since pro- mulgated the doctrine that trees live indefinitely, and never die but from injury or disease. The death of our great forest-trees is commonly owing to fracture, in consequence of the decay of the inner portion of the stem, which no longer performs any but a me- chanical ofiice. On the other hand, many crystals undergo decomposition, of form at least, within a MECHANISM OF VITAL ACTIONS. 357 longer or shorter period, by ejfHorescence or deliques- cence. The very conditions of organic life imply a liability to disable its implements. A river chokes up its own bed with detritus ; a chimney fills itself up with soot. The organism is a multilocular sac of fluids which are loaded with dissolved and suspended matters. The smoke of life ascends from innumer- able pores of animal bodies, from the first gasp to the last breath which is expelled. What marvel that the vessels become thickened, and the working or- gans clogged, with accumulating deposits ? We can only wonder, with the hymn to which we have re- ferred, that the harmony of so exquisitely adjusted a mefthanism should be so long maintained, and not at aU at the brevity of life in any of its forms, or the diversity of its duration. , . But there is the great mystery of reproduction. Are there any acts of inorganic nature parallel to those which take place in the development of an embryo of one of the higher animals ? This de- velopment may be decomposed into the following separate elements: — 1. A movement of assimilation imparted by an organism to a separable product of secretion or of growth ; 2. A difierentiating move- ment, which divides and arranges the formative materials into the substance of tissues and organs ; 3. A modelling force, or shaping agency, which de- termines the form of the several parts and of the whole ; 4. A co-ordinating force, which brings the 358 MECHANISM OF VITAL ACTIONS. various separate acts into harmony with one another, the motus regius of Lord Bacon. Now, the question is, not whether all these actions are combined in any other known group of material changes than embryonic . development, but whether any one of them is absolutely sui generis. And, first, we do not see why molecular movements may not be imparted by one portion of matter to another, as well as movements in mass. Fire is so propagated, and forms a new centre independent of its origin. Mag- netism is imparted from one body to another, without diminution of its intensity in the first. Secondly, the rending apart of the most intimately combined ele- ments, and their distribution to the positive and neg- ative poles respectively, may illustrate the separation of the several constituents of the embryonic structure from one another. A very weak current will decom- pose saline mixtures, and even refractory oxides. Heat alone, as we hd,ve seen, will decompose water. Is it not in harmony with these physical facts, that a weak current of heat, long continued, as in incuba- tion, should induce the separation and quasi polar arrangement of the loosely combined atoms which are to form the embryo ? Thirdly, is not the shaping power more obvious in the rhombs of a fragment of Iceland spar than in the disc of a lichen, which falls on a stone, and spreads just as a drop of rain would spread ? "We may, in fact, see the two forms of the modelling process — Nature's plane and spherical MECHANISM OF VITAL ACTIONS. 359 geometry — in operation side by side in the same structure. The raphides, or included crystals, which we often find in great abundance in vegetable cells, — those of the onion, for instance, — illustrate the point in question. Lastly, we have abeady seen cause to deny that the principle of harmony of parts, or multi- plicity in unity, can be confined to living bodies, without overlooking the most obvious adjustments of the elements of general nature to one another and to one great plan. " The wonderful uniformity in the planetary system," says Newton, " must be allowed the effect of choice ; and so must the uniformity in the bodies of animals." It appears, from the survey we have taken, that we might expect, from the general character of the crea- tive plan, that, as pre-existing materials were em- ployed to form organic structures, so pre-existing force or forces would be employed to maintain organic actions, or unconscious life. It is certain that the materials of the organism are, to a great extent, subject to the common laws of mechanical and chemical forces. It is not proved that these same forces are -incompetent to produce the whole series of interstitial changes in which the functions of life common to vegetables and animals consist. On the contrary, the more we vary our experiments and extend our observation, the more difi&cult we find the task of assigning limits to their power. The preservation of specific form and dimensions has not 360 MEOHANISM OF VITAL ACTIONS. appeared to be confined to living beings. The co-operation of the parts of an organized structure does, indeed, imply a plan, or pre-established har- mony, but no more than the arrangement of the spheres, or the relation of the elements to one anoth- er. Each little -world of life shows only the same solida/rity, on a small scale, that prevents the universe from being a chaos. Limits of duration are not pecu- liar to living beings, nor always evident in them. Re- production combines several modes of action, no one of which is without its inorganic parallel. Given, then, a plant or a man, there seems no good reason why either should not begin to live with all its naight, so soon as the conditions of light, heat, air, — whatever stimuli or food it requires, — shall be made to act upon it. Such is the case with the drowned man who is "brought to life." He was defunct to all intents and purposes, except that the organs and fluids had not had time to become clogged, or decomposed, when a whi-ff of air set the whole machinery going again. " Two is my num- ber," said Sir Charles Napier. " Two wives, two daughters, two sons, and two deaths. I died at Co- runna, and now the grim old villain approaches again." Life is not the absolute unit we suppose. If a man is dead who "breathes his last," or "ex- pires," such dead men have unquestionably been restored to life without a miracle. In other words, a man may be dead conditionally, — dead, unless there MECHANISM OF VITAL ACTIONS. 361 happen to be a double bellows or a galvanic battery in the neighborhood, and some one who knows how to use it. But if a man is not dead so long as any so-called living process goes on, then most men are buried alive ; for there, is no doubt that certain secre- tions — the mucous secretion, among others, as one of our best pathologists thinks — take place for a con- siderable time after a person has " expired." Prob- ably a certain number of those who have just died or expired could be resuscitated to movement, if not to consciousness, by artificial respiration, if it were a thing to be desired. The reason that they cannot be permanently restored, like those rescued from the water, is that some organ or fluid has undergone an important injury, ij^ the vast majority of cases, if not in all. Life is a necessary attribute, then, of a perfect organism exposed to the proper external influ- ences, as much as gravity is of a metal, or hard- ness of a diamond. Just as the Creator, in call- ing the material elements into existence, contem- plated their fitness to form a part of the living creation yet to be, so did He also difiuse such forces, or forms of force, through the world, as should of necessity manifest themselves through any perfect organism as what we call life. Such is the conclusion pointed at by the range of analogies we have adduced. A vast number of facts testify in its favor, and it is hard to find any that oppose it whic> 16 362 MECHANISM OF VITAL ACTIONS. cannot be explained. Whatever incomprehensible mystery there may have been in the first fabrication of these living time-keepers which measure ages in their conscious or unconscious movements, one com- mon key seems enough to wind them all up and set them going. We may not accept Mr. Newport's gen- eralization as to light, but whatever form of force we may recognize as the prirhum mobile in the series of organic movements, we are contented to accept as the chosen mode of action of the all-pervading Presence. If the Deity has seen fit to make one agent serve many purposes, the fact will be acquiesced in, in the face of the threatened San Benitos of all the Linn^an Societies. The battle-ground of Atheism is not in the field of natural science ; meaning by that the study of mate- rial phenomena. The argument from design to an iatelligent Contriver does not require the knowledge of Cuvier or Humboldt to make it satisfactory. Every man carries about with him in his own or- ganization a syllogism which all the logic in the world can never mend. If his scepticism will not melt away in such an ocean of evidence, it is because it is insoluble. Whatever contrivances have been em- ployed, the grand result of an immeasurable whole, all the parts of which are fitted together with a fore- sight and wisdom which it mocks the human intel- lect to attempt to sound, except along its shallower edges, remains to be accounted for, and Paley's ar- MECHANISM OF VITAL ACTIONS. 363 gument from the watch to its maker illustrates the simple course of reasoning which the healthy mind is naturally forced to follow. The evidence we hare been considering applies to the perfect and mature organism, and does not reach the question how such organisms first came into being. Who shall tell us whether the first egg was parent or offspring of the first fowl ? The poet must answer for the philosopher. Milton has ventured tb paraphrase the Scriptural account of creation with a freedom not always allowed to modern science. " The tepid caves, and fens, and shores " hatch their feathered broods from eggs. The grassy clods become the mothers of young cattle. The bees appear, not a single pair, but " swarming," as our own naturalists tell us they must have appeared. But our prosaic evidence as to the introduction of the forms of life upon our planet is limited. And, first, there is no authentic evidence that the development of any organism has been directly ob- served without the demonstrated or probable presence of a germ derived from a previous structure having similar characters. Even the vexed question of the ori^n of the entozoa, or internal parasites, has re- ceived its approximate solution from modern investi- gations. The tape-worm, for iastance, is found to exist in two difierent forms, or stages of develop- ment. Each perfect tape-worm contains some twelve millions of eggs, capable of being reduced to a float- 364 MECHANISM OF VITAL ACTIONS. ing dust, and thus being deposited on various articles used as food. The mouse, nibbling at everything, swallows some of these, and they grow in his body into the state of cystic worms, an intermediate form of development, only of late recognized as being a stage of the tape-worm's growth. By and by the cat eats the mouse, and the cystic worm, finding its proper habitat in this animal's alimentary canal, as- sumes the true proportions of the tcenia crassicolis. And so, another cystic worm, which is common in the flesh of oxen, sheep, and especially pigs, becomes, by a similar metamorphosis, the tmnia solium, or long tape-worm of their human consumer. The tribes that live on raw flesh are said to be particularly subject to the tape-worm. The hint derived from their experience may serve as an offset against Dr. Kane's Arctic experience, and the recommendation of a raw diet from nearer sources. So far as our immediate object is concerned, we have got rid of one enigma in finding, not only the cradles, but the nurseries, of these entozoa. We are obhged to con- sign the supposed instances of equivocal generation derived from their history to the same category with Virgil's swarm of bees born from a decaying carcass. But, in the second place, the evidence of Geology has made it plain that new forms of life have been called into being at many different periods of the earth's history. The multitude of distinct floras and faunas in different regions and strata of the earth MECHANISM OF VITAL ACTIONS. 365 sufficiently proves that the formation of new organ- isms has been as much a part of the regular order of things in creation as the precession of the' equinoxes, or upheavals and depressions, or any of those changes that work out their great results in the longer cycles of time. No one who observes the manner in which new specific forms are gradually introduced among those already existing, can help seeing that such new formations may have been quietly intercalated in the midst of thejr predecessors by a series of operations in which, as in the mighty processes by which new continents are uplifted, nothing but secondary agen- cies were apparent. Chemistry teaches us, as we have seen, that no new materials were required to be called into being. It is not to be supposed that certain parcels of carbon or of oxygen were created when the first living forms, containing these elements as a matter of necessity, were fashioned, inasmuch as they already existed in immeasurable abundance. What was wanted was, not the materials of the or- ganism, or of its germ, but the force to bring them together without the intermediate action of a parent structure. The creation of matter out of nothing is perfectly credible as a fact, but not definitely con- ceivable by our imaginations. The combination of pre-existing elements, and the development of new properties in the resulting compound, is what we daily witness. If the most insignificant infusorial plant or ani- 366 MECHANISM OF VITAL ACTIONS. mal, having well-defined specific characters, had been evolved under our own eyes, in circumstances pre- cluding the possible existence of a germ derived from a previous similar being, the fact would furnish us with a theory of the organic creation, so far as the purely vital, not the spiritual, side is concerned. Not having any such fact to appeal to, but, on the con- trary, finding the rule that' whatever lives comes from a germ absolutely universal, so far as we are acquainted with actual life, we are reduced to barren speculation as to the special mechanism employed in the many changes of programme which the palaeon- tologist points out to us in the vegetable and animal world of the past. " The world is in its dotage, and yet the cosmogo- ny, or creation of the world" puzzles us, as it did the philosopher from whom these words are cited. By feeling our way up, through what is possible, or at least conceivable, from the laws of the inorganic world to the simplest manifestations of life, we may construct a theory of the evolution of life by means of the existing forces of nature, acting in different degree or intensity from their present ordinary mode of operation. Let us construct such a theory, not to lean upon it, but to see what degree of plausibility it may present, or how its weakness may drive us to another hypothe- sis. We will try to make the most of it, as an advo- cate pleads his client's cause without compromising MECHANISM OF VITAL ACTIONS. 367 his private opinion. Suppose the problem to be the mechanism of the introduction of vegetable life. And, first, let us illustrate our possible relations to this question by an imaginary picture of a body of philosophers of a somewhat ruder stamp than our- selves, and the statement of a question which may have occurred to them, and taxed their highest faculties. A group of savages, living in a remote island, have from time immemorial been in "the habit of employing fire for warming themselves and in cook- ing. They never suffer it to be extinguished every- where at once, for they know that they cannot re- kindle it except from another fire. They breed it as we breed trees in our nurseries. The fact of burning is no more a mystery to them than any other natural fact ; its phenomena are constant, determinable be- forehand, and controllable, and although they cannot talk about carbon and oxygen as button-using sages talk, they practically know the laws of combustion. They know that fire is prolific and self-developiug ; that it has its little red seeds, and in due time its slender buds, and broad waving corolla, like a flower ; that it loves air, and hates water ; that it gives pleas- ure or pain, according to the way of using it ; that it renders the flesh of the canine race still more ac- ceptable than their living presence, and even adds new tenderness to the paternal relation, in case of premature bereavement. All this they know. But 868 MECHANISM OF VITAL ACTIONS. if they are asked where the first fire came fi^om, or how it was born, they have no answer to render, or only an idle story to tell. It was the gift of the Great Spirit, or some tawny Prometheus stole it from heaven. As for any mechanism by which it can be produced, they are entirely unable to suggest or con- ceive it. The wind, they know, fans a spark into a flame, but they laugh at the idea that the wind should kindle a fire without a single spark to begin with. At length a great hurricane sweeps over their island. It sways the tangled forest-branches backward and forward ; it rends and twists and grinds them, until the earth is strewed with their fragments. Two dry boughs are swinging across each other, and chafing in the blast. Presently a smoke rises from their point of crossing, and then a flame, — the woods are set on fire ; but the great mystery is solved, and from that time forward the natives rub two sticks together when they desire to have the means of warming their fingers, or discussing the merits of such game as they may have bagged in their last skirmish. We stand in the same relation to the origin of vegetable life as that in which the savages stood to the origin of fire, before the tempest revealed it. Give us but one little vegetable spark, and we can in due time kindle it by our appliances into a flame of blossoms wreathed in a cloud of foliage. Thrust into the soil this little brown scale, one of those which the elm has dropped in thousands at our feet, MECHANISM OF VITAL ACTIONS. 369 and it will go on towering and spreading until it overshadows the fourth part of an acre. Take this double-winged germ, which looks so like an Egyptian amulet, and burj it. Out of its core will spring a tall shaft that will wear its greenness for a centuTy, though scarred with many a wound, through which its sweet juices have been stolen. This persistent force, building up the elm and the maple out of such mere specks of matter, holding steadily to the specific characters of each in every diversity of soil and cli- mate, and maintaining them through the vicissitudes of a hundred seasons, is as great a mystery as would be the production of such a seed as either of those mentioned by deposition from the air which contains their elements, or their formation de novo from any collection of their proximate principles. It is only because we are not in the habit of witnessing the formation of germs as a daily occurrence, that we invest it with preternatural conditions. Geologists, who are constantly dealing with successive new crea- tions, learn to accept the primitive evolution of an organism as a regular process, equally with its con- tinuance. The lighting of a friction-match is not more wonderful than the conflagration of a great city which it kindles. If Schultze and Schwann had .succeeded, instead of failed, in their experiments on equivocal generation, we should have taken the fact as quietly as the invention of lucifers. Let us proceed with our theoretical construction. 16* X 370 MECHANISM OF VITAL ACTIONS. We have as much right to say that carbon has a tendency to take the form of a plant under certain circumstances, as that it has to become a diamond under other conditions. We do not see it changing directly into a plant ; did we ever see it crystallizing into a diamond ? Let us now consider the earth just at the period before the first evolution of vegetable life. As uncounted billions of tons of carbon have since been abstracted from the atmosphere to repre- sent what we may call the fixed organic capital of our planet, as well as vast quantities of other ele- ments derived from the earth and the waters, we may suppose the soil and atmosphere to have then represented a saturated solution of the elements of vegetable organisms. Some change of condition, natural, bxit exceptional, like the hurricane in our imaginary picture, — an influx of alien elements from some distant source, or an alteration of temperature, for instance, — destroys the equilibrium of the solu- tion. There takes place a vast precipitate of living crystals, — needle-like, acuminated, porous, crusted with an inorganic coat of silex, — the grass which covers the plains and hill-sides. The organic solu- tion having been thus reduced, the next living pre- cipitate may probably be of a different grade, more slowly formed, more complex, a higher vegetable growth. Would this process be a whit more incom- prehensible than the deposition of a cube of common salt from a clear fluid ? Now, although a nucleus in MECHANISM OF VITAL ACTIONS. 371 the shape of a pre-existing cube of salt helps and accel- erates this last process,, it is not always necessary to it. So the living shape, which commonly depends for de- velopment on its pre-existing nucleus, or germ, may be conceived, under certain conditions, to be formed without it, obeying the same general forces, which are confessedly strong enough to shape and build up a mighty tree out of a mere particle of matter, or more properly from the elements, to which this par- ticle has given their first direction. After a certain number of vital precipitations, we might suppose the solution, atmospheric or other, of the organizable sub- stances, to retain just so much of these principles as would be sufficient to keep up the integrity of the organic deposits. The cube of salt will retain its form indefinitely, -if kept in the fluid from which it was deposited. And thus we see a reason for the fact that every organism is immersed in a solution of its own constituents. It does not follow that we must be able to imitate this natural process by our artifi^cial arrangements. To say nothing of our very imperfect control of the' natural forces, the scale of magnitude of the experiment may entirely determine the results. Spontaneous combustion happens not unfrequently in heaps of vegetable matter ; but no experimenter will expect the same substances to take fire in such quantities as he examines by the micro- scope. It is only going a step further in our supposition 372 • MECHANISM OF VITAL ACTIONS to conceive the first stage of vital precipitation as a simpler process. "We may suppose the living pre- cipitate to consist of what we may call indiffereid germs, that is, assimilating and self-developing cen- tres, determinable, but not yet determined ; bearing the same relation to vegetable growths , generally, which the seed of an apple or pear bears to the many possible varieties that may spring from it. This hypothesis is by no means identical with that of progressive development. It supposes the exist- ence of permanent types, but conceives each type to represent the plastic diagonal of two forces, — a gen- eral organizing principle and a local determining one. The line of direction once fixed persists indefinitely, self-perpetuating, in the individual and the species, a vital movement parallel to its own axis. It is not our fault if these indifferent germs are the same things as the semina rerum of the old heathen Lu- cretius and his masters ; the question is, whether they do not assist our conception of the mechanism of creation, and remove a part of its seeming diffi- culty. We might apply this hypothesis of indifferent germs to that singular parallelism without identity observed in the organisms of remote regions. The resemblance between many growths of the Eastern and Western continents, for instance, would follow as the result of the diffusion of identical germs amidst similar, but not identical, general conditions MECHANISM OF VITAL ACTIONS. 373 of soil and climate. The same series of resemblances might be expected, which we see in distant, but cor- responding, parts »f the body, in various affections of the skin. Both arms or both cheeks often present very nearly the same diseased aspect, the blood being the common source of the disturbing element, and certain corresponding parts on the two sides of the body furnishing the conditions for its development. So the two planetary limbs thrust through the folds of the ocean, one on either side, may be supposed to throw out their gi-asses, or oaks, or elms ; like each other, but not the same. " God has been pleased," says Paley, " to prescribe limits to his own power, and to work his ends within these limits." "We can conceive of the introduction of vegetable life without any over-stepping of the present self-prescribed limits of Divine power, as we understand them. It is not absurd to suppose that new vegetable types may be forming from time to time in the existing order of things. The vulgar belief is in favor of such occurrences. The extraor- dinary fact of the appearance of oaks after a pine- growth has been removed, and other occurrences gf similar nature, have never been thoroughly investi- gated, so far as we can learn. Scientific men ques- tion curiously on the subject ; there is a doubt in their minds about the acorns, if they accept the facts about the oaks, as commonly alleged. It is strange that such substantial seeds Bhould be scattered so 374 MECHANISM OF VITAL ACTIONS. widely. It. is stranger that such perishable matter as they hold should retain its vitality so long. The experiments on equivocal generation have been made too recently, and by men of too much judgment, to allow us to treat the doctrine with contempt. A thousand negative experiments can never settle the question definitively. We do not say that it is proba- ble, but we cannot say it is not true, that new types may be intercalated every century or every year into the existing flora. If the Dix pear was created for the first time in a garden in Washington Street, who shall say that the same power may not have just given us a new fungus in some corner of its vast nursery ? Whatever difficulties we find in attemptiag to frame a conception of the first evolution of animal life, there are certain facts which we are authorized to take as guides in our reasonings or imaginings upon the matter. Science confirms the statement of Revelation, that animal life must have come into being after vegetable life. The plain reason is, that plants are necessary to prepare the food of animals. And since no existing animal organism is ever built up directly from the elements, but only out of mate- rials derived directly or mediately from the vegetable world, we may question whether those first created were put together directly from the elements. The first animals were necessarily placed where their food was abundant. But their food contained the ele- MECHANISM OF VITAL ACTIONS. 375 ments of their bodies, and why should not the proxi- mate principles contained in the acctiniulations of vegetable matter about their birthplace have fur- nished the materials of the first, as well as of all subsequent organisms ? The primordial development of the higher animals presents this peculiar diflBculty, — that their germs depend for their evolution on their continued connec- tion with the parent. We can conceive of an infu- sorial seed or ovum as being formed by the " con- course of atoms," guided by that Infinite "Wisdom which we see every day groupuig the same atoms about their living nuclei. Reasonable men experi- ment with the hope of observing such a fact. But no one since, Paracelsus — unless it be the mother of Frankenstein — has thought of getting up an artificial homunculus, or homo, or even a lower mammal, or a bird. Vaucanson's duck was perhaps the nearest approach to such a performance. He could utter the monosyllable abhorred of medical men, and make himself disagreeable in more ways than it is neces- sary to mention. But he was nothing better than wood, and illustrates the hopeless distance between the bestof our paltry toys and the universe of mira- cles shut up in any one of the more perfect animal organisms. So difficult has the problem of the evolu- tion of the higher animal forms appeared to specula- tive philosophers, that they have invented the theory of progressive development of the superior from the 376 MECHANISM OF VITAL ACTIONS. lower types. The sharp lines -which separate species, as shown by observation of every organic form, ex- tinct as well as living, have caused this famous and seductive hypothesis to be very generally rejected as untenable. With all the difficulties, however, that stand in the way of our conceiving of the evolution of a mammal by the aid of the general forces of nature acting on the organic elements, we do not see where to draw the line which shall separate the higher from the lower forms of life, and assign a different origin to the two divisions of the series. Reasoning from be- low upwards, we should come to this frank conclu- sion, that, as definite form, limited duration, growth and decay, harmony of parts, transmissible qualities, all implying a controlling intelligence, are manifested in the inorganic world, we cannot assume that the same forces which produce its phenomena may not show themselves through all forms of organized mat- ter as vital force. And as the conditions of action of these forces must have varied at different periods of the earth's history, we cannot assume that they have always been incompetent to bring together the elements of organized matter. The various organic forms which we observe fossilized in the strata of the earth, without any parent structures in the subjacent layers, may be considered as marking by their appear- ance the epoch of successive " fits of easy transmis- sion " of the plastic elemental influence. MECHANISM OF VITAL ACTIONS. 377 " Sed, quia finem aliquam pariandi debet habere, Destitit ; ut mulier, spatio defessa vetusto." And here we leave this aspect of the question, to look at it in another point of view. We recognize two, and only two, great divisions in created things. To the first class of his creatures the Deity sustains only active relations. AH their qualities, functions, adjustments, harmonies, are im- mediate expressions of his wisdom and power. Ev- ery specific form is a manifestation of the Supreme thought. Every elemental movement is the Sover- eign's self in action. The only question is whether he has at one time been present in our elements with an organizing force, and afterwards withdrawn this particular manifestation, or whether under the same conditions these elements would always manifest his ideas in the production of the same forms, just as they now maintain the present forms of life by a per- petual miracle, which 'we fail to recognize as such only because it is familiar to our daily experience. We have stated, as well as our space permitted, the argument for the presence of an organizing force in the elements around us. To the second class of his creatures the Creator stands in passive as well as active relations. They are no longer simple instruments to do his bidding. They may i.isobey him, and violate the harmonies of the universe. They have the great prerogative of self-determination, which, with knowledge of the 378, MECHANISM OF VITAL ACTIONS. moral relations of their acts, constitutes them respon- sible beings. Now, if our previous view of matter and of ele- mental force as continuous Divine manifestations is correct, they could not in the nature of things become self-determining existences. The creation of inde- pendent centres of will and action involves a change in the character of the formative agencies hitherto at work in the portion of the universe with which we are acquainted. And here we come at once upon that mystery of mysteries : How and when are these spiritual natures called into being, and what is their relation to the material frames whose fundamental vital action we have alone considered ? Have they existed in some former state, as Plato taught in the Academy, and Dr. Edward Beecher has maintained in the Church ? Are the shores of embryonic life crowded with souls waiting for their bodies, as Lu- cretius tells his readers was the foolish fable, and as Brigham Young reveals to his congregation and an- nounces in his harem ? Or can it be that Tennyson has solved the difficulty when he tells us that, " star and system rolling past, A soul shall draw &om out the vast. And strike hia being into bonnds, " And, moved through life of lower phase, Besult in man, be born and think " ? Or does the soul organize its own body, as thoughtful men have held, from Aristotle to Mr. Garth Wil- kinson ? MECHANISM OF VITAL ACTIONS. 379 Into these and similar questions we cannot now enter, if under any circumstances we should be w'ill- ing to cast a line into such fathomless abysses of speculation. But as we have followed the physical view of life upward until we have reached an im- passable limit, it is but fair to indicate briefly the re- versed aspect of living nature, when viewed from above downward, by taking, as the point of depart- ure, its spiritual apex, instead of its material base. The introduction of self-determining existence, or sub-creative centres, into the order of things, marks, as we have said, the great change of action by which Omnipotence saw fit to assume passive, as well as active, relations to its creatures. There is nothing in light br ■ heat, or electricity, or chemical or me- chanical force, that can give any account of spiritual existence. When the first human soul was intro- duced to earthly being, if not before the date of this last birth of creation, there was a new force put forth which was not any of these. And so, whenever a new soul takes mortal shape, we recognize it as an emanation from its Maker by some other channel than through the elemental substances or influences that wait upon its secondary or simply organic neces- sities. We could not think it strange that, at the period of this spiritual evolution, a force running parallel with it in the material world, — a force not identical with any of the ordinary physical agencies, — should 380 MECHANISM OF VITAL ACTIONS. combine the elements of the bodily form, and shape it to the wants of the immaterial principle. We shoTild not therefore be constrained to throw upon the common forces of Nature that wonderful develop- ment from simple to complex, from general to special, which carries a translucent vesicle through a series of evolutions and differentiations, untU it wears the shape of the august being to whom the Deity has delegated a portion of his omnipotence. But this conclusion would oblige us to argue backward from it to the lower animals, whose material frames and organic existence are essentially identical in their composition and mode of being with our own. And conceding that a special change of character in the forces of Nature marks the appearance of animal Hfe, there would be strong reason for extending the same supposition to the vegetable kingdom. This is only one instance of the difference between our conclu- sions when we look from the higher sphere, and those which we naturally accept from the workshops of material philosophy. We mxist be content to re- main in doubt on many details of creation not revealed to us, on which we can only shape a few half-shadowed hypotheses. In conclusion, we recognize our spiritual natures as having only incidental and temporary relations with the material substance and general forces of the universe. But we may concede that, the further our examination extends, the more completely the or- MECHANISM OF VITAL ACTIONS. 381 ganic or simply vital forces appear to resolve them- selves into manifestations of those closely related or mntually convertible principles which give activity to the unconscious portion of the universe. "We have no experimental evidence that these physical agencies can form any living germ by their action upon mat- ter ; nor can we prove the contrary. The only di- rectly observed conditions of the evolution of a living structure involve the presence of a germ de- rived from a being of similar characters. But obser- vation of the earth's strata shows that new forms of life have appeared at numerous successive periods by some other creative mechanism. We can frame hy- potheses not inconsistent with the ordinary laws of matter to account for such formations, but they can be regarded only as more or less ingenious specula- . tions. We are obhged to recognize a special in- tervention of creative power in the introduction of spiritual existence in the midst of the pre-existing unconscious creation. If we allow that higher modes of action have once been superinduced upon the ordinary physical forces, we cannot deny the possi- bility, and even probability, of repeated changes in the working machinery of creation, coinciding with the evolution of each new type of organization. And if new formtilse of force in combination with matter preceded the creation of each organism, or group of organisms, we can understand that a special vital formula may be involved in the continuance of their 882 MECHANISM OF VITAL ACTIONS. existence. Thus accepting the fact of a change of law as a possible part of the constitution of the uni- verse, we arrive, independently of Revelation, at the doctrine of Miracles, as this term is commonly imder- stood. But in the view we have taken, whatever part may be assigned to the physical forces in the produc- tion and phenomena of life, all being is not the less one perpetual miracle, in which the Infinite Creator, acting through what we often call secondary causes, is himself the moving principle of the universe he first framed and never ceases to sustain. YALEDICTOEY ADDRESS, BELITEREI) TO THE MEDICAI 6EADUATES 01 HAEVAED UNIVEESITY, AT IHZ ANNUAL COMMENCEMENT, Wedhesdat, Mabch 10, 1858. VALEDICTORY ADDRESS. Gentlemen of the Graduating Class, — It is my grateful duty to address you a few words in the name of the Medical Faculty, under the aus- pices of which you have just entered the Medical Profession. In their name I welcome you to the labors, the obligations, the honors, and the rewards which, if you are faithful, you may look for in your chosen caUing. In their name I offer you the hand of fellowship, and call you henceforth brothers. These elder brethren of the same great family repeat to you the words of welcome. The wide community of prac- titioners receives you in full communion from this moment. You are enrolled hereafter on that long list of the Healers of men, which stretches back un- broken to the days of Heroes and Demigods, until its earliest traditions blend with the story of the bright- est of the ancient Divinities. Once Medidnce Doctor, always Doctor Medicines. You can unfrock a clergyman and unwed a husband, but you can never put off the title you have just won. Trusting that you will always cling to it, as it will 17 386 VALEDICTOEY ADDRESS. cling to you, I shall venture to offer a few hints which you may find of use in your professional career. The first counsel I would offer is this : Form a dis- tinct PLAN for life, including duties to fulfil, virtues to practise, powers to develop, knowledge to attain, graces to acquire. Circumstances may change your plan, experience may show that it requires modifi- cation, but start with it as complete as if the per- formance were sure to be the exact copy of the pro- gramme. K you reject this first piece of advice, I am afraid nothing else I can say wiU be of service. Some weakness of mind or of moral purpose can alone account for your trusting to impulse and cir- cumstances. Nothing else goes on well without a plan ; neither a game of chess, nor a campaign, nor a manufacturing or commercial enterprise, and do you think that you can play this game of life, that you can fight this desperate battle, that you can organize this mighty enterprise, without sitting down to count the cost and fix the principles of action by which you are to be governed ? It is not likely that any of you will deliberately lay down a course of action pointing to a low end, to be reached by ignoble means. But keep a few noble models before you. For faithful life-long study of science you will find no better example than John Hunter, never satisfied until he had the pericardium of Nature open and her heart throbbing naked in his VALEDICTOET ADDRESS. 387 hand. For calm, large, illuminated, phUosopHcal intellect, hallowed by every exalted trait of charac- ter, you will look in vain for a more perfect pattern than Haller. But ask your seniors who is their living model, and if they all give you the same name, then ask them why he is thus honored, and their answers will go far toward furnishing the outline of that course I would hope you may lay down and follow. Let us look, in the very brief space at our disposal, at some of those larger and lesser rules which might be supposed to enter as elements into the plan of a physician's life. Duty draws the great circle which includes all else within it. Of your responsibility to the Head Phy- sician of tins vast planetary ambulance, or travelling hospital which we call Earth, I need say little. We reach the Creator chiefly through his creatures. Whoso gave the cup of cold water to the disciple gave it to the Master ; whoso received that Master received the Infinite Father who sent him. If per- formed in the right spirit, there is no higher worship than the unpurchased service of the medical priest- hood. The sick man's faltered blessiag reaches heaven through the battered roof of his hovel be- fore the Te Deum that reverberates in vast cathe- , drals. Your duty as physicians involves the practice of every virtue and the shunning of every vice. But there are certain virtufes and graces of pre-eminent 388 VALEDICTOEY ADDRESS. necessity to the physician, and certain vices and minor faults against which he must be particularly guarded. And first, of truth. Lying is the great temptation to vrhich physicians are exposed. Clergymen are expected to tell such portions of truth as they think will be useful. Tlaeir danger is tlie suppressio veri, rather than direct falsehood. Lawyers stand in pro- fessional and technical relations to veracity. Thus, the clerk swears a witness to tell the truth, the whole truth, and nothing but the truth. The lawyer is expected to get out of the witness not exactly the truth, but a portion of the truth, and nothing but the truth — which suits him. The fact that there axe two lawyers pulling at the witness in different direc- tions, makes it little better ; the horses pulled differ- ent ways in that frightful old punishment of tearing men to pieces ; so much the worse for the man. But this is an understood thing, and we do not hesitate to believe a lawyer — outside of the court-room. The physician, however, is not provided with a special license to say the thing which is not. He is expected to know the truth, and to be ready to tell it. Yet nothing is harder than for him always to do it. Whenever he makes an unnecessary visit, he tells a lie. Whenever he writes an unnecessary pre- scription, he tells a lie. It is audibly whispered that some of the " general practitioners," as they are called in England, who make their profit on the VALEDICTOKY ADDRESS. 389 medicines tliey dispense, are top foud of giving those complicated mixtures which can be cliarged at a pleasing iigure in their accounts. It would be better if the patient were allowed a certain discount from his bill for every dose he took, just as children are compensated by their parents for swallowing hideous medicinal draughts. , All false pretences whatsoever, acted or spoken ; all superficial diagnoses, where the practitioner does not know what he knows, or, still worse, knows that he does not know ; all unwarranted prognoses and promises of cure ; all claiming for treatment that which may have been owing to Nature only ; all shallow excuses for the results of bad practice, are lies and nothing else. There is one safe rule which I will venture to lay down for your guide in every professional act, in- volving the immediate relation with the object of, your care ; so plain that it may be sneered at as a truism, but so difficult to follow that he who has never broken it deserves canonizing better than many saints in the calendar : A physicicm^s first duty is to Ms patient; his second only, to himself. All quackery reverses this principle as. its funda- mental axiom. Every practitioner who reverses it is a quack. A man who follows it may be ignorant, but his ignorance will often be safer than a selfish man's knowledge. You will find that this principle will not only keep 390 VALEDICTORY ADDRESS. you in the great highway of trutla, but that if it is ever a question whetlaer you must leave that broad path, it will serve you as a guide. A lie is a deadly poison. You have no right to give it in large or small doses, for any selfish purpose connected with your profession, any more than for other selfish ob- iects. But as you administer arsenic or strychnia in certain cases, without blame ; nay, as it may be your duty to give them to a patient ; are there not also cases in which the moral poison of deceit is rightly employed for a patient's welfare ? So many noble- hearted and conscientious persons have scruples about any infraction of the absolute rule of truth, that I am willing briefly to discuss and illustrate a question which will often be presented to you hereafter. Truth in the abstract is perhaps made too much of as compared to certain other laws established by as high authority. If the Creator made the tree-toad so like the moss-covered bark to which it clings, and the larva of a sphinx so closely resembling the elm-leaf on which it lives, and that other larva so exquisitely like a broken twig, not only in color, but in the angle at which it stands from the branch to which it holds, with the obvious end of deceiving their natural ene- mies, are not these examples which man may follow ? The Tibboo, when he sees his enemy in the distance, shrinks into a motionless heap, trusting that he may be taken for a lump of black basalt, such as is fre- quently met with in his native desert. The Austrar VALKDICTOEY ADDRESS. S91 lian, following the same instinct, crouches in such form that he may be taken for one of the burnt stumps common in his forest region. Are they not right in deceiving, or lying, to save their lives ? or would a Christian missionary forbid their saving them by such a trick ? If an English lady were chased by a gang of murdering and worse than murdering Sepoys, would she not have a right to cheat their pursuit by covering herself with leaves, so as to be taken for a heap of them ? If you were starving on a wreck, would you die of hunger father than cheat a fish out of the water by an artificial bait ? If a school-house were on fire, would you get the children quietly down stairs under any convenient pretence, or tell them the precise truth, and so have a rush and a score or two of them crushed to death in five minutes ? > These extreme cases test the question of the abso- lute inviolability of truth. It seems to me that no one virtue can be allowed to exclude all others, with which in this mortal state it may sometimes stand in opposition. Absolute justice must be tempered by mercy ; absolute truth, by the law of self-preservation, by the harmless deceits of courtesy, by the excursions of the imaginative faculty, by the exigencies of hu- man frailty, which cannot always bear the truth in health, still more in disease. Truth is the breath of life to human society. It is the food of the immortal spirit. Yet a single word 392 VALEDICTORY ADDEESS. of it may kill a man as suddenly as a drop of prussic acid. An old gentleman was sitting' at table when the news that Napoleon had returned from Elba was told him. He started up, repeated a line from a Erench play, which may be thus Englished, — The fatal secret is at length revealed, and fell senseless in apoplexy. You remember the story of the old man who expired on hearing that his sons were crowned at the Olympic games. A worthy inhabitant of a village in New Hampshire fell dead on hearing that he was chosen town clerk. I think the physician may, in extreme cases, deal with truth as he does with food, for the sake of his patient's welfare or existence. He may partly or wholly withhold it, or, under certain circumstances, medicate it with the deadly poison of honest fraud. He must often look the cheerfulness he cannot feel, and encourage the hope he cannot confidently share. He must sometimes conceal and sometimes disguise a truth which it would be perilous or fatal to speak out. I will tell you two stories to fix these remarks in your memory. When I was a boy, a grim old Doctor in a neighboring town was struck down and crushed by a loaded sledge. He got up, staggered a few paces, fell, and died. He had been in attendance upon an ancient lady, a connection of my own, who at that moment was lying in a most critical position. VALEDICTORY ADDRESS. 393 The news of the accident reached her, but not its fatal character. Presently the minister of the parish came in, and a brief conversation like this followed : — Is the Doctor badly hurt ? — Yes, badly. — Does he suffer much? — He does not; he is easy. —-And so the old gentlewoman blessed God and went off to sleep ; to learn the whole story at a fitter and safer moment. I know the minister was a man of truth, and I think he showed himself in this instance a man of wisdom. Of the great caution with which truth must often be handled, I cannot give you a better illustration than the following from my own experience. A young man, accompanied by his young wife, came from a distant place, and sent for me to see him at his hotel. He wanted his chest examined, he told me. — - Did he wish to be informed of what I might discover ? — He did. — I made the ante-mortem autopsy desired. Tubercles ; cavities ; disease in full blast ; death wait- ing at the door. I did not say this, of course, but waited for his question. — Are there any tubercles ? he asked presently. — Yes, there are. — There was silence for a brief space, and then, like Esau, he lifted up his voice and wept ; he cried with a great and exceeding bitter cry, and then the twain, husband and wife, with loud ululation and passionate wring- ing of hands, shrieked in wild chorus like the keeners of an Irish funeral, and would not be soothed or comforted. The fool ! He had brought a letter from 17* 894 VALEDICTORY ADDEBSS. his physician, warning me not to give an opinion to the patient himself, but to write it to him, tlie medi- cal adviser, and this letter the patient had kept back, determined to have my opinion from my own lips, not doubting that it would be favorable. In six weeks he was dead, aiid I never questioned that his own folly and my telling him the naked truth killed him before his time. If the physician, then, is ever authorized to tam- per with truth, for the good of those whose lives are intrusted to him, you see how his moral sense may become endangered. Plain speaking, with plenty of discreet silence, is the rule ; but read the story of the wife of Cfficinna Paetus, with her sick husband and dead child, in the letters of Pliny the Younger (Lib. III. XVI.), and that of good King David's faithful wife Michal, how she cheated Saul's cut-throats (1 Samuel xix. 13), before you proclaim that homicide is always better than vericide. If you can avoid this most easily besetting sin of falsehood, to which your profession offers such pecu- liar temptations, and for which it affords such facili- ties, I can hardly fear that the closely related virtues which cling to truth, honesty and fidelity to those who trust you, will be wanting to jovlt character. That you must be temperate, so that you can be masters of your faculties at all times ; that you. must be pure, so that you shall pass the sacred barriers of the family circle, open to you as to none other of all VALEDICTORY ADDRESS. 395 the outside world, without polluting its sanctuary by your presence, it is, I think, needless for me to urge. Charity is the eminent virtue of the medical pror fession. Show me the garret or the cellar which its messengers do not penetrate ; tell me of the pestilence which its heroes have not braved in their errands of mercy ; name to me the young practitioner who is not ready to be the servant of servants in the cause of humanity, or the old one whose counsel is not ready for him in his perplexities, and I will expatiate upon the claims of a virtue .which I am content to leave you to learn from those who have gone before you, and whose footprints you will find in the path to every haunt of stricken humanity. But there are lesser virtues, with their correspond- ing failings, which will bear a few words of counsel. First, then, of that honorable reserve with refer- ence to the history of his patient, which should be- long to every practitioner. No high-minded or even well-bred man can ever forget it ; yet men who might be supposed both high-tninded and well-bred have been known habitually to violate its sacred law. As a breach of trust, it demands the sternest sentence which can be pronounced on the offence of a faith- less agent. As a mark of' vanity and egotism, there is nothing more characteristic than to be always babbling abotit one's patients, and nothing brings a man an ampler return of contempt among his feUows. But as this kind of talk is often intended to prove a 396 VALEDIOTOEY ADDRESS. man's respectability by showing that he attends rich or great people, and as this implies that a medical man needs some contact of the kind to give him po- sition, it breaks the next rule I shall give you, and must be stigmatized as leze-majesty toward the Di- vine Art of Healing. This next rule I proclaim in no hesitating accents : Respect yov/r own profession I If Sir Astley Cooper was ever called to let off the impure ichor from the bloated limbs of George the Fourth, it was the King who was honored by the visit, and not the Surgeon. If you do not feel as you cross the millionnaire's threshold that your Art is nobler than his palace, the footman who lets you in is your fitting companion, and not his master. Respect your profession, and you will not chatter about your " patrons," thinking to gUd yourselves by rubbing against wealth and splendor. Be a little proud, — it will not hurt you ; and remember that it depends on how the profession bears itself whether its members are the peers of the highest, or the barely tolerated operatives of society, like those Egyptian dissectors, hired to use their ignoble implements, and then chased from the house where they had exercised their craft, followed by curses and volleys of stones. The Father of your Art treated with a Monarch as his equal. But the Barber-Surgeons' Hall is still standing in London. You may hold yourselves fit for the palaces of princes, or you may creep back to the Hall of the Barber- VALEDICTORY ADDRESS. 397 Surgeons, just as you like. Eichard Wiseman, who believed that a rotten old king, with the corona Ve- neris encircling his forehead with its copper diadem, could cure scrofula by laying his finger on its sub- ject, — Richard Wiseman, one of the lights of the profession in his time, spoke about giving his patients over to his " servants " to be dressed after an opera- tion. We do not count the young physician or the medical student as of menial condition, though in the noble humility of science to which all things are clean, or of that " entire affection " which, as Spenser tells us, " hateth nicer hands," they stoop to offices which the white-gloved waiter would shrink from performing. It is not here, certainly, where John Brooks — not without urgent solicitation from lips which still retain their impassioned energy — was taken from his quiet country rides, to hold the helm of our Imperial State ; not here, where Joseph War- ren left the bedside of his patients to fall on the smoking breastwork of yonder summit, dragging with him, as he fell, the curtain that hung before the grandest drama ever acted on the stage of time, — not here that the Healer of men is to be looked down upon from any pedestal of power or opulence ! If you respect your profession as you ought, you will respect all honorable practitioners in this hon- ored calling. And respecting them and yourselves, you will beware of all degrading jealousies, add de- spise every unfair art which may promise to raise 398 VALEDICTORY ADDRESS. you at the expense of a rival. How hard it is not to undervalue those who are hotly com|)eting with us for the prizes of life ! In every great crisis our in- stincts are apt suddenly to rise upon us, and in these exciting struggles we are liable to be seized by that passion which led the fiery race-horse, in the height of a desperate contest, to catch his rival with his teeth as he passed, and hold him back from the goal by which a few strides would have borne him. But for the condemnation of this sin I must turn you over to the tenth commandment, which, in its last general clause, unquestionably contains this special rule for physicians, — Thou shall nol covet Ihy neigh- bor's patienls. You can hardly cultivate any sturdy root of virtue but it will bear the leaves and flowers of some natural grace or other. If you are always fair to your pro- fessional brethren, you will almost of necessity en- courage those habits of courtesy in your intercourse with them which are the breathing organs and the blossoms of the virtue from which they spring. And now let me add various suggestions relating to matters of conduct which I cannot but think may influence your course, and contribute to your success and happiness. I will state them more or less con- cisely as they seem to require, but I shall utter them magisterially, for the place in which I stand allows me to speak with a certain authority. VALEDICTORY ADDRESS. 399 Avoid all habits that tend to make you unwilling to go wherever you are wanted at any time. No over-feeding or drinking or narcotic must fasten a ball and chain to your ankle. Semper paratus is the only motto for a physician 1 . The necessity oipwnctuality is generally well under- stood by the profession in cities. In the coutntry it is not unusual to observe a kind of testudinous torpor of motion, common to both man and beast, and which can hardly fail to reach the medical prac- titioner. Punctuality is so important, in consulta- tions especially, to the patient as well as the prac- titioner, that nothing can excuse the want of it, — not even having nothing to do, — for the busiest peo- ple, as everybody knows, are the most punctual. There is another precept which I borrow from my wise friend and venerated instructor the Emeritus Professor of Theory and Practice ; and you may be very sure that he never laid down a rule he did not keep himself. Endeavor always to make your visit to a patient at the same regular time, when he ex- pects you. You will save him a great deal of fretting, and occasionally prevent his sending for your rival when he has got tired of waiting for you. Your conduct in the sick-room, in conversation with the patient or his friends, is a matter of very great importance to their welfare and to your own reputation. You remember the ancient surgical precept, — Tuio, cito, jwcwnde. I wiU venture to 400 VALEDICTORY ADDRESS. write a parallel precept under it, for the manner in which a medical practitioner shall operate with his tongue ; a much more dangerous instrument than the scalpel or the bistoury. Breviter, suaviter, caute. Say not too much, speak it gently, and guard it cautiously. Always remember that words used be- fore patients or their friends are like coppers given to children ; you think little of them, but the chil- dren count them over and over, make all conceivable imaginary uses of them, and very likely change them into something or other which makes them sick, and causes you to be sent for to clean out the stomach you have so unwittingly filled with trash ; a task not so easy as it was to give them the means of filling it. The forming of a diagnosis, the utterance of a prognosis, and the laying down of a plan of treat- ment, all demand certain particiilar cautions. You must learn them by your mistakes, it may be feared, but there are a few hints which you may not be the worse for hearing. Sooner or later, everybody is tripped up in forming a diagnosis. I saw Velpeau tie one of the carotid arteries for a supposed anexirism, which was only a little harmless tumor, and kill his patient. Mr. Dease, of Dublin, was more fortunate in a case which he boldly declared an abscess, while others thought it an aneurism. He thrust a lancet into it, and proved himself in the right. Soon after, he made another sim- ilar diagnosis. He thrust in his lancet as before, and VALEDICTOEY ADDEESS. 401 out gushed the patient's blood and his life with it. The next morning Mr. Dease was found dead and floating in his own blood. He had divided the femoral artery. The same caution that the surgeon must exercise. in his examination of external diseases, the physician must carry into all his physical explorations. If the one can be cheated by an external swelling, the other may be deceived by an internal disease. Be very careful ; be very slow ; be very modest in the pres- ence of Nature. One special caution let me add. If you are ever so accurate in your physical explora- tions, do. not rely too much upon your results. Given fifty men with a certain fixed amount of organic dis- ease, twenty may die, twenty may linger indefinitely, and ten may never know they have anything the matter with them. I think you will pai'don my say- ing that I havfe known something of the arts of direct exploration, though I wrote a youthful Essay on them, which, of course, is liable to be considered a, presump- tion to the contrary. I would not, therefore, under- value them, but I will say that a diagnosis which maps out the physical condition ever so accurately, is, in a large proportion of cases, of less consequence than the opinion of a sensible man of experience, founded on the history of the disease, though he has never seen the patient. And this leads me to speak of prognosis and its fallacies. I have doomed people, and seen others doom them, over and over again, on the strength of 402 VALEDICTORY ADDRESS. physical signs, and they have lived in the most con- tumacious and scientifically unjustifiable manner as long as they liked, and some of them are living still. I see two men in the street, very often, who were both as good as dead in the opinion of all who saw them in their extremity. People will insist on liv- ing, sometimes, though manifestly moribvmd. In Dr. Elder's Life of Kane you will find a case of this sort, told by Dr. Kane himself. The captain of a ship was dying of seuiTy, but the crew mutinied, and he gave up dying for the present to take care of them. An old lady in this city, near her end, got a little vexed about a proposed change in her will ; made up her mind not to die just then ; ordered a coach ; was driven twenty miles to the house of a relative, and lived four years longer. Cotton Mather tells some good stories which he picked up in his experience, or out of his books, showing the unstable equilibrium of prognosis. Simon Stone was shot in nine places, and as he lay for dead the Indians made two hacks with a hatchet to cut his head off. He got well, however, and was a lusty fellow in Cotton Mather's time. Jabez Musgrove was shot with a bullet which went in at his ear and came out at his eye on the other side. A couple of bullets went through his body also. Jabez got well, however, and lived many years. Per contra, Colonel Rossiter, cracking a plum-stone with his teeth, broke a tooth and lost his life. We have seen physicians dying, like Spigelius, from a scratch ; VALEDICTORY ADDEESS. 403 and a man who had had a crowbar shot through his head alive and well. These extreme cases are warn- ings. But you can never be too cautious in your prognosis, in the view of the great uncertainty of the course of any disease not long watched, and the many unexpected turns it may take. I think I am not the first to utter the following caution : Beware how you take away hope from any human being. Nothing is clearer than that the mer- ciful Creator intends to blind most people as they pass down into the dark valley. Without very good reasons, temporal or spiritual, we should not inter- fere with his kind arrangements. It is the height of cruelty and the extreme of impertinence to tell your patient he must die, except you are sure that he wishes to know it, or that there is some particular cause for his knowing it. I should be especially unwilling to tell a child that it could not recover ; if the theologians think it necessary, let them take the responsibility. God leads it by the hand to the edge of the precipice in happy unconsciousness, and I would not open its eyes to what he wisely conceals. Having settled the cautious method to be pursued in deciding what a disease is, and what its course is to be ; having considered how much of your knowl- edge or belief is to be told, and to whom it is to be imparted, the whole question of treatment remains to be reduced to system. It is not a pleasant thing to find that one has killed 404 VALEDICTORY ADDEESS. a patient by a slip of the pen. I am afraid our bar- barous method of writing prescriptions in what is sometimes fancifully called Latin, and with the old astrological sign of Jupiter at the head of them to bring good luck, may have helped to swell the list of casualties. We understand why plants and minerals should have technical names, but I am much disposed to think that good plain English, written out at full length, is good enough for the practical physician's use. Why should I employ the language of Oelsus ? He commonly used none but his own. However, if we must use a dead language, and symbols which are not only dead, but damned, by all soiind theology, let us be very careful in forming those medical quavers and semiquavers that stand for ounces and drachms, and all our other enlightened hieroglyphics. One other rule I may venture to give, forced upon me by my own experience. After writing a recipe, make it an invariable rule to read it over, not mechanically, but with all your faculties wide awake. One sometimes writes a prescription as if his hand were guided by a medium, — automatically, as the hind legs of a water- beetle strike out in the water after they are separated from the rest of him. If all of you will follow the rule I have given, sooner or later some one among you will very probably find himself the author of a homicidal document, which but for this precaution might have carried out its intentions. - With regard to the exhibition of drugs as a part VALEDIOTOEY ADDRESS. 406 of your medical treatment, the golden rule is, be sparimff. Many remedies you give would make a well person so ill that he would send for you at once if he had taken one of your doses accidentally. It is not quite fair to give such things to a sick man, unless it is clear that they will do more good than the very considerable harm you know they will cause. Be very gracious with children especially. I have seen old men shiver at the recollection of the rhubarb and jalap of infancy. You may depend upon it that half the success of Homoeopathy is due to the sweet peace it has brought into the nursery. Between the gurgling down of loathsome mixtures and the saccha- rine deliquescence of a minute globule, what tender mother could for a moment hesitate ? Let me add one other hint which I believe will approve itself on trial. After proper experience of the most approved forms of remedies, or of such as you shall yourselves select and combine, make out your own brief list of real every-day prescriptions, and do not fall into the habit of those extempora- neous fancy-combinations, which amuse the physician more than they profit the patient. Once more : if you must give a medicine, do it in a manly way, and not in half-doses, hacking but not chopping at the stem of the deadly-fruited tree you would bring down. Remember this, too ; that although remedies may often be combined advantageously, the difficully of estimating the effects of a prescription is as the 406 VALEDICTORY ADDRESS. square of the number of its ingredients. 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