THIS DISEASE IS BEYOND MY PRACTICE.” 
 
 AN ADDRESS 
 
 BY 
 
 Hon. JOS. B. CUMMING 
 
 AT THE 
 
 MEDICAL COMMENCEMENT 
 
 OF THE 
 
 UNIVERSITY OF GEORGIA 
 
 MARCH 1, 1881. 
 
 Chronicle Job Print, 
 Augusta, Ga. 
 
Digitized by the Internet Archive 
 in 2016 with funding from 
 Duke University Libraries 
 
 https://archive.org/details/thisdiseaseisbeyOOcumm 
 
The doctor and “the waiting gentle woman" watched in 
 the ante-chamber of the sick Queen. The scene, which I 
 speak of, is laid a long time ago. The saintly Edward the 
 Confessor sits on the throne of England and Macbeth, with 
 desperate, bloody hand, grasps the sceptre of Scotland. The 
 sick chamber is bare and comfortless, for the abodes of Kings 
 in those times and those then rude countries of Northern 
 Europe lacked the comforts and conveniences of domestic life 
 now common in the house of the mechanic and the cottage 
 of the laborer; and this Castle of Dunsinane, destined next 
 day to witness the “equivocation of the fiend that lies like 
 truth’’, this Dunsinane where “hang out the banners on the 
 outward walls”, this Dunsinane which was to witness the 
 startling onset of Birnam Wood, may have been a tolerable 
 abode for the well and the strong, but was a dreary place for 
 a sick woman, were she Queen or beggar. 
 
 For the gentle woman, who watches the sick Queen, this 
 is the last — as it turns out — of many nights of vigil by her 
 bedside ; for the doctor, who watches with her, it is the second. 
 Being the second and there being as yet no manifestation of 
 the disorders which he has been called in to observe and pre- 
 scribe for, he begins to doubt their existence. This old time 
 doctor has always commanded my esteem, especially by the 
 honest utterance, to which I shall presently call your attention, 
 but partly, also, by the plain, non-technical language, so grate- 
 ful to the layman, in which he discusses the Queen's symp- 
 toms. While he is in the midst of this simple talk, all doubts 
 that he has previously entertained of the existence of her 
 disorder, are set at rest; for there, in her night dress, holding 
 a taper, “fast asleep,” her “eyes open,” “but their sense shut," 
 she stands before them, seeming to wash the small white hand, 
 which “all the perfumes of Arbaia cannot sweeten," and utter- 
 ing broken — and heart-broken — sentences, full of dark allu- 
 sions to the night of horror, in which her ruin commenced. 
 Then it is that this good honest doctor exclaims: “This dis- 
 ease is beyond my practice.” I take this sentence as the 
 suggestion of a few thoughts, for which 1 claim no higher 
 value than for a mere placebo. 
 
 It was not strange that the doctor pronounced this disease 
 beyond his practice. At least it was not strange that he 
 thought it so, however faithless he may have been to the tra- 
 ditions of his profession, in making this open confession of 
 
 3 
 
failure. Not strange, for, in the first place, at any stage of 
 medical science, this would have been a hopeless case. It 
 would have been not less so in the nineteenth century, and at 
 the Hotel Dieu, in Paris, than it was in the eleventh at dreary 
 and battle leaguered Dunsinane. For the Queen had poisoned 
 the springs of life. She had planted in her breast “a rooted 
 sorrow.” She had aroused the furies and now they took their 
 place upon the midnight pillow. 
 
 “More needed she the divine than the physician." 
 
 Remorse, for which there is no specific, had done its 
 work on the delicate tissues of the brain, and the physician 
 of any age, from Esculapius to Bro vm-Sequard, could only 
 recognize in her case a ruin. 
 
 But even if the case, instead of being one of this universal 
 and panchronous hopelessness, had indeed been one with 
 which modern medical science deals with vase and success, 
 in all probability our honest Macbethian doctor would still 
 have found it beyond his practice. If this good doctor had 
 been in Spain, he would not, perhaps, have so soon pronounced 
 disease in general beyond his skill. The Moors, who conquered 
 that country, were at that period of history the most enlight- 
 ened and learned people in Europe. In medicine no less than 
 in everything else in the nature of science, these Orientals 
 were far in advance of the people of the West. Had our good 
 old doctor been a turbaned Moor, he would not have been 
 brought so early in an ordinary case to the confession of the 
 text. But being only a Scot of the period, his learning and 
 science soon came to an end. For Britain was like the rest of 
 Europe, Spain excepted, rude and ignorant, and medicine 
 which, in all times and countries, has borne some direct ratio 
 to general learning, was in a very low state. Besides, while 
 there is no evidence that our excellent Macbethian doctor w-as 
 in religion any thing except a layman, as a fact, most of the 
 practitioners of medicine were priests and monks, and prayers 
 and saints were more in demand at the bedside of the sick 
 than prescriptions and sinful doctors. What bleeding and a 
 very limited materia medica could not remedy some relic of a 
 saint might cure ; but if the relic was of like inefficacy, the 
 monkish practitioner of this sj^stem of medicine must then 
 prepare to do what confession and shrift could do for the part- 
 ing soul. Soon, ah ! very soon, in those good old days, did the 
 fine old doctor reach the end of his art. With anatomy still 
 oppressed by the idea that it was sacrilegious to dissect a 
 human body ; with the circulation of the blood not discovered ; 
 
 4 
 
with the theory of respiration not understood ; with a very 
 limited known materia medica ; with chemistry unstudied, 
 except as the means of discovering the philosopher's stone — 
 in a word, with dense ignorance on every subject relating to 
 medicine, there was little for the doctor to do but to bleed, 
 to bleed after the fashion of the time ; to look wise after the 
 manner of his brethren of all times, and very early in his case, 
 unless the vis medicatrix triumphed over disease and remedy 
 alike, to make the confession, at least to his own heart, that 
 the disease was beyond his practice. 
 
 Returning to this utterance of our good doctor, I desire 
 to say of it in all sincerity, and without any admixture what- 
 ever of sarcasm, that he ought not to have made this confes- 
 sion under ordinary circumstances. It did no harm on this 
 particular occasion, for the patient, whom it might have in- 
 jured, was beyond its reach, both by reason of the general 
 hopelessness of her case and by her particular state at the time 
 of insensibility to actual surroundings. To make such a con- 
 fession to a conscious patient would be unpardonable. Its 
 logical sequence would be the abandonment of the field, where 
 the rival forces of disease and health are contending. To do 
 so is to dismiss the strongest ally of physician and patient — 
 hope — and to reinforce the enemy with the cohorts of despair. 
 And thus, when the physician seats himself by the couch of 
 his patient, his first duty is to question pulse and tongue, and 
 all other witnesses of his patient’s condition, what that con- 
 dition is ; and also a part of that duty is, though he may doubt, 
 though he may question in vain, to assume a tone of certainty. 
 And when he tells his patient with confidence that there is a 
 spot, which he locates with nicety one inch from the lower 
 part of the left lung, and a half an inch from some other point, 
 the size of a silver dime, inflamed to a certain shade of redness, 
 which he also specifies, and that it is the inflammation of this 
 spot which has given his patient fever and made him reflect 
 upon his sins, and think of putting his house in order; when he 
 does this so unfalteringly and wfith such an air of quiet con- 
 fidence that the patient for the time attributes to him the eye 
 of a lynx, and feels satisfied, that though he is himself des- 
 perately ill, here at least is a man who knows to the nicety of 
 a hair what is the matter with him ; this excellent physician is 
 not playing the charlatan. He is simply holding a line of bat- 
 tle, presenting a brave and confident front until the disposi- 
 tions of the enemy can be accurately ascertained. He may not 
 prescribe and treat on the line of his confident assurances, but 
 he will put out his skirmish line of placebos and develop the 
 
 5 
 
enemy. In the meantime he does right to pretend to know all 
 about the disease and what is to be done. What good general 
 ever on the eve of battle expressed to his soldiers doubt or 
 apprehension of the result? He may feel his own weakness 
 and know his enemy’s strength. He may at the moment be 
 prudently preparing for defeat and planing retreat, but his 
 ringing battle orders speak only of advance and victory. 
 
 I may appear to treat the occasion too lightly. But, in- 
 deed, such is not my intention. I recognize thoroughly that 
 levity would be singularly out of place in addressing those, 
 whose experience with the suffering side of human life is 
 about to begin. I do not forget how much of the time of the 
 good physicion is spent in the solemn border land between 
 life and death — the land of the valley and the river. I remem- 
 ber how often he descends into the misty, shadowy region 
 neither all of life nor all of death — but partly of both — that 
 region where the every day sounds of this life seem far off 
 and low, and where the listening ear seems to hear, faintly at 
 least, the waves beating on the other shore. I recollect to 
 him suffering and anguish in every form are frequent com- 
 panions. That while mingling like other men with his fellow- 
 men, his pathway is thronged with mournful shades. I know 
 that the cry of distress is a sound in his ears as ceaseless as 
 that which breathes faint and low, but forever, in the concave 
 shells of ocean. I cannot forget that the day which dedicates 
 you to such a life, hallowed by the atmosphere of suffering in 
 which it is to be spent, ennobled by the labors and anxieties 
 which it is to endure, is no time for jest or levity, even if the 
 subject might provoke it. And standing face to face with 
 the life, which opens to the faithful, earnest physician, I 
 would lose sight of all the provocations to satire, which might 
 be presented by the blunders and absurdities of the profession 
 in past ages, or the solemn pretention to superhuman wisdom 
 sometime observed in the present; and I would readily adopt 
 the serious tone appropriate to this occasion. 
 
 In that tone, and returning to what I call my text, the 
 next reflection suggested by it is ; How much less often now 
 is the physician driven to this despairing utterance even to 
 his own heart. Since those old days, when our good docioi 
 confessed the end of his skill, stupendous have been the ad- 
 vances in all departments of scientific learning. Xo branch 
 of learning has outstripped medicine. The human intellect, 
 whose triumphs have reproduced the age. of miracles, has 
 shone nowhere more brightly than in the science and piactice 
 of medicine. It woukrbe presumptuous in me, a layman, 
 
 6 
 
addressing professional men in reference to their own pro- 
 fession, to undertake to speake minutely of the causes and 
 results of this wondrous change. 1 can speak but in general 
 terms. The ignorant empiric of old has given place to the 
 man of science ; materia rnedica grown from a few simples to 
 proportions co-extensive with the vegetable and mineral world. 
 The knowledge of anatomy changed from the assumed analogy 
 between frames of the lower animals and man's to accurate 
 knowledge of the human organization itself. Pain and physi- 
 cal anguish, the. fell destroyers of thousands, whom the disease 
 itself would have spared, conquered by blessed anesthetics. 
 Multitudes of disorders cured by surgical operations, then not 
 ventured, or by remedies not then known. And as the result 
 of these changes, and of others more numerous and more vast, 
 which you know better than I do, the material lengthening of 
 the average human life. If I might venture an opinion touch- 
 ing the accomplished, and a speculation in reference to the 
 prospective, I would say that the triumphs already achieved 
 and the hope of conquests yet to be made depend most of 
 all upon those things that relate to diagnosis. Am I not 
 right in thinking that all the means, scientific and mechanical, 
 which enable the physician to see, actually to see, the seat of 
 the disease, to hear, aye actually to hear, the language of the 
 afflicted organ, are immense gains in the practice of the healing 
 art? It is one thing to stand outside the living human frame and 
 conjecture what may be its hidden disease, and quite another 
 to see, by the aid of medical inventions, the disorder no longer 
 hidden. Put yourselves back along with your brethren of 
 former times, who had not the speculum, the stethoscope, 
 ophthalmoscope, or the auroscope, to whom the interior of the 
 living human organism, for lack of these, was wrapped in im- 
 penetrable darkness; for whom the heart and the lungs were 
 dumb, or spoke only in muffled tones; and consider your im- 
 mense advantage. It is the advantage of certainty over con- 
 jecture, of knowledge over guessing — the advantage of the 
 sure evidence of eye and ear over the uncertain results of 
 fallible reasoning — it is such inventions as these, that showing 
 the physician where and what is the trouble, enable him to 
 deal intelligently with it. But while these are vast strides, 
 after all how far short of the exigencies of the case do they 
 stop. The greater part of the human frame is still impene- 
 trable to the eye of the physician so long as it lives. That 
 life, which it is the object of the physician to save, stands an 
 impregnable fortress in his path, when he seeks to penetrate 
 the lurking places of the enemies of life. All the aid of the 
 
stethoscope, what is it? The physician hears the rush of the 
 stream of life; he sees it not. The traveler hears in the dis- 
 tance the flow of waters, and knows that whence it comes 
 some majestic river is coursing towards the sea, but not until 
 he approaches and stands upon its banks, will he see its 
 breadth and understands it depth, and know what pleasant 
 islands or what rugged rocks obstruct its course; whether its 
 waters flow clear and limpid or roll along muddy and turbid. 
 With the aid of this same invaluable stethoscope, the physi- 
 cian can hear the passage of air through the lungs, but he 
 cannot see the trace it leaves. He is as one walking abroad, 
 who hears in the distance the sweep of the wind and the 
 noise of the waves, but not until he approaches the coast and 
 casts his eye abroad over the sea, will he know whether it be 
 a gentle breeze whispering to the wave and the wave kissing 
 the pebbly beach, or the rushing of the gale and the roar of the 
 breakers." And so medical science should not relax its re- 
 searches until that which is now only heard with the ear shall 
 be seen also with the eye. And is there anything wild in this 
 suggestion? Already through the stethoscope the heart has 
 given up its secrets and the lungs have whispered their tale 
 of life or death to the listening ear. Already the brain has 
 revealed through the ophthalmoscope some of its mysteries 
 to the searching eye. And the auroscope has found a clue 
 even to the intricacies of the ear, though the}- be complex as 
 the labyrinth of Crete. Have the stethoscope, the ophthalmo- 
 scope and the auroscope, exhausted the inventive mind? Do 
 these triumphs of science mark also the limits of science? And 
 is it wild to anticipate that some new application of the laws 
 of light, some new wonder of electricity, some agent, old or 
 new, may yet reveal to the eye of the physician the now 
 hidden wonders of the living frame, so that they will be seen 
 as a man sees the face of Ins friend? Every daily newspaper 
 reveals a greater marvel. One man sits in lus office at A\ asn- 
 ington — there comes flashing to him this message from a peak 
 in the Rocky Mountains: The snow is falling thick and fast 
 along the mountain sides. From the great lakes comes ano fli- 
 er : A mighty wind is rushing from the Northwest to the 
 
 Southeast, whose breath is icy. The Atlantic sends up from 
 its coasts a notice of fog and mist. The Gulf makes signal ot 
 rain. Our own Georgia, perhaps, sends a joyous gieeting ci 
 clear skies and soft, light winds; and Florida takes up the 
 refrain, “fair and still," “still and fair. And to this man. 
 receiving these messages, the future, hitherto wrapped in 
 more impenetrable darkness than the hidden paits of the m 
 
 8 
 
ing human frame, is revealed ; and the march of the elements, 
 hitherto less understood than the progress of disease, is spread 
 out before him, and back goes the message to this place : 
 Display storm signals and let the ships ride at anchor. To 
 this other: Let the barque sail with the assurance of sunny 
 seas and favoring winds. In advance of the icy blast speeds 
 the warning to the farmer: Seek shelter for your flocks and 
 
 herds; while, in another direction, wings the message: Drive 
 
 your teams afield under a clear sky and amid the whispering 
 of Spring. Seeing the wonderful triumphs of the human in- 
 tellect, is it extravagant to anticipate a not distant day when 
 all parts of the living human frame will lie bare to the eye of 
 the physician. Then, knowing for a certainty what the disease 
 is, how seldom he will have occasion to say : “This disease 
 
 is beyond my practice.” 
 
 But the discoveries of science, the triumphs of mechanism, 
 may be what they may be in aid of the healing art; but one 
 disease will continue to be beyond the practice of the most 
 skillful physician. This so-called disease is death. \Ye lis- 
 tened, yesterday, with delight to a discourse delivered by the 
 honored Dean of the Faculty, which proceeded on the highest 
 planes of thought, was enriched by the stores of profound 
 learning, and swept along in the. strains of the purest diction. 
 Its theme was the Persistence of Life. AYe have no occasion 
 to oppose these grand speculations. This rapt vision of the 
 philosopher may be realized, but death of that human frame, 
 which is the field of the physician’s labor, will continue. The 
 forces of life may persist in another form; but this vision of 
 the philosopher does not contemplate a time when the forces 
 of life shall be so understood that their exhaustion in the 
 human frame may be prevented ; that the seat of life will be so 
 well ascertained that it can be effectually guarded. It does 
 contemplate that this human frame shall still, like the house 
 of the chambered nautilus, be left “an out-grown shell by life’s 
 unresting sea.” Nor need we contend with the theologian, 
 who teaches that death came by sin, and cry out in unbidden 
 doubt: The birds of the air, the songsters of hedge and grove, 
 when sinned they? And yet, do their pinions never fail and 
 do their voices not cease their sweet notes forever? By what 
 deadly impurity did the violet and the lilly, the jasmine and 
 the rose, forfeit their pristine immortality? When did the 
 falling leaf become the solemn declaration that all nature had 
 sinned? It is enough. Philosophy and theology alike recog- 
 nize the continuance of death. But why call death disease? 
 Why regard it otherwise than birth itself? They are both 
 
 9 
 
stations in the existence of that mystery, which we name man. 
 Death marks the separation between the living and “those 
 other living ’whom we call the dead.” Premature death is 
 disease. The buds, which put forth today to greet the first 
 morning of Spring, may in their immaturity meet a chilling 
 frost, wither, decay and die. This is disease. But the rose 
 which opens to the April sky and blooms in all its beauty, and 
 shed's all its fragrance on the vernal air, and in due time 
 scatters its last leaves upon the ground, is not the victim of 
 disease. It has filled to the full the measure of its being. And 
 so with the wonderful human frame. There is hope that, with 
 the progress of knowledge, no disease, which shortens its due 
 existence, will be beyond the practice of the physician. But 
 that which marks its termination — as the falling rose leaf 
 whispers that the perfect mission of the rose is accomplished 
 — will be alike for philosopher, theologian and physician, ever 
 "beyond his practice.” 
 
 10