::• THOMAS introductory Address . . . 1864 ctl- /M- 71708 736 > Columbia (Bntoergftp intijeCttpoflrttJgork College of siciang ano burgeon* Mrarp Digitized by the Internet Archive in 2011 with funding from Open Knowledge Commons http://www.archive.org/details/introductoryaddr02thom >X\^vrv-^V ^^eV^>-v-o>Q~^ Cu J^\^^/ v fc^ INTRODUCTORY ADDRESS DKLIVEKKI) AT THE j* c%i . M£f r '*'■ NEW YORK, OCTOBER 17tli, 1864, r r. Gaillaed Thomas, M.D;, PROFESSOR ADJUNCT OF OBSTETRICS. y"~ NEW YORK: W II. TRAFTON & CO, STATIONERS AND PRINTERS 55 & S7 Broad-Street. 1 864. ' 1* V J ll- A' . - •c'^Sf ' .» INTRODUCTORY ADDRESS DELIVERED AT THE $0ilcp $i l^bgjsuto mil Jtowjeons, NEW YORK, OCTOBER 17th, 1864, T. G-aillakd Thomas, M. D., PROFESSOR ADJUNCT OF OBSTETRICS. NEW YORK: W. H. TRAFTON & CO , STATIONERS AND PRINTERS, 85 & 8T Bkoad Stbeet. 1864. 1 At a meeting of the Class of cne College of Physicians and Surgeons, held November 1st, on motion of Mr. Russel Withers, Mr. Samuel St. J. Smith was appointed Chairman. The following Resolutions were then adopted : 1. That a Committee be appointed to wait on Professor T. G. Thomas, and to solicit for publication the manuscript of his Introductory Address, delivered before the class, October 17th. 2. That Messrs. Russel Withers, Joseph S. Winston, and Timothy Bigelow constitute that Committee. In accordance with these instructions the following correspondence was held with Prof. Thomas : To T. Gaillard Thomas, M. D., Adjunct Professor of Obstetrics, College of Physicians and Surgeons. Bear Sir : We, as the Committee appointed to wait on you, respectfully request that you would favor us with a copy of your Introductory Address, delivered at the commencement of the present session, in order that it may be published. The students are desirous of securing for themselves and their friends the pleasure of its perusal, and for the public the advantages which must follow the dissemination of the truths which it embodies. They will also value it highly as a souvenir of yourself, and of the time they are now spending so agreeably and so profitably under your instruction. RUSSEL WITHERS, ) JOSEPH S. WINSTON, I Committee. TIMOTHY BIGELOW, ) College of Physicians and Surgeons, ) 3rd November, 1864. ^ New York, November Zrd, 1864. Messrs. Russel Withers, Joseph S. Winston, and Timothy Bigelow. Gentlemen : — It affords me pleasure to enclose to you the manuscript of my Introductory Address, requested by you as a Committee of the Class. In doing so, allow me to thank you most cordially for the kind tone of your communication, and to assure you of the gratification afforded me by the expressions of good will which it conveys. Believe me very truly yours, T. GAILLARD THOMAS, M. D. ADDRESS Gentlemen : The kindness of my associates of the faculty of the College of Physicians and Surgeons has accorded me the pleasing- task of welcoming you to these halls, and of extending to you the hand of friendly greeting. Most sincerely do I assure you of the gratification which this meeting with you affords them. As they look around, they recognize the well-known faces of many, who for the past two years have met them in the lecture rooms ; of others who, having passed through their collegiate lives, are now reflecting credit upon the in- stitution which they represent in the noble calling of their adoption ; and of still many more who, although unknown to them, come here to-night to testify their confidence by intrusting them with the guardianship of their commencing pupilage. Thus, gentlemen, the remembrance of pleasant associations with some of you is to-night mingled with the anticipation of an acquaintance with others, which may re- sult in ties of mutual respect, esteem, and friendship. The relation of teacher and pupil is one ever fraught with interest : but few can appreciate how especially it is so be- tween the instructor and student of medicine. Should the preceptors of an academic and literary course be in any way wanting in their duties, undoubtedly evil would result from their sending forth numbers of badly-instructed men to influence the tone of society, and to trammel the progress of the arts and sciences, nay, perchance, the progress of civiliza- tion itself. But compare even these results with those accru- ing from the dissemination through the land of empirical and ADDEESS ignorant physicians ! Think of the grave trusts which would be inefficiently dealt with, the valuable lives which would be sacrificed, the hearths which would be desolated by their misguided efforts ! Do you wonder, then, that such an occa- sion as this should be one of peculiar interest to your teachers, in view of the weighty responsibility resting upon thern in ref- erence to your future careers, your future influence on the^ welfare of society ? To those of you who come here, for the first time, to-night, the momentous nature of the choice which binds you to an arduous and trying profession must be apparent. Like all other avocations in life, and in a much greater degree than most of them, that which, to-night, you choose requires much of self-denial, labor, and anxiety; but in compensation for these, it offers pleasures which will by their power fascinate and enchain you as its devoted followers, in spite of its trials. Who among you, even upon its threshold, does not thrill with pride at enrolling his name as a disciple of an art which, coeval with society, dates back to the earliest literature of the Latin tongue, has outlived empires and nations, was the chosen work of Christ himself, and which numbers among its vo- taries the names of Hippocrates and Galen, Celsus and Avi- cenna, Morgagni, Pare, Harvey, and a host of others, whose memories shall live so long as our planet shall exist, sur- rounded by an aureola of glory, and embalmed by the grati- tude of mankind ? This, gentlemen, is the profession to which you now declare yourselves prepared for devotion. Be not deceived by the flippant language of a modern radicalism^ which would have you believe that you are merely joining a feeble sect, which, born but yesterday, may live but for to- morrow, to be then annihilated by a more recent doctrine, the offspring of the brain of some enthusiast or lunatic. Be not beguiled into the belief that the science of medicine has been and is as changing as the ocean's shore; that what it was a century ago is almost forgotten in what it is ; and that its present will soon be blotted out by its future of a few ADDRESS. years to come. It is not so. The profession of Hippocrates will be yours, altered and illuminated, it is true, by modern improvements ; but the same in its noble object, the same in its exalted requirements, the same in its spirit of devotion, unchanged by the surges of quackery and the aspersions of an oft-deluded public. Like some stout ship which has crossed the ocean, dashing its billows with contempt aside, disre- garding its tempests, and gallantly resisting its thunders, the science of medicine has passed steadily onwards through centuries of time, despising the attacks of charlatanism, and at our day stands pre-eminently firm as one of the bulwarks of society. He who would enrol under such a banner, should carefully question himself as to his fitness to meet its requirements ; no sordid thought should weigh in the balance : no petty interest should guide him. He whose mental capacity will not permit him to rise to the level of a high minded, magnanimous, and Christian gentleman should seek some other sphere of labor. It has been well said that " the profession of medicine is the noblest of professions, the meanest of trades/' "With the belief that you have weighed this evening's choice with care, and that you approach the course of life which it involves, with a due appreciation of its responsibilities and requirements, let me say a few words as to the method by which you should prepare your minds, by study and observa- tion, to perforin its functions. Every medical class is divided, by the character of the curriculum adopted in this country, into two sections ; the first being composed of those who are passing through their novitiate, and devoting themselves to the theoretical part of the course, Anatomy, Physiology, Chemistry, Materia Medica, &c, and the second of more advanced pupils, who, having finished one or two terms of study, and anticipating soon to take the doctorate, are studying diseases at the bedside of the sick. The courses thus followed are known as didactic and clinical. It would indeed be difficult to say which of these is the more important, for neither should in anywise be neglected. ADDRESS The first prepares the mind to avail itself of the second, and the second, followed under the supervision of scientific practitioners, teaches the student how to investigate disease, trains his mind in a proper mode of thinking, and makes him aware of the acuteness of observation which may be developed by cultivation. Were I called upon, however, to decide, I should advise the neglect of the clinical course, rather than the didactic ; for without a scientific basis no mind, however brilliant it may be, can ever hope for excellence in medicine, and will likely fall into the channels of empiricism ; while, with a thorough groundwork of scientific and purely theoret- ical knowledge, a keen observer may make himself a skillful and able practitioner. Let me, then, urge those who are beginners, in the strong- est terms, to confine themselves to the rudiments of their edu- cation, and to avoid the folly of endeavoring to study disease at the bedside, the history of which, as observed by others, the means of investigating which, and the alterations exerted by which on the physiological condition of the patient, are unknown to him. How irrational would it be for one to study a case of poisoning by arsenic, when ignorant of the chemistry of the poison, and the anatomy and physiology of the stomach which it has injured ! And yet, this is just what the student does in every disease which he essays to study before passing through the preliminary course. As well might the scholar strive to read, who has neglected to master the alphabet. Probably, however, a majority of you have passed through this period, and are prepared to enter upon the study of the habits and character of the great enemy, for whose destruc- tion our order was and is created, and to compass whose over- throw we delve into the bowels of the earth, fathom the depths of ocean, pluck out the secrets of the massive rocks, and draw down the lightnings of heaven itself. Were I to advise you in studying disease in the hospitals, dispensaries, and clinical rooms, to avoid studying the cure of disease, you would smile, and ask " why then study at all ?" Address. 9 I will not go so far as to give this counsel, but so sure am I that great injury has been done, not only to students, but to the profession itself, from the earliest times to the present, by a devotion to mere therapeutics, causing a neglect of points which would have directed and altered the means of cure, that I must specially guard you against being thus dis' tracted from the closest observations of the natural phenomena, or, as it has been termed, the natural history of diseases. By this term is meant the phenomena, characteristics, duration, and results of morbid conditions left to nature, i. e. uninter- fered with by medicines, and simply guarded from extraneous disturbing influences. The subject has been greatly neglected, for centuries, and of such vital importance do I regard it, as bearing upon your future proficiency as physicians, that I make it my theme for this evening's address. Remain igno- rant of it, and you shut the gates of the avenue which leads to progress in medicine ; master it, and your therapeutic know- ledge will become certain, and its application a science. Tou would naturally conclude, that the first study which would have engaged the attention of the pioneers in the art of heal- ing, would have been that of the nature of the affections which they desired to cure, so that they might have learned what assistance was required ; and by a comparison of the results of unaided, with aided cases, concluded how far they had met with success in their efforts. But, unfortunately, in the infancy of our profession, tin's was not done. Men leaped to the conclu- sion that all diseases tended to death, and at once proceeding to give aid by a variety of means, soon blinded themselves as to the results. When the malady followed its natural course to recovery, they laid to their souls the flattering unction that they had cured it ; and when their interference turned the scale for death, they attributed the unfortunate issue to the malignancy of the disorder which had resisted their well directed efforts. All this made more and more impenetrable the veil which hung over nature's dealing with disease, and the ignorance thus fostered is, for me, the key to many mys- teries in our science. It reconciles the similarity of result 10 ADDRESS. obtained by modes of practice diametrically opposed; gives me the reason for the success of systems of charlatanism, based upon the most preposterous tenets, and explains the confidence felt, even by wise men, in therapeutic plans which were utter- ly without merit. To convince you of the truth of these views, I will claim your attention, as we take a retrospective glance at some of the methods of treatment adopted for diseases during the past two centuries, and, having laid them before you, I shall com- pare their results with those accruing from an entire neglect of medication, and leaving the disorders to the hand of nature. Should we discover that nature, unaided, accomplishes better results than many of these methods have done by active interference, then is it plain, that such interference was in- jurious. Should we, after arriving at this conclusion, discover no process by which nature can be aided, and her efforts made more effective, it would plainly be our duty to leave her to her work. But, should we learn that a given plan of treatment pos- sesses the power of adding to her efficiency, shortening the natural course of disease, and diminishing suffering during its progress, it is equally plain that its adoption is pointed out, both by reason and humanity. It is truly astonishing to look back into the musty tomes of by-gone centuries, and see the great changes in the treatment of diseases which have occurred, from time to time, as we ad- vance to the present ; and still more wonderful is it to learn, from incontestable evidence, that although incongruous, con- tradictory, and often entirely opposed, they all cured the ills of flesh, and consequently commanded the confidence of those who practiced them, and those who relied on them for relief. Let me cite for example the practice of Sydenham, whom I quote as the best representative of the physicians of the Seventeenth Century, about the middle of which he flourished. His directions for treating Pleurisy (which, however, he ADDRESS. 11 evidently confounded with Pneumonia) are these : " Bleed from the arm of the affected side ten ounces. Red Poppy "Water, ------- 3 iv. Sal Prunella, --------- 3!. Syr. Yiolets, --------- 3 i. M. et ft. haust, to be taken directly after the first bleeding. Sweet Almonds, -------- v. Melon Seeds, --------- 5 ss. Gourd Seeds, -------.- 3 ss. White Poppy Seeds, ------ 3 iii- Barley Water, -------- o. ss. Rose Water, --------- 3 il. Sugar Candy, - . - - q. s. M. et ft. emulsio secudem artem. § iv. to be taken every four hours. Pectoral Decoction, - - - - - - - o. ji. Syr. Yiolets, ......... ^ S s. Syr. Maidenhair, ........ ^ ss. Sugar Candy, --------- q. s. M. et ft. Apozem., one-half pint to be taken daily. We stop here for breath (as the poor patient likewise probably tried to do), but this is not all. 01. Sweet Almonds, § ii. Syr. Yiolets, --------- s i. Syr. Maidenhair, -------- 3" i. Sugar Candy, --------- q. s. 12 ADDRESS. M. et ft. linctus, to be taken frequently. Oil of Sweet Almonds or fresh Linseed Oil may be taken alone. £. 01. Sweet Almonds, ------- | i. 01. Lilies, -■---.'■----■.-_ g i. Ointment Marsh Mallows, -'■■-•■-'- - § i. M. et ft. lint., to be rubbed on the affected part night and morning. Lay a cabbage leaf over the part, repeat the bleeding three times more (i. e. ten ounces each time), so as in all to make four days, as long as the pain and dyspnoea continue." This is copied verbatim from the writings of Sydenham, the medical exponent of his time ; compare it with the treatment of a case of Pleurisy or Pneumonia at our day by our most enlightened practitioners; a few cups are applied to the side affected, an arterial sedative or sudorific is administered, all the functions of the body are carefully watched, the diet made simple and nutritious, and our success, as proved by statistics, is infinitely superior to that of our predecessors. It would be useless to quote more ; this is a fair and honest example of the therapeutics of those times. The disease seemed to be regarded as an enemy besieged in a town, which was to be destroyed, even at the risk of destroying the town itself. In the first quarter of the Sixteenth Century, we are in- formed by Ambrose Pare, who lived at that period, that the' surgeons treated wounds by separating their lips and pouring in boiling oil to check the flow of blood. Unquestionably, the wounds thus treated generally got well, or the practice would have been discontinued. To-day these same wounds would be treated by the application of cloths, soaked in clear water, and still do they go on to recovery. Both methods, though so opposite and unlike, resulted in the same issue — recovery. ADDRESS. 13 But we need not refer to past history to find plans of treat- ment as much at variance with each other as those just mentioned are, with the views of the present, and yet are supported by men of rare judgment, and practised with suc- cess in similar diseases. In our own time, we see M. Bouillaud, of Paris, bleeding in Pneumonia, Pleurisy, Pericarditis, Rheumatism, and many other affections, in which, Dr. Todd, of London, systematically stimulated with brandy and fed upon nutritious food ; and not only did they do so, but their respective schools endorsed then- views, each with equal warmth ; imitated their leaders, and claimed respectively the most brilliant results. Now it is evident that both schools could not have been right, one at least must have done injury to the diseases treated, if it be admitted that the other did good ; and yet, in the face of all this, I tell you that my belief is that both parties reported recoveries truthfully, and that both parties were sincere in their belief that they contributed to the gratifying results. There must be a key to this mystery, a solution of this paradox. For me, there is none other than this, that the dis- eases treated had a natural tendency to recovery, and that the Almighty has, in his infinite wisdom, endowed the ani- mal frame with an inherent curative power which often de- feats the machinations of misguided men. If the professors of medicine have been misled by a neglect of the study of the natural phenomena of diseases, what must have been the baneful results of the complete ignorance of this subject on the part of the people ? It has offered a wide field to quackery, and caused whole communities to pass un- der the yoke of deception and imposture. This has been so in all ages, and at no period more so than the present ; for, alas! we live in the age of quackery, and doubly, alas! is America proving the very Canaan of the tribe. If the sons of Paracelsus ever looked forward to a promised land, they have found it. Columbus discovered their true El Dorado. It is an undoubted fact that no system of charlatanism has 14 ADDRESS. ever flourished which has not reported, and reported truth- fully, thousands of recoveries under its ministrations, how- ever injurious or harmless its modes of treatment. However at variance their doctrines, however ridiculous their tenets, however inefficient their therapeutics, all which have run the course which is set before systems of imposture, have un- questionably published to the world recoveries from grave disorders, which no man, who consented to draw the scales of prejudice from his eyes, could gainsay. But to be con- vinced of the truth of this apparently singular statement, fol- low me as I investigate a few of the popular fallacies which have appeared during the past hundred years. Towards the close of the last century a physician, named Perkins, who resided in Connecticut, made a most wonderful, startling, and momentous discovery. He discovered that certain metallic substances had, when applied to the animal body and passed along it like the poles of a battery, the glo- rious power of drawing out diseases, very much as the mag- net would draw a needle from your pocket. In accordance with this knowledge, he constructed two metallic stems, about 3 inches long, blunt at one extremity and pointed at the other, one being composed apparently of brass, and the other of steel, though this is not certain, as (in a moment of moral obliquity, doubtless) the discoverer obtained a patent for and kept them secret. ISTo sooner was the great discovery of Dr. Perkins made known than the trumpet of fame spread its reputation with lightning speed to the uttermost parts of the earth. Certificates assert- ing most excellent cures from the highest dignitaries of the land, from judges and generals, from leading merchants, from ladies eminent for charity, and I need not say great numbers of endorsements from eminent divines, poured in like a paper flood. Dr. Benjamin Douglass Perkins went to London, so as to give England an opportunity of benefiting by the great in- vention, and soon it was discovered that what would draw out disease from an American would likewise act upon an Eng- ADDRESS. 15 lishman, for great cures soon occurred, and the land of our forefathers applauded to the echo this great boon. Other countries of Europe experienced the influence of the reform, and especially did it meet with success in Denmark. Large numbers of cures were published daily ; pains were removed as if by magic as the tractors were passed ; swellings visibly went down, tumors disappeared, the lame walked, the blind saw, and miracles seemed about to be revived. Dr. Wor- thington Hooker, of JSTew Haven, a townsman of Dr. Perkins, to whose interesting history I am indebted for this sketch, declares that he has now in his library a volume of 200 printed pages, containing the records of great numbers of undoubted cures. Meanwhile Dr. Perkins sold thousands of tractors at five guineas a pair, and even medical men used and endorsed them. The nobility of England, anxious to benefit the poor by disseminating the great blessing, seized upon it with avidity, and at once established a large infirmary. This was founded with all the pomp and circumstance which charac- terises inaugurations by our transatlantic brethren, and was under the patronage of the first men of the land. Lord Rivers was president of the board of governors, and a long list of titled names followed his as vice-presidents. I have not men- tioned to you, because I thought it needless to do so, that in all this, the ladies were most enthusiastic, for in what great work are they not foremost? The constitution of the infirmary, in acknowledging this fact, provided that ladies should have the right to vote by proxy. In March, 1802, the number of cures, computed as effected by the tractors, amounted to one million five hundred thousand. Well was the fortunate Dr. Perkins sustained in the language with which he closed his report, " It is believed that no medical remedy yet discovered has been supported by so many well authenticated and im- portant cures performed in so short a time." In spite of all the evidence adduced, there were sceptics in the land, (but alas, gentlemen, where do we not find sceptics?) who declared that all this was the effect of the imagination, 16 ADDRESS. and one Dr. Haygarth, making a pair of tractors of wood, which he painted to resemble those of Perkins, really did produce the same results, curious as it may appear. But these sceptics were soon put to confusion, and " Perkinism," as the discovery was called, marched in triumph through the world, and the " Perkinean Institute," under the skillful management of the philanthropic Lord Rivers and the noble vice-presi- dents, became a blessing to suffering humanity. All this occurred, and was fully reported in 1802 ; we now live sixty- two years after that time. Where now is Perkinism, and the Perkinean Institute, and Perkins' tractors ? History is silent, and when you ask society, it hangs its head and blushes slight- ly at its own credulity. Do you doubt that recoveries oc- curred under this system ? I do not for a moment ; for how could Lord Rivers, and the titled vice presidents, and the clergymen who gave certificates, and the ladies who voted by proxy, all have been deluded ? They were not deluded, gentle- men, they merely called recoveries, cures ; that was all. From the days of Hippocrates down to the present, abun- dant recognition of the value of water in the cure of disease, may everywhere in medical literature be found. It was, however, only regarded as a means of cure, no one pretend- ing to view it as a system, till the beginning of this century, when the idea of so doing occurred to the untutored mind of a Silesian peasant, named Vincent Priessnitz. Discarding the knowledge gained by 2,000 years of patient medical research, putting at naught the authority of all the physicians of the world, this bold innovator reduced the entire field of thera- peutics to the use of water. He maintained that, let the na- ture of the affection be what it might, it could be readily cured by water, which was the only means to be employed. "Were the story, as thus far told, new to you, you would at once conclude that the poor fellow was consigned to some well-regulated asylum, where his mind might be restored to health. But this was not done : his doctrine found hundreds of thousands of believers all over the civilized world ; volume after volume was written upon it, and in a short time the ADBKES8. 17 wisest and best men of this country and of Europe, were splashing in every conceivable kind of bath, with all the con- fidence which would have possessed one who entered of old the pool of Bethesda. Upwards of 200 institutions for the treatment of diseases on this plan were established in diiferent parts of the world, and many of these still exist ; but time, the great adjuster of human affairs, has well nigh robbed the system of its livery of charlatanism, and many physicians avail themselves of these well-regulated hygienic establish- ments, as one means of curing disease. Thus " Hydropathy" has been brought to the occupancy of the position which it has held in all ages, and we have to thank Vmcent Priessnitz for doing much to systematise and utilise it. That thousands of recoveries took place under it, when practised to the exclusion of all medication, and that some cures were effected by it, no candid mind can doubt. Some years ago, there arose *in this country a medical sect, which owed its origin to an illiterate, though shrewd man, which for a time had many adherents in all portions of the land, and promised, as the multitude thought, to supplant the necessity of educated physicians, by so simpli- fying the entire matter that any one could practise with success. From the name of its founder, Thompson, this system received the name of " Thompsonianism," or " Thomp- sonism ;" and from the fact of its discarding all mineral medicines, it was likewise called the " Botanical Practice." In the opinion of Dr. Thompson, all diseases were due to a check of perspiration, and the only method of curing them was their expulsion through the skin. To accomplish this, he relied almost entirely upon vapor baths, lobelia, and capsicum. At the time that this doctrine was promul- gated I resided in the southern portion of this country, and well do I remember the furor which it created. Whole communities were converted to it ; men who refused to give credence to it were regarded as prejudiced, or besotted by the old practice, and many prominent citizens, who had hun- dreds of beings dependent on them for guidance, absolutely 18 ADDRESS. discharged their physicians, under the absurd belief that they would be able to take charge of the sick and perform the functions of the most difficult of professions, without knowl- edge or experience. This was not done by the half-educated or ignorant, but by refined and intelligent gentlemen, men who would have ridiculed a like infatuation on any other subject. Many of my own friends yielded to the influences which surrounded them, and were swept into the vortex of this barefaced imposture. Among them I saw a great many cases treated, and I remember well that I saw a great many recoveries. Indeed, in vigorous persons, the success of the plan was by no means contemptible ; it was only in the very young and aged that it appeared particularly fatal. Scarce half a century has passed since the inauguration of Thompso- nianism, and now all that we see of it is an occasional relic in some small country village ; scattered and insignificant relics, which, though like those of the mastodon, they remind us of the great body of which they formed a part, will never, like them, serve as material for its reconstruction, An example of a still more wonderful popular delusion than any of those mentioned, and a good demonstration of the tendency of diseases to recovery, presents itself in a sys- tem which has not yet lived its allotted time, but which is fast approaching the terminus of its existence. I allude to " Ho- moeopathy," which was inaugurated by Samuel Hahnemann, a native of Messein, in Germany, about the commencement of this century. This most extraordinary man pretended to an especial illumination as to a law which governed the cure of all diseases, and openly declared his belief that his discov- ery would revolutionize the mistaken notions which had existed since the birth of Christ. You are aware that his system rests upon the pretended fact that diseases are cured by like morbid states, which he proposed to develop in the economy, by the administration of drugs, infinitessimally di- vided. A curious feature of this most remarkable doctrine was the administration, in infinitessirnal doses, of substances of which we take a large amount every day, as food. For ADDBESS. 19 example, to a man eating, daily, whole grains of animal char- coal on his roast beef, and vegetable charcoal on his toasted bread, he would administer less than the ten-thousandth part of a grain, with the hope that this, " potentised," as he ex- pressed it, by being rubbed in a mortar, would be more powerful than the number of grains eaten as food. In reference to the law, let me remark, that the discovery of that or any other law, which would relieve our noble art from its present uncertainties and put it on a level with the exact sciences, would be hailed with joy by every one of its followers. The very millennium of medicine would have arrived, and the honest and sincere physicians of the whole world would hasten to bow down in homage before the heaven-sent messenger. Had the discovery of Perkins, or Priessnitz, or Thompson, or Hahnemann, been true; had they been able to stand the test of experiment ; it would have carried joy to the breast of every votary of the healing art, and each would have shouted " Eureka" as he embraced it. But, alas ! gentlemen, the long-sought law is not yet found ; it may be to-morrow, but it is not to-day ; and worse still, we have, so far, no evidence whatever than any such law exists. This is a digression : let us return. Hahnemann, in pur- suance of the doctrine already enunciated, divided the drugs which he employed into the smallest, imaginable particles, and gave great powers to these, by agitation and trituration with alcohol or sugar. Let me inform you how the homoao- pathic dilutions are arrived at, and then make some compu- tations, with the intent of conveying to your minds a correct idea of the amount of medicine which they will each contain. One drop of a pure tincture (say for instance, tincture of opium, called laudanum) is added to one hundred drops of alcohol to make the first dilution ; one drop of this (which contains one-hundredth of the original drop) is added to one hundred drops of alcohol to make the second ; one drop of this is added to one hundred drops of alcohol to make the third, and so on to the thirtieth, and even the three thou- 20 ADDRESS. sandth, which has been employed by many homceopatbists. It is evident to yon, that, knowing this, we can easily cal- culate the strength of each dilution. By the same process, drugs are triturated with sugar, and divided into pellets of a given size. In the Organ on (the text book of homoeopathy) Hahnemann says, at page 289, " It holds good, and will continue to hold good, as a homoeopathic thera- peutic maxim, not to be refuted by any experience in the world, that the best dose of the properly selected remedy is always the very smallest one, in one of the high dynamisations (x or the 30th dilution), as well for acute as chronic diseases." Now let us suppose one grain of camphor divided into pellets of the 30th dilution ; each pellet will consist of a mass of su- gar, with the decillionth of a grain of camphor added to it. An entire grain of camphor is about the size of the head of a large pin, and this mass it is which is divided into decillionths. Suppose now that these pellets were arranged side by side so as to make a straight line ; that line would extend from earth to a point considerably beyond the moon. Yet Hahnemann declared that each of these pellets would contain enough of the original grain of camphor, not only to aifect the system, but, in time, to produce a disease in it. The population of the earth is generally stated as being nine hundred millions, for convenience we will call it one thousand millions. It is evident that the grain of camphor, the size of a pin's head, divided into billionths even, would give a great number of doses to every person on the globe, for a billion is a million millions, and this number of doses is to be divided among only one thousand millions. If this is true of the billionth of a grain, what must it be of the decillionth, which is thus reached in arithmetical computation ; first we have a million, then a billion, then a trillion, then a quadrillion, quintillion, sextillion, septillion, octillion, nonillion, and then a decillion, which was Hahnemann's favorite dose. It is evident that to reduce this grain to decillionths, it would require a large mass of sugar. This has never been accurately computed for the decillionth, that I know of; but it has for a quintillionth, ADDRESS. 21 which is an infinitely smaller dilution, and for this, it would require for the grain, the size of a pins head, sixty-one globes of sugar, each equal in size to the earth. "When these facts are brought to the notice of horuoeopa- thists, many of them at once declare that they do not regard Hahnemann as correct, in believing in the high dilutions ; and the sect has, I believe, divided itself into low dilutionists, or those who, in spite of their apostle, use the tenth and twelfth dilutions, and the high dilutionists or those who go as high as the 3,000th. Now, those who pretend to use the large doses of homoeopathy, are scarcely in a more tenable position than their brethren ; for it has been clearly proven, by careful calculation, that the strength of the tenth dilution is equal to one drop of any tincture (say Laudanum) dissolved in a mass of fluid 500 times greater than the Lake of Geneva. The eleventh dilution would require a mass of water greater than the Mediterranean sea, for one drop of Laudanum, of which the common dose is twenty -five drops ; and the twelfth could scarcely be accomplished in a sea extending over the surface of the whole earth, and 500 fathoms deep. You smiled, a while ago, at the belief in Perkins' tractors ; you ridicule the belief in clairvoyants and fortune tellers ; and yet do they compare with the belief in all this ? Now, with these facts, there are but two ways to deal : first, to deny their being facts ; or secondly, to agree that they prove the system preposterous. I do not know what part of the statements you can doubt ; they are those collected by Prof. Simpson of Edinburgh, after careful research, and like all mathematical deductions, they are simply undeniable. If I place ten apples before you, and add ten to them, you cannot, if so disposed, deny the resultant being twenty, for it is a mathematical fact, not a matter of opinion. So with the statements here made ; they are all open to examination, and all susceptible of mathematical proof, however astounding they may appear. This then is the system, which a man not in an asylum for the insane, dared to offer to the world, this is the doctrine which thousands of the wisest in the world accepted as a boon 22 ADDRESS* from heaven, and this the therapeutic procedure which has undoubtedly witnessed the recovery of thousands of persons, sick with grave disorders, aye, even with disorders pronounced incurable by members of the profession of medicine. Did it cure its infatuated votaries ? Far from it ; but it allowed na- ture to do so. Some lives it has unquestionably saved, by occupying the therapeutic field, and preventing dangerous medication ; many it has undoubtedly destroyed, by keeping from the bedside the true physician, who might have wrested the sufferer from the hand of the destroying angel, by a proper use of those drugs with which the Almighty has endowed our art. I trust that the tenor of this discourse will bear me out in the assertion that I am not citing these systems of charlatan- ism for the purpose of railing at or inveighing against them. Far from this, I regard such systems as among the many evils inher- ent to society, and which cannot be expunged, because they are absolute necessities. They constitute a supply meeting a demand felt by a portion of every community. So long as the minds and educations of men remain as at present organised, so long will there be those who crave quackery and deception, not only in medicine, but in religion, philosophy, and every other sphere of human thought. I merely use them to cor- roborate my position, that the secret of their success consists in the tendency of diseases to recovery, and their appropria- tion of the credit which is nature's due with reference to the result. It is almost incredible what unwarrantable interference with diseases has been engendered by a neglect of the study of their natural tendencies and courses. So marked has this been that it has built up systems of quackery as havens of refuge from the " nimia diligentia" of sincere but misguided physicians. Let me recall to you a notable example of such interference to which I have already alluded. In 1536, Ambrose Pare, then an unknown youth of nineteen, was appointed by Francis I., of France, a surgeon in his army. Anxious to ADDKESS. 23 learn, lie gave strict attention to the work of experienced and eminent surgeons, and saw them always pour into the fresh wounds occurring in battle, boiling oil. One evening he had under his care a number of wounded, and into their lace- rated bodies diligently poured the seething pitch, till all was used. Then his mind was much disquieted, for a number of wounds remained, into which no boiling oil had been poured. The next day, to his surprise, he found that the poor neglected fellows had done better than their more fortunate, but scalded neighbors. Instantly the genius of the man seized upon an accidental discovery, and by his efforts he abolished the prac- tice in future. Now the surgeons who had for years used boiling oil in this way, were sincere, but certainly mistaken men ; and their mistake arose from not finding out how wounds behaved when let alone. Chance taught this to Pare, and hence an improvement in his art. You may sup- pose that a parallel drawn between this occurrence, and any of those now taking place, would be exaggerated; but it would not. There are hundreds of sincere practitioners to- day, who are, in my judgment, pouring boiling oil into wounds, which if watched as Pare watched them, would be found to do better without it. Let me more clearly lay the matter before you by reference to some experiments, to which many of you were witnesses during the past winter. I have been in the habit in clinical teaching (as many others have done in different parts of the world) of leaving a certain number of cases, which I felt that I could conscientiously allow to progress without interference, to run their courses, that the students might appreciate how much nature could do in effecting a cure. I shall not now weary you by particulars, but merely give you the gross re- sults to which such experiments lead. If fifty cases of pleurisy (the disease for which Sydenham prescribed so vigorously) be placed in bed, carefully nursed, dieted, guarded from deleterious inflnences, and receive not a particle of medicine of any kind, the probabilities are that not one case would end fatally ; all would likely recover unless 24 A D ft ft E S g . some peculiarity of constitution, the unfavorable age of the person, or accidental complication should alter the result. The ancients supposed that inflammations of the heart, pericarditis and endocarditis, would always prove fatal, unless checked by treatment ; we know by experiment that this is a mistake ; both diseases are in the vast majority of cases recov- ered from, leaving the heart more or less crippled, it is true, but still not destroying life as primary acute attacks. Peri- carditis will as a very general rule run its course, and even- tuate in recovery, without any resort to medication ; and endo- carditis so often does so, that its existence is commonly not recognized at all ; the only evidence of its ever having existed being found in its effects on the valves of the heart. Tonsillitis, or Quincy, is a fearful disease to watch through its course ; for when at its height, it appears to the looker on, that death by strangulation or starvation must soon put an end to the patient's suffering. The sufferer struggles for breath, gasps wildly, and swallowing is often for days a mat- ter of utter impossibility. For this affection, in time gone by, the lancet, and other equally active means, were always resorted to ; and what wonder when we look at the results of the plan ; all the cases thus treated recovered. So did all the wounds into which Pare poured boiling oil, and mark the parallel further : when Pare omitted the oil, still the wounds got well, and I assure you with reference to the worst cases of Tonsillitis, that if they be left without medicine, none of them (unless in some exceptional case, as of an old or very weak person) would end fatally. They look as if they would die, but they do not do so ; they recover. Scarlet Fever of simple form, Measles, and even Yarioloid, in the vast majority of cases, will end in recovery without the slightest medication. But of all diseases which excite terror in the minds of by- standers, none does so more markedly than convulsions in children. Of course, the dangers will generally depend upon the cause of the seizure, but, even in this dreaded disorder, the majority will recover, even if no interference be practised. Another disease worth instancing in this connection is Cholera Morbus ; a pathological series made up of a succes- sion of efforts, on the part of offended nature, to free itself from disorder. In this effort nature generally, nay, we may almost say always, succeeds in effecting a cure, unless in the extremes of age, or in a very debilitated patient. You all know what dreaded scourges exist in Typhus and Typhoid Fevers. The vacant seats at thousands of hearths throughout our land stand solemn witnesses to their ravages. Read in the literature of the past the list of remedies at various times regarded as specifics for these fevers, and you will wonder at its length. Were I to write the drugs advised during the last century in their management, upon the walls before me, space would be wanting to accommodate their names. Within the last year the Commissioners of Public Charities in this city, advised of the fact that pure air and nourishment are the appropriate remedies for these affections, and assured by the physicians of Bellevue Hospital, that they will prove more amenable to this treatment than to any amount or kind of dosing, have placed all such cases upon an island in the middle of the East River, where thev are lodged in pavilions, which admit of the most perfect ventilation. The experiment has been tried under the judicious care of Dr. A. L. Loomis of this city, and to show you its results, I read a statement received from him in reference to it. " I have had charge of the Typhus Fever cases," says Dr. Loomis, " for five months ; during this time not a particle of medicine and no stimulants have been employed, and the results have been one death in every sixteen and two-third cases ; while, as you are aware, the per centage under the old plan was one in six. Dr. Murchison, a late English writer, states them in England as one in five." These facts are certainly most astonishing, yet here they stand in bold relief as facts, presenting them- selves so prominently that he who runs must read. But why prolong the list ? The tendency of the vast major- ity of diseases is to recovery, and not to death. A few, as for example Cancer, Consumption, Bright's disease, Hydrophobia, 26 ADDRESS. and cerebral affections, show no such benign tendency ; but what rational and unprejudiced physician of to-day will pretend, that there are any medicines which accomplish in these affections one-half of what is effected by air, exercise, diet, and rest? These are only the gross results obtained by the study of the natural phenomena of diseases ; there are many others which will be noted ; and when, guided by the knowledge thus gained, we resort to medicines in similar conditions, we will be able to appreciate their results, by the comparison of the duration and progress of aided, and unaided cases. Without such knowledge, we are often blinded by our own efforts ; and employing the too common reasoning of "post hoc, ergo propter hoc" attribute to them credit, which is not their due. I remember some years ago a report being made to the Imperial Academy of France by a sincere and in- dustrious member, who had for a length of time been using a remedy with great success in a certain disease. After reading a number of carefully noted cases, he came to the conclusion that, by the proposed treatment, the disease could be cured in sixteen days. The essay was much commended, and a committee appointed to investigate the matter. At a subse- quent meeting its chairman reported, that the remedy had been fully tested; a number of cases had been treated by the proposed plan, and an equal number left without any treat- ment. Those subjected to the treatment had, as the truthful member had related, recovered in sixteen days, but those left to nature had all recovered in fifteen. Have we not in these facts the true explanation of the har- mony of result between modes of practice utterly opposed to each other ? — of those of Sydenham and the physicians of to- day, of Bouilland and Todd, and of the wonderful results of Perkinism, Thompsonianism, Hydropathy, and Homoeopathy ? These plans differed most widely, and yet the results were the same ; the diseases got well, some in spite of the treat- ment, some uninfluenced by it on account of its inefficiency, and some by its help. To elucidate this matter, let us suppose ADDRESS. 27 a patient laboring under a severe attack of suppurative ton- sillitis, or quinsy. The natural course of the affection is to pass through a period which entails great suffering, and then to pass off, generally by formation of abscess. Suppose that Perkins's tractors were employed in the case ; it would pass steadily through its period of suffering and apparent danger, and in due time the patient would recover. Could we blame him, in his ignorance of what nature effects in this disease, in believing the tractors a great remedy for quinsy ? Or, perchance, the honor was not destined for Perkinism, and that the patient pins his faith to the view that heaven in- tended that all man's ills should be cured by water : he is wrapped, and douched, and splashed, and showered; and still the inevitable abscess breaks, and still recovery occurs. Or a follower of Thompson is called in : the sufferer is nearly liquified with vapor baths, and dosed with lobelia ; in spite of which nature resists the attack, and he is saved. But perhaps the patient's lines have fallen in pleasant places, perhaps he is under the gentle sway of a follower of Hahnemann. His kind attendant, actuated by the purest motives, pours one drop of the tincture of belladonna into New York Bay, or Long Island Sound, and gives the agon- ized sufferer one drop of the mixture. It is only a question of time ; the abscess breaks, and the grateful patient thanks a beneficent Providence for the creation of Hahnemann, and the creation of so much water on the earth for the dilution of his medicines. Thus as all roads lead to Eome, so do all these modes of practice lead to recovery. The " vis medicatrix naturae" has accomplished a great result, and the man who has watched its workings supposes the result all due to him, as did the fly who sat upon the whirling chariot, crediting himself with all the noise and dust which it excited. Prom what I have said, thus far, you may charge me with want of confidence in the power and utility of drugs, and the propriety of interference with disease. In this you greatly misconceive me. I have mentioned a number of diseases 28 ADDRESS. which, left to nature, will generally be recovered from, but I do not advise you to use no medicines in these cases ; I tell you that nature, without medicines, cures them, and that if medicines do not produce absolute and palpable good results, they had better not be given. I go further than this, and recommend you, when a disease is progressing favorably, to let it alone. But if by drugs, or any other means, you can soothe pain, ward off complications, cut short the natural duration of the malady, or prevent disagreeable sequelae, em- ploy them in large and decided doses. All these ends I am convinced they accomplish to a certain extent ; nay, more, you will sometimes see the well-directed prescription snatch your patient from impending death, calm the racking agony of mind as well as body, and cause a prom- ising future to dawn upon a gloomy present. This is my belief in drugs rightly used ; but mark me, gen- tlemen, the idea that a physician is sent for to give medicines is a grievous error, which, even now, affects society, and works great evil. Some of my most difficult daily tasks are preventing patients from dosing themselves. The duty of our high calling is to prevent and cure disease, not to dole out medicines. A patient comes to you with palpitation of the heart, and you tell him to desist from the abuse of tobacco ; another with an irritable stomach, and you restrict him in the use of alcohol ; another with dyspepsia, and you advise the removal of decayed teeth and the introduction of artificial ones ; another with persistent headache, and you advise him to sleep in fresh air instead of foul ; another with intestinal disorders, and you recommend his desisting from the constant use of medicines which are injuring him ; a pale young lady presents herself in cadaverous beauty, and you order animal food of which she takes none, exercise which she has neglect- ed, and a diminution in the amount of green tea that she is in the habit of drinking ; a mother brings a restless, sleepless, aggravating baby, of which she has made a miniature De Quincey, and you advise a supply of proper nourishment to the starveling ; are you not performing a higher duty ADDRESS than drugging them, and would you not be more success- ful ? Far be it from me to advise you not to interfere with dis- ease ; it would be to forswear my profession, for it is for suc- cessful interference with it that the physician is created. I do not urge you to abjure the use of drugs when good can be ef- fected by them, but I do urge you, and that fearlessly and strongly, against the polypharmacy, the everlasting, pitiless dosing which has built up systems of quackery, and caused them to nourish at the expense of the lives of the community, because they became havens of refuge from therapeutic perse- cution. Can you not appreciate a poor sufferer's flying to a charlatan rather than have the orthodox Pare pour boiling oil into his wound, and can you not conceive of one, even a wise man, clasping the knees of Hahnemann, and praying him to protect his helpless pleurisy from the lancet and linctus, and blister, and liniment, and morning draught and evening draught of the accomplished and learned Sydenham ? Look around you at the systems of charlatanism now existing, and you will see that in their ranks is not to be found one name which has ever been whispered by fame ; not one known by faintest report to science, and this is not only so at our day, it has been so in all time, for talent rarely consents to prostitute itself to deception. Where then are we to seek with success for the real supporters of these false doctrines ? In the regu- lar profession. Hahnemann was the offspring, not of science, not of truth, but of the practice of Sydenham. That many of the charlatans of all ages have been sincere men, I do not doubt : it is folly to call them all knaves. They are often more deluded than their patients, firmer believers than those whom they mislead. Ignorant of the course of disease, when left to nature's management, and of the recupe- rative powers of the system, they are deceived in their con- clusions as to the results effected by the means which they employ. Dr. Hooker entertains no doubt that Perkins be- lieved in the truth of his system, and I have as little that Hahnemann was thus deluded : but was the great Sydenham 30 ADDEE8S. less so in concluding that by bleeding, blistering, cupping, leeching, and salivating he cured diseases which experi- ence teaches us run their courses to recovery, when left alone ? Again, you may say, " If all systems lead to recovery, ho w does it really matter to which of them one intrusts himself?" I reply, that in the majority of diseases the patient will re- cover, unless in the hands of an Indian Thug himself ; but is recovery all that is desired ? A case of acute rheumatism, treated by the most inefficient means, will recover probably in six weeks, for that is the natural duration of the disease ; but would it not be to the sufferer's interest and comfort to have the period of torture diminished one-half, to avoid the severe pain and risk of death attendant upon these attacks, and to rise from his bed saved from heart disease, the so fre~ quent sequel of the affection ? He who shoots the foaming rapids under the guidance of a pilot who forever teazes the rudder is in great danger : would he be in less, to pass the perilous spot without a rud- der, leaving the ship to the course of the current ? No ; either plan would be fraught with dangers, which would be avoided by a careful hand, that touched, even strained the rudder when needful, but trusted to the current's course when it swept him in the right direction. A short time since Dr. "W. A. Hammond, late Surgeon- General of the Army of the United States, issued an order prohibiting the use of calomel and antimony by the surgeons in its employ. What a commentary was this on the use of these drugs, at our day ! Do you suppose that a man of Dr. Hammond's capacity and experience regarded calomel and antimony as useless or injurious agencies ? !STo ; he accorded, I am sure, great remedial virtues to each of them ; but the logical mind of the man led him to weigh the good which they could, with the injury that they did accomplish, and having no means by which to prevent his subordinates from their abuse, he suppressed them, preferring that their ad- vantages should be lost rather than that those intrusted to his ADDRESS. 31 care should suffer from the great evils which they might inflict. In the midst of so much doubt and diversity of opinion, where shall the rational physician of to-day stand, untrammeled by the prejudices of a by-gone age, and stimulated to investiga- tion and progress by the great medical discoveries of the last half century ? For him there is a vantage ground between the two extremes, neither verging towards meddlesome inter- ference on the one hand, nor imbecile neglect on the other. Familiarized with the true nature of diseases, and recognising fully his own power, and (what is equally important) his own weakness, he will approach his duties with the knowledge most likely to aid him in the relief of suffering humanity. Such knowledge always begets power. Armed by this, and discarding all mystery, all deception, both of himself and others, he may, at some time, crown the efforts of a well-spent life, by the proud satisfaction, the undying glory, of increasing the resources of his God-like art. ■ :/M ,Uy COLUMBIA UNIVERSITY LIBRARY TMS „oo k is due on »fffi?£*£Z£2% SLSement with (heLitaamnjnjharge. C2B(2S»)M ,0 ° %?