MEDICAL ESSAYS

By Oliver Wendell Holmes

1842-1882

CONTENTS:

I. HOMEOPATHY AND ITS KINDRED DELUSIONS

II. THE CONTAGIOUSNESS OF PUERPERAL FEVER

III. CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE

IV. BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE

V. SCHOLASTIC AND BEDSIDE TEACHING

VI. THE MEDICAL PROFESSION IN MASSACHUSETTS

VII. THE YOUNG PRACTITIONER

VIII. MEDICAL LIBRARIES

IX. SOME OF MY EARLY TEACHERS

PREFACE. 

The character of the opposition which some of these papers have met withsuggests the inference that they contain really important, but unwelcometruths. Negatives multiplied into each other change their sign andbecome positives. Hostile criticisms meeting together are oftenequivalent to praise, and the square of fault-finding turns out to bethe 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 numbers of our negative constituency. The larger portion of my limited circle of readers must be quiteindifferent to, if not ignorant of, the adverse opinions which have beenexpressed or recorded concerning any of these Addresses or Essays nowsubmitted to their own judgment. It is proper, however, to informthem, that some of the positions maintained in these pages have beenunsparingly attacked, with various degrees of ability, scholarship, and good-breeding. The tone of criticism naturally changes with localconditions in different parts of a country extended like our own, sothat it is one of the most convenient gauges of the partial movements inthe direction of civilization. It is satisfactory to add, that the viewsassailed have also been unflinchingly defended by unsought champions, among the ablest of whom it is pleasant to mention, at this moment ofpolitical alienation, the Editor of the Charleston Medical Journal. 

"Currents and Counter-Currents" was written and delivered as an Oration, a florid rhetorical composition, expressly intended to secure theattention of an audience not easy to hold as listeners. It succeededin doing this, and also in being as curiously misunderstood andmisrepresented as if it had been a political harangue. This gave it morelocal notoriety than it might otherwise have attained, so that, as Ilearn, one ingenious person made use of its title as an advertisement toa production of his own. 

The commonest mode of misrepresentation was this: qualifiedpropositions, the whole meaning of which depended on the qualifications, were stripped of these and taken as absolute. Thus, the attempt toestablish a presumption against giving poisons to sick persons wasconsidered as equivalent to condemning the use of these substances. The only important inference the writer has been able to draw from thegreater number of the refutations of his opinions which have been kindlysent him, is that the preliminary education of the Medical Profession isnot always what it ought to be. 

One concession he is willing to make, whatever sacrifice of pride itmay involve. The story of Massasoit, which has furnished a coral, as itwere, for some teething critics, when subjected to a powerful logicalanalysis, though correct in its essentials, proves to have been toldwith exceptionable breadth of statement, and therefore (to resumethe metaphor) has been slightly rounded off at its edges, so as tobe smoother for any who may wish to bite upon it hereafter. Inother respects the Discourse has hardly been touched. It is only anindividual's expression, in his own way, of opinions entertained byhundreds of the Medical Profession in every civilized country, and hasnothing in it which on revision the writer sees cause to retract ormodify. The superstitions it attacks lie at the very foundation ofHomoeopathy, and of almost every form of medical charlatanism. Stillthe mere routinists and unthinking artisans in most callings dislikewhatever shakes the dust out of their traditions, and it may beunreasonable to expect that Medicine will always prove an exception tothe rule. One half the opposition which the numerical system of Louishas met with, as applied to the results of treatment, has been owingto the fact that it showed the movements of disease to be far moreindependent of the kind of practice pursued than was agreeable to thepride 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 construction upon it, which it was notintended to admit. Outside pressure is less felt in the physician's ownhousehold; that is all. If this does not sometimes influence him to givemedicine, or what seems to be medicine, when among those who have moreconfidence in drugging than his own family commonly has, the learnedProfessor Dunglison is hereby requested to apologize for his definitionof the word Placebo, or to expunge it from his Medical Dictionary. 

One thing is certain. A loud outcry on a slight touch reveals the weakspot in a profession, as well as in a patient. It is a doubtful policyto oppose the freest speech in those of our own number who are trying toshow us where they honestly believe our weakness lies. Vast as arethe advances of our Science and Art, may it not possibly prove onexamination that we retain other old barbarisms beside the use of theastrological sign of Jupiter, with which we endeavor to insure good luckto our prescriptions? Is it the act of a friend or a foe to try to pointthem out to our brethren when asked to address them, and is the speakerto 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 published nearly twentyyears ago, and has been long out of print, so that the author tried invain to procure a copy until the kindness of a friend supplied him withthe only one he has had for years. A foolish story reached his ears thathe 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 whatevernovelty they may have possessed. All its predictions have been submittedto the formidable test of time. They appear to have stood it, so far, about as well as most uninspired prophecies; indeed, some of themrequire much less accommodation than certain grave commentators employin their readings of the ancient Prophets. 

If some statistics recently published are correct, Homoeopathy has madevery slow progress in Europe. 

In all England, as it appears, there are hardly a fifth moreHomoeopathic practitioners than there are students attending Lectures atthe Massachusetts Medical College at the present time. In America it hasundoubtedly proved more popular and lucrative, yet how loose a hold ithas on the public confidence is shown by the fact that, when a speciallyvalued life, which has been played with by one of its agents, isseriously threatened, the first thing we expect to hear is that aregular practitioner is by the patient's bed, and the Homoeopathiccounsellor overruled or discarded. Again, how many of the ardent andcapricious persons who embraced Homoeopathy have run the whole round ofpretentious novelties;--have been boarded at water-cure establishments, closeted with uterine and other specialists, and finally wandered overseas to put themselves in charge of foreign celebrities, who dosed themas lustily as they were ever dosed before they took to globules! Itwill surprise many to learn to what a shadow of a shade Homoeopathyhas dwindled in the hands of many of its noted practitioners. Theitch-doctrine is treated with contempt. Infinitesimal doses are replacedby full ones whenever the fancy-practitioner chooses. Good Homoeopathicreasons can be found for employing anything that anybody wants toemploy. Homoeopathy is now merely a name, an unproved theory, and a boxof pellets pretending to be specifics, which, as all of us know, failignominiously in those cases where we would thankfully sacrifice all ourprejudices and give the world to have them true to their promises. 

Homoeopathy has not died out so rapidly as Tractoration. Perhaps it waswell that it should not, for it has taught us a lesson of the healingfaculty of Nature which was needed, and for which many of us have madeproper acknowledgments. But it probably does more harm than good tomedical science at the present time, by keeping up the delusion oftreating everything by specifics, --the old barbarous notion that sickpeople should feed on poisons [Lachesis, arrow-poison, obtained from aserpent (Pulte). Crotalus horridus, rattlesnake's venom (Neidhard). Theless dangerous Pediculus capitis is the favorite remedy of Dr. Mure, theEnglish "Apostle of Homoeopathy. " These are examples of the retrogradecurrent setting towards barbarism] against which a part of the Discourseat the beginning of this volume is directed. 

The infinitesimal globules have not become a curiosity as yet, likePerkins's Tractors. But time is a very elastic element in Geology andProphecy. 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 ortwo beyond our time, if necessary, when the prophecy will no doubt provetrue. 

It might be fitting to add a few words with regard to the Essay on theContagiousness of Puerperal Fever. But the whole question I considerto be now transferred from the domain of medical inquiry to theconsideration of Life Insurance agencies and Grand Juries. For thejustification of this somewhat sharply accented language I must referthe reader to the paper itself for details which I regret to have beenforced to place on permanent record. 

BOSTON, January, 1861. 

A SECOND PREFACE. 

These Lectures and Essays are arranged in the order corresponding tothe date of their delivery or publication. They must, of course, be readwith a constant reference to these dates, by such as care to readthem. I have not attempted to modernize their aspect or character inpresenting them, in this somewhat altered connection, to the public. Several of them were contained in a former volume which received itsname from the Address called "Currents and Counter-Currents. " Some ofthose contained in the former volume have been replaced by others. TheEssay called "Mechanism of Vital Actions" has been transferred to adistinct collection of Miscellaneous essays, forming a separate volume. 

I had some intention of including with these papers an Essay onIntermittent Fever in New England, which received one of the Boylstonprizes in 1837, and was published in the following year. But as thiswas upon a subject of local interest, chiefly, and would have taken up agood deal of room, I thought it best to leave it out, trusting thatthe stray copies to be met with in musty book-shops would sufficientlysupply the not very extensive or urgent demand for a paper almost half acentury old. 

Some of these papers created a little stir when they first fell fromthe press into the pool of public consciousness. They will slide in veryquietly now in this new edition, and find out for themselves whether thewaters are those of Lethe, or whether they are to live for a time as notwholly unvalued reminiscences. 

March 21, 1883. 

PREFACE TO THE NEW EDITION. 

These Essays are old enough now to go alone without staff or crutchin the shape of Prefaces. A very few words may be a convenience to thereader who takes up the book and wishes to know what he is likely tofind in it. 

 HOMOEOPATHY AND ITS KINDRED DELUSIONS. 

Homoeopathy has proved lucrative, and so long as it continues to be sowill surely exist, --as surely as astrology, palmistry, and other methodsof getting a living out of the weakness and credulity of mankind andwomankind. Though it has no pretensions to be considered as belongingamong the sciences, it may be looked upon by a scientific man as acurious object of study among the vagaries of the human mind. Itsinfluence for good or the contrary may be made a matter of calminvestigation. I have studied it in the Essay before the reader, underthe aspect of an extravagant and purely imaginative creation of itsfounder. Since that first essay was written, nearly half a century ago, we have all had a chance to witness its practical working. Two oppositeinferences may be drawn from its doctrines and practice. The first isthat which is accepted by its disciples. This is that all diseases are"cured" by drugs. The opposite conclusion is drawn by a much largernumber of persons. As they see that patients are very commonly gettingwell under treatment by infinitesimal drugging, which they considerequivalent to no medication at all, they come to disbelieve in everyform of drugging and put their whole trust in "nature. " Thus experience, "From seeming evil still educing good, "

has shown that the dealers in this preposterous system ofpseudo-therapeutics have cooperated with the wiser class ofpractitioners in breaking up the system of over-dosing and over-druggingwhich has been one of the standing reproaches of medical practice. Whilekeeping up the miserable delusion that diseases were all to be "cured"by drugging, Homoeopathy has been unintentionally showing that theywould very generally get well without any drugging at all. In the meantime the newer doctrines of the "mind cure, " the "faith cure, " and therest are encroaching on the territory so long monopolized by that mostingenious of the pseudo-sciences. It would not be surprising if itswhole ground should be taken possession of by these new claimants withtheir flattering appeals to the imaginative class of persons open tosuch attacks. Similia similabus may prove fatally true for once, ifHomoeopathy is killed out by its new-born rivals. 

It takes a very moderate amount of erudition to unearth a charlatanlike the supposed father of the infinitesimal dosing system. The realinventor of that specious trickery was an Irishman by the name ofButler. The whole story is to be found in the "Ortus Medicinm" of VanHelmont. I have given some account of his chapter "Butler" in differentarticles, but I would refer the students of our Homoeopathic educationalinstitutions to the original, which they will find very interesting andcurious. 

 CURRENTS AND COUNTER-CURRENTS

My attack on over-drugging brought out some hostile comments andtreatment. Thirty years ago I expressed myself with more vivacity thanI should show if I were writing on the same subjects today. Some ofmy more lively remarks called out very sharp animadversion. Thusmy illustration of prevention as often better than treatment in themother's words to her child which had got a poisonous berry in itsmouth, --"Spit it out!" gave mortal offence to a well-known New Yorkpractitioner and writer, who advised the Massachusetts Medical Societyto spit out the offending speaker. Worse than this was my statement ofmy belief that if a ship-load of miscellaneous drugs, with certainvery important exceptions, --drugs, many of which were then often givenneedlessly and in excess, as then used "could be sunk to the bottom ofthe sea, it would be all the better for mankind and all the worsefor the fishes. " This was too bad. The sentence was misquoted, quotedwithout its qualifying conditions, and frightened some of my worthyprofessional brethren as much as if I had told them to throw all physicto the dogs. But for the epigrammatic sting the sentiment would havebeen unnoticed as a harmless overstatement at the very worst. 

Since this lecture was delivered a great and, as I think, beneficialchange has taken place in the practice of medicine. The habit of theEnglish "general practitioner" of making his profit out of the pills andpotions he administered was ruinous to professional advancement and thedignity of the physician. When a half-starving medical man felt that hemust give his patient draught and boluses for which he could charge him, he was in a pitiable position and too likely to persuade himself thathis drugs were useful to his patient because they were profitableto him. This practice has prevailed a good deal in America, and wasdoubtless the source in some measure of the errors I combated. 

 THE CONTAGIOUSNESS OF PUERPERAL FEVER. 

This Essay was read before a small Association called "The Society forMedical Improvement, " and published in a Medical Journal which lastedbut a single year. It naturally attracted less attention than it wouldhave done if published in such a periodical as the "American Journal ofMedical Sciences. " Still it had its effect, as I have every reasonto believe. I cannot doubt that it has saved the lives of many youngmothers by calling attention to the existence and propagation of"Puerperal Fever as a Private Pestilence, " and laying down rules fortaking the necessary precautions against it. The case has long beendecided in favor of the views I advocated, but, at the time when I wrotetwo of the most celebrated professors of Obstetrics in this countryopposed my conclusions with all the weight of their experience andposition. 

This paper was written in a great heat and with passionate indignation. If I touched it at all I might trim its rhetorical exuberance, but Iprefer to leave it all its original strength of expression. I could not, if I had tried, have disguised the feelings with which I regarded theattempt to put out of sight the frightful facts which I brought forwardand the necessary conclusions to which they led. Of course the wholematter has been looked at in a new point of view since the microbe asa vehicle of contagion has been brought into light, and explained themechanism of that which was plain enough as a fact to all who were notblind or who did not shut their eyes. 

O. W. H. 

BEVERLY Farms, Mass. , August 3, 1891

HOMOEOPATHY AND ITS KINDRED DELUSIONS

[Two lectures delivered before the Boston Society for the Diffusion ofUseful Knowledge. 1842. ]

[When a physician attempts to convince a person, who has fallen into theHomoeopathic delusion, of the emptiness of its pretensions, he is oftenanswered by a statement of cases in which its practitioners are thoughtto have effected wonderful cures. The main object of the first of theseLectures is to show, by abundant facts, that such statements, made bypersons unacquainted with the fluctuations of disease and the fallaciesof observation, are to be considered in general as of little or no valuein establishing the truth of a medical doctrine or the utility of amethod of practice. 

Those kind friends who suggest to a person suffering from a tediouscomplaint, that he "Had better try Homoeopathy, " are apt to enforcetheir suggestion by adding, that "at any rate it can do no harm. " Thismay or may not be true as regards the individual. But it always doesvery great harm to the community to encourage ignorance, error, ordeception in a profession which deals with the life and health of ourfellow-creatures. Whether or not those who countenance Homoeopathy areguilty of this injustice towards others, the second of these Lecturesmay afford them some means of determining. 

To deny that good effects may happen from the observance of diet andregimen when prescribed by Homoeopathists as well as by others, would bevery unfair to them. But to suppose that men with minds so constitutedas to accept such statements and embrace such doctrines as make upthe so-called science of Homoeopathy are more competent than others toregulate the circumstances which influence the human body in health anddisease, would be judging very harshly the average capacity of ordinarypractitioners. 

To deny that some patients may have been actually benefited throughthe influence exerted upon their imaginations, would be to refuseto Homoeopathy what all are willing to concede to every one of thosenumerous modes of practice known to all intelligent persons by anopprobrious title. 

So long as the body is affected through the mind, no audacious device, even of the most manifestly dishonest character, can fail of producingoccasional good to those who yield it an implicit or even a partialfaith. The argument founded on this occasional good would be asapplicable in justifying the counterfeiter and giving circulation tohis base coin, on the ground that a spurious dollar had often relieved apoor man's necessities. 

Homoeopathy has come before our public at a period when the growingspirit of eclecticism has prepared many ingenious and honest minds tolisten to all new doctrines with a candor liable to degenerate intoweakness. It is not impossible that the pretended evolution of great andmysterious virtues from infinitely attenuated atoms may have enticed afew over-refining philosophers, who have slid into a vague beliefthat matter subdivided grows less material, and approaches nearer toa spiritual nature as it requires a more powerful microscope for itsdetection. 

However this may be, some persons seem disposed to take the ground ofMenzel that the Laity must pass formal judgment between the Physicianand the Homoeopathist, as it once did between Luther and the Romanists. The practitioner and the scholar must not, therefore, smile at theamount of time and labor expended in these Lectures upon this shadowysystem; which, in the calm and serious judgment of many of the wisestmembers of the medical profession, is not entitled by anything it hasever said or done to the notoriety of a public rebuke, still less to thehonors of critical martyrdom. ]

I

I have selected four topics for this lecture, the first three of which Ishall touch but slightly, the last more fully. They are

1. The Royal 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 Perkinism. 

The first two illustrate the ease with which numerous facts areaccumulated to prove the most fanciful and senseless extravagances. 

The third exhibits the entire insufficiency of exalted wisdom, immaculate honesty, and vast general acquirements to make a goodphysician of a great bishop. 

The fourth shows us the intimate machinery of an extinct delusion, whichflourished only forty years ago; drawn in all its details, as beinga rich and comparatively recent illustration of the pretensions, thearguments, the patronage, by means of which windy errors have long been, and will long continue to be, swollen into transient consequence. All display in superfluous abundance the boundless credulity andexcitability of mankind upon subjects connected with medicine. 

"From the time of Edward the Confessor to Queen Anne, the monarchs ofEngland were in the habit of touching those who were brought to themsuffering with the scrofula, for the cure of that distemper. Williamthe Third had good sense enough to discontinue the practice, but Anneresumed it, and, among her other patients, performed the royal operationupon a child, who, in spite of his, disease, grew up at last into SamuelJohnson. After laying his hand upon the sufferers, it was customary forthe monarch to hang a gold piece around the neck of each patient. Verystrict precautions were adopted to prevent those who thought more of thegolden angel hung round the neck by a white ribbon, than of relief oftheir bodily infirmities, from making too many calls, as they sometimesattempted to do. According to the statement of the advocates andcontemporaries of this remedy, none ever failed of receiving benefitunless their little faith and credulity starved their merits. Some aresaid to have been cured immediately on the very touch, others did notso easily get rid of their swellings, until they were touched a secondtime. Several cases are related, of persons who had been blind forseveral weeks, and months, and obliged even to be led to Whitehall, yetrecovered their sight immediately upon being touched, so as to walk awaywithout any guide. " So widely, at one period, was the belief diffused, that, in the course of twelve years, nearly a hundred thousand personswere touched by Charles the Second. Catholic divines; in disputes uponthe orthodoxy of their church, did not deny that the power had descendedto protestant princes;--Dr. Harpsfield, in his "Ecclesiastical Historyof England, " admitted it, and in Wiseman's words, "when Bishop Tookerwould make use of this Argument to prove the Truth of our Church, Smitheus doth not thereupon go about to deny the Matter of fact; nay, both he and Cope acknowledge it. " "I myself, " says Wiseman, the bestEnglish surgical writer of his day, [Edinburgh Medical and SurgicalJournal, vol. Iii. P. 103. ]--"I my self have been a frequent Eye-witnessof many hundred of Cures performed by his Majesties Touch alone, withoutany assistance of Chirurgery; and those, many of them such as had tiredout the endeavours of able Chirurgeons before they came hither. It wereendless to recite what I myself have seen, and what I have receivedacknowledgments of by Letter, not only from the severall parts of thisNation, but also from Ireland, Scotland, Jersey, Garnsey. It is needlessalso to remember what Miracles of this nature were performed by the veryBloud of his late Majesty of Blessed memory, after whose decollationby the inhuman Barbarity of the Regicides, the reliques of that weregathered on Chips and in Handkerchieffs by the pious Devotes, who couldnot but think so great a suffering in so honourable and pious a Cause, would be attended by an extraordinary assistance of God, and some morethen ordinary a miracle: nor did their Faith deceive them in this therepoint, being so many hundred that found the benefit of it. " [SeverallChirurgicall Treatises. London. 1676. P. 246. ]

Obstinate and incredulous men, as he tells us, accounted for these curesin three ways: by the journey and change of air the patients obtainedin coming to London; by the influence of imagination; and the wearing ofgold. 

To these objections he answers, 1st. That many of those cured wereinhabitants of the city. 2d. That the subjects of treatment werefrequently infants. 3d. That sometimes silver was given, and sometimesnothing, yet the patients were cured. 

A superstition resembling this probably exists at the present timein some ignorant districts of England and this country. A writer in aMedical Journal in the year 1807, speaks of a farmer in Devonshire, who, being a ninth son of a ninth son, is thought endowed with healing powerslike those of ancient royalty, and who is accustomed one day in everyweek to strike for the evil. 

I remember that one of my schoolmates told me, when a boy, of a seventhson of a seventh son, somewhere in Essex County, who touched for thescrofula, and who used to hang a silver fourpence halfpenny about theneck of those who came to him, which fourpence halfpenny it was solemnlyaffirmed became of a remarkably black color after having been some timeworn, and that his own brother had been subjected to this extraordinarytreatment; but I must add that my schoolmate drew a bow of remarkablelength, strength, and toughness for his tender years. 

One of the most curious examples of the fallacy of popular belief andthe uncertainty of asserted facts in medical experience is to be foundin the history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT. 

Fabricius Hildanus, whose name is familiar to every surgical scholar, and Lord Bacon, who frequently dipped a little into medicine, aremy principal authorities for the few circumstances I shall mentionregarding it. The Weapon Ointment was a preparation used for the healingof wounds, but instead of its being applied to them, the injuredpart was washed and bandaged, and the weapon with which the wound wasinflicted was carefully anointed with the unguent. Empirics, ignorantbarbers, and men of that sort, are said to have especially employed it. Still there were not wanting some among the more respectable members ofthe medical profession who supported its claims. The composition of thisointment was complicated, in the different formulae given by differentauthorities; but some substances addressed to the imagination, ratherthan 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 histime. He was fully aware that a part of the real secret of the UnguentumArmarium consisted in the washing and bandaging the wound and thenletting it alone. But he could not resist the solemn assertionsrespecting its efficacy; he gave way before the outcry of facts, andtherefore, instead of denying all their pretensions, he admitted andtried to account for them upon supernatural grounds. As the virtue ofthose applications, he says, which are made to the weapon cannotreach the wound, and as they can produce no effect without contact, itfollows, of necessity, that the Devil must have a hand in thebusiness; and as he is by far the most long headed and experienced ofpractitioners, he cannot find this a matter of any great difficulty. Hildanus himself reports, in detail, the case of a lady who had receiveda moderate wound, for which the Unguentum Armarium was employed withoutthe slightest use. Yet instead of receiving this flat case of failure asany evidence against the remedy, he accounts for its not succeedingby the devout character of the lady, and her freedom from thatsuperstitious and over-imaginative tendency which the Devil requires inthose who are to be benefited by his devices. 

Lord Bacon speaks of the Weapon Ointment, in his Natural History, ashaving in its favor the testimony of men of credit, though, in his ownlanguage, he himself "as yet is not fully inclined to believe it. " Hisremarks upon the asserted facts respecting it show a mixture of wisesuspicion and partial belief. He does not like the precise directionsgiven as to the circumstances under which the animals from which some ofthe materials were obtained were to be killed; for he thought it lookedlike a provision for an excuse in case of failure, by laying the faultto the omission of some of these circumstances. But he likes well that"they do not observe the confecting of the Ointment under any certainconstellation; which is commonly the excuse of magical medicines, whenthey fail, that they were not made under a fit figure of heaven. " [Thiswas a mistake, however, since the two recipes given by Hildanus are bothvery explicit as to the aspect of the heavens required for differentstages of the process. ] "It was pretended that if the offending weaponcould not be had, it would serve the purpose to anoint a wooden one madelike it. " "This, " says Bacon, "I should doubt to be a device to keepthis strange form of cure in request and use; because many times youcannot come by the weapon itself. " And in closing his remarks on thestatements of the advocates of the ointment, he says, "Lastly, itwill cure a beast as well as a man, which I like best of all therest, because it subjecteth the matter to an easy trial. " It is worthremembering, that more than two hundred years ago, when an absurd andfantastic remedy was asserted to possess wonderful power, and whensensible persons ascribed its pretended influence to imagination, it wasboldly answered that the cure took place when the wounded party did notknow of the application made to the weapon, and even when a brute animalwas the subject of the experiment, and that this assertion, as we allknow it was, came in such a shape as to shake the incredulity of thekeenest thinker of his time. The very same assertion has been sincerepeated in favor of Perkinism, and, since that, of Homoeopathy. 

The same essential idea as that of the Weapon Ointment reproduced itselfin the still more famous SYMPATHETIC POWDER. This Powder was said tohave the faculty, if applied to the blood-stained garments of a woundedperson, to cure his injuries, even though he were at a great distance atthe time. A friar, returning from the East, brought the recipe to Europesomewhat before the middle of the seventeenth century. The Grand Duke ofFlorence, in which city the friar was residing, heard of his cures, andtried, but without success, to obtain his secret. Sir Kenehn Digby, anEnglishman well known to fame, was fortunate enough to do him a favor, which wrought upon his feelings and induced him to impart to hisbenefactor the composition of his extraordinary Powder. This Englishknight was at different periods of his life an admiral, a theologian, acritic, a metaphysician, a politician, and a disciple of Alchemy. As isnot unfrequent with versatile and inflammable people, he caught fire atthe first spark of a new medical discovery, and no sooner got home toEngland than he began to spread the conflagration. 

An opportunity soon offered itself to try the powers of the famouspowder. Mr. J. Howell, having been wounded in endeavoring to part twoof his friends who were fighting a duel, submitted himself to a trialof the Sympathetic Powder. Four days after he received his wounds, SirKenehn dipped one of Mr. Howell's gaiters 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 thechamber, had not, the least idea of what was doing with his garter. Hethen returned home, leaving his garter in the hands of Sir Kenelm, whohad hung it up to dry, when Mr. Howell sent his servant in a great hurryto tell him that his wounds were paining him horribly; the garter wastherefore replaced in the solution of the Powder, "and the patient gotwell 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, werecognizant of this fact; and James himself, being curious to know thesecret of this remedy, asked it of Sir Kenelm, who revealed it to him, and his Majesty had the opportunity of making several trials of itsefficacy, "which all succeeded in a surprising manner. " [Dict. DesSciences Medieales. ]

The king's physician, Dr. Mayerne, was made master of the secret, which he carried to France and communicated to the Duke of Mayenne, whoperformed 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 whoseagency it soon ceased to be a secret. What was this wonderful substancewhich so astonished kings, princes, dukes, knights, and doctors? Nothingbut powdered blue vitriol. But it was made to undergo several processesthat conferred on it extraordinary virtues. Twice or thrice it was to bedissolved, filtered, and crystallized. The crystals were to be laid inthe sun during the months of June, July, and August, taking care toturn them carefully that all should be exposed. Then they were to bepowdered, triturated, and again exposed to the sun, again reduced to avery fine powder, and secured in a vessel, while hot, from the sunshine. If there seem anything remarkable in the fact of such astonishingproperties being developed by this process, it must be from ourshort-sightedness, for common salt and charcoal develop powers quite asmarvellous after a certain number of thumps, stirs, and shakes, from thehands of modern workers of miracles. In fact the Unguentum Armarium andSympathetic Powder resemble some more recent prescriptions; the latterconsisting in an infinite dilution of the common dose in which remediesare given, and the two former in an infinite dilution of the commondistance at which they are applied. 

Whether philosophers, and more especially metaphysicians, have anypeculiar tendency to dabble in drugs and dose themselves with physic, is a question which might suggest itself to the reader of theirbiographies. 

When Bishop Berkeley visited the illustrious Malebranche at Paris, he found him in his cell, cooking in a small pipkin a medicine for aninflammation of the lungs, from which he was suffering; and the disease, being unfortunately aggravated by the vehemence of their discussion, orthe contents of the pipkin, carried him off in the course of a few days. Berkeley himself afforded a remarkable illustration of a truth whichhas long been known to the members of one of the learned professions, namely, that no amount of talent, or of acquirements in otherdepartments, can rescue from lamentable folly those who, withoutsomething of the requisite preparation, undertake to experiment withnostrums upon themselves and their neighbors. The exalted character ofBerkeley 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. Allhis contemporaries agreed with the satirist in ascribing

 "'To Berkeley every virtue under heaven. '

"Even the discerning, fastidious, and turbulent Atterbury said, after aninterview with him, 'So much understanding, so much knowledge, so muchinnocence, and such humility, I did not think had been the portion ofany but angels, till I saw this gentleman. '"

But among the writings of this great and good man is an Essay of themost curious character, illustrating his weakness upon the point inquestion, and entitled, "Siris, a Chain of Philosophical Reflectionsand Inquiries concerning the Virtues of TAR WATER, and divers otherSubjects, "--an essay which begins with a recipe for his favorite fluid, and slides by gentle gradations into an examination of the sublimestdoctrines of Plato. To show how far a man of honesty and benevolence, and with a mind of singular acuteness and depth, may be run away with bya favorite notion on a subject which his habits and education do not fithim to investigate, I shall give a short account of this Essay, merelystating that as all the supposed virtues of Tar Water, made public insuccessive editions of his treatise by so illustrious an author, havenot saved it from neglect and disgrace, it may be fairly assumed thatthey were mainly imaginary. 

The bishop, as is usual in such cases, speaks of himself asindispensably obliged, by the duty he owes to mankind, to make hisexperience public. Now this was by no means evident, nor does it followin general, that because a man has formed a favorable opinion ofa person or a thing he has not the proper means of thoroughlyunderstanding, he shall be bound to print it, and thus give currencyto his impressions, which may be erroneous, and therefore injurious. He would have done much better to have laid his impressions before someexperienced physicians and surgeons, such as Dr. Mead and Mr. Cheselden, to have asked them to try his experiment over again, and have beenguided by their answers. But the good bishop got excited; he pleasedhimself with the thought that he had discovered a great panacea; andhaving once tasted the bewitching cup of self-quackery, like many beforeand since his time, he was so infatuated with the draught that he wouldinsist 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 quartof tar, leaving it forty-eight hours, and pouring off the clear water. Such was the specific which the great metaphysician recommended foraverting and curing all manner of diseases. It was, if he might bebelieved, a preventive of the small-pox, and of great use in the courseof the disease. It was a cure for impurities of the blood, coughs, pleurisy, peripneumony, erysipelas, asthma, indigestion, carchexia, hysterics, dropsy, mortification, scurvy, and hypochondria. It was ofgreat use in gout and fevers, and was an excellent preservative ofthe teeth and gums; answered all the purpose of Elixir Proprietatis, Stoughton's drops, diet drinks, and mineral waters; was particularly tobe recommended to sea-faring persons, ladies, and men of studious andsedentary lives; could never be taken too long, but, on the contrary, produced advantages which sometimes did not begin to show themselves fortwo or three months. 

"From my representing Tar Water as good for so many things, " saysBerkeley, "some perhaps may conclude it is good for nothing. But charityobligeth me to say what I know, and what I think, however it may betaken. Men may censure and object as they please, but I appeal to timeand experiment. Effects misimputed, cases wrong told, circumstancesoverlooked, perhaps, too, prejudices and partialities against truth, mayfor a time prevail and keep her at the bottom of her well, from whencenevertheless she emergeth sooner or later, and strikes the eyes ofall who do not keep them shut. " I cannot resist the temptation ofillustrating the bishop's belief in the wonderful powers of his remedy, by a few sentences from different parts of his essay. "The hardnessof stubbed vulgar constitutions renders them insensible of a thousandthings that fret and gall those delicate people, who, as if their skinwas peeled off, feel to the quick everything that touches them. Thetender nerves and low spirits of such poor creatures would be muchrelieved by the use of Tar Water, which might prolong and cheer theirlives. " "It [the Tar Water] may be made stronger for brute beasts, ashorses, in whose disorders I have found it very useful. " "This samewater will also give charitable relief to the ladies, who often want itmore than the parish poor; being many of them never able to make a goodmeal, and sitting pale, puny, and forbidden, like ghosts, at their owntable, victims of vapors and indigestion. " It does not appear among thevirtues of Tar Water that "children cried for it, " as for some of ourmodern remedies, but the bishop says, "I have known children take itfor above six months together with great benefit, and without anyinconvenience; and after long and repeated experience I do esteem ita most excellent diet drink, fitted to all seasons and ages. " Aftermentioning its usefulness in febrile complaints, he says: "I have hadall this confirmed by my own experience in the late sickly season of theyear one thousand seven hundred and forty-one, having had twenty-fivefevers in my own family cured by this medicinal water, drunk copiously. "And to finish these extracts with a most important suggestion for theimprovement of the British nation: "It is much to be lamented that ourInsulars who act and think so much for themselves, should yet, fromgrossness of air and diet, grow stupid or doat sooner than other people, who, by virtue of elastic air, water-drinking, and light food, preservetheir faculties to extreme old age; an advantage which may perhapsbe approached, if not equaled, 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 tostir up a quart of the panacea. He was an illustrious man, but he heldtwo very odd opinions; that tar water was everything, and that the wholematerial universe was nothing. 

 --------------------------

Most of those present have at some time in their lives heard mentionmade of the METALLIC TRACTORS, 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 ourown countrymen also, about forty years since, and called "TerribleTractoration. " The Metallic Tractors are now so utterly abandoned thatI have only by good fortune fallen upon a single one of a pair, to showfor the sake of illustration. For more than thirty years this greatdiscovery, which was to banish at least half the evils which afflicthumanity, has been sleeping undisturbed in the grave of oblivion. Not avoice has, for this long period, been raised in its favor; its noble andlearned patrons, its public institutions, its eloquent advocates, itsbrilliant promises are all covered with the dust of silent neglect;and of the generation which has sprung up since the period when itflourished, very few know anything of its history, and hardly eventhe title which in its palmy days it bore of PERKINISM. Taking it assettled, then, as no one appears to answer for it, that Perkinism isentirely dead and gone, that both in public and private, officiallyand individually, its former adherents even allow it to be absolutelydefunct, I select it for anatomical examination. If this pretendeddiscovery was made public; if it was long kept before the public; if itwas addressed to the people of different countries; if it was formallyinvestigated by scientific men, and systematically adopted by benevolentpersons, who did everything in their power to diffuse the knowledgeand practice of it; if various collateral motives, such as interestand vanity, were embarked in its cause; if, notwithstanding all thesethings, it gradually sickened and died, then the conclusion seems a fairone, that it did not deserve to live. Contrasting its failure withits high pretensions, it is fair to call it an imposition; whetheran expressly fraudulent contrivance or not, some might be ready toquestion. Everything historically shown to have happened concerning themode of promulgation, the wide diffusion, the apparent success of thisdelusion, the respectability and enthusiasm of its advocates, isof great interest in showing to what extent and by what means aconsiderable part of the community may be led into the belief of thatwhich is to be eventually considered' as an idle folly. If there is anyexisting folly, fraudulent or innocent in its origin, which appeals tocertain arguments for its support; provided that the very same argumentscan be shown to have been used for Perkinism with as good reason, theywill at once fall to the ground. Still more, if it shall appear that thegeneral course of any existing delusion bears a strong resemblance tothat of Perkinism, that the former is most frequently advocated by thesame class of persons who were conspicuous in behalf of the latter, andtreated with contempt or opposed by the same kind of persons who thustreated Perkinism; if the facts in favor of both have a similar aspect;if the motives of their originators and propagators may be presumedto have been similar; then there is every reason to suppose that theexisting folly will follow in the footsteps of the past, and afterdisplaying a given amount of cunning and credulity in those deceivingand deceived, will drop from the public view like a fruit which hasripened into spontaneous rottenness, and be succeeded by the fresh bloomof some other delusion required by the same excitable portion of thecommunity. 

Dr. Elisha Perkins was born at Norwich, Connecticut, in the year 1740. He had practised his profession with a good local reputation for manyyears, when he fell upon a course of experiments, as it is related, which led to his great discovery. He conceived the idea that metallicsubstances might have the effect of removing diseases, if applied ina certain manner; a notion probably suggested by the then recentexperiments of Galvani, in which muscular contractions were found to beproduced by the contact of two metals with the living fibre. It was in1796 that his discovery was promulgated in the shape of the MetallicTractors, 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 of different complaints, such as rheumatism, local pains, inflammations, and even tumors, bydrawing them over the affected part very lightly for about twentyminutes. Dr. Perkins took out a patent for his discovery, and travelledabout the country to diffuse the new practice. He soon found numerousadvocates of his discovery, many of them of high standing and influence. In the year 1798 the tractors had crossed the Atlantic, and werepublicly employed in the Royal Hospital at Copenhagen. About the sametime the son of the inventor, Mr. Benjamin Douglass Perkins, carriedthem to London, where they soon attracted attention. The Danishphysicians published an account of their cases, containing numerousinstances of alleged success, in a respectable octavo volume. In theyear 1804 an establishment, honored with the name of the PerkineanInstitution, was founded in London. The transactions of this institutionwere published in pamphlets, the Perkinean Society had public dinnersat the Crown and Anchor, and a poet celebrated their medical triumph instrains like these:

 "See, pointed metals, blest 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. Benjamin Douglass Perkins wascalmly pocketing money, so that after some half a dozen years he leftthe country with more than ten thousand pounds, which had been paid himby the believers in Great Britain. But in spite of all this success, andthe number of those interested and committed in its behalf, Perkinismsoon began to decline, and in 1811 the Tractors are spoken of by anintelligent writer as being almost forgotten. Such was the origin andduration of this doctrine and practice, into the history of which wewill now look a little more narrowly. 

Let us see, then, by whose agency this delusion was established and keptup; whether it was principally by those who were accustomed to medicalpursuits, or those whose habits and modes of reasoning were different;whether it was with the approbation of those learned bodies usuallysupposed to take an interest in scientific discoveries, or only ofindividuals whose claims to distinction were founded upon their positionin society, or political station, or literary eminence; whether thejudicious or excitable classes entered most deeply into it; whether, inshort, the scientific men of that time were deceived, or only intrudedupon, and shouted down for the moment by persons who had no particularcall to invade their precincts. 

Not much, perhaps, was to be expected of the Medical Profession in theway of encouragement. One Dr. Fuller, who wrote in England, himselfa Perkinist, thus expressed his opinion: "It must be an extraordinaryexertion of virtue and humanity for a medical man, whose livelihooddepends either on the sale of drugs, or on receiving a guinea forwriting a prescription, which must relate to those drugs, to say tohis patient, 'You had better purchase a set of Tractors to keep in yourfamily; they will cure you without the expense of my attendance, or thedanger of the common medical practice. ' For very obvious reasons medicalmen must never be expected to recommend the use of Perkinism. TheTractors must trust for their patronage to the enlightened andphilanthropic out of the profession, or to medical men retired frompractice, and who know of no other interest than the luxury of relievingthe distressed. And I do not despair of seeing the day when but very fewof this description as well as private families will be without them. "

Whether the motives assigned by this medical man to his professionalbrethren existed or not, it is true that Dr. Perkins did not gain agreat deal at their hands. The Connecticut Medical Society expelled himin 1797 for violating their law against the use of nostrums, or secretremedies. The leading English physicians appear to have looked on withsingular apathy or contempt at the miracles which it was pretended wereenacting in the hands of the apostles of the new practice. In lookingover the reviews of the time, I have found little beyond briefoccasional notices of their pretensions; the columns of these journalsbeing occupied with subjects of more permanent interest. The state ofthings in London is best learned, however, from the satirical poemto which I have already alluded as having been written at the periodreferred to. This was entitled, "Terrible Tractoration!! A PoeticalPetition against Galvanizing Trumpery and the Perkinistic Institution. Most respectfully addressed to the Royal College of Physicians, byChristopher Caustic, M. D. , LL. D. , A. S. S. , Fellow of the RoyalCollege of Physicians, Aberdeen, and Honorary Member of no less thannineteen very learned Societies. " Two editions of this work werepublished in London in the years 1803 and 1804, and one or two have beenpublished in this country. 

"Terrible Tractoration" is supposed, by those who never read it, to bea satire upon the follies of Perkins and his followers. It is, on thecontrary, a most zealous defence of Perkinism, and a fierce attack uponits opponents, most especially upon such of the medical professionas treated the subject with neglect or ridicule. The Royal College ofPhysicians was the more peculiar object of the attack, but with thisbody, the editors of some of the leading periodicals, and severalphysicians distinguished at that time, and even now remembered fortheir services to science and humanity, were involved in unsparingdenunciations. The work is by no means of the simply humorous characterit might be supposed, but is overloaded with notes of the most seriouslypolemical nature. Much of the history of the subject, indeed, is to belooked for in this volume. 

It appears from this work that the principal members of the medicalprofession, so far from hailing Mr. Benjamin Douglass Perkins as anotherHarvey or Jenner, looked very coldly upon him and his Tractors; and itis now evident that, though they were much abused for so doing, theyknew very well what they had to deal with, and were altogether in theright. The delusion at last attracted such an amount of attention as toinduce Dr. Haygarth and some others of respectable standing to institutesome experiments which I shall mention in their proper place, the resultof which might have seemed sufficient to show the emptiness of the wholecontrivance. 

The Royal Society, that learned body which for ages has constitutedthe best tribunal to which Britain can appeal in questions of science, accepted Mr. Perkins's Tractors and the book written about them, passedthe customary vote of thanks, and never thought of troubling itselffurther in the investigation of pretensions of such an aspect. It isnot to be denied that a considerable number of physicians did avowthemselves advocates of the new practice; but out of the whole catalogueof those who were publicly proclaimed as such, no one has ever beenknown, so far as I am aware, to the scientific world, except inconnection with the short-lived notoriety of Perkinism. Who werethe people, then, to whose activity, influence, or standing withthe community was owing all the temporary excitement produced by theMetallic Tractors?

First, those persons who had been induced to purchase a pair ofTractors. These little bits of brass and iron, the intrinsic value ofwhich might, perhaps, amount to ninepence, were sold at five guineas apair! A man who has paid twenty-five dollars for his whistle is apt toblow it louder and longer than other people. So it appeared that whenthe "Perkinean Society" applied to the possessors of Tractors in themetropolis to concur in the establishment of a public institution forthe use of these instruments upon the poor, "it was found that only fiveout of above a hundred objected to subscribe, on account of their wantof confidence in the efficacy of the practice; and these, " the committeeobserves, "there is reason to believe, never gave them a fair trial, probably never used them in more than one case, and that perhaps acase in which the Tractors had never been recommended as serviceable. ""Purchasers of the Tractors, " said one of their ardent advocates, "wouldbe among the last to approve of them if they had reason to supposethemselves defrauded of five guineas. " He forgot poor Moses, with his"gross of green spectacles, with silver rims and shagreen cases. " "Dearmother, " cried the boy, "why won't you listen to reason? I had them adead bargain, or I should not have bought them. The silver rims alonewill sell for double the money. "

But it is an undeniable fact, that many persons of considerablestanding, and in some instances holding the most elevated positions insociety, openly patronized the new practice. In a translation of a workentitled "Experiments with the Metallic Tractors, " originally publishedin Danish, thence rendered successively into German and English, Mr. Benjamin Perkins, who edited the English edition, has given a copiousenumeration of the distinguished individuals, both in America andEurope, whose patronage he enjoyed. He goes so far as to signify thatROYALTY itself was to be included among the number. When the PerkineanInstitution was founded, no less a person than Lord Rivers was electedPresident, and eleven other individuals of distinction, among themGovernor Franklin, son of Dr. Franklin, figured as Vice-Presidents. LordHenniker, a member of the Royal Society, who is spoken of as a manof judgment and talents, condescended to patronize the astonishingdiscovery, and at different times bought three pairs of Tractors. Whenthe Tractors were introduced into Europe, a large number of testimonialsaccompanied them from various distinguished characters in America, thelist of whom is given in the translation of the Danish work referred toas follows:

"Those who have individually stated cases, or who have presented theirnames to the public as men who approved of this remedy, and acknowledgedthemselves instrumental in circulating the Tractors, are fifty-six innumber; thirty-four of whom are physicians and surgeons, and many ofthem of the first eminence, thirteen clergymen, most of whom are doctorsof divinity, and connected with the literary institutions of America;among the remainder are two members of Congress, one professor ofnatural philosophy in a college, etc. , etc. " It seemed to be takenrather hardly by Mr. Perkins that the translators of the work which heedited, 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 pamphletpublished in America, in which these titles were given in full. Thusone of these testimonials is from "John Tyler, Esq. , a magistrate in thecounty of New London, and late Brigadier-General of the militia inthat State. " The "omission of the General's title" is the subject ofcomplaint, as if this title were sufficient evidence of the commandingpowers of one of the patrons of tractoration. A similar complaint ismade when "Calvin Goddard, Esq. , of Plainfield, Attorney at Law, anda member of the Legislature of the State of Connecticut, " is mentionedwithout his titular honors, and even on account of the omission of theproper official titles belonging to "Nathan Pierce, Esq. , Governor andManager of the Almshouse of Newburyport. " These instances show the greatimportance to be attached to civil and military dignities, in qualifyingtheir holders to judge of scientific subjects, a truth which has notbeen overlooked by the legitimate successors of the Perkinists. In GreatBritain, the Tractors were not less honored than in America, by thelearned and the illustrious. The "Perkinistic Committee" made thisstatement in their report: "Mr. Perkins has annually laid before thepublic a large collection of new cases communicated to him for thatpurpose by disinterested and intelligent characters, from almost everyquarter of Great Britain. In regard to the competency of these vouchers, it will be sufficient simply to state that, amongst others whose nameshave been attached to their communications, are eight professors, infour different universities, twenty-one regular Physicians, nineteenSurgeons, thirty Clergymen, twelve of whom are Doctors of Divinity, andnumerous other characters of equal respectability. "

It cannot but excite our notice and surprise that the number ofclergymen both in America and Great Britain who thrust forward theirevidence on this medical topic was singularly large in proportionto that of the members of the medical profession. Whole pages arecontributed by such worthies as the Rev. Dr. Trotter of Hans Place, the Rear. Waring Willett, Chaplain to the Earl of Dunmore, the Rev. Dr. Clarke, Chaplain to the Prince of Wales. The style of thesetheologico-medical communications may be seen in the following from adivine who was also professor in one of the colleges of New England. "I have used the Tractors with success in several other cases in myown family, and although, like Naaman the Syrian, I cannot tell whythe waters of Jordan should be better than Abana and Pharpar, riversof Damascus; yet since experience has proved them so, no reasoningcan change the opinion. Indeed, the causes of all common facts are, wethink, perfectly well known to us; and it is very probable, fifty ora hundred years hence, we shall as well know why the Metallic Tractorsshould in a few minutes remove violent pains, as we now know whycantharides and opium will produce opposite effects, namely, we shallknow very little about either excepting facts. " Fifty or a hundred yearshence! if he could have looked forward forty years, he would haveseen the descendants of the "Perkinistic" philosophers swallowinginfinitesimal globules, and knowing and caring as much about theTractors as the people at Saratoga Springs do about the waters of Abanaand Pharpar. 

I trust it will not be thought in any degree disrespectful to aprofession which we all honor, that I have mentioned the great zealof many clergymen in the cause of Perkinism. I hope, too, that I maywithout offence suggest the causes which have often led them out oftheir own province into one to which their education has no specialreference. The members of that profession ought to be, and commonly are, persons of benevolent character. Their duties carry them into the midstof families, and particularly at times when the members of them aresuffering from bodily illness. It is natural enough that a strong desireshould be excited to alleviate sufferings which may have defiedthe efforts of professional skill; as natural that any remedy whichrecommends itself to the belief or the fancy of the spiritual physicianshould be applied with the hope of benefit; and perfectly certain thatthe weakness of human nature, from which no profession is exempt, will lead him to take the most flattering view of its effects upon thepatient; his own sagacity and judgment being staked upon the success ofthe trial. The inventor of the Tractors was aware of these truths. Hetherefore sent the Tractors gratuitously to many clergymen, accompaniedwith a formal certificate that the holder had become entitled to theirpossession by the payment of five guineas. This was practised in ourown neighborhood, and I remember finding one of these certificates, so presented, which proved that amongst the risks of infancy I had toencounter Perkins's Tractors. Two clergymen of Boston and the vicinity, both well known to local fame, gave in their testimony to the valueof the instruments thus presented to them; an unusually moderateproportion, when it is remembered that to the common motives of whichI have spoken was added the seduction of a gift for which the profanepublic was expected to pay so largely. 

It was remarkable, also, that Perkinism, which had so little successwith the medical and scientific part of the community, found great favorin the eyes of its more lovely and less obstinate portion. "The lady ofMajor Oxholin, "--I quote from Mr. Perkins's volume, --"having been latelyin America, had seen and heard much of the great effects of Perkinism. Influenced by a most benevolent disposition, she brought these Tractorsand the pamphlet with her to Europe, with a laudable desire of extendingtheir utility to her suffering countrymen. " Such was the channel bywhich the Tractors were conveyed to Denmark, where they soon became theruling passion. The workmen, says a French writer, could not manufacturethem fast enough. Women carried them about their persons, and delightedin bringing them into general use. To what extent the Tractors werefavored with the patronage of English and American ladies, it is ofcourse not easy to say, except on general principles, as their nameswere not brought before the public. But one of Dr. Haygarth's storiesmay lead us to conjecture that there was a class of female practitionerswho went about doing good with the Tractors in England as well as inDenmark. A certain lady had the misfortune to have a spot as big as asilver penny at the corner of her eye, caused by a bruise, or some suchinjury. Another lady, who was a friend of hers, and a strong believer inPerkinism, was very anxious to try the effects of tractoration uponthis unfortunate blemish. The patient consented; the lady "produced theinstruments, and, after drawing them four or five times over the spot, declared that it changed to a paler color, and on repeating the use ofthem a few minutes longer, that it had almost vanished, and was scarcelyvisible, and departed in high triumph at her success. " The lady whounderwent the operation assured the narrator "that she looked in theglass immediately after, and that not the least visible alteration hadtaken place. "

It would be a very interesting question, what was the intellectualcharacter of those persons most conspicuous in behalf of the Perkinisticdelusion? Such an inquiry might bring to light some principles whichwe could hereafter apply to the study of other popular errors. But theobscurity into which nearly all these enthusiasts have subsided rendersthe question easier to ask than to answer. I believe it would havebeen found that most of these persons were of ardent temperament andof considerable imagination, and that their history would showthat Perkinism was not the first nor the last hobby-horse they rodefuriously. Many of them may very probably have been persons of more thancommon talent, of active and ingenious minds, of versatile powers andvarious acquirements. Such, for instance, was the estimable man to whomI have repeatedly referred as a warm defender of tractoration, anda bitter assailant of its enemies. The story tells itself in thebiographical preface to his poem. He went to London with the viewof introducing a hydraulic machine, which he and his Vermont friendsregarded as a very important invention. He found, however, that themachine was already in common use in that metropolis. A brother Yankee, then in London, had started the project of a mill, which was to becarried by the water of the Thames. He was sanguine enough to purchaseone fifth of this concern, which also proved a failure. At about thesame period he wrote the work which proved the great excitement of hismind upon the subject of the transient folly then before the public. Originally a lawyer, he was in succession a mechanician, a poet, and aneditor, meeting with far less success in each of these departmentsthan usually attends men of less varied gifts, but of more tranquil andphlegmatic composition. But who is ignorant that there is a class ofminds characterized by qualities like those I have mentioned; minds withmany bright and even beautiful traits; but aimless and fickle as thebutterfly; that settle upon every gayly-colored illusion as it opensinto flower, and flutter away to another when the first has dropped itsleaves, and stands naked in the icy air of truth!

Let us now look at the general tenor of the arguments addressed bybelievers to sceptics and opponents. Foremost of all, emblazoned at thehead of every column, loudest shouted by every triumphant disputant, held up as paramount to all other considerations, stretched like animpenetrable shield to protect the weakest advocate of the great causeagainst the weapons of the adversary, was that omnipotent monosyllablewhich has been the patrimony of cheats and the currency of dupes fromtime immemorial, --Facts! Facts! Facts! First came the published casesof the American clergymen, brigadier-generals, almshouse governors, representatives, attorneys, and esquires. Then came the publishedcases of the surgeons of Copenhagen. Then followed reports of aboutone hundred and fifty cases published in England, "demonstrating theefficacy of the metallic practice in a variety of complaints both uponthe human body and on horses, etc. " But the progress of facts in GreatBritain did not stop here. Let those who rely upon the numbers of theirtestimonials, as being alone sufficient to prove the soundness andstability of a medical novelty, digest the following from the reportof the Perkinistic Committee. "The cases published [in Great Britain]amounted, in March last, the date of Mr. Perkins's last publication, to about five thousand. Supposing that not more than one cure in threehundred which the Tractors have performed has been published, and theproportion is probably much greater, it will be seen that the number, toMarch last, will have exceeded one million five hundred thousand!"

Next in order after the appeal to what were called facts, came a seriesof arguments, which have been so long bruised and battered round in thecause of every doctrine or pretension, new, monstrous, or deliriouslyimpossible, that each of them is as odiously familiar to the scientificscholar as the faces of so many old acquaintances, among the lessreputable classes, to the officers of police. 

No doubt many of my hearers will recognize, in the following passages, arguments they may have heard brought forward with triumphant confidencein behalf of some doctrine not yet extinct. No doubt some may havehonestly thought they proved something; may have used them with thepurpose of convincing their friends, or of silencing the opponentsof their favorite doctrine, whatever that might be. But any trainof arguments which was contrived for Perkinism, which was just asapplicable to it as to any other new doctrine in the same branch ofscience, and which was fully employed against its adversaries fortyyears since, might, in common charity, be suffered to slumber in thegrave of Perkinism. Whether or not the following sentences, takenliterally from the work of Mr. Perkins, were the originals of some ofthe idle propositions we hear bandied about from time to time, let thosewho listen judge. 

The following is the test assumed for the new practice: "If diseases arereally removed, as those persons who have practised extensively withthe Tractors declare, it should seem there would be but little doubtof their being generally adopted; but if the numerous reports of theirefficacy which have been published are forgeries, or are unfounded, the practice ought to be crushed. " To this I merely add, it has beencrushed. 

The following sentence applies to that a priori judging and uncandidclass of individuals who buy their dinners without tasting all thefood there is in the market. "On all discoveries there are persons who, without descending to any inquiry into the truth, pretend to know, as itwere by intuition, that newly asserted facts are founded in thegrossest errors. These were those who knew that Harvey's report of thecirculation of the blood was a preposterous and ridiculous suggestion, and in latter later days there were others who knew that Franklindeserved reproach for declaring that points were preferable to balls forprotecting buildings from lightning. "

Again: "This unwarrantable mode of offering assertion for proof, sounauthorized and even unprecedented except in the condemnation ofa Galileo, the persecution of a Copernicus, and a few other acts ofinquisitorial authority, in the times of ignorance and superstition, affords but a lamentable instance of one of his remarks, that this isfar from being the Age of Reason. "

"The most valuable medicines in the Materia Medica act on principles ofwhich we are totally ignorant. None have ever yet been able to explainhow opium produces sleep, or how bark cures intermittent fevers; and yetfew, it is hoped, will be so absurd as to desist from the use of theseimportant articles because they know nothing of the principle of theiroperations. " Or if the argument is preferred, in the eloquent languageof the Perkinistic poet:

 "What though the CAUSES may not be explained, Since these EFFECTS are duly ascertained, Let not self-interest, prejudice, or pride, Induce mankind to set the means aside; Means which, though simple, are by Heaven designed to alleviate the woes of human kind. "

This course of argument is so often employed, that it deserves to beexpanded a little, so that its length and breadth may be fairly seen. A series of what are called facts is brought forward to prove some veryimprobable doctrine. It is objected by judicious people, or such as havedevoted themselves to analogous subjects, that these assumed facts arein direct opposition to all that is known of the course of nature, thatthe universal experience of the past affords a powerful presumptionagainst their truth, and that in proportion to the gravity of theseobjections, should be the number and competence of the witnesses. Theanswer is a ready one. What do we know of the mysteries of Nature? Dowe understand the intricate machinery of the Universe? When to this isadded the never-failing quotation, "There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy, "--

the question is thought to be finally disposed of. 

Take the case of astrology as an example. It is in itself strange andincredible that the relations of the heavenly bodies to each other at agiven moment of time, perhaps half a century ago, should have anythingto do with my success or misfortune in any undertaking of to-day. But what right have I to say it cannot be so? Can I bind the sweetinfluences of Pleiades, or loose the bands of Orion? I do not know bywhat mighty magic the planets roll in their fluid paths, confined tocircles as unchanging as if they were rings of steel, nor why the greatwave of ocean follows in a sleepless round upon the skirts of moonlight;nor cam I say from any certain knowledge that the phases of the heavenlybodies, or even the falling of the leaves of the forest, or the mannerin which the sands lie upon the sea-shore, may not be knit up byinvisible threads with the web of human destiny. There is a classof minds much more ready to believe that which is at first sightincredible, and because it is incredible, than what is generally thoughtreasonable. Credo quia impossibile est, --"I believe, because it isimpossible, "--is an old paradoxical expression which might be literallyapplied to this tribe of persons. And they always succeed in findingsomething marvellous, to call out the exercise of their robust faith. The old Cabalistic teachers maintained that there was not a verse, line, word, or even letter in the Bible which had not a special efficacyeither to defend the person who rightly employed it, or to injure hisenemies; always provided the original Hebrew was made use of. In thehands of modern Cabalists every substance, no matter how inert, acquireswonderful medicinal virtues, provided it be used in a proper state ofpurity and subdivision. 

I have already mentioned the motives attributed by the Perkinists to theMedical Profession, as preventing its members from receiving the newbut unwelcome truths. This accusation is repeated in different forms andplaces, as, for instance, in the following passage: "Will the medicalman who has spent much money and labor in the pursuit of the arcanaof Physic, and on the exercise of which depends his support in life, proclaim the inefficacy of his art, and recommend a remedy tohis patient which the most unlettered in society can employ asadvantageously as himself? and a remedy, too, which, unlike the drops, the pills, the powders, etc. , of the Materia Medica, is inconsumable, and ever in readiness to be employed in successive diseases?"

As usual with these people, much indignation was expressed at anyparallel between their particular doctrine and practice and those oftheir exploded predecessors. "The motives, " says the disinterestedMr. Perkins, "which must have impelled to this attempt at classing theMETALLIC PRACTICE with the most paltry of empyrical projects, are buttoo thinly veiled to escape detection. "

To all these arguments was added, as a matter of course, an appeal tothe feelings of the benevolent in behalf of suffering humanity, in theshape of a notice that the poor would be treated gratis. It is prettywell understood that this gratuitous treatment of the poor does notnecessarily imply an excess of benevolence, any more than the gratuitousdistribution of a trader's shop-bills is an evidence of remarkablegenerosity; in short, that it is one of those things which honest menoften do from the best motives, but which rogues and impostors neverfail to announce as one of their special recommendations. It isastonishing to see how these things brighten up at the touch of Mr. Perkins's poet:

 "Ye worthy, honored, philanthropic few, The muse shall weave her brightest wreaths for you, Who in Humanity's bland cause unite, Nor heed the shaft by interest aimed or spite; Like the great Pattern of Benevolence, Hygeia's blessings to the poor dispense; And though opposed by folly's servile brood, ENJOY THE LUXURY OF DOING GOOD. "

Having thus sketched the history of Perkinism in its days of prosperity;having seen how it sprung into being, and by what means it maintainedits influence, it only remains to tell the brief story of itsdiscomfiture and final downfall. The vast majority of the sensible partof the medical profession were contented, so far as we can judge, tolet it die out of itself. It was in vain that the advocates of thisinvaluable discovery exclaimed over their perverse and interestedobstinacy, --in vain that they called up the injured ghosts of Harvey, Galileo, and Copernicus to shame that unbelieving generation; theBaillies and the Heberdens, --men whose names have come down to usas synonymous with honor and wisdom, --bore their reproaches in meeksilence, and left them unanswered to their fate. There were some others, however, who, believing the public to labor under a delusion, thought itworth while to see whether the charm would be broken by an open trial ofits virtue, as compared with that of some less hallowed formula. Itmust be remembered that a peculiar value was attached to the MetallicTractors, as made and patented by Mr. Perkins. Dr. Haygarth, of Bath, performed various experiments upon patients afflicted with differentcomplaints, --the patients supposing that the real five-guinea Tractorswere employed. Strange to relate, he obtained equally wonderful effectswith Tractors of lead and of wood; with nails, pieces of bone, slatepencil, and tobacco-pipe. Dr. Alderson employed sham Tractors made ofwood, and produced such effects upon five patients that they returnedsolemn thanks in church for their cures. A single specimen of thesecases may stand for all of them. Ann Hill had suffered for some monthsfrom pain in the right arm and shoulder. The Tractors (wooden ones) wereapplied, and in the space of five minutes she expressed herself relievedin the following apostrophe: "Bless me! why, who could have thought it, that them little things could pull the pain from one. Well, to be sure, the longer one lives, the more one sees; ah, dear!"

These experiments did not result in the immediate extinction ofPerkinism. Doubtless they were a great comfort to many obstinateunbelievers, and helped to settle some sceptical minds; but for the realPerkinistic enthusiasts, it may be questioned whether they would at thattime have changed their opinion though one had risen from the dead toassure them that it was an error. It perished without violence, by aneasy and natural process. Like the famous toy of Mongolfier, it rose bymeans of heated air, --the fevered breath of enthusiastic ignorance, --andwhen this grew cool, as it always does in a little while, it collapsedand fell. 

And now, on reviewing the whole subject, how shall we account for theextraordinary prevalence of the belief in Perkinism among a portion ofwhat is supposed to be the thinking part of the community?

Could the cures have been real ones, produced by the principle of ANIMALMAGNETISM? To this it may be answered that the Perkinists ridiculed theidea of approximating Mesmer and the founder of their own doctrine, thatnothing like the somnambulic condition seems to have followed the use ofthe Tractors, and that neither the exertion of the will nor the powersof the individual who operated seem to have been considered of anyconsequence. Besides, the absolute neglect into which the Tractors soondeclined is good evidence that they were incapable of affording anyconsiderable and permanent relief in the complaints for the cure ofwhich they were applied. 

Of course a large number of apparent cures were due solely to nature;which is true under every form of treatment, orthodox or empirical. Of course many persons experienced at least temporary relief from thestrong impression made upon their minds by this novel and marvellousmethod of treatment. 

Many, again, influenced by the sanguine hopes of those about them, likedying people, who often say sincerely, from day to day, that they aregetting better, cheated themselves into a false and short-lived beliefthat they were cured; and as happens in such cases, the public neverknew more than the first half of the story. 

When it was said to the Perkinists, that whatever effects they producedwere merely through the imagination, they declared (like the advocatesof the ROYAL TOUCH and the UNGUENTUM ARMARIUM) that this explanationwas sufficiently disproved by the fact of numerous and successful cureswhich had been witnessed in infants and brute animals. Dr. Haygarthreplied to this, that "in these cases it is not the Patient, but theObserver, who is deceived by his own imagination, " and that such may bethe fact, we have seen in the case of the good lady who thought she hadconjured away the spot from her friend's countenance, when it remainedjust as before. 

As to the motives of the inventor and vender of the Tractors, the factsmust be allowed to speak for themselves. But when two little bits ofbrass and iron are patented, as an invention, as the result of numerousexperiments, when people are led, or even allowed, to infer that theyare a peculiar compound, when they are artfully associated with a newand brilliant discovery (which then happened to be Galvanism), when theyare sold at many hundred times their value, and the seller prints hisopinion that a Hospital will suffer inconvenience, "unless it possessesmany sets of the Tractors, and these placed in the hands of the patientsto practise on each other, " one cannot but suspect that they werecontrived in the neighborhood of a wooden nutmeg factory; that legs ofham in that region are not made of the best mahogany; and that such asbuy their cucumber seed in that vicinity have to wait for the fruit aslong as the Indians for their crop of gunpowder. 

 --------------------------

The succeeding lecture will be devoted to an examination of thedoctrines of Samuel Hahnemann and his disciples; doctrines which someconsider new and others old; the common title of which is variouslyknown as Ho-moeopathy, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy, andthe claims of which are considered by some as infinitely important, andby many as immeasurably ridiculous. 

I wish to state, for the sake of any who may be interested in thesubject, that I shall treat it, not by ridicule, but by argument;perhaps with great freedom, but with good temper and in peaceablelanguage; with very little hope of reclaiming converts, with no desireof making enemies, but with a firm belief that its pretensions andassertions cannot stand before a single hour of calm investigation. 

II. 

It may be thought that a direct attack upon the pretensions ofHOMOEOPATHY is an uncalled-for aggression upon an unoffending doctrineand its peaceful advocates. 

But a little inquiry will show that it has long assumed so hostile aposition with respect to the Medical Profession, that any trouble I, orany other member of that profession, may choose to bestow upon it may beconsidered merely as a matter of self-defence. It began with an attemptto show the insignificance of all existing medical knowledge. It notonly laid claim to wonderful powers of its own, but it declared thecommon practice to be attended with the most positively injuriouseffects, that by it acute diseases are aggravated, and chronic diseasesrendered incurable. It has at various times brought forward collectionsof figures having the air of statistical documents, pretending to showa great proportional mortality among the patients of the MedicalProfession, as compared with those treated according to its own rules. Not contented with choosing a name of classical origin for itself, itinvented one for the whole community of innocent physicians, assuringthem, to their great surprise, that they were all ALLOPATHISTS, whetherthey knew it or not, and including all the illustrious masters of thepast, from Hippocrates down to Hunter, under the same gratuitous title. The line, then, has been drawn by the champions of the new doctrine;they have lifted the lance, they have sounded the charge, and areresponsible for any little skirmishing which may happen. 

But, independently of any such grounds of active resistance, the subjectinvolves interests so disproportioned to its intrinsic claims, that itis no more than an act of humanity to give it a public examination. Ifthe new doctrine is not truth, it is a dangerous, a deadly error. If itis a mere illusion, and acquires the same degree of influence that wehave often seen obtained by other illusions, there is not one of myaudience who may not have occasion to deplore the fatal credulity whichlistened to its promises. 

I shall therefore undertake a sober examination of its principles, itsfacts, and some points of its history. The limited time at my disposalrequires me to condense as much as possible what I have to say, butI shall endeavor to be plain and direct in expressing it. Not onestatement shall be made which cannot be supported by unimpeachablereference: not one word shall be uttered which I am not as willing toprint as to speak. I have no quibbles to utter, and I shall stoopto answer none; but, with full faith in the sufficiency of a plainstatement of facts and reasons, I submit the subject to the discernmentof my audience. 

The question may be asked in the outset, --Have you submitted thedoctrines you are professing to examine to the test of long-repeated andcareful experiment; have you tried to see whether they were true or not?To this I answer, that it is abundantly evident, from what has oftenhappened, that it would be of no manner of use for me to allege theresults of any experiments I might have instituted. Again and again havethe most explicit statements been made by the most competent persons ofthe utter failure of all their trials, and there were the same abundantexplanations offered as used to be for the Unguentum Armarium and theMetallic Tractors. I could by no possibility perform any experimentsthe result of which could not be easily explained away so as to be of noconclusive significance. Besides, as arguments in favor of Homoeopathyare constantly addressed to the public in journals, pamphlets, and evenlectures, by inexperienced dilettanti, the same channel must be open toall its opponents. 

It is necessary, for the sake of those to whom the whole subject maybe new, to give in the smallest possible compass the substance ofthe Homoeopathic Doctrine. Samuel Hahnemann, its founder, is a Germanphysician, now living in Paris, [Hahnemann died in 1843. ] at the age ofeighty-seven years. In 1796 he published the first paper containing hispeculiar notions; in 1805 his first work on the subject; in 1810 hissomewhat famous "Organon of the Healing Art;" the next year whathe called the "Pure Materia Medica;" and in 1828 his last work, the"Treatise on Chronic Diseases. " He has therefore been writing atintervals on his favorite subject for nearly half a century. 

The one great doctrine which constitutes the basis of Homoeopathy as asystem is expressed by the Latin aphorism, "SIMILIA SIBILIBUS CURANTUR, "

or like cures like, that is, diseases are cured by agents capableof producing symptoms resembling those found in the disease undertreatment. A disease for Hahnemann consists essentially in a groupof symptoms. The proper medicine for any disease is the one which iscapable of producing a similar group of symptoms when given to a healthyperson. 

It is of course necessary to know what are the trains of symptomsexcited by different substances, when administered to persons in health, if any such can be shown to exist. Hahnemann and his disciples givecatalogues of the symptoms which they affirm were produced uponthemselves or others by a large number of drugs which they submitted toexperiment. 

The second great fact which Hahnemann professes to have established isthe efficacy of medicinal substances reduced to a wonderful degree ofminuteness or dilution. The following account of his mode of preparinghis medicines is from his work on Chronic Diseases, which has not, Ibelieve, yet been translated into English. A grain of the substance, if it is solid, a drop if it is liquid, is to be added to about a thirdpart of one hundred grains of sugar of milk in an unglazed porcelaincapsule which has had the polish removed from the lower part of itscavity by rubbing it with wet sand; they are to be mingled for aninstant with a bone or horn spatula, and then rubbed together for sixminutes; then the mass is to be scraped together from the mortar andpestle, which is to take four minutes; then to be again rubbed for sixminutes. Four minutes are then to be devoted to scraping the powder intoa heap, and the second third of the hundred grains of sugar of milkto be added. Then they are to be stirred an instant and rubbed sixminutes, --again to be scraped together four minutes and forcibly rubbedsix; once more scraped together for four minutes, when the last thirdof the hundred grains of sugar of milk is to be added and mingled bystirring with the spatula; six minutes of forcible rubbing, four ofscraping together, and six more (positively the last six) of rubbing, finish this part of the process. 

Every grain of this powder contains the hundredth of a grain of themedicinal substance mingled with the sugar of milk. If, therefore, agrain of the powder just prepared is mingled with another hundred grainsof sugar of milk, and the process just described repeated, we shall havea powder of which every grain contains the hundredth of the hundredth, or the ten thousandth part of a grain of the medicinal substance. Repeatthe same process with the same quantity of fresh sugar of milk, andevery grain of your powder will contain the millionth of a grain of themedicinal substance. When the powder is of this strength, it is readyto employ in the further solutions and dilutions to be made use of inpractice. 

A grain of the powder is to be taken, a hundred drops of alcohol areto be poured on it, the vial is to be slowly turned for a few minutes, until the powder is dissolved, and two shakes are to be given to it. Onthis point I will quote Hahnemann's own words. "A long experience andmultiplied observations upon the sick lead me within the last fewyears to prefer giving only two shakes to medicinal liquids, whereas Iformerly used to give ten. " The process of dilution is carried on inthe same way as the attenuation of the powder was done; each successivedilution with alcohol reducing the medicine to a hundredth part of thequantity of that which preceded it. In this way the dilution of theoriginal millionth of a grain of medicine contained in the grain ofpowder operated on is carried successively to the billionth, trillionth, quadrillionth, quintillionth, and very often much higher fractionaldivisions. A dose of any of these medicines is a minute fraction of adrop, obtained by moistening with them one or more little globules ofsugar, of which Hahnemann says it takes about two hundred to weigh agrain. 

As an instance of the strength of the medicines prescribed by Hahnemann, I will mention carbonate of lime. He does not employ common chalk, butprefers a little portion of the friable part of an oystershell. Of thissubstance, carried to the sextillionth degree, so much as one or twoglobules of the size mentioned can convey is a common dose. But forpersons of very delicate nerves it is proper that the dilution shouldbe carried to the decillionth degree. That is, an important medicinaleffect is to be expected from the two hundredth or hundredth part ofthe millionth of the millionth of the millionth of the millionth ofthe millionth of the millionth of the millionth of the millionth of themillionth of the millionth of a grain of oyster-shell. This is onlythe tenth degree of potency, but some of his disciples profess to haveobtained palpable effects from "much higher dilutions. "

The third great doctrine of Hahnemann is the following. Seven eighthsat least of all chronic diseases are produced by the existence in thesystem of that infectious disorder known in the language of scienceby the appellation of PSORA, but to the less refined portion of thecommunity by the name of ITCH. In the words of Hahnemann's "Organon, ""This Psora is the sole true and fundamental cause that produces allthe other countless forms of disease, which, under the names of nervousdebility, hysteria, hypochondriasis, insanity, melancholy, idiocy, madness, epilepsy, and spasms of all kinds, softening of the bones, or rickets, scoliosis and cyphosis, caries, cancer, fungua haematodes, gout, --yellow jaundice and cyanosis, dropsy, --"

["The degrees of DILUTION must not be confounded with those of POTENCY. Their relations may be seen by this table:

lst dilution, --One hundredth of a drop or grain. 

2d " One ten thousandth. 

3d " One millionth, marked I. 

4th " One hundred millionth. 

5th " One ten thousand millionth. 

6th " One million millionth, or one billionth, marked II. 

7th " One hundred billionth. 

8th " One ten thousand billionth. 

9th " One million billionth, or one trillionth, marked III. 

10th " One hundred trillionth. 

11th " One ten thousand trillionth. 

12th " One million trillionth, or one quadrillionth, marked IV. , --and so on indefinitely. 

The large figures denote the degrees of POTENCY. ]

"gastralgia, epistaxis, haemoptysis, --asthma and suppuration of thelungs, --megrim, deafness, cataract and amaurosis, --paralysis, loss ofsense, pains of every kind, etc. , appear in our pathology as so manypeculiar, distinct, and independent diseases. "

For the last three centuries, if the same authority may be trusted, under the influence of the more refined personal habits which haveprevailed, and the application of various external remedies which repelthe affection from the skin; Psora has revealed itself in these numerousforms of internal disease, instead of appearing, as in former periods, under the aspect of an external malady. 

These are the three cardinal doctrines of Hahnemann, as laid down inthose standard works of Homoeopathy, the "Organon" and the "Treatise onChronic Diseases. "

Several other principles may be added, upon all of which he insists withgreat force, and which are very generally received by his disciples. 

1. Very little power is allowed to the curative efforts of nature. Hahnemann goes so far as to say that no one has ever seen the simpleefforts of nature effect the durable recovery of a patient from achronic disease. In general, the Homoeopathist calls every recoverywhich happens under his treatment a cure. 

2. Every medicinal substance must be administered in a state of themost perfect purity, and uncombined with any other. The union of severalremedies in a single prescription destroys its utility, and, accordingto the "Organon, " frequently adds a new disease. 

3. A large number of substances commonly thought to be inert developgreat medicinal powers when prepared in the manner already described;and a great proportion of them are ascertained to have specificantidotes in case their excessive effects require to be neutralized. 

4. Diseases should be recognized, as far as possible, not by any of thecommon names imposed upon them, as fever or epilepsy, but as individualcollections of symptoms, each of which differs from every othercollection. 

5. The symptoms of any complaint must be described with the mostminute exactness, and so far as possible in the patient's own words. Toillustrate the kind of circumstances the patient is expected to record, I will mention one or two from the 313th page of the "Treatise onChronic Diseases, "--being the first one at which I opened accidentally. 

"After dinner, disposition to sleep; the patient winks. "

"After dinner, prostration and feeling of weakness (nine days aftertaking the remedy). "

This remedy was that same oyster-shell which is to be prescribed"fractions of the sextillionth or decillionth degree. " According toHahnemann, the action of a single dose of the size mentioned does notfully display itself in some cases until twenty-four or even thirtydays after it is taken, and in such instances has not exhausted its goodeffects until towards the fortieth or fiftieth day, --before which timeit would be absurd and injurious to administer a new remedy. 

So much for the doctrines of Hahnemann, which have been stated withoutcomment, or exaggeration of any of their features, very much as anyadherent of his opinions might have stated them, if obliged to compressthem into so narrow a space. 

Does Hahnemann himself represent Homoeopathy as it now exists? Hecertainly ought to be its best representative, after having created it, and devoted his life to it for half a century. He is spoken of as thegreat physician of the time, in most, if not all Homoeopathic works. Ifhe is not authority on the subject of his own doctrines, who is? So faras I am aware, not one tangible discovery in the so-called science hasever been ascribed to any other observer; at least, no general principleor law, of consequence enough to claim any prominence in Homoeopathicworks, has ever been pretended to have originated with any of hisillustrious disciples. He is one of the only two Homoeopathic writerswith whom, as I shall mention, the Paris publisher will have anything todo upon his own account. The other is Jahr, whose Manual is little morethan a catalogue of symptoms and remedies. If any persons choose toreject Hahnemann as not in the main representing Homoeopathy, if theystrike at his authority, if they wink out of sight his deliberate andformally announced results, it is an act of suicidal rashness; for uponhis sagacity and powers of observation, and experience, as embodied inhis works, and especially in his Materia Medica, repose the foundationsof Homoeopathy as a practical system. 

So far as I can learn from the conflicting statements made upon thesubject, the following is the present condition of belief. 

1. All of any note agree that the law Similia similibus is the onlyfundamental principle in medicine. Of course if any man does not agreeto this the name Homoeopathist can no longer be applied to him withpropriety. 

2. The belief in and employment of the infinitesimal doses is general, and in some places universal, among the advocates of Homoeopathy; but adistinct movement has been made in Germany to get rid of any restrictionto the use of these doses, and to employ medicines with the same licenseas other practitioners. 

3. The doctrine of the origin of most chronic diseases in Psora, notwithstanding Hahnemann says it cost him twelve years of study andresearch to establish the fact and its practical consequences, hasmet with great neglect and even opposition from very many of his owndisciples. 

It is true, notwithstanding, that, throughout most of their writingswhich I have seen, there runs a prevailing tone of great deference toHahnemann's opinions, a constant reference to his authority, a generalagreement with the minor points of his belief, and a pretence ofharmonious union in a common faith. [Those who will take the troubleto look over Hull's Translation of Jahr's Manual may observe how littlecomparative space is given to remedies resting upon any other authoritythan that of Hahnemann. ]

Many persons, and most physicians and scientific men, would be satisfiedwith the statement of these doctrines, and examine them no further. They would consider it vastly more probable that any observer in sofallacious and difficult a field of inquiry as medicine had been ledinto error, or walked into it of his own accord, than that such numerousand extraordinary facts had really just come to light. They would feel aright to exercise the same obduracy towards them as the French Instituteis in the habit of displaying when memoirs or models are offered to itrelating to the squaring of the circle or perpetual motion; which it isthe rule to pass over without notice. They would feel as astronomers andnatural philosophers must have felt when, some half a dozen years ago, an unknown man came forward, and asked for an opportunity to demonstrateto Arago and his colleagues that the moon and planets were at a distanceof a little more than a hundred miles from the earth. And so they wouldnot even look into Homoeopathy, though all its advocates should exclaimin the words of Mr. Benjamin Douglass Perkins, vender of the MetallicTractors, that "On all discoveries there are persons who, withoutdescending to any inquiry into the truth, pretend to know, as it wereby intuition, that newly asserted facts are founded in the grossesterrors. " And they would lay their heads upon their pillows with aperfectly clear conscience, although they were assured that they werebehaving in the same way that people of old did towards Harvey, Galileo, and Copernicus, the identical great names which were invoked by Mr. Benjamin Douglass Perkins. 

But experience has shown that the character of these assertions isnot sufficient to deter many, from examining their claims to belief. I therefore lean but very slightly on the extravagance and extremeapparent singularity of their pretensions. I might have omitted them, but on the whole it seemed more just to the claims of my argumentto suggest the vast complication of improbabilities involved in thestatements enumerated. Every one must of course judge for himself as tothe weight of these objections, which are by no means brought forward asa proof of the extravagance of Homoeopathy, but simply as entitled toa brief consideration before the facts of the case are submitted to ourscrutiny. 

The three great asserted discoveries of Hahnemann are entirelyunconnected with and independent of each other. Were there any naturalrelation between them it would seem probable enough that the discoveryof the first would have led to that of the others. But assuming it to bea fact that diseases are cured by remedies capable of producing symptomslike their own, no manifest relation exists between this fact andthe next assertion, namely, the power of the infinitesimal doses. Andallowing both these to be true, neither has the remotest affinity tothe third new doctrine, that which declares seven eighths of all chronicdiseases to be owing to Psora. 

This want of any obvious relation between Hahnemann's three cardinaldoctrines appears to be self-evident upon inspection. But if, as isoften true with his disciples, they prefer the authority of one of theirown number, I will refer them to Dr. Trinks's paper on the present stateof Homoeopathy in Europe, with which, of course, they are familiar, ashis name is mentioned as one of the most prominent champions of theirfaith, in their American official organ. It would be a fact without aparallel in the history, not merely of medicine, but of science, thatthree such unconnected and astonishing discoveries, each of them acomplete revolution of all that ages of the most varied experience hadbeen taught to believe, should spring full formed from the brain of asingle individual. 

Let us look a moment at the first of his doctrines. Improbable thoughit may seem to some, there is no essential absurdity involved in theproposition that diseases yield to remedies capable of producing likesymptoms. There are, on the other hand, some analogies which lend adegree of plausibility to the statement. There are well-ascertainedfacts, known from the earliest periods of medicine, showing that, undercertain circumstances, the very medicine which, from its known effects, one would expect to aggravate the disease, may contribute to its relief. I may be permitted to allude, in the most general way, to the case inwhich the spontaneous efforts of an overtasked stomach are quieted bythe agency of a drug which that organ refuses to entertain upon anyterms. But that every cure ever performed by medicine should havebeen founded upon this principle, although without the knowledge of aphysician; that the Homoeopathic axiom is, as Hahnemann asserts, "thesole law of nature in therapeutics, " a law of which nothing more thana transient glimpse ever presented itself to the innumerable host ofmedical observers, is a dogma of such sweeping extent, and pregnantnovelty, that it demands a corresponding breadth and depth ofunquestionable facts to cover its vast pretensions. 

So much ridicule has been thrown upon the pretended powers of theminute doses that I shall only touch upon this point for the purpose ofconveying, by illustrations, some shadow of ideas far transcending thepowers of the imagination to realize. It must be remembered that thesecomparisons are not matters susceptible of dispute, being foundedon simple arithmetical computations, level to the capacity of anyintelligent schoolboy. A person who once wrote a very small pamphletmade some show of objecting to calculations of thus kind, on the groundthat the highest dilutions could easily be made with a few ounces ofalcohol. But he should have remembered that at every successive dilutionhe lays aside or throws away ninety-nine hundredths of the fluid onwhich he is operating, and that, although he begins with a drop, he onlyprepares a millionth, billionth, trillionth, and similar fractions ofit, all of which, added together, would constitute but a vastly minuteportion of the drop with which he began. But now let us suppose we takeone single drop of the Tincture of Camomile, and that the whole of thiswere to be carried through the common series of dilutions. 

A calculation nearly like the following was made by Dr. Panvini, and maybe readily followed in its essential particulars by any one who chooses. 

For the first dilution it would take 100 drops of alcohol. 

For the second dilution it would take 10;000 drops, or about a pint. 

For the third dilution it would take 100 pints. 

For the fourth dilution it would take 10, 000 pints, or more than 1, 000gallons, and so on to the ninth dilution, which would take ten billiongallons, which he computed would fill the basin of Lake Agnano, a bodyof water two miles in circumference. The twelfth dilution would ofcourse fill a million such lakes. By the time the seventeenth degree ofdilution should be reached, the alcohol required would equal in quantitythe waters of ten thousand Adriatic seas. Trifling errors must beexpected, but they are as likely to be on one side as the other, and anylittle matter like Lake Superior or the Caspian would be but a drop inthe bucket. 

Swallowers of globules, one of your little pellets, moistened inthe mingled waves of one million lakes of alcohol, each two miles incircumference, with which had been blended that one drop of Tinctureof Camomile, would be of precisely the strength recommended for thatmedicine in your favorite Jahr's Manual, "against the most sudden, frightful, and fatal diseases!" [In the French edition of 1834, theproper doses of the medicines are mentioned, and Camomile is markedIV. Why are the doses omitted in Hull's Translation, except in threeinstances out of the whole two hundred remedies, notwithstanding thepromise in the preface that "some remarks upon the doses used maybe found at the head of each medicine"? Possibly because it makesno difference whether they are employed in one Homoeopathic dose oranother; but then it is very singular that such precise directionswere formerly given in the same work, and that Hahnemann's "experience"should have led him to draw the nice distinctions we have seen in aformer part of this Lecture (p. 44). ]

And proceeding on the common data, I have just made a calculationwhich shows that this single drop of Tincture of Camomile, given in thequantity ordered by Jahr's Manual, would have supplied every individualof the whole human family, past and present, with more than five billiondoses each, the action of each dose lasting about four days. 

Yet this is given only at the quadrillionth, or fourth degree ofpotency, and various substances are frequently administered atthe decillionth or tenth degree, and occasionally at still higherattenuations with professed medicinal results. Is there not in this asgreat an exception to all the hitherto received laws of nature as in themiracle of the loaves and fishes? Ask this question of a Homoeopathist, and he will answer by referring to the effects produced by a very minuteportion of vaccine matter, or the extraordinary diffusion of odors. Butthe vaccine matter is one of those substances called morbid poisons, ofwhich it is a peculiar character to multiply themselves, when introducedinto the system, as a seed does in the soil. Therefore the hundredthpart of a grain of the vaccine matter, if no more than this is employed, soon increases in quantity, until, in the course of about a week, it isa grain or more, and can be removed in considerable drops. And what is avery curious illustration of Homoeopathy, it does not produce its most. Characteristic effects until it is already in sufficient quantitynot merely to be visible, but to be collected for further use. Thethoughtlessness which can allow an inference to be extended from aproduct of disease possessing this susceptibility of multiplication whenconveyed into the living body, to substances of inorganic origin, suchas silex or sulphur, would be capable of arguing that a pebble mayproduce a mountain, because an acorn can become a forest. 

As to the analogy to be found between the alleged action of theinfinitely attenuated doses, and the effects of some odorous substanceswhich possess the extraordinary power of diffusing their imponderableemanations through a very wide space, however it may be abused inargument, and rapidly as it evaporates on examination, it is not likethat just mentioned, wholly without meaning. The fact of the vastdiffusion of some odors, as that of musk or the rose, for instance, haslong been cited as the most remarkable illustration of the divisibilityof matter, and the nicety of the senses. And if this were compared withthe effects of a very minute dose of morphia on the whole system, or thesudden and fatal impression of a single drop of prussic acid, or, with what comes still nearer, the poisonous influence of an atmosphereimpregnated with invisible malaria, we should find in each of theseexamples an evidence of the degree to which nature, in some fewinstances, concentrates powerful qualities in minute or subtile forms ofmatter. But if a man comes to me with a pestle and mortar in his hand, and tells me that he will take a little speck of some substance whichnobody ever thought to have any smell at all, as, for instance, a grainof chalk or of charcoal, and that he will, after an hour or two ofrubbing and scraping, develop in a portion of it an odor which, if thewhole grain were used, would be capable of pervading an apartment, ahouse, a village, a province, an empire, nay, the entire atmosphere ofthis broad planet upon which we tread; and that from each of fifty orsixty substances he can in this way develop a distinct and hithertounknown odor: and if he tries to show that all this is rendered quitereasonable by the analogy of musk and roses, I shall certainly bejustified in considering him incapable of reasoning, and beyond thereach of my argument. What if, instead of this, he professes to developnew and wonderful medicinal powers from the same speck of chalk orcharcoal, in such proportions as would impregnate every pond, lake, river, sea, and ocean of our globe, and appeals to the same analogy infavor of the probability of his assertion. 

All this may be true, notwithstanding these considerations. But soextraordinary would be the fact, that a single atom of substances whicha child might swallow without harm by the teaspoonful could, by an easymechanical process, be made to develop such inconceivable powers, thatnothing but the strictest agreement of the most cautious experimenters, secured by every guaranty that they were honest and faithful, appealingto repeated experiments in public, with every precaution to guardagainst error, and with the most plain and peremptory results, shouldinduce us to lend any credence to such pretensions. 

The third doctrine, that Psora, the other name of which you remember, isthe cause of the great majority of chronic diseases, is a startlingone, to say the least. That an affection always recognized as avery unpleasant personal companion, but generally regarded as amere temporary incommodity, readily yielding to treatment in thoseunfortunate enough to suffer from it, and hardly known among thebetter classes of society, should be all at once found out by a Germanphysician to be the great scourge of mankind, the cause of theirseverest bodily and mental calamities, cancer and consumption, idiocyand madness, must excite our unqualified surprise. And when theoriginator of this singular truth ascribes, as in the page now openbefore me, the declining health of a disgraced courtier, the chronicmalady of a bereaved mother, even the melancholy of the love-sickand slighted maiden, to nothing more nor less than the insignificant, unseemly, and almost unmentionable ITCH, does it not seem as if thevery soil upon which we stand were dissolving into chaos, over theearthquake-heaving of discovery?

And when one man claims to have established these three independenttruths, which are about as remote from each other as the discoveryof the law of gravitation, the invention of printing, and that of themariner's compass, unless the facts in their favor are overwhelmingand unanimous, the question naturally arises, Is not this man deceivinghimself, or trying to deceive others?

I proceed to examine the proofs of the leading ideas of Hahnemann andhis school. 

In order to show the axiom, similia similibus curantur (or like is curedby like), to be the basis of the healing art, --"the sole law of naturein therapeutics, "--it is necessary, 1. That the symptoms produced by drugs in healthy persons should befaithfully studied and recorded. 

2. That drugs should be shown to be always capable of curing thosediseases most like their own symptoms. 

3. That remedies should be shown not to cure diseases when they do notproduce symptoms resembling those presented in these diseases. 

1. The effects of drugs upon healthy persons have been studied byHahnemann and his associates. Their results were made known in hisMateria Medica, a work in three large volumes in the French translation, published about eight years ago. The mode of experimentation appears tohave been, to take the substance on trial, either in common or minutedoses, and then to set down every little sensation, every littlemovement of mind or body, which occurred within many succeeding hoursor days, as being produced solely by the substance employed. When I haveenumerated some of the symptoms attributed to the power of the drugstaken, you will be able to judge how much value is to be ascribed to theassertions of such observers. 

The following list was taken literally from the Materia Medica ofHahnemann, by my friend M. Vernois, for whose accuracy I am willingto be responsible. He has given seven pages of these symptoms, notselected, but taken at hazard from the French translation of the work. Ishall be very brief in my citations. 

"After stooping some time, sense of painful weight about the head uponresuming the erect posture. "

"An itching, tickling sensation at the outer edge of the palm of theleft hand, which obliges the person to scratch. " The medicine wasacetate of lime, and as the action of the globule taken is said to lasttwenty-eight days, you may judge how many such symptoms as the lastmight be supposed to happen. 

Among the symptoms attributed to muriatic acid are these: a catarrh, sighing, pimples; "after having written a long time with the back alittle bent over, violent pain in the back and shoulder-blades, asif from a strain, "--"dreams which are not remembered, --disposition tomental dejection, --wakefulness before and after midnight. "

I might extend this catalogue almost indefinitely. I have not citedthese specimens with any view to exciting a sense of the ridiculous, which many others of those mentioned would not fail to do, but to showthat the common accidents of sensation, the little bodily inconveniencesto which all of us are subject, are seriously and systematicallyascribed to whatever medicine may have been exhibited, even in theminute doses I have mentioned, whole days or weeks previously. 

To these are added all the symptoms ever said by anybody, whetherdeserving confidence or not, as I shall hereafter illustrate, to beproduced by the substance in question. 

The effects of sixty-four medicinal substances, ascertained by oneor both of these methods, are enumerated in the Materia Medicaof Hahnemann, which may be considered as the basis of practicalHomoeopathy. In the Manual of Jahr, which is the common guide, so far asI know, of those who practise Homoeopathy in these regions, two hundredremedies are enumerated, many of which, however, have never beenemployed in practice. In at least one edition there were no means ofdistinguishing those which had been tried upon the sick from the others. It is true that marks have been added in the edition employed here, which serve to distinguish them; but what are we to think of a standardpractical author on Materia Medica, who at one time omits to designatethe proper doses of his remedies, and at another to let us have anymeans of knowing whether a remedy has ever been tried or not, whilehe is recommending its employment in the most critical and threateningdiseases?

I think that, from what I have shown of the character of Hahnemann'sexperiments, it would be a satisfaction to any candid inquirer toknow whether other persons, to whose assertions he could lookwith confidence, confirm these pretended facts. Now there are manyindividuals, long and well known to the scientific world, who have triedthese experiments upon healthy subjects, and utterly deny that theireffects have at all corresponded to Hahnemann's assertions. 

I will take, for instance, the statements of Andral (and I am notreferring to his well-known public experiments in his hospital) as tothe result of his own trials. This distinguished physician is Professorof Medicine in the School of Paris, and one of the most widely known andvalued authors upon practical and theoretical subjects the professioncan claim in any country. He is a man of great kindness of character, a most liberal eclectic by nature and habit, of unquestioned integrity, and is called, in the leading article of the first number of the"Homoepathic Examiner, " "an eminent and very enlightened allopathist. "Assisted by a number of other persons in good health, he experimentedon the effects of cinchona, aconite, sulphur, arnica, and the other mosthighly extolled remedies. His experiments lasted a year, and he statedpublicly to the Academy of Medicine that they never produced theslightest appearance of the symptoms attributed to them. The results ofa man like this, so extensively known as one of the most philosophicaland candid, as well as brilliant of instructors, and whose admirableabilities and signal liberality are generally conceded, ought to be ofgreat weight in deciding the question. 

M. Double, a well-known medical writer and a physician of high standingin Paris, had occasion so long ago as 1801, before he had heard ofHomoeopathy, to make experiments upon Cinchona, or Peruvian bark. He andseveral others took the drug in every kind of dose for four months, andthe fever it is pretended by Hahnemann to excite never was produced. 

M. Bonnet, President of the Royal Society of Medicine of Bordeaux, hadoccasion to observe many soldiers during the Peninsular War, who madeuse of Cinchona as a preservative against different diseases, but henever found it to produce the pretended paroxysms. 

If any objection were made to evidence of this kind, I would refer tothe express experiments on many of the Homoeopathic substances, whichwere given to healthy persons with every precaution as to diet andregimen, by M. Louis Fleury, without being followed by the slightest ofthe pretended consequences. And let me mention as a curious fact, thatthe same quantity of arsenic given to one animal in the common form ofthe unprepared powder, and to another after having been rubbed up intosix hundred globules, offered no particular difference of activity inthe two cases. 

This is a strange contradiction to the doctrine of the development ofwhat they call dynamic power, by means of friction and subdivision. 

In 1835 a public challenge was offered to the best known Homoeopathicphysician in Paris to select any ten substances asserted to produce themost striking effects; to prepare them himself; to choose one by lotwithout knowing which of them he had taken, and try it upon himself orany intelligent and devoted Homoeopathist, and, waiting his own time, to come forward and tell what substance had been employed. The challengewas at first accepted, but the acceptance retracted before the time oftrial arrived. 

From all this I think it fair to conclude that the catalogues ofsymptoms attributed in Homoeopathic works to the influence of variousdrugs upon healthy persons are not entitled to any confidence. 

2. It is necessary to show, in the next place, that medicinal substancesare always capable of curing diseases most like their own symptoms. For facts relating to this question we must look to two sources; therecorded experience of the medical profession in general, and theresults of trials made according to Homoeopathic principles, and capableof testing the truth of the doctrine. 

No person, that I am aware of, has ever denied that in some cases thereexists a resemblance between the effects of a remedy and the symptomsof diseases in which it is beneficial. This has been recognized, asHahnemann himself has shown, from the time of Hippocrates. But accordingto the records of the medical profession, as they have been hithertointerpreted, this is true of only a very small proportion of usefulremedies. Nor has it ever been considered as an established truth thatthe efficacy of even these few remedies was in any definite ratio totheir power of producing symptoms more or less like those they cured. 

Such was the state of opinion when Hahnemann came forward with theproposition that all the cases of successful treatment found in theworks of all preceding medical writers were to be ascribed solely to theoperation of the Homoeopathic principle, which had effected the cure, although without the physician's knowledge that this was the realsecret. And strange as it may seem, he was enabled to give such adegree of plausibility to this assertion, that any person not acquaintedsomewhat with medical literature, not quite familiar, I should rathersay, with the relative value of medical evidence, according to thesources whence it is derived, would be almost frightened into thebelief, at seeing the pages upon pages of Latin names he has summoned ashis witnesses. 

It has hitherto been customary, when examining the writings of authorsof preceding ages, upon subjects as to which they were less enlightenedthan ourselves, and which they were very liable to misrepresent, toexercise some little discretion; to discriminate, in some measure, between writers deserving confidence and those not entitled to it. Butthere is not the least appearance of any such delicacy on the part ofHahnemann. A large majority of the names of old authors he citesare wholly unknown to science. With some of them I have been longacquainted, and I know that their accounts of diseases are no more to betrusted than their contemporary Ambroise Pare's stories of mermen, and similar absurdities. But if my judgment is rejected, as beinga prejudiced one, I can refer to Cullen, who mentioned three ofHahnemann's authors in one sentence, as being "not necessarily badauthorities; but certainly such when they delivered very improbableevents;" and as this was said more than half a century ago, it could nothave had any reference to Hahnemann. But although not the slightestsign of discrimination is visible in his quotations, --although for hima handful of chaff from Schenck is all the same thing as a measure ofwheat from Morgagni, --there is a formidable display of authorities, andan abundant proof of ingenious researches to be found in each ofthe great works of Hahnemann with which I am familiar. [Some painfulsurmises might arise as to the erudition of Hahnemann's EnglishTranslator, who makes two individuals of "Zacutus, Lucitanus, " aswell as respecting that of the conductors of an American Homoeopathicperiodical, who suffer the name of the world-renowned Cardanus to bespelt Cardamus in at least three places, were not this gross ignoranceof course attributable only to the printer. ]

It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, hasproved many of Hahnemann's quotations from old authors to be adulterateand false. What particular instances he has pointed out I have no meansof learning. And it is probably wholly impossible on this side of theAtlantic, and even in most of the public libraries of Europe, tofind anything more than a small fraction of the innumerable obscurepublications which the neglect of grocers and trunkmakers has sparedto be ransacked by the all-devouring genius of Homoeopathy. I haveendeavored to verify such passages as my own library afforded me themeans of doing. For some I have looked in vain, for want, as I amwilling to believe, of more exact references. But this I am able toaffirm, that, out of the very small number which I have been able, totrace back to their original authors, I have found two to be wronglyquoted, one of them being a gross misrepresentation. 

The first is from the ancient Roman author, Caelius Aurelianus;the second from the venerable folio of Forestus. Hahnemann uses thefollowing expressions, --if he is not misrepresented in the EnglishTranslation of the 'Organon': "Asclepiades on one occasion cured aninflammation of the brain by administering a small quantity of wine. "After correcting the erroneous reference of the Translator, I can findno such case alluded to in the chapter. But Caelius Aurelianus mentionstwo modes of treatment employed by Asclepiades, into both of which theuse of wine entered, as being "in the highest degree irrational anddangerous. " [Caelius Aurel. De Morb. Acut. Et Chron. Lib. I. Cap. Xv. Not xvi. Amsterdam. Wetstein, 1755. ]

In speaking of the oil of anise-seed, Hahnemann says that Forestusobserved violent colic caused by its administration. But, as the authortells the story, a young man took, by the counsel of a surgeon, an acridand virulent medicine, the name of which is not given, which brought ona most cruel fit of the gripes and colic. After this another surgeon wascalled, who gave him oil of anise-seed and wine, "which increased hissuffering. " [Observ. Et Curat. Med. Lib. XXI obs. Xiii. Frankfort, 1614. ] Now if this was the Homoeopathic remedy, as Hahnemann pretends, it might be a fair question why the young man was not cured by it. Butit is a much graver question why a man who has shrewdness and learningenough to go so far after his facts, should think it right to treat themwith such astonishing negligence or such artful unfairness. 

Even if every word he had pretended to take from his old authoritieswere to be found in them, even if the authority of every one of theseauthors were beyond question, the looseness with which they are used toprove whatever Hahnemann chooses is beyond the bounds of credibility. Let me give one instance to illustrate the character of this man'smind. Hahnemann asserts, in a note annexed to the 110th paragraph ofthe "Organon, " that the smell of the rose will cause certain persons tofaint. And he says in the text that substances which produce peculiareffects of this nature on particular constitutions cure the samesymptoms in people in general. Then in another note to the sameparagraph he quotes the following fact from one of the last sources onewould have looked to for medical information, the Byzantine Historians. 

"It was by these means (i. E. Homoeopathically) that the Princess Eudosiawith rose-water restored a person who had fainted!"

Is it possible that a man who is guilty of such pedantic folly asthis, --a man who can see a confirmation of his doctrine in such arecovery as this, --a recovery which is happening every day, froma breath of air, a drop or two of water, untying a bonnet-string, loosening a stay-lace, and which can hardly help happening, whateveris done, --is it possible that a man, of whose pages, not here and thereone, but hundreds upon hundreds are loaded with such trivialities, isthe Newton, the Columbus, the Harvey of the nineteenth century!

The whole process of demonstration he employs is this. An experiment isinstituted with some drug upon one or more healthy persons. Everythingthat happens for a number of days or weeks is, as we have seen, setdown as an effect of the medicine. Old volumes are then ransackedpromiscuously, and every morbid sensation or change that anybody eversaid was produced by the drug in question is added to the list ofsymptoms. By one or both of these methods, each of the sixty-foursubstances enumerated by Hahnemann is shown to produce a very largenumber of symptoms, the lowest in his scale being ninety-seven, and thehighest fourteen hundred and ninety-one. And having made out thislist respecting any drug, a catalogue which, as you may observe in anyHomoeopathic manual, contains various symptoms belonging to every organof the body, what can be easier than to find alleged cures in everymedical author which can at once be attributed to the Homoeopathicprinciple; still more if the grave of extinguished credulity is calledupon to give up its dead bones as living witnesses; and worst of all, ifthe monuments of the past are to be mutilated in favor of "the sole lawof Nature in therapeutics"?

There are a few familiar facts of which great use has been made as anentering wedge for the Homoeopathic doctrine. They have been sufferedto pass current so long that it is time they should be nailed tothe counter, a little operation which I undertake, with perfectcheerfulness, to perform for them. 

The first is a supposed illustration of the Homoeopathic law found inthe precept given for the treatment of parts which have been frozen, byfriction with snow or similar means. But we deceive ourselves by names, if we suppose the frozen part to be treated by cold, and not by heat. The snow may even be actually warmer than the part to which it isapplied. But even if it were at the same temperature when applied, itnever did and never could do the least good to a frozen part, except asa mode of regulating the application of what? of heat. But the heat mustbe applied gradually, just as food must be given a little at a time tothose perishing with hunger. If the patient were brought into a warmroom, heat would be applied very rapidly, were not something interposedto prevent this, and allow its gradual admission. Snow or iced water isexactly what is wanted; it is not cold to the part; it is very possiblywarm, on the contrary, for these terms are relative, and if it does notmelt and let the heat in, or is not taken away, the part will remainfrozen up until doomsday. Now the treatment of a frozen limb by heat, inlarge or small quantities, is not Homoeopathy. 

The next supposed illustration of the Homoeopathic law is the allegedsuccessful management of burns, by holding them to the fire. This is apopular mode of treating those burns which are of too little consequenceto require any more efficacious remedy, and would inevitably get well ofthemselves, without any trouble being bestowed upon them. It producesa most acute pain in the part, which is followed by some loss ofsensibility, as happens with the eye after exposure to strong light, andthe ear after being subjected to very intense sounds. This is all itis capable of doing, and all further notions of its efficacy must beattributed merely to the vulgar love of paradox. If this example affordsany comfort to the Homoeopathist, it seems as cruel to deprive him ofit as it would be to convince the mistress of the smoke-jack or theflatiron that the fire does not literally "draw the fire out, " which isher hypothesis. 

But if it were true that frost-bites were cured by cold and burns byheat, it would be subversive, so far as it went, of the great principleof Homoeopathy. 

For you will remember that this principle is that Like cures Like, andnot that Same cures Same; that there is resemblance and not identitybetween the symptoms of the disease and those produced by the drug whichcures it, and none have been readier to insist upon this distinctionthan the Homoeopathists themselves. For if Same cures Same, then everypoison must be its own antidote, --which is neither a part of theirtheory nor their so-called experience. They have been asked oftenenough, why it was that arsenic could not cure the mischief whicharsenic had caused, and why the infectious cause of small-pox did notremedy the disease it had produced, and then they were ready enough tosee the distinction I have pointed out. O no! it was not the hair of thesame dog, but only of one very much like him!

A third instance in proof of the Homoeopathic law is sought for in theacknowledged efficacy of vaccination. And how does the law apply tothis? It is granted by the advocates of Homoeopathy that there is aresemblance between the effects of the vaccine virus on a person inhealth and the symptoms of small-pox. Therefore, according to the rule, the vaccine virus will cure the small-pox, which, as everybody knows, isentirely untrue. But it prevents small-pox, say the Homoeopathists. Yes, and so does small-pox prevent itself from ever happening again, and weknow just as much of the principle involved in the one case as in theother. For this is only one of a series of facts which we are whollyunable to explain. Small-pox, measles, scarlet-fever, hooping-cough, protect those who have them once from future attacks; but nettle-rashand catarrh and lung fever, each of which is just as Homoeopathic toitself as any one of the others, have no such preservative power. Weare obliged to accept the fact, unexplained, and we can do no more forvaccination than for the rest. 

I come now to the most directly practical point connected with thesubject, namely, --

What is the state of the evidence as to the efficacy of the properHomoeopathic treatment in the cure of diseases. 

As the treatment adopted by the Homoeopathists has been almostuniversally by means of the infinitesimal doses, the question of theirefficacy is thrown open, in common with that of the truth of theirfundamental axiom, as both are tested in practice. 

We must look for facts as to the actual working of Homoeopathy to threesources. 

1. The statements of the unprofessional public. 

2. The assertions of Homoeopathic practitioners. 

3. The results of trials by competent and honest physicians, not pledgedto the system. 

I think, after what we have seen of medical facts, as they arerepresented by incompetent persons, we are disposed to attribute littlevalue to all statements of wonderful cures, coming from those who havenever been accustomed to watch the caprices of disease, and have notcooled down their young enthusiasm by the habit of tranquil observation. Those who know nothing of the natural progress of a malady, of itsordinary duration, of its various modes of terminating, of its liabilityto accidental complications, of the signs which mark its insignificanceor severity, of what is to be expected of it when left to itself, of howmuch or how little is to be anticipated from remedies, those who knownothing or next to nothing of all these things, and who are in a greatstate of excitement from benevolence, sympathy, or zeal for a newmedical discovery, can hardly be expected to be sound judges of factswhich have misled so many sagacious men, who have spent their lives inthe daily study and observation of them. I believe that, after havingdrawn the portrait of defunct Perkinism, with its five thousand printedcures, and its million and a half computed ones, its miracles blazonedabout through America, Denmark, and England; after relating that fortyyears ago women carried the Tractors about in their pockets, and workmencould not make them fast enough for the public demand; and then showingyou, as a curiosity, a single one of these instruments, an odd one of apair, which I obtained only by a lucky accident, so utterly lost is thememory of all their wonderful achievements; I believe, after all this, Ineed not waste time in showing that medical accuracy is not to be lookedfor in the florid reports of benevolent associations, the assertionsof illustrious patrons, the lax effusions of daily journals, or theeffervescent gossip of the tea-table. 

Dr. Hering, whose name is somewhat familiar to the champions ofHomoeopathy, has said that "the new healing art is not to be judgedby its success in isolated cases only, but according to its success ingeneral, its innate truth, and the incontrovertible nature of its innateprinciples. "

We have seen something of "the incontrovertible nature of its innateprinciples, " and it seems probable, on the whole, that its success ingeneral must be made up of its success in isolated cases. Some attemptshave been made, however, to finish the whole matter by sweepingstatistical documents, which are intended to prove its triumphantsuccess over the common practice. 

It is well known to those who have had the good fortune to see the"Homoeopathic Examiner, " that this journal led off, in its first number, with a grand display of everything the newly imported doctrine had toshow for itself. It is well remarked, on the twenty-third page of thisarticle, that "the comparison of bills of mortality among an equalnumber of sick, treated by divers methods, is a most poor and lameway to get at conclusions touching principles of the healing art. " Inconfirmation of which, the author proceeds upon the twenty-fifth pageto prove the superiority of the Homoeopathic treatment of cholera, by precisely these very bills of mortality. Now, every intelligentphysician is aware that the poison of cholera differed so much in itsactivity at different times and, places, that it was next to impossibleto form any opinion as to the results of treatment, unless everyprecaution was taken to secure the most perfectly correspondingconditions in the patients treated, and hardly even then. Of course, then, a Russian Admiral, by the name of Mordvinov, backed by a numberof so-called physicians practising in Russian villages, is singularlycompetent to the task of settling the whole question of the utility ofthis or that kind of treatment; to prove that, if not more than eightand a half per cent. Of those attacked with the disease perished, therest owed their immunity to Hahnemann. I can remember when more thana hundred patients in a public institution were attacked with what, Idoubt not, many Homoeopathic physicians (to say nothing of Homoeopathicadmirals) would have called cholera, and not one of them died, thoughtreated in the common way, and it is my firm belief that, if such aresult had followed the administration of the omnipotent globules, itwould have been in the mouth of every adept in Europe, from Quin ofLondon to Spohr of Gandersheim. No longer ago than yesterday, in one ofthe most widely circulated papers of this city, there was published anassertion that the mortality in several Homoeopathic Hospitals wasnot quite five in a hundred, whereas, in what are called by the writerAllopathic Hospitals, it is said to be eleven in a hundred. An honestman should be ashamed of such an argumentum ad ignorantiam. Themortality of a hospital depends not merely on the treatment of thepatients, but on the class of diseases it is in the habit of receiving, on the place where it is, on the season, and many other circumstances. For instance, there are many hospitals in the great cities of Europethat receive few diseases of a nature to endanger life, and, on theother hand, there are others where dangerous diseases are accumulatedout of the common proportion. Thus, in the wards of Louis, at theHospital of La Pitie, a vast number of patients in the last stages ofconsumption were constantly entering, to swell the mortality of thathospital. It was because he was known to pay particular attention tothe diseases of the chest that patients laboring under those fatalaffections to an incurable extent were so constantly coming in upon him. It is always a miserable appeal to the thoughtlessness of the vulgar, toallege the naked fact of the less comparative mortality in the practiceof one hospital or of one physician than another, as an evidence of thesuperiority of their treatment. Other things being equal, it must alwaysbe expected that those institutions and individuals enjoying to thehighest degree the confidence of the community will lose the largestproportion of their patients; for the simple reason that they willnaturally be looked to by those suffering from the gravest classof diseases; that many, who know that they are affected with mortaldisease, will choose to die under their care or shelter, while thesubjects of trifling maladies, and merely troublesome symptoms, amusethemselves to any extent among the fancy practitioners. When, therefore, Dr. Mublenbein, as stated in the "Homoeopathic Examiner, " and quotedin yesterday's "Daily Advertiser, " asserts that the mortality amonghis patients is only one per cent. Since he has practised Homoeopathy, whereas it was six per cent. When he employed the common mode ofpractice, I am convinced by this, his own statement, that the citizensof Brunswick, whenever they are seriously sick, take good care not tosend for Dr. Muhlenbein!

It is evidently impossible that I should attempt, within the compass ofa single lecture, any detailed examination of the very numerous casesreported in the Homoeopathic Treatises and Journals. Having been in thehabit of receiving the French "Archives of Homoeopathic Medicine" untilthe premature decease of that Journal, I have had the opportunity ofbecoming acquainted somewhat with the style of these documents, andexperiencing whatever degree of conviction they were calculated toproduce. Although of course I do not wish any value to be assumed for myopinion, such as it is, I consider that you are entitled to hear it. Sofar, then, as I am acquainted with the general character of the casesreported by the Homoeopathic physicians, they would for the most partbe considered as wholly undeserving a place in any English, French, or American periodical of high standing, if, instead of favoring thedoctrine they were intended to support, they were brought forward toprove the efficacy of any common remedy administered by any commonpractitioner. There are occasional exceptions to this remark; but thegeneral truth of it is rendered probable by the fact that these casesare always, or almost always, written with the single object of showingthe efficacy of the medicine used, or the skill of the practitioner, andit is recognized as a general rule that such cases deserve very littleconfidence. Yet they may sound well enough, one at a time, to those whoare not fully aware of the fallacies of medical evidence. Let me statea case in illustration. Nobody doubts that some patients recover underevery form of practice. Probably all are willing to allow that alarge majority, for instance, ninety in a hundred, of such cases asa physician is called to in daily practice, would recover, sooner orlater, with more or less difficulty, provided nothing were done tointerfere seriously with the efforts of nature. 

Suppose, then, a physician who has a hundred patients prescribes toeach of them pills made of some entirely inert substance, as starch, for instance. Ninety of them get well, or if he chooses to use suchlanguage, he cures ninety of them. It is evident, according to thedoctrine of chances, that there must be a considerable number ofcoincidences between the relief of the patient and the administrationof the remedy. It is altogether probable that there will happen two orthree very striking coincidences out of the whole ninety cases, in whichit would seem evident that the medicine produced the relief, thoughit had, as we assumed, nothing to do with it. Now suppose that thephysician publishes these cases, will they not have a plausibleappearance of proving that which, as we granted at the outset, wasentirely false? Suppose that instead of pills of starch he employsmicroscopic sugarplums, with the five' million billion trillionthpart of a suspicion of aconite or pulsatilla, and then publishes hissuccessful cases, through the leaden lips of the press, or the livingones of his female acquaintances, --does that make the impression a lesserroneous one? But so it is that in Homoeopathic works and journals andgossip one can never, or next to never, find anything but successfulcases, which might do very well as a proof of superior skill, did it notprove as much for the swindling advertisers whose certificates disgraceso many of our newspapers. How long will it take mankind to learn thatwhile they listen to "the speaking hundreds and units, " who make theworld ring with the pretended triumphs they have witnessed, the "dumbmillions" of deluded and injured victims are paying the daily forfeit oftheir misplaced confidence!

I am sorry to see, also, that a degree of ignorance as to the naturalcourse of diseases is often shown in these published cases, which, although it may not be detected by the unprofessional reader, conveys anunpleasant impression to those who are acquainted with the subject. Thusa young woman affected with jaundice is mentioned in the German "Annalsof Clinical Homoeopathy" as having been cured in twenty-nine days bypulsatilla and nux vomica. Rummel, a well-known writer of the sameschool, speaks of curing a case of jaundice in thirty-four days byHomoeopathic doses of pulsatilla, aconite, and cinchona. I happened tohave a case in my own household, a few weeks since, which lasted aboutten days, and this was longer than I have repeatedly seen it in hospitalpractice, so that it was nothing to boast of. 

Dr. Munneche of Lichtenburg in Saxony is called to a patient withsprained ankle who had been a fortnight under the common treatment. Thepatient gets well by the use of arnica in a little more than a monthlonger, and this extraordinary fact is published in the French "Archivesof Homoeopathic Medicine. "

In the same Journal is recorded the case of a patient who with nothingmore, so far as any proof goes, than inluenza, gets down to her shopupon the sixth day. 

And again, the cool way in which everything favorable in a case is setdown by these people entirely to their treatment, may be seen in a caseof croup reported in the "Homoeopathic Gazette" of Leipsic, in whichleeches, blistering, inhalation of hot vapor, and powerful internalmedicine had been employed, and yet the merit was all attributed to onedrop of some Homoeopathic fluid. 

I need not multiply these quotations, which illustrate the grounds ofan opinion which the time does not allow me to justify more at length;other such cases are lying open before me; there is no end to them ifmore were wanted; for nothing is necessary but to look into any of thenumerous broken-down Journals of Homoeopathy, the volumes of which maybe found on the shelves of those curious in such matters. 

A number of public trials of Homoeopathy have been made in differentparts of the world. Six of these are mentioned in the Manifesto of the"Homoeopathic Examiner. " Now to suppose that any trial can absolutelysilence people, would be to forget the whole experience of the past. Dr. Haygarth and Dr. Alderson could not stop the sale of the five-guineaTractors, although they proved that they could work the same miracleswith pieces of wood and tobacco-pipe. It takes time for truth to operateas well as Homoeopathic globules. Many persons thought the results ofthese trials were decisive enough of the nullity of the treatment; thosewho wish to see the kind of special pleading and evasion by which it isattempted to cover results which, stated by the "Homoeopathic Examiner"itself, look exceedingly like a miserable failure, may consult theopening flourish of that Journal. I had not the intention to speak ofthese public trials at all, having abundant other evidence on the point. But I think it best, on the whole, to mention two of them in a fewwords, --that instituted at Naples and that of Andral. 

There have been few names in the medical profession, for the last halfcentury, so widely known throughout the world of science as that of M. Esquirol, whose life was devoted to the treatment of insanity, and whowas without a rival in that department of practical medicine. It is froman analysis communicated by him to the "Gazette Medicale de Paris" thatI derive my acquaintance with the account of the trial at Naples by Dr. Panvini, physician to the Hospital della Pace. This account seems tobe entirely deserving of credit. Ten patients were set apart, and notallowed to take any medicine at all, --much against the wish of theHomoeopathic physician. All of them got well, and of course all of themwould have been claimed as triumphs if they had been submitted to thetreatment. Six other slight cases (each of which is specified) got wellunder the Homoeopathic treatment, none of its asserted specific effectsbeing manifested. 

All the rest were cases of grave disease; and so far as the trial, whichwas interrupted about the fortieth day, extended, the patients grewworse, or received no benefit. A case is reported on the page beforeme of a soldier affected with acute inflammation in the chest, who tooksuccessively aconite, bryonia, nux vomica, and pulsatilla, and afterthirty-eight days of treatment remained without any important change inhis disease. The Homoeopathic physician who treated these patients wasM. De Horatiis, who had the previous year been announcing his wonderfulcures. And M. Esquirol asserted to the Academy of Medicine in 1835, that this M. De Horatiis, who is one of the prominent personages in the"Examiner's" Manifesto published in 1840, had subsequently renouncedHomoeopathy. I may remark, by the way, that this same periodical, whichis so very easy in explaining away the results of these trials, makes amistake of only six years or a little more as to the time when this atNaples was instituted. 

M. Andral, the "eminent and very enlightened allopathist" of the"Homoeopathic Examiner, " made the following statement in March, 1835, tothe Academy of Medicine: "I have submitted this doctrine to experiment;I can reckon at this time from one hundred and thirty to one hundred andforty cases, recorded with perfect fairness, in a great hospital, underthe eye of numerous witnesses; to avoid every objection--I obtained myremedies of M. Guibourt, who keeps a Homoeopathic pharmacy, and whosestrict exactness is well known; the regimen has been scrupulouslyobserved, and I obtained from the sisters attached to the hospital aspecial regimen, such as Hahnemann orders. I was told, however, somemonths since, that I had not been faithful to all the rules of thedoctrine. I therefore took the trouble to begin again; I have studiedthe practice of the Parisian Homoeopathists, as I had studied theirbooks, and I became convinced that they treated their patients as I hadtreated mine, and I affirm that I have been as rigorously exact in thetreatment as any other person. "

And he expressly asserts the entire nullity of the influence of allthe Homoeopathic remedies tried by him in modifying, so far as he couldobserve, the progress or termination of diseases. It deserves noticethat he experimented with the most boasted substances, --cinchona, aconite, mercury, bryonia, belladonna. Aconite, for instance, he sayshe administered in more than forty cases of that collection of feverishsymptoms in which it exerts so much power, according to Hahnemann, andin not one of them did it have the slightest influence, the pulse andheat remaining as before. 

These statements look pretty honest, and would seem hard to be explainedaway, but it is calmly said that he "did not know enough of the methodto select the remedies with any tolerable precision. " ["HomoeopathicExaminer, vol. I. P. 22. ]

"Nothing is left to the caprice of the physician. " (In a word, insteadof being dependent upon blind chance, that there is an infalliblelaw, guided by which; the physician MUST select the proper remedies. ')['Ibid. , ' in a notice of Menzel's paper. ] Who are they that practiceHomoeopathy, and say this of a man with the Materia Medica of Hahnemannlying before him? Who are they that send these same globules, on whichhe experimented, accompanied by a little book, into families, whosemembers are thought competent to employ them, when they deny any suchcapacity to a man whose life has been passed at the bedside of patients, the most prominent teacher in the first Medical Faculty in the world, the consulting physician of the King of France, and one of the mostrenowned practical writers, not merely of his nation, but of his age?I leave the quibbles by which such persons would try to creep out fromunder the crushing weight of these conclusions to the unfortunates whosuppose that a reply is equivalent to an answer. 

Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris, invited two Homoeopathic practitioners to experiment in his wards. Oneof these was Curie, now of London, whose works are on the countersof some of our bookstores, and probably in the hands of some of myaudience. This gentleman, whom Dr. Baillie declares to be an enlightenedman, and perfectly sincere in his convictions, brought his own medicinesfrom the pharmacy which furnished Hahnemann himself, and employed themfor four or five months upon patients in his ward, and with resultsequally unsatisfactory, as appears from Dr. Baillie's statement ata meeting of the Academy of Medicine. And a similar experiment waspermitted by the Clinical Professor of the Hotel Dieu of Lyons, with thesame complete failure. 

But these are old and prejudiced practitioners. Very well, then take thestatement of Dr. Fleury, a most intelligent young physician, who treatedhomoeopathically more than fifty patients, suffering from diseaseswhich it was not dangerous to treat in this way, taking every kind ofprecaution as to regimen, removal of disturbing influences, and thestate of the atmosphere, insisted upon by the most vigorous partisansof the doctrine, and found not the slightest effect produced by themedicines. And more than this, read nine of these cases, which he haspublished, as I have just done, and observe the absolute nullity ofaconite, belladonna, and bryonia, against the symptoms over which theyare pretended to exert such palpable, such obvious, such astonishinginfluences. In the view of these statements, it is impossible not torealize the entire futility of attempting to silence this assertedscience by the flattest and most peremptory results of experiment. Wereall the hospital physicians of Europe and America to devote themselves, for the requisite period, to this sole pursuit, and were their resultsto be unanimous as to the total worthlessness of the whole system inpractice, this slippery delusion would slide through their fingerswithout the slightest discomposure, when, as they supposed, they hadcrushed every joint in its tortuous and trailing body. 

3. I have said, that to show the truth of the Homoeopathic doctrine, as announced by Hahnemann, it would be necessary to show, in the thirdplace, that remedies never cure diseases when they are not capable ofproducing similar symptoms! The burden of this somewhat comprehensivedemonstration lying entirely upon the advocates of this doctrine, it maybe left to their mature reflections. 

It entered into my original plan to treat of the doctrine relating toPsora, or itch, --an almost insane conception, which I am glad to get ridof, for this is a subject one does not care to handle without gloves. Iam saved this trouble, however, by finding that many of the disciplesof Hahnemann, those disciples the very gospel of whose faith stands uponhis word, make very light of his authority on this point, although hehimself says, "It has cost me twelve years of study and research totrace out the source of this incredible number of chronic affections, to discover this great truth, which remained concealed from allmy predecessors and contemporaries, to establish the basis of itsdemonstration, and find out, at the same time, the curative medicinesthat were fit to combat this hydra in all its different forms. "

But, in the face of all this, the following remarks are made by Wolff, of Dresden, whose essays, according to the editor of the "HomoeopathicExaminer, " "represent the opinions of a large majority of Homoeopathistsin Europe. "

"It cannot be unknown to any one at all familiar with Homoeopathicliterature, that Hahnemann's idea of tracing the large majority ofchronic diseases to actual itch has met with the greatest oppositionfrom Homoeopathic physicians themselves. " And again, "If the Psorictheory has led to no proper schism, the reason is to be found in thefact that it is almost without any influence in practice. "

We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Dukeof Baden, " and a "distinguished" Homoeopathist, actually asked Hahnemannfor the proof that chronic diseases, such as dropsy, for instance, neverarise from any other cause than itch; and that, according to commonreport, the venerable sage was highly incensed (fort courrouce) withDr. Hartmann, of Leipsic, another "distinguished" Homoeopathist, formaintaining that they certainly did arise from other causes. 

And Dr. Fielitz, in the "Homoeopathic Gazette" of Leipsic, after saying, in a good-natured way, that Psora is the Devil in medicine, and thatphysicians are divided on this point into diabolists and exorcists, declares that, according to a remark of Hahnemann, the whole civilizedworld is affected with Psora. I must therefore disappoint any advocateof Hahnemann who may honor me with his presence, by not attacking adoctrine on which some of the disciples of his creed would be very happyto have its adversaries waste their time and strength. I will not meddlewith this excrescence, which, though often used in time of peace, wouldbe dropped, like the limb of a shell-fish, the moment it was assailed;time is too precious, and the harvest of living extravagances nods tooheavily to my sickle, that I should blunt it upon straw and stubble. 

I will close the subject with a brief examination of some of thestatements made in Homoeopathic works, and more particularly in thebrilliant Manifesto of the "Examiner, " before referred to. And first, itis there stated under the head of "Homoeopathic Literature, " that"SEVEN HUNDRED volumes have been issued from the press developing thepeculiarities of the system, and many of them possessed of a scientificcharacter that savans know well how to respect. " If my assertion wereproper evidence in the case, I should declare, that, having seen a goodmany of these publications, from the year 1834, when I bought the workof the Rev. Thomas Everest, [Dr. Curie speaks of this silly pamphlet ashaving been published in 1835. ] to within a few weeks, when I receivedmy last importation of Homaeopathic literature, I have found that all, with a very few exceptions, were stitched pamphlets varying fromtwenty or thirty pages to somewhat less than a hundred, and generallyresembling each other as much as so many spelling-books. 

But not being evidence in the case, I will give you the testimony ofDr. Trinks, of Dresden, who flourishes on the fifteenth page of the sameManifesto as one of the most distinguished among the Homoeopathistsof Europe. I translate the sentence literally from the "Archives de laMedecine Homoeopathique. "

"The literature of Homoeopathy, if that honorable name must be appliedto all kinds of book-making, has been degraded to the condition of thehumblest servitude. Productions without talent, without spirit, withoutdiscrimination, flat and pitiful eulogies, exaggerations surpassing thelimits of the most robust faith, invectives against such as dared todoubt the dogmas which had been proclaimed, or catalogues of remedies;of such materials is it composed! From distance to distance only, haveappeared some memoirs useful to science or practice, which appear as somany green oases in the midst of this literary desert. "

It is a very natural as well as a curious question to ask, What has beenthe success of Homoeopathy in the different countries of Europe, andwhat is its present condition?

The greatest reliance of the advocates of Homoeopathy is of courseon Germany. We know very little of its medical schools, its medicaldoctrines, or its medical men, compared with those of England andFrance. And, therefore, when an intelligent traveller gives a directaccount from personal inspection of the miserable condition of theHomoeopathic hospital at Leipsic, the first established in Europe, andthe first on the list of the ever-memorable Manifesto, it is easy enoughanswer or elude the fact by citing various hard names of "distinguished"practitioners, which sound just as well to the uninformed public as ifthey were Meckel, or Tiedemann, or Langenbeck. Dr. Leo-Wolf, who, to besure, is opposed to Homoeopathy, but who is a scholar, and ought to knowsomething of his own countrymen, assures us that "Dr. Kopp is the onlyGerman Homoeopathist, if we can call him so, who has been distinguishedas an author and practitioner before he examined this method. " And Dr. Lee, the same gentleman in whose travels the paragraph relating tothe Leipsic Hospital is to be found, says the same thing. And I willcheerfully expose myself to any impertinent remark which it mightsuggest, to assure my audience that I never heard or saw one authenticHomoeopathic name of any country in Europe, which I had ever heardmentioned before as connected with medical science by a single word ordeed sufficient to make it in any degree familiar to my ears, unlessArnold of Heidelberg is the anatomist who discovered a little nervouscentre, called the otic ganglion. But you need ask no better proof ofwho and what the German adherents of this doctrine must be, than thetestimony of a German Homoeopathist as to the wretched character of theworks they manufacture to enforce its claims. 

As for the act of this or that government tolerating or encouragingHomoeopathy, every person of common intelligence knows that it is a mereform granted or denied according to the general principles of policyadopted in different states, or the degree of influence which some fewpersons who have adopted it may happen to have at court. What may bethe value of certain pompous titles with which many of the advocates ofHomoeopathy are honored, it might be disrespectful to question. But inthe mean time the judicious inquirer may ponder over an extract whichI translate from a paper relating to a personage well known to thecommunity as Williams the Oculist, with whom I had the honor of crossingthe Atlantic some years since, and who himself handed me two copies ofthe paper in question. 

"To say that he was oculist of Louis XVIII. And of Charles X. , andthat he now enjoys the same title with respect to His Majesty, LouisPhilippe, and the King of the Belgians, is unquestionably to say a greatdeal; and yet it is one of the least of his titles to public confidence. His reputation rests upon a basis more substantial even than thenumerous diplomas with which he is provided, than the membership of thedifferent medical societies which have chosen him as their associate, "etc. , etc. 

And as to one more point, it is time that the public should fullyunderstand that the common method of supporting barefaced impostureat the present day, both in Europe and in this country, consists intrumping up "Dispensaries, " "Colleges of Health, " and other advertisingcharitable clap-traps, which use the poor as decoy-ducks for the rich, and the proprietors of which have a strong predilection for the titleof "Professor. " These names, therefore, have come to be of little orno value as evidence of the good character, still less of the highpretensions of those who invoke their authority. Nor does itfollow, even when a chair is founded in connection with a well-knowninstitution, that it has either a salary or an occupant; so that it maybe, and probably is, a mere harmless piece of toleration on the part ofthe government if a Professorship of Homoeopathy is really in existenceat Jena or Heidelberg. And finally, in order to correct the error of anywho might suppose that the whole Medical Profession of Germany has longsince fallen into the delusions of Hahnemann, I will quote two lineswhich a celebrated anatomist and surgeon (whose name will occur again inthis lecture in connection with a very pleasing letter) addressed to theFrench Academy of Medicine in 1835. "I happened to be in Germany somemonths since, at a meeting of nearly six hundred physicians; one ofthem wished to bring up the question of Homoeopathy; they would not evenlisten to him. " This may have been very impolite and bigoted, butthat is not precisely the point in reference to which I mention thecircumstance. 

But if we cannot easily get at Germany, we can very easily obtain exactinformation from France and England. I took the trouble to write somemonths ago to two friends in Paris, in whom I could place confidence, for information upon the subject. One of them answered briefly to theeffect that nothing was said about it. When the late Curator of theLowell Institute, at his request, asked about the works upon thesubject, he was told that they had remained a long time on the shelvesquite unsalable, and never spoken of. 

The other gentleman, [Dr. Henry T. Bigelow, now Professor of Surgeryin Harvard University] whose name is well known to my audience, and whoneeds no commendation of mine, had the kindness to procure for me manypublications upon the subject, and some information which sets the wholematter at rest, so far as Paris is concerned. He went directly to theBaillieres, the principal and almost the only publishers of all theHomoeopathic books and journals in that city. The following factswere taken by him from the account-books of this publishing firm. FourHomoeopathic Journals have been published in Paris; three of them by theBaillieres. 

The reception they met with may be judged of by showing the number ofsubscribers to each on the books of the publishing firm. 

A Review published by some other house, which lasted one year, and hadabout fifty subscribers, appeared in 1834, 1835. 

There were only four Journals of Homoeopathy ever published in Paris. The Baillieres informed my correspondent that the sale of Homoeopathicbooks was much less than formerly, and that consequently they shouldundertake to publish no new books upon the subject, except those of Jahror Hahnemann. "This man, " says my correspondent, --referring to one ofthe brothers, --"the publisher and headquarters of Homoeopathy in Paris, informs me that it is going down in England and Germany as well asin Paris. " For all the facts he had stated he pledged himself asresponsible. 

Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, andsince then has been going down. 

Louis told my correspondent that no person of distinction in Paris hadembraced Homoeopathy, and that it was declining. If you ask who Louisis, I refer you to the well-known Homoeopathist, Peschier of Geneva, whosays, addressing him, "I respect no one more than yourself; the feelingwhich guides your researches, your labors, and your pen, is so honorableand rare, that I could not but bow down before it; and I own, if therewere any allopathist who inspired me with higher veneration, it would behim and not yourself whom I should address. "

Among the names of "Distinguished Homoeopathists, " however, displayed inimposing columns, in the index of the "Homoeopathic Examiner, " are thoseof MARJOLIN, AMUSSAT, and BRESCHET, names well known to the world ofscience, and the last of them identified with some of the most valuablecontributions which anatomical knowledge has received since thecommencement of the present century. One Dr. Chrysaora, who standssponsor for many facts in that Journal, makes the following statementamong the rest: "Professors, who are esteemed among the mostdistinguished of the Faculty (Faculty de Medicine), both as to knowledgeand reputation, have openly confessed the power of Homoeopathia informs of disease where the ordinary method of practice proved totallyinsufficient. It affords me the highest pleasure to select from amongthese gentlemen, Marjolin, Amussat, and Breschet. "

Here is a literal translation of an original letter, now in mypossession, from one of these Homoeopathists to my correspondent:--

"DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER:

"You have had the kindness to inform me in your letter that a newAmerican Journal, the 'New World, ' has made use of my name in support ofthe pretended Homoeopathic doctrines, and that I am represented as oneof the warmest partisans of Homoeopathy in France. 

"I am vastly surprised at the reputation manufactured for me upon thenew continent; but I am obliged, in deference to truth, to reject itwith my whole energy. I spurn far from me everything which relates tothat charlatanism called Homoeopathy, for these pretended doctrinescannot endure the scrutiny of wise and enlightened persons, who areguided by honorable sentiments in the practice of the noblest of arts. 

"PARIS, 3d November, 1841

"I am, etc. , etc. , "G. BRESCHET, "Professor in the Faculty of Medicine, Member of the Institute, Surgeonof Hotel Dieu, and Consulting Surgeon to the King, etc. " [I first saw M. Breschet's name mentioned in that Journal]

Concerning Amussat, my correspondent writes, that he was informed byMadame Hahnemann, who converses in French more readily than her husband, and therefore often speaks for him, that "he was not a physician, neither Homoeopathist nor Allopathist, but that he was the surgeonof their own establishment; that is, performed as a surgeon all theoperations they had occasion for in their practice. "

I regret not having made any inquiries as to Marjolin, who, I doubt not, would strike his ponderous snuff-box until it resounded like the Grecianhorse, at hearing such a doctrine associated with his respectable name. I was not aware, when writing to Paris, that this worthy Professor, whose lectures I long attended, was included in these audacious claims;but after the specimens I have given of the accuracy of the foreigncorrespondence of the "Homoeopathic Examiner, " any further informationI might obtain would seem so superfluous as hardly to be worth thepostage. 

Homoeopathy may be said, then, to be in a sufficiently miserablecondition in Paris. Yet there lives, and there has lived for years, theillustrious Samuel Hahnemann, who himself assured my correspondent thatno place offered the advantages of Paris in its investigation, by reasonof the attention there paid to it. 

In England, it appears by the statement of Dr. Curie in October, 1839, about eight years after its introduction into the country, that therewere eighteen Homoeopathic physicians in the United Kingdom, of whomonly three were to be found out of London, and that many of thesepractised Homoeopathy in secret. 

It will be seen, therefore, that, according to the recent statement ofone of its leading English advocates, Homoeopathy had obtained not quitehalf as many practical disciples in England as Perkinism could show foritself in a somewhat less period from the time of its first promulgationin that country. 

Dr. Curie's letter, dated London, October 30, 1839, says there is "onein Dublin, Dr. Luther; at Glasgow, Dr. Scott. " The "distinguished"Chrysaora writes from Paris, dating October 20, 1839, "On the otherhand, Homoeopathy is commencing to make an inroad into England bythe way of Ireland. At Dublin, distinguished physicians have alreadyembraced the new system, and a great part of the nobility and gentryof that city have emancipated themselves from the English fashion andprofessional authority. "

But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronizeHomoeopathy; the Queen Dowager Adelaide has been treated by aHomoeopathic physician. "Jarley is the delight of the nobility andgentry. " "The Royal Family are the patrons of Jarley. "

Let me ask if a Marquis and a Knight are better than two Lords, andif the Dowager of Royalty is better than Royalty itself, all of whichillustrious dignities were claimed in behalf of Benjamin DouglassPerkins?

But if the balance is thought too evenly suspended in this case, anotherinstance can be given in which the evidence of British noblemen andtheir ladies is shown to be as valuable in establishing the character ofa medical man or doctrine, as would be the testimony of the Marquis ofWaterford concerning the present condition and prospects of missionaryenterprise. I have before me an octavo volume of more than four hundredpages, in which, among much similar matter, I find highly commendatoryletters from the Marchioness of Ormond, Lady Harriet Kavanagh, theCountess of Buckinghamshire, the Right Hon. Viscount Ingestre, M. P. , and the Most Noble, the Marquis of Sligo, --all addressed to "JohnSt. John Long, Esq, " a wretched charlatan, twice tried for, and onceconvicted of, manslaughter at the Old Bailey. 

This poor creature, too, like all of his tribe, speaks of the medicalprofession as a great confederation of bigoted monopolists. He, too, says that "If an innovator should appear, holding out hope to thosein despair, and curing disorders which the faculty have recorded asirremediable, he is at once, and without inquiry, denounced as anempiric and an impostor. " He, too, cites the inevitable names of Galileoand Harvey, and refers to the feelings excited by the great discovery ofJenner. From the treatment of the great astronomer who was visited withthe punishment of other heretics by the ecclesiastical authorities of aCatholic country some centuries since, there is no very direct inferenceto be drawn to the medical profession of the present time. His nameshould be babbled no longer, after having been placarded for thehundredth time in the pages of St. John Long. But if we are doomedto see constant reference to the names of Harvey and Jenner in everyworthless pamphlet containing the prospectus of some new trick upon thepublic, let us, once for all, stare the facts in the face, and see howthe discoveries of these great men were actually received by the medicalprofession. 

In 1628, Harvey published his first work upon the circulation. Hisdoctrines were a complete revolution of the prevailing opinions of allantiquity. They immediately found both champions and opponents; ofwhich last, one only, Riolanus, seemed to Harvey worthy of an answer, onaccount of his "rank, fame, and learning. " Controversy in science, as inreligion, was not, in those days, carried on with all the courtesy whichour present habits demand, and it is possible that some hard words mayhave been applied to Harvey, as it is very certain that he used the mostcontemptuous expressions towards others. 

Harvey declares in his second letter to Riolanus, "Since the firstdiscovery of the circulation, hardly a day, or a moment, has passedwithout my hearing it both well and ill spoken of; some attack it withgreat hostility, others defend it with high encomiums; one party believethat I have abundantly proved the truth of the doctrine against allthe weight of opposing arguments, by experiments, observations, anddissections; others think it not yet sufficiently cleared up, and freefrom objections. " Two really eminent Professors, Plempius of Louvain, and Walaeus of Leyden, were among its early advocates. 

The opinions sanctioned by the authority of long ages, and the names ofHippocrates and Galen, dissolved away, gradually, but certainly, beforethe demonstrations of Harvey. Twenty-four years after the publication ofhis first work, and six years before his death, his bust in marblewas placed in the Hall of the College of Physicians, with a suitableinscription recording his discoveries. 

Two years after this he was unanimously invited to accept the Presidencyof that body; and he lived to see his doctrine established, and allreputable opposition withdrawn. 

There were many circumstances connected with the discovery of Dr. Jennerwhich were of a nature to excite repugnance and opposition. The practiceof inoculation for the small-pox had already disarmed that disease ofmany of its terrors. The introduction of a contagious disease from abrute creature into the human system naturally struck the public mindwith a sensation of disgust and apprehension, and a part of the medicalpublic may have shared these feelings. I find that Jenner's discovery ofvaccination was made public in June, 1798. In July of the same year thecelebrated surgeon, Mr. Cline, vaccinated a child with virus receivedfrom Dr. Jenner, and in communicating the success of this experiment, he mentions that Dr. Lister, formerly of the Small-Pox Hospital, andhimself, are convinced of the efficacy of the cow-pox. In Novemberof the same year, Dr. Pearson published his "Inquiry, " containing thetestimony of numerous practitioners in different parts of the kingdom, to the efficacy of the practice. Dr. HAYGARTH, who was so conspicuousin exposing the follies of Perkinism, was among the very earliestto express his opinion in favor of vaccination. In 1801, Dr. Lettsommentions the circumstance "as being to the honor of the medicalprofessors, that they have very generally encouraged this salutarypractice, although it is certainly calculated to lessen their pecuniaryadvantages by its tendency to extirpate a fertile source of professionalpractice. "

In the same year the Medical Committee of Paris spoke of vaccination ina public letter, as "the most brilliant and most important discoveryof the eighteenth century. " The Directors of a Society for theExtermination of the Small-Pox, in a Report dated October 1st, 1807, "congratulate the public on the very favorable opinion which the RoyalCollege of Physicians of London, after a most minute and laboriousinvestigation made by the command of his Majesty, have a second timeexpressed on the subject of vaccination, in their Report laid before theHouse of Commons, in the last session of Parliament; in consequence ofwhich the sum of twenty thousand pounds was voted to Dr. Jenner, asa remuneration for his discovery, in addition to ten thousand poundsbefore granted. " (In June, 1802. )

These and similar accusations, so often brought up against the MedicalProfession, are only one mode in which is manifested a spirit ofopposition not merely to medical science, but to all science, and to allsound knowledge. It is a spirit which neither understands itself nor theobject at which it is aiming. It gropes among the loose records of thepast, and the floating fables of the moment, to glean a few truths orfalsehoods tending to prove, if they prove anything, that the personswho have passed their lives in the study of a branch of knowledgethe very essence of which must always consist in long and accurateobservation, are less competent to judge of new doctrines in their owndepartment than the rest of the community. It belongs to the clown insociety, the destructive in politics, and the rogue in practice. 

The name of Harvey, whose great discovery was the legitimate result ofhis severe training and patient study, should be mentioned only to checkthe pretensions of presumptuous ignorance. The example of Jenner, who gave his inestimable secret, the result of twenty-two years ofexperiment and researches, unpurchased, to the public, --when, as wassaid in Parliament, he might have made a hundred thousand pounds by itas well as any smaller sum, --should be referred to only to rebuke theselfish venders of secret remedies, among whom his early history obligesus reluctantly to record Samuel Hahnemann. Those who speak of the greatbody of physicians as if they were united in a league to support thesuperannuated notions of the past against the progress of improvement, have read the history of medicine to little purpose. The prevalentfailing of this profession has been, on the contrary, to lend a toocredulous ear to ambitious and plausible innovators. If at the presenttime ten years of public notoriety have passed over any doctrineprofessing to be of importance in medical science, and if it has notsucceeded in raising up a powerful body of able, learned, and ingeniousadvocates for its claims, the fault must be in the doctrine and not inthe medical profession. 

Homoeopathy has had a still more extended period of trial than this, and we have seen with what results. It only remains to throw out a fewconjectures as to the particular manner in which it is to break up anddisappear. 

1. The confidence of the few believers in this delusion will neversurvive the loss of friends who may die of any acute disease, under atreatment such as that prescribed by Homoeopathy. It is doubtful how farcases of this kind will be trusted to its tender mercies, but whereverit acquires any considerable foothold, such cases must come, and withthem the ruin of those who practise it, should any highly valued life bethus sacrificed. 

2. After its novelty has worn out, the ardent and capricious individualswho constitute the most prominent class of its patrons will return tovisible doses, were it only for the sake of a change. 

3. The Semi-Homoeopathic practitioner will gradually withdraw fromthe rotten half of his business and try to make the public forget hisconnection with it. 

4. The ultra Homoeopathist will either recant and try to rejoin themedical profession; or he will embrace some newer and if possibleequally extravagant doctrine; or he will stick to his colors and godown with his sinking doctrine. Very few will pursue the course lastmentioned. 

A single fact may serve to point out in what direction there willprobably be a movement of the dissolving atoms of Homoeopathy. On the13th page of the too frequently cited Manifesto of the "Examiner" I readthe following stately paragraph:

"Bigelius, M. D. , physician to the Emperor of Russia, whose elevatedreputation is well known in Europe, has been an acknowledged advocateof Hahnemann's doctrines for several years. He abandoned Allopathia forHomoeopathia. " The date of this statement is January, 1840. I find onlooking at the booksellers' catalogues that one Bigel, or Bigelius, to speak more classically, has been at various times publishingHomoeopathic books for some years. 

Again, on looking into the "Encyclographie des Sciences Medicales" forApril, 1840, I find a work entitled "Manual of HYDROSUDOPATHY, or theTreatment of Diseases by Cold Water, etc. , etc. , by Dr. Bigel, Physicianof the School of Strasburg, Member of the Medico-Chirurgical Instituteof Naples, of the Academy of St. Petersburg, --Assessor of the College ofthe Empire of Russia, Physician of his late Imperial Highness the GrandDuke Constantine, Chevalier of the Legion of Honor, etc. " Hydrosudopathyor Hydropathy, as it is sometimes called, is a new medical doctrine orpractice which has sprung up in Germany since Homoeopathy, which itbids fair to drive out of the market, if, as Dr. Bigel says, fourteenphysicians afflicted with diseases which defied themselves and theircolleagues came to Graefenberg, in the year 1836 alone, and were cured. Now Dr. Bigel, "whose elevated reputation is well known in Europe, "writes as follows: "The reader will not fail to see in this defence ofthe curative method of Graefenberg a profession of medical faith, andhe will be correct in so doing. " And his work closes with the followingsentence, worthy of so distinguished an individual: "We believe, withreligion, that the water of baptism purifies the soul from its originalsin; let us believe also, with experience, that it is for our corporealsins the redeemer of the human body. " If Bigel, Physician to the lateGrand Duke Constantine, is identical with Bigel whom the "Examiner"calls Physician to the Emperor of Russia, it appears that he is nowactively engaged in throwing cold water at once upon his patients andthe future prospects of Homoeopathy. 

If, as must be admitted, no one of Hahnemann's doctrines is receivedwith tolerable unanimity among his disciples, except the central axiom, Similia similibus curantur; if this axiom itself relies mainly for itssupport upon the folly and trickery of Hahnemann, what can we think ofthose who announce themselves ready to relinquish all the accumulatedtreasures of our art, to trifle with life upon the strength of thesefantastic theories? What shall we think of professed practitioners ofmedicine, if, in the words of Jahr, "from ignorance, for their personalconvenience, or through charlatanism, they treat their patients oneday Homoeopathically and the next Allopathically;" if they parade theirpretended new science before the unguarded portion of the community;if they suffer their names to be coupled with it wherever it may gain acredulous patient; and deny all responsibility for its character, refuseall argument for its doctrines, allege no palliation for the ignoranceand deception interwoven with every thread of its flimsy tissue, whenthey are questioned by those competent to judge and entitled to ananswer?

Such is the pretended science of Homoeopathy, to which you are asked totrust your lives and the lives of those dearest to you. A mingled massof perverse ingenuity, of tinsel erudition, of imbecile credulity, andof artful misrepresentation, too often mingled in practice, if wemay trust the authority of its founder, with heartless and shamelessimposition. Because it is suffered so often to appeal unanswered to thepublic, because it has its journals, its patrons, its apostles, someare weak enough to suppose it can escape the inevitable doom of utterdisgrace and oblivion. Not many years can pass away before the samecuriosity excited by one of Perkins's Tractors will be awakened at thesight of one of the Infinitesimal Globules. If it should claim a longerexistence, it can only be by falling into the hands of the sordidwretches who wring their bread from the cold grasp of disease and deathin the hovels of ignorant poverty. 

As one humble member of a profession which for more than two thousandyears has devoted itself to the pursuit of the best earthly interestsof mankind, always assailed and insulted from without by such as areignorant of its infinite perplexities and labors, always striving inunequal contest with the hundred-armed giant who walks in the noonday, and sleeps not in the midnight, yet still toiling, not merely for itselfand the present moment, but for the race and the future, I have liftedmy voice against this lifeless delusion, rolling its shapeless bulk intothe path of a noble science it is too weak to strike, or to injure. 

THE CONTAGIOUSNESS OF PUERPERAL FEVER

Printed in 1843; reprinted with additions, 1855. 

THE POINT AT ISSUE. 

THE AFFIRMATIVE. 

"The disease known as Puerperal Fever is so far contagious as to befrequently carried from patient to patient by physicians and nurses. " O. W. Holmes, 1843. 

THE NEGATIVE. 

"The result of the whole discussion will, I trust, serve, not only toexalt your views of the value and dignity of our profession, but todivest your minds of the overpowering dread that you can ever become, especially to woman, under the extremely interesting circumstancesof gestation and parturition, the minister of evil; that you can everconvey, in any possible manner, a horrible virus, so destructive inits effects, and so mysterious in its operations as that attributed topuerperal fever. "--Professor Hodge, 1852. 

"I prefer to attribute them to accident, or Providence, of which I canform a conception, rather than to a contagion of which I cannot form anyclear idea, at least as to this particular malady. "--Professor Meigs, 1852. 

". . . In the propagation of which they have no more to do, than with thepropagation of cholera from Jessore to San Francisco, and from Mauritiusto St. Petersburg. "--Professor Meigs, 1854. 

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"I arrived at that certainty in the matter, that I could venture toforetell what women would be affected with the disease, upon hearing bywhat midwife they were to be delivered, or by what nurse they were tobe attended, during their lying-in; and, almost in every instance, myprediction was verified. "--Gordon, 1795. 

"A certain number of deaths is caused every year by the contagion ofpuerperal fever, communicated by the nurses and medical attendants. "Farr, in Fifth Annual Report of Registrar-General of England, 1843. 

". . . Boards of health, if such exist, or, without them, the medicalinstitutions of a country, should have the power of coercing, or ofinflicting some kind of punishment on those who recklessly go from casesof puerperal fevers to parturient or puerperal females, withoutusing due precaution; and who, having been shown the risk, criminallyencounter it, and convey pestilence and death to the persons they areemployed to aid in the most interesting and suffering period of femaleexistence. " --Copland's Medical Dictionary, Art. Puerperal States andDiseases, 1852. 

"We conceive it unnecessary to go into detail to prove the contagiousnature of this disease, as there are few, if any, American practitionerswho do not believe in this doctrine. "--Dr. Lee, in Additions to Articlelast cited. 

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[INTRODUCTORY NOTE. ] It happened, some years ago, that a discussionarose in a Medical Society of which I was a member, involving thesubject of a certain supposed cause of disease, about which somethingwas known, a good deal suspected, and not a little feared. Thediscussion was suggested by a case, reported at the preceding meeting, of a physician who made an examination of the body of a patient who haddied with puerperal fever, and who himself died in less than a week, apparently in consequence of a wound received at the examination, havingattended several women in confinement in the mean time, all of whom, asit was alleged, were attacked with puerperal fever. 

Whatever apprehensions and beliefs were entertained, it was plain thata fuller knowledge of the facts relating to the subject would beacceptable to all present. I therefore felt that it would be doing agood service to look into the best records I could find, and inquire ofthe most trustworthy practitioners I knew, to learn what experiencehad to teach in the matter, and arrived at the results contained in thefollowing pages. 

The Essay was read before the Boston Society for Medical Improvement, and, at the request of the Society, printed in the "New EnglandQuarterly Journal of Medicine and Surgery" for April, 1843. As thisJournal never obtained a large circulation, and ceased to be publishedafter a year's existence, and as the few copies I had struck offseparately were soon lost sight of among the friends to whom they weresent, the Essay can hardly be said to have been fully brought before theProfession. 

The subject of this Paper has the same profound interest for me atthe present moment as it had when I was first collecting the terribleevidence out of which, as it seems to me, the commonest exercise ofreason could not help shaping the truth it involved. It is not merely onaccount of the bearing of the question, --if there is a question, --on allthat is most sacred in human life and happiness, that the subject cannotlose its interest. It is because it seems evident that a fair statementof the facts must produce its proper influence on a very largeproportion of well-constituted and unprejudiced minds. Individuals may, here and there, resist the practical bearing of the evidence on theirown feelings or interests; some may fail to see its meaning, as somepersons may be found who cannot tell red from green; but I cannot doubtthat most readers will be satisfied and convinced, to loathing, longbefore they have finished the dark obituary calendar laid before them. 

I do not know that I shall ever again have so good an opportunity ofbeing useful as was granted me by the raising of the question whichproduced this Essay. For I have abundant evidence that it has made manypractitioners more cautious in their relations with puerperal females, and I have no doubt it will do so still, if it has a chance of beingread, though it should call out a hundred counterblasts, proving to thesatisfaction of their authors that it proved nothing. And for my part, Ihad rather rescue one mother from being poisoned by her attendant, thanclaim to have saved forty out of fifty patients to whom I had carriedthe disease. Thus, I am willing to avail myself of any hint coming fromwithout to offer this paper once more to the press. The occasionhas presented itself, as will be seen, in a convenient if not in aflattering form. 

I send this Essay again to the MEDICAL PROFESSION, without the changeof a word or syllable. I find, on reviewing it, that it anticipates andeliminates those secondary questions which cannot be entertained for amoment until the one great point of fact is peremptorily settled. In itsvery statement of the doctrine maintained it avoids all discussionof the nature of the disease "known as puerperal fever, " and all thesomewhat stale philology of the word contagion. It mentions, fairlyenough, the names of sceptics, or unbelievers as to the reality ofpersonal transmission; of Dewees, of Tonnelle, of Duges, of Baudelocque, and others; of course, not including those whose works were thenunwritten or unpublished; nor enumerating all the Continental writerswho, in ignorance of the great mass of evidence accumulated by Britishpractitioners, could hardly be called well informed on this subject. Itmeets all the array of negative cases, --those in which disease did notfollow exposure, --by the striking example of small-pox, which, although one of the most contagious of diseases, is subject to the mostremarkable irregularities and seeming caprices in its transmission. Itmakes full allowance for other causes besides personal transmission, especially for epidemic influences. It allows for the possibilityof different modes of conveyance of the destructive principle. Itrecognizes and supports the belief that a series of cases may originatefrom a single primitive source which affects each new patient in turn;and especially from cases of Erysipelas. It does not undertake todiscuss the theoretical aspect of the subject; that is a secondarymatter of consideration. Where facts are numerous, and unquestionable, and unequivocal in their significance, theory must follow them as itbest may, keeping time with their step, and not go before them, marchingto the sound of its own drum and trumpet. Having thus narrowed its areato a limited practical platform of discussion, a matter of life anddeath, and not of phrases or theories, it covers every inch of it with amass of evidence which I conceive a Committee of Husbands, who can countcoincidences and draw conclusions as well as a Synod of Accoucheurs, would justly consider as affording ample reasons for an unceremoniousdismissal of a practitioner (if it is conceivable that such a step couldbe waited for), after five or six funerals had marked the path of hisdaily visits, while other practitioners were not thus escorted. To theProfession, therefore, I submit the paper in its original form, andleave it to take care of itself. 

To the MEDICAL STUDENTS, into whose hands this Essay may fall, somewords of introduction may be appropriate, and perhaps, to a small numberof them, necessary. There are some among them who, from youth, or wantof training, are easily bewildered and confused in any conflict ofopinions into which their studies lead them. They are liable to losesight of the main question in collateral issues, and to be run away withby suggestive speculations. They confound belief with evidence, oftentrusting the first because it is expressed with energy, and slightingthe latter because it is calm and unimpassioned. They are not satisfiedwith proof; they cannot believe a point is settled so long as everybodyis not silenced. They have not learned that error is got out of theminds that cherish it, as the taenia is removed from the body, onejoint, or a few joints at a time, for the most part, rarely the wholeevil at once. They naturally have faith in their instructors, turning tothem for truth, and taking what they may choose to give them; babes inknowledge, not yet able to tell the breast from the bottle, pumping awayfor the milk of truth at all that offers, were it nothing better than aProfessor's shrivelled forefinger. 

In the earliest and embryonic stage of professional development, anyviolent impression on the instructor's mind is apt to be followed bysome lasting effect on that of the pupil. No mother's mark is morepermanent than the mental naevi and moles, and excrescences, andmutilations, that students carry with them out of the lecture-room, ifonce the teeming intellect which nourishes theirs has been scared fromits propriety by any misshapen fantasy. Even an impatient or petulantexpression, which to a philosopher would be a mere index of the lowstate of amiability of the speaker at the moment of its utterance, maypass into the young mind as an element of its future constitution, toinjure its temper or corrupt its judgment. It is a duty, therefore, which we owe to this younger class of students, to clear any importanttruth which may have been rendered questionable in their minds by suchlanguage, or any truth-teller against whom they may have been prejudicedby hasty epithets, from the impressions such words have left. Until thisis done, they are not ready for the question, where there is a question, for them to decide. Even if we ourselves are the subjects of theprejudice, there seems to be no impropriety in showing that thisprejudice is local or personal, and not an acknowledged conviction withthe public at large. It may be necessary to break through our usualhabits of reserve to do this, but this is the fault of the position inwhich others have placed us. 

Two widely-known and highly-esteemed practitioners, Professors in twoof the largest Medical Schools of the Union, teaching the branch ofart which includes the Diseases of Women, and therefore speaking withauthority; addressing in their lectures and printed publications largenumbers of young men, many of them in the tenderest immaturity ofknowledge, have recently taken ground in a formal way against thedoctrine maintained in this paper:

On the Non-Contagious Character of Puerperal Fever: An IntroductoryLecture. By Hugh L. Hodge, M. D. , Professor of Obstetrics in theUniversity of Pennsylvania. Delivered Monday, October 11, 1852. Philadelphia, 1852. 

On the Nature, Signs, and Treatment of Childbed Fevers: in a Series ofLetters addressed to the Students of his Class. By Charles D. Meigs, M. D. , Professor of Midwifery and the Diseases of Women and Children inJefferson Medical College, Philadelphia, etc. , etc. Philadelphia, 1854. Letter VI. 

The first of the two publications, Dr. Hodge's Lecture, while itstheoretical considerations and negative experiences do not seem to me torequire any further notice than such as lay ready for them in my Essaywritten long before, is, I am pleased to say, unobjectionable in toneand language, and may be read without offence. 

This can hardly be said of the chapter of Dr. Meigs's volume whichtreats of Contagion in Childbed Fever. There are expressions used in itwhich might well put a stop to all scientific discussions, were theyto form the current coin in our exchange of opinions. I leave the "veryyoung gentlemen, " whose careful expositions of the results of practicein more than six thousand cases are characterized as "the jejune andfizenless dreamings of sophomore writers, " to the sympathies of those"dear young friends, " and "dear young gentlemen, " who will judge howmuch to value their instructor's counsel to think for themselves, knowing what they are to expect if they happen not to think as he does. 

One unpalatable expression I suppose the laws of construction obligeme to appropriate to myself, as my reward for a certain amount of laborbestowed on the investigation of a very important question of evidence, and a statement of my own practical conclusions. I take no offence, andattempt no retort. No man makes a quarrel with me over the counterpanethat covers a mother, with her new-born infant at her breast. There isno epithet in the vocabulary of slight and sarcasm that can reach mypersonal sensibilities in such a controversy. Only just so far as adisrespectful phrase may turn the student aside from the examination ofthe evidence, by discrediting or dishonoring the witness, does it callfor any word of notice. 

I appeal from the disparaging language by which the Professor in theJefferson School of Philadelphia world dispose of my claims to belistened to. I appeal, not to the vote of the Society for MedicalImprovement, although this was an unusual evidence of interest in thepaper in question, for it was a vote passed among my own townsmen; norto the opinion of any American, for none know better than the Professorsin the great Schools of Philadelphia how cheaply the praise of nativecontemporary criticism is obtained. I appeal to the recorded opinionsof those whom I do not know, and who do not know me, nor care forme, except for the truth that I may have uttered; to Copland, in his"Medical Dictionary, " who has spoken of my Essay in phrases to whichthe pamphlets of American "scribblers" are seldom used from Europeanauthorities; to Ramsbotham, whose compendious eulogy is allthat self-love could ask; to the "Fifth Annual Report" of theRegistrar-General of England, in which the second-hand abstract ofmy Essay figures largely, and not without favorable comment, in animportant appended paper. These testimonies, half forgotten untilthis circumstance recalled them, are dragged into the light, not in aparoxysm of vanity, but to show that there may be food for thought inthe small pamphlet which the Philadelphia Teacher treats so lightly. They were at least unsought for, and would never have been proclaimedbut for the sake of securing the privilege of a decent and unprejudicedhearing. 

I will take it for granted that they have so far counterpoised thedepreciating language of my fellow-countryman and fellow-teacher as togain me a reader here and there among the youthful class of students Iam now addressing. It is only for their sake that I think it necessaryto analyze, or explain, or illustrate, or corroborate any portion ofthe following Essay. But I know that nothing can be made too plain forbeginners; and as I do not expect the practitioner, or even the moremature student, to take the trouble to follow me through an Introductionwhich I consider wholly unnecessary and superfluous for them, I shallnot hesitate to stoop to the most elementary simplicity for the benefitof the younger student. I do this more willingly because it affords agood opportunity, as it seems to me, of exercising the untrained mindin that medical logic which does not seem to have been either taught orpractised in our schools of late, to the extent that might be desired. 

I will now exhibit, in a series of propositions reduced to theirsimplest expression, the same essential statements and conclusions asare contained in the Essay, with such commentaries and explanations asmay be profitable to the inexperienced class of readers addressed. 

I. It has been long believed, by many competent observers, thatPuerperal Fever (so called) is sometimes carried from patient to patientby medical assistants. 

II. The express object of this Essay is to prove that it is so carried. 

III. In order to prove this point, it is not necessary to consultany medical theorist as to whether or not it is consistent with hispreconceived notions that such a mode of transfer should exist. 

IV. If the medical theorist insists on being consulted, and we see fitto indulge him, he cannot be allowed to assume that the alleged laws ofcontagion, deduced from observation in other diseases, shall be citedto disprove the alleged laws deduced from observation in this. Sciencewould never make progress under such conditions. Neither the longincubation of hydrophobia, nor the protecting power of vaccination, would ever have been admitted, if the results of observation inthese affections had been rejected as contradictory to the previouslyascertained laws of contagion. 

V. The disease in question is not a common one; producing, on theaverage, about three deaths in a thousand births, according to theEnglish Registration returns which I have examined. 

VI. When an unusually large number of cases of this disease occur aboutthe same time, it is inferred, therefore, that there exists some specialcause for this increased frequency. If the disease prevails extensivelyover a wide region of country, it is attributed without dispute toan epidemic influence. If it prevails in a single locality, as in ahospital, and not elsewhere, this is considered proof that some localcause is there active in its production. 

VII. When a large number of cases of this disease occur in rapidsuccession, in one individual's ordinary practice, and few or noneelsewhere, these cases appearing in scattered localities, in patients ofthe same average condition as those who escape under the care of others, there is the same reason for connecting the cause of the disease withthe person in this instance, as with the place in that last mentioned. 

VIII. Many series of cases, answering to these conditions, are givenin this Essay, and many others will be referred to which have occurredsince it was written. 

IX. The alleged results of observation may be set aside; first, becausethe so-called facts are in their own nature equivocal; secondly, becausethey stand on insufficient authority; thirdly, because they are notsufficiently numerous. But, in this case, the disease is one of strikingand well-marked character; the witnesses are experts, interested indenying and disbelieving the facts; the number of consecutive cases inmany instances frightful, and the number of series of cases such that Ihave no room for many of them except by mere reference. 

X. These results of observation, being admitted, may, we will suppose, be interpreted in different methods. Thus the coincidences may beconsidered the effect of chance. I have had the chances calculated bya competent person, that a given practitioner, A. , shall have sixteenfatal cases in a month, on the following data: A. To average attendanceupon two hundred and fifty births in a year; three deaths in onethousand births to be assumed as the average from puerperal fever; noepidemic to be at the time prevailing. It follows, from the answer givenme, that if we suppose every one of the five hundred thousand annualbirths of England to have been recorded during the last half-century, there would not be one chance in a million million million millions thatone such series should be noted. No possible fractional error in thiscalculation can render the chance a working probability. Applied todozens of series of various lengths, it is obviously an absurdity. Chance, therefore, is out of the question as an explanation of theadmitted coincidences. 

XI. There is, therefore, some relation of cause and effect between thephysician's presence and the patient's disease. 

XII. Until it is proved to what removable condition attaching to theattendant the disease is owing, he is bound to stay away from hispatients so soon as he finds himself singled out to be tracked by thedisease. How long, and with what other precautions, I have suggested, without dictating, at the close of my Essay. If the physician doesnot at once act on any reasonable suspicion of his being the medium oftransfer, the families where he is engaged, if they are allowed to knowthe facts, should decline his services for the time. His feelings on theoccasion, however interesting to himself, should not be even named inthis connection. A physician who talks about ceremony and gratitude, andservices rendered, and the treatment he got, surely forgets himself;it is impossible that he should seriously think of these small matterswhere there is even a question whether he may not carry disease, anddeath, and bereavement into any one of "his families, " as they aresometimes called. 

I will now point out to the young student the mode in which he mayrelieve his mind of any confusion, or possibly, if very young, anydoubt, which the perusal of Dr. Meigs's Sixth Letter may have raised inhis mind. 

The most prominent ideas of the Letter are, first, that thetransmissible nature of puerperal fever appears improbable, and, secondly, that it would be very inconvenient to the writer. Dr. Woodville, Physician to the Small-Pox and Inoculation Hospital inLondon, found it improbable, and exceedingly inconvenient to himself, that cow pox should prevent small-pox; but Dr. Jenner took the libertyto prove the fact, notwithstanding. 

I will first call the young student's attention to the show of negativefacts (exposure without subsequent disease), of which much seems to bethought. And I may at the same time refer him to Dr. Hodge's Lecture, where he will find the same kind of facts and reasoning. Let him nowtake up Watson's Lectures, the good sense and spirit of which have madehis book a universal favorite, and open to the chapter on ContinuedFever. He will find a paragraph containing the following sentence: "Aman might say, 'I was in the battle of Waterloo, and saw many men aroundme fall down and die, and it was said that they were struck down bymusket-balls; but I know better than that, for I was there all thetime, and so were many of my friends, and we were never hit by anymusket-balls. Musket-balls, therefore, could not have been the cause ofthe deaths we witnessed. ' And if, like contagion, they were not palpableto the senses, such a person might go on to affirm that no proof existedof there being any such thing as musket-balls. " Now let the student turnback to the chapter on Hydrophobia in the same volume. He will find thatJohn Hunter knew a case in which, of twenty-one persons bitten, only onedied of the disease. He will find that one dog at Charenton was bittenat different times by thirty different mad dogs, and outlived it all. Is there no such thing, then, as hydrophobia? Would one take no especialprecautions if his wife, about to become a mother, had been bitten by arabid animal, because so many escape? Or let him look at "Underwood onDiseases of Children, " [Philadelphia, 1842, p. 244, note. ] and he willfind the case of a young woman who was inoculated eight times in thirtydays, at the same time attending several children with smallpox, and yetwas not infected. But seven weeks afterwards she took the disease anddied. 

It would seem as if the force of this argument could hardly fail to beseen, if it were granted that every one of these series of cases were soreported as to prove that there could have been no transfer of disease. There is not one of them so reported, in the Lecture or the Letter, asto prove that the disease may not have been carried by the practitioner. I strongly suspect that it was so carried in some of these cases, butfrom the character of the very imperfect evidence the question can neverbe settled without further disclosures. 

Although the Letter is, as I have implied, principally taken up withsecondary and collateral questions, and might therefore be set aside asin the main irrelevant, I am willing, for the student's sake, to touchsome of these questions briefly, as an illustration of its logicalcharacter. 

The first thing to be done, as I thought when I wrote my Essay, wasto throw out all discussions of the word contagion, and this I dideffectually by the careful wording of my statement of the subject to bediscussed. My object was not to settle the etymology or definition ofa word, but to show that women had often died in childbed, poisoned insome way by their medical attendants. On the other point, I, at least, have no controversy with anybody, and I think the student will do wellto avoid it in this connection. If I must define my position, however, as well as the term in question, I am contented with Worcester'sdefinition; provided always this avowal do not open another sidecontroversy on the merits of his Dictionary, which Dr. Meigs has notcited, as compared with Webster's, which he has. 

I cannot see the propriety of insisting that all the laws of theeruptive fevers must necessarily hold true of this peculiar diseaseof puerperal women. If there were any such propriety, the laws of theeruptive fevers must at least be stated correctly. It is not true, for instance, as Dr. Meigs states, that contagion is "no respecter ofpersons;" that "it attacks all individuals alike. " To give one example:Dr. Gregory, of the Small-Pox Hospital, who ought to know, says thatpersons pass through life apparently insensible to or unsusceptible ofthe small-pox virus, and that the same persons do not take the vaccinedisease. 

As to the short time of incubation, of which so much is made, we haveno right to decide beforehand whether it shall be long or short, in thecases we are considering. A dissection wound may produce symptoms ofpoisoning in six hours; the bite of a rabid animal may take as manymonths. 

After the student has read the case in Dr. Meigs's 136th paragraph, andthe following one, in which he exclaims against the idea of contagion, because the patient, delivered on the 26th of December, was attacked intwenty-four hours, and died on the third day, let him read what happenedat the "Black Assizes" of 1577 and 1750. In the first case, six hundredpersons sickened the same night of the exposure, and three hundred morein three days. [Elliotson's Practice, p. 298. ] Of those attacked in thelatter year, the exposure being on the 11th of May, Alderman Lambertdied on the 13th, Under-Sheriff Cox on the 14th, and many of note beforethe 20th. But these are old stories. Let the student listen then to Dr. Gerhard, whose reputation as a cautious observer he may be supposed toknow. "The nurse was shaving a man, who died in a few hours after hisentrance; he inhaled his breath, which had a nauseous taste, and in anhour afterwards was taken with nausea, cephalalgia, and singing of theears. From that moment the attack began, and assumed a severe character. The assistant was supporting another patient, who died soon afterwards;he felt the pungent heat upon his skin, and was taken immediately withthe symptoms of typhus. " [Am. Jour. Med. Sciences, Feb. 1837, p. 299. ]It is by notes of cases, rather than notes of admiration, that we mustbe guided, when we study the Revised Statutes of Nature, as laid downfrom the curule chairs of Medicine. 

Let the student read Dr. Meigs's 140th paragraph soberly, and thenremember, that not only does he infer, suspect, and surmise, but heactually asserts (page 154), "there was poison in the house, " becausethree out of five patients admitted into a ward had puerperal fever anddied. Have I not as much right to draw a positive inference from "Dr. A. 's" seventy exclusive cases as he from the three cases in the ward ofthe Dublin Hospital? All practical medicine, and all action in commonaffairs, is founded on inferences. How does Dr. Meigs know that thepatients he bled in puerperal fever would not have all got well if hehad not bled them?

"You see a man discharge a gun at another; you see the flash, you hearthe report, you see the person fall a lifeless corpse; and you infer, from all these circumstances, that there was a ball discharged from thegun, which entered his body and caused his death, because such is theusual and natural cause of such an effect. But you did not see the ballleave the gun, pass through the air, and enter the body of theslain; and your testimony to the fact of killing is, therefore, onlyinferential, --in other words, circumstantial. It is possible that noball was in the gun; and we infer that there was, only because we cannotaccount for death on any other supposition. " [Chief Justice Gibson, inAm. Law Journal, vol. Vi. P. 123. ]

"The question always comes to this: Is the circumstance of intercoursewith the sick followed by the appearance of the disease in a proportionof cases so much greater than any other circumstance common to anyportion of the inhabitants of the place under observation, as to make itinconceivable that the succession of cases occurring in persons havingthat intercourse should have been the result of chance? If so, theinference is unavoidable, that that intercourse must have acted as acause of the disease. All observations which do not bear strictlyon that point are irrelevant, and, in the case of an epidemic firstappearing in a town or district, a succession of two cases is sometimessufficient to furnish evidence which, on the principle I have stated, isnearly irresistible. "

Possibly an inexperienced youth may be awe-struck by the quotation fromCuvier. These words, or their equivalent, are certainly to be found inhis Introduction. So are the words "top not come down"! to be found inthe Bible, and they were as much meant for the ladies' head-dresses asthe words of Cuvier were meant to make clinical observation wait for apermit from anybody to look with its eyes and count on its fingers. Letthe inquiring youth read the whole Introduction, and he will see whatthey mean. 

I intend no breach of courtesy, but this is a proper place to warn thestudent against skimming the prefaces and introductions of works formottoes and embellishments to his thesis. He cannot learn anatomy bythrusting an exploring needle into the body. He will be very liableto misquote his author's meaning while he is picking off his outsidesentences. He may make as great a blunder as that simple prince whopraised the conductor of his orchestra for the piece just before theoverture; the musician was too good a courtier to tell him that it wasonly the tuning of the instruments. 

To the six propositions in the 142d paragraph, and the remarks about"specific" diseases, the answer, if any is necessary, seems very simple. An inflammation of a serous membrane may give rise to secretions whichact as a poison, whether that be a "specific" poison or not, as Dr. Homer has told his young readers, and as dissectors know too well; andthat poison may produce its symptoms in a few hours after the system hasreceived it, as any may see in Druitt's "Surgery, " if they care to look. Puerperal peritonitis may produce such a poison, and puerperal women maybe very sensible to its influences, conveyed by contact or exhalation. Whether this is so or not, facts alone can determine, and to facts wehave had recourse to settle it. 

The following statement is made by Dr. Meigs in his 142d paragraph, anddeveloped more at length, with rhetorical amplifications, in the 134th. "No human being, save a pregnant or parturient woman, is susceptible tothe poison. " This statement is wholly incorrect, as I am sorry to haveto point out to a Teacher in Dr. Meigs's position. I do not object tothe erudition which quotes Willis and Fernelius, the last of whom waspleasantly said to have "preserved the dregs of the Arabs in the honeyof his Latinity. " But I could wish that more modern authorities had notbeen overlooked. On this point, for instance, among the numerous factsdisproving the statement, the "American Journal of Medical Sciences, "published not far from his lecture-room, would have presented him witha respectable catalog of such cases. Thus he might refer to Mr. Storrs'spaper "On the Contagious Effects of Puerperal Fever on the Male Subject;or on Persons not Childbearing" (Jan. 1846), or to Dr. Reid's case(April, 1846), or to Dr. Barron's statement of the children's dyingof peritonitis in an epidemic of puerperal fever at the PhiladelphiaHospital (Oct. 1842), or to various instances cited in Dr. Kneeland'sarticle (April, 186). Or, if he would have referred to the "New YorkJournal, " he might have seen Prof. Austin Flint's cases. Or, if he hadhonored my Essay so far, he might have found striking instances of thesame kind in the first of the new series of cases there reported andelsewhere. I do not see the bearing of his proposition, if it were true. But it is one of those assertions that fall in a moment before a slightexamination of the facts; and I confess my surprise, that a professorwho lectures on the Diseases of Women should have ventured to make it. 

Nearly seven pages are devoted to showing that I was wrong in saying Iwould not be "understood to imply that there exists a doubt in the mindof any well-informed member of the medical profession as to the factthat puerperal fever is sometimes communicated from one person toanother, both directly and indirectly. " I will devote seven lines tothese seven pages, which seven lines, if I may say it without offence, are, as it seems to me, six more than are strictly necessary. 

The following authors are cited as sceptics by Dr. Meigs: Dewees. --Icited the same passage. Did not know half the facts. RobertLee. --Believes the disease is sometimes communicable by contagion. Tonnelle, Baudelocque. Both cited by me. Jacquemier. --Published threeyears after my Essay. Kiwisch. "Behindhand in knowledge of PuerperalFever. " [B. & F. Med. Rev. Jan. 1842. ] Paul Dubois. --Scanzoni. 

These Continental writers not well informed on this point. [See Dr. Simpson's Remarks at Meeting of Edin. Med. Chir. Soc. (Am. Jour. Oct. 1851. )]

The story of Von Busch is of interest and value, but there is nothing init which need perplex the student. It is not pretended that the diseaseis always, or even, it may be, in the majority of cases, carried aboutby attendants; only that it is so carried in certain cases. That it mayhave local and epidemic causes, as well as that depending on personaltransmission, is not disputed. Remember how small-pox often disappearsfrom a community in spite of its contagious character, and the necessaryexposure of many persons to those suffering from it; in both diseasescontagion is only one of the coefficients of the disease. 

I have already spoken of the possibility that Dr. Meigs may have beenthe medium of transfer of puerperal fever in some of the cases he hasbriefly catalogued. Of Dr. Rutter's cases I do not know how to speak. Ionly ask the student to read the facts stated by Dr. Condie, as givenin my Essay, and say whether or not a man should allow his wife to beattended by a practitioner in whose hands "scarcely a female that hasbeen delivered for weeks past has escaped an attack, " "while no instanceof the disease has occurred in the patients of any other accoucheurpractising in the same district. " If I understand Dr. Meigs and Dr. Hodge, they would not warn the physician or spare the patient under suchcircumstances. They would "go on, " if I understand them, not to seven, or seventy, only, but to seventy times seven, if they could findpatients. If this is not what they mean, may we respectfully ask them tostate what they do mean, to their next classes, in the name of humanity, if not of science!

I might repeat the question asked concerning Dr. Rutter's cases, withreference to those reported by Dr. Roberton. Perhaps, however, thestudent would like to know the opinion of a person in the habit ofworking at matters of this kind in a practical point of view. To satisfyhim on this ground, I addressed the following question to the Presidentof one of our principal Insurance Companies, leaving Dr. Meigs's bookand my Essay in his hands at the same time. 

Question. "If such facts as Roberton's cases were before you, and theattendant had had ten, or even five fatal cases, or three, or two even, would you, or would you not, if insuring the life of the next patient tobe taken care of by that attendant, expect an extra premium over that ofan average case of childbirth?"

Answer. "Of course I should require a very large extra premium, if Iwould take take risk at all. "

But I do not choose to add the expressions of indignation which theexamination of the facts before him called out. I was satisfied from theeffect they produced on him, that if all the hideous catalogues ofcases now accumulated were fully brought to the knowledge of the public, nothing, since the days of Burke and Hare, has raised such a cry ofhorror as would be shrieked in the ears of the Profession. 

Dr. Meigs has elsewhere invoked "Providence" as the alternative ofaccident, to account for the "coincidences. " ("Obstetrics, " Phil. 1852, p. 631. ) If so, Providence either acts through the agency of secondarycauses, as in other diseases, or not. If through such causes, let usfind out what they are, as we try to do in other cases. It may be truethat offences, or diseases, will come, but "woe unto him through whomthey come, " if we catch him in the voluntary or careless act of bringingthem! But if Providence does not act through secondary causes in thisparticular sphere of etiology, then why does Dr. Meigs take such painsto reason so extensively about the laws of contagion, which, on thatsupposition, have no more to do with this case than with the plaguewhich destroyed the people after David had numbered them? Above all, what becomes of the theological aspect of the question, when he assertsthat a practitioner was "only unlucky in meeting with the epidemiccases?" (Op. Cit. P. 633. ) We do not deny that the God of battlesdecides the fate of nations; but we like to have the biggest squadronson our side, and we are particular that our soldiers should not only saytheir prayers, but also keep their powder dry. We do not deny the agencyof Providence in the disaster at Norwalk, but we turn off the engineer, and charge the Company five thousand dollars apiece for every life thatis sacrificed. 

Why a grand jury should not bring in a bill against a physician whoswitches off a score of women one after the other along his privatetrack, when he knows that there is a black gulf at the end of it, downwhich they are to plunge, while the great highway is clear, is more thanI can answer. It is not by laying the open draw to Providence that he isto escape the charge of manslaughter. 

To finish with all these lesser matters of question, I am unable to seewhy a female must necessarily be unattended in her confinement, becauseshe declines the services of a particular practitioner. In all theseries of cases mentioned, the death-carrying attendant was surroundedby others not tracked by disease and its consequences. Which, I wouldask, is worse, --to call in another, even a rival practitioner, or tosubmit an unsuspecting female to a risk which an Insurance Company wouldhave nothing to do with?

I do not expect ever to return to this subject. There is a point ofmental saturation, beyond which argument cannot be forced withoutbreeding impatient, if not harsh, feelings towards those who refuse tobe convinced. If I have so far manifested neither, it is well to stophere, and leave the rest to those younger friends who may have morestomach for the dregs of a stale argument. 

The extent of my prefatory remarks may lead some to think that I attachtoo much importance to my own Essay. Others may wonder that I shouldexpend so many words upon the two productions referred to, the Letterand the Lecture. I do consider my Essay of much importance so long asthe doctrine it maintains is treated as a question, and so long as anyimportant part of the defence of that doctrine is thought to rest onits evidence or arguments. I cannot treat as insignificant any opinionsbearing on life, and interests dearer than life, proclaimed yearly tohundreds of young men, who will carry them to their legitimate resultsin practice. 

The teachings of the two Professors in the great schools of Philadelphiaare sure to be listened to, not only by their immediate pupils, but bythe Profession at large. I am too much in earnest for either humilityor vanity, but I do entreat those who hold the keys of life and death tolisten to me also for this once. I ask no personal favor; but I beg tobe heard in behalf of the women whose lives are at stake, until somestronger voice shall plead for them. 

I trust that I have made the issue perfectly distinct and intelligible. And let it be remembered that this is no subject to be smoothed over bynicely adjusted phrases of half-assent and half-censure divided betweenthe parties. The balance must be struck boldly and the result declaredplainly. If I have been hasty, presumptuous, ill-informed, illogical; ifmy array of facts means nothing; if there is no reason for any cautionin the view of these facts; let me be told so on such authority that Imust believe it, and I will be silent henceforth, recognizing that mymind is in a state of disorganization. If the doctrine I have maintainedis a mournful truth; if to disbelieve it, and to practise on thisdisbelief, and to teach others so to disbelieve and practise, is tocarry desolation, and to charter others to carry it, into confidingfamilies, let it be proclaimed as plainly what is to be thought of theteachings of those who sneer at the alleged dangers, and scout the veryidea of precaution. Let it be remembered that persons are nothing inthis matter; better that twenty pamphleteers should be silenced, or asmany professors unseated, than that one mother's life should betaken. There is no quarrel here between men, but there is deadlyincompatibility and exterminating warfare between doctrines. Coincidences meaning nothing, though a man have a monopoly of thedisease for weeks or months; or cause and effect, the cause being insome way connected with the person; this is the question. If I am wrong, let me be put down by such a rebuke as no rash declaimer has receivedsince there has been a public opinion in the medical profession ofAmerica; if I am right, let doctrines which lead to professionalhomicide be no longer taught from the chairs of those two greatInstitutions. Indifference will not do here; our Journalists andCommittees have no right to take up their pages with minute anatomyand tediously detailed cases, while it is a question whether or not the"blackdeath" of child-bed is to be scattered broadcast by the agency ofthe mother's friend and adviser. Let the men who mould opinions look toit; if there is any voluntary blindness, any interested oversight, anyculpable negligence, even, in such a matter, and the facts shall reachthe public ear; the pestilence-carrier of the lying-in chamber must lookto God for pardon, for man will never forgive him. 

 THE CONTAGIOUSNESS OF PUERPERAL FEVER. 

In collecting, enforcing, and adding to the evidence accumulated uponthis most serious subject, I would not be understood to imply that thereexists a doubt in the mind of any well-informed member of the medicalprofession as to the fact that puerperal fever is sometimes communicatedfrom one person to another, both directly and indirectly. In the presentstate of our knowledge upon this point I should consider such doubtsmerely as a proof that the sceptic had either not examined the evidence, or, having examined it, refused to accept its plain and unavoidableconsequences. I should be sorry to think, with Dr. Rigby, that it wasa case of "oblique vision;" I should be unwilling to force home theargumentum ad hominem of Dr. Blundell, but I would not consent to makea question of a momentous fact which is no longer to be considered asa subject for trivial discussions, but to be acted upon withsilent promptitude. It signifies nothing that wise and experiencedpractitioners have sometimes doubted the reality of the danger inquestion; no man has the right to doubt it any longer. No negativefacts, no opposing opinions, be they what they may, or whose they may, can form any answer to the series of cases now within the reach of allwho choose to explore the records of medical science. 

If there are some who conceive that any important end would be answeredby recording such opinions, or by collecting the history of all thecases they could find in which no evidence of the influence of contagionexisted, I believe they are in error. Suppose a few writers of authoritycan be found to profess a disbelief in contagion, --and they are very fewcompared with those who think differently, --is it quite clear that theyformed their opinions on a view of all the facts, or is it not apparentthat they relied mostly on their own solitary experience? Still further, of those whose names are quoted, is it not true that scarcely a singleone could by any possibility have known the half or the tenth of thefacts bearing on the subject which have reached such a frightful amountwithin the last few years? Again, as to the utility of negative facts, as we may briefly call them, --instances, namely, in which exposure hasnot been followed by disease, --although, like other truths, they maybe worth knowing, I do not see that they are like to shed any importantlight upon the subject before us. Every such instance requires a gooddeal of circumstantial explanation before it can be accepted. It is notenough that a practitioner should have had a single case of puerperalfever not followed by others. It must be known whether he attendedothers while this case was in progress, whether he went directly fromone chamber to others, whether he took any, and what precautions. It isimportant to know that several women were exposed to infectionderived from the patient, so that allowance may be made for want ofpredisposition. Now if of negative facts so sifted there could beaccumulated a hundred for every one plain instance of communication hererecorded, I trust it need not be said that we are bound to guard andwatch over the hundredth tenant of our fold, though the ninety andnine may be sure of escaping the wolf at its entrance. If any one isdisposed, then, to take a hundred instances of lives endangered orsacrificed out of those I have mentioned, and make it reasonably clearthat within a similar time and compass ten thousand escaped the sameexposure, I shall thank him for his industry, but I must be permitted tohold to my own practical conclusions, and beg him to adopt or at leastto examine them also. Children that walk in calico before open fires arenot always burned to death; the instances to the contrary may be worthrecording; but by no means if they are to be used as arguments againstwoollen frocks and high fenders. 

I am not sure that this paper will escape another remark which it mightbe wished were founded in justice. It may be said that the facts aretoo generally known and acknowledged to require any formal argument orexposition, that there is nothing new in the positions advanced, andno need of laying additional statements before the Profession. But onturning to two works, one almost universally, and the other extensivelyappealed to as authority in this country, I see ample reason tooverlook this objection. In the last edition of Dewees's Treatise on the"Diseases of Females, " it is expressly said, "In this country, under nocircumstance that puerperal fever has appeared hitherto, does it affordthe slightest ground for the belief that it is contagious. " In the"Philadelphia Practice of Midwifery" not one word can be found in thechapter devoted to this disease which would lead the reader to suspectthat the idea of contagion had ever been entertained. It seems proper, therefore, to remind those who are in the habit of referring to theseworks for guidance, that there may possibly be some sources of dangerthey have slighted or omitted, quite as important as a triflingirregularity of diet, or a confined state of the bowels, and thatwhatever confidence a physician may have in his own mode of treatment, his services are of questionable value whenever he carries the bane aswell as the antidote about his person. 

The practical point to be illustrated is the following:

The disease known as Puerperal Fever is so far contagious as to befrequently carried from patient to patient by physicians and nurses. 

Let me begin by throwing out certain incidental questions, which, without being absolutely essential, would render the subject morecomplicated, and by making such concessions and assumptions as may befairly supposed to be without the pale of discussion. 

1. It is granted that all the forms of what is called puerperal fevermay not be, and probably are not, equally contagious or infectious. Ido not enter into the distinctions which have been drawn by authors, because the facts do not appear to me sufficient to establish anyabsolute line of demarcation between such forms as may be propagated bycontagion and those which are never so propagated. This general result Ishall only support by the authority of Dr. Ramsbotham, who gives, as theresult of his experience, that the same symptoms belong to what he callsthe infectious and the sporadic forms of the disease, and the opinionof Armstrong in his original Essay. If others can show any suchdistinction, I leave it to them to do it. But there are cases enoughthat show the prevalence of the disease among the patients of a singlepractitioner when it was in no degree epidemic, in the proper senseof the term. I may refer to those of Mr. Roberton and of Dr. Peirson, hereafter to be cited, as examples. 

2. I shall not enter into any dispute about the particular mode ofinfection, whether it be by the atmosphere the physician carries abouthim into the sick-chamber, or by the direct application of the virus tothe absorbing surfaces with which his hand comes in contact. Many factsand opinions are in favor of each of these modes of transmission. But itis obvious that in the majority of cases it must be impossible to decideby which of these channels the disease is conveyed, from the nature ofthe intercourse between the physician and the patient. 

3. It is not pretended that the contagion of puerperal fever must alwaysbe followed by the disease. It is true of all contagious diseases, thatthey frequently spare those who appear to be fully submitted to theirinfluence. Even the vaccine virus, fresh from the subject, fails everyday to produce its legitimate effect, though every precaution is takento insure its action. This is still more remarkably the case withscarlet fever and some other diseases. 

4. It is granted that the disease may be produced and variously modifiedby many causes besides contagion, and more especially by epidemic andendemic influences. But this is not peculiar to the disease in question. There is no doubt that small-pox is propagated to a great extent bycontagion, yet it goes through the same periods of periodical increaseand diminution which have been remarked in puerperal fever. If thequestion is asked how we are to reconcile the great variations in themortality of puerperal fever in different seasons and places with thesupposition of contagion, I will answer it by another question fromMr. Farr's letter to the Registrar-General. He makes the statement that"five die weekly of small-pox in the metropolis when the disease is notepidemic, "--and adds, "The problem for solution is, --Why do the fivedeaths become 10, 15, 20, 31, 58, 88, weekly, and then progressivelyfall through the same measured steps?"

5. I take it for granted, that if it can be shown that great numbersof lives have been and are sacrificed to ignorance or blindness on thispoint, no other error of which physicians or nurses may be occasionallysuspected will be alleged in palliation of this; but that whenever andwherever they can be shown to carry disease and death instead of healthand safety, the common instincts of humanity will silence every attemptto explain away their responsibility. 

The treatise of Dr. Gordon of Aberdeen was published in the year 1795, being among the earlier special works upon the disease. Apart ofhis testimony has been occasionally copied into other works, but hisexpressions are so clear, his experience is given with such manlydistinctness and disinterested honesty, that it may be quoted as a modelwhich might have been often followed with advantage. 

"This disease seized such women only as were visited, or delivered by apractitioner, or taken care of by a nurse, who had previously attendedpatients affected with the disease. "

"I had evident proofs of its infectious nature, and that the infectionwas as readily communicated as that of the small-pox or measles, and operated more speedily than any other infection with which I amacquainted. "

"I had evident proofs that every person who had been with a patientin the puerperal fever became charged with an atmosphere of infection, which was communicated to every pregnant woman who happened to comewithin its sphere. This is not an assertion, but a fact, admittingof demonstration, as may be seen by a perusal of the foregoingtable, "--referring to a table of seventy-seven cases, in many of whichthe channel of propagation was evident. 

He adds, "It is a disagreeable declaration for me to mention, that Imyself was the means of carrying the infection to a great number ofwomen. " He then enumerates a number of instances in which the diseasewas conveyed by midwives and others to the neighboring villages, anddeclares that "these facts fully prove that the cause of the puerperalfever, of which I treat, was a specific contagion, or infection, altogether unconnected with a noxious constitution of the atmosphere. "

But his most terrible evidence is given in these words: "I ARRIVED ATTHAT CERTAINTY IN THE MATTER, THAT I COULD VENTURE TO FORETELL WHATWOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT MIDWIFETHEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE ATTENDED, DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE, MY PREDICTION WASVERIFIED. "

Even previously to Gordon, Mr. White of Manchester had said, "I amacquainted with two gentlemen in another town, where the whole businessof midwifery is divided betwixt them, and it is very remarkable that oneof them loses several patients every year of the puerperal fever, andthe other never so much as meets with the disorder, "--a differencewhich he seems to attribute to their various modes of treatment. [On theManagement of Lying-in Women, p. 120. ]

Dr. Armstrong has given a number of instances in his Essay on PuerperalFever, of the prevalence of the disease among the patients of a singlepractitioner. At Sunderland, "in all, forty-three cases occurred fromthe 1st of January to the 1st of October, when the disease ceased; andof this number forty were witnessed by Mr. Gregson and his assistant, Mr. Gregory, the remainder having been separately seen by threeaccoucheurs. " There is appended to the London edition of this Essay, aletter from Mr. Gregson, in which that gentleman says, in reference tothe great number of cases occurring in his practice, "The cause of thisI cannot pretend fully to explain, but I should be wanting in commonliberality if I were to make any hesitation in asserting, that thedisease which appeared in my practice was highly contagious, andcommunicable from one puerperal woman to another. " "It is customaryamong the lower and middle ranks of people to make frequent personalvisits to puerperal women resident in the same neighborhood, and I haveample evidence for affirming that the infection of the disease was oftencarried about in that manner; and, however painful to my feelings, I must in candor declare, that it is very probable the contagion wasconveyed, in some instances, by myself, though I took every possiblecare to prevent such a thing from happening, the moment that Iascertained that the distemper was infectious. " Dr. Armstrong goes on tomention six other instances within his knowledge, in which the diseasehad at different times and places been limited, in the same singularmanner, to the practice of individuals, while it existed scarcely ifat all among the patients of others around them. Two of the gentlemenbecame so convinced of their conveying the contagion, that they withdrewfor a time from practice. 

I find a brief notice, in an American Journal, of another series ofcases, first mentioned by Mr. Davies, in the "Medical Repository. " Thisgentleman stated his conviction that the disease is contagious. 

"In the autumn of 1822 he met with twelve cases, while his medicalfriends in the neighborhood did not meet with any, 'or at least veryfew. ' He could attribute this circumstance to no other cause than hishaving been present at the examination, after death, of two cases, sometime previous, and of his having imparted the disease to his patients, notwithstanding every precaution. "

Dr. Gooch says, "It is not uncommon for the greater number of cases tooccur in the practice of one man, whilst the other practitioners of theneighborhood, who are not more skilful or more busy, meet with fewor none. A practitioner opened the body of a woman who had died ofpuerperal fever, and continued to wear the same clothes. A lady whom hedelivered a few days afterwards was attacked with and died of a similardisease; two more of his lying-in patients, in rapid succession, metwith the same fate; struck by the thought, that he might have carriedcontagion in his clothes, he instantly changed them, and 'met with nomore cases of the kind. ' A woman in the country, who was employed aswasherwoman and nurse, washed the linen of one who had died of puerperalfever; the next lying-in patient she nursed died of the same disease;a third nursed by her met with the same fate, till the neighborhood, getting afraid of her, ceased to employ her. "

In the winter of the year 1824, "Several instances occurred of itsprevalence among the patients of particular practitioners, whilst otherswho were equally busy met with few or none. One instance of thiskind was very remarkable. A general practitioner, in large midwiferypractice, lost so many patients from puerperal fever, that he determinedto deliver no more for some time, but that his partner should attend inhis place. This plan was pursued for one month, during which not a caseof the disease occurred in their practice. The elder practitioner, beingthen sufficiently recovered, returned to his practice, but the firstpatient he attended was attacked by the disease and died. A physician, who met him in consultation soon afterwards, about a case of a differentkind, and who knew nothing of his misfortune, asked him whetherpuerperal fever was at all prevalent in his neighborhood, on which heburst into tears, and related the above circumstances. 

"Among the cases which I saw this season in consultation, four occurredin one month in the practice of one medical man, and all of themterminated fatally. " [Lond. Med. Gaz. May 2, 1835. ]

Dr. Ramsbotham asserted, in a Lecture at the London Hospital, thathe had known the disease spread through a particular district, or beconfined to the practice of a particular person, almost every patientbeing attacked with it, while others had not a single case. It seemedcapable, he thought, of conveyance, not only by common modes; butthrough the dress of the attendants upon the patient. 

In a letter to be found in the "London Medical Gazette" for January, 1840, Mr. Roberton of Manchester makes the statement which I here givein a somewhat condensed form. 

A midwife delivered a woman on the 4th of December, 1830, who died soonafter with the symptoms of puerperal fever. In one month from this datethe same midwife delivered thirty women, residing in different parts ofan extensive suburb, of which number sixteen caught the disease and alldied. These were the only cases which had occurred for a considerabletime in Manchester. The other midwives connected with the samecharitable institution as the woman already mentioned are twenty-five innumber, and deliver, on an average, ninety women a week, or about threehundred and eighty a month. None of these women had a case of puerperalfever. "Yet all this time this woman was crossing the other midwives inevery direction, scores of the patients of the charity being deliveredby them in the very same quarters where her cases of fever werehappening. "

Mr. Roberton remarks, that little more than half the women she deliveredduring this month took the fever; that on some days all escaped, onothers only one or more out of three or four; a circumstance similar towhat is seen in other infectious maladies. 

Dr. Blundell says, "Those who have never made the experiment can havebut a faint conception how difficult it is to obtain the exact truthrespecting any occurrence in which feelings and interests are concerned. Omitting particulars, then, I content myself with remarking, generally, that from more than one district I have received accounts of theprevalence of puerperal fever in the practice of some individuals, whileits occurrence in that of others, in the same neighborhood, was notobserved. Some, as I have been told, have lost ten, twelve, or a greaternumber of patients, in scarcely broken succession; like their evilgenius, the puerperal fever has seemed to stalk behind them whereverthey went. Some have deemed it prudent to retire for a time frompractice. In fine, that this fever may occur spontaneously, I admit;that its infectious nature may be plausibly disputed, I do not deny; butI add, considerately, that in my own family I had rather that thoseI esteemed the most should be delivered, unaided, in a stable, by themanger-side, than that they should receive the best help, in the fairestapartment, but exposed to the vapors of this pitiless disease. Gossipingfriends, wet-nurses, monthly nurses, the practitioner himself, theseare the channels by which, as I suspect, the infection is principallyconveyed. "

At a meeting of the Royal Medical and Chirurgical Society, Dr. Kingmentioned that some years since a practitioner at Woolwich lost sixteenpatients from puerperal fever in the same year. He was compelled to giveup practice for one or two years, his business being divided amongthe neighboring practitioners. No case of puerperal fever occurredafterwards, neither had any of the neighboring surgeons any cases ofthis disease. 

At the same meeting Mr. Hutchinson mentioned the occurrence of threeconsecutive cases of puerperal fever, followed subsequently by twoothers, all in the practice of one accoucheur. [Lancet, May 2, 1840. ]

Dr. Lee makes the following statement: "In the last two weeks ofSeptember, 1827, five fatal cases of uterine inflammation came under ourobservation. All the individuals so attacked had been attended in laborby the same midwife, and no example of a febrile or inflammatory diseaseof a serious nature occurred during that period among the other patientsof the Westminster General Dispensary, who had been attended by theother midwives belonging to that institution. "

The recurrence of long series of cases like those I have cited, reportedby those most interested to disbelieve in contagion, scatteredalong through an interval of half a century, might have been thoughtsufficient to satisfy the minds of all inquirers that here wassomething more than a singular coincidence. But if, on a more extendedobservation, it should be found that the same ominous groups of casesclustering about individual practitioners were observed in a remotecountry, at different times, and in widely separated regions, it wouldseem incredible that any should be found too prejudiced or indolent toaccept the solemn truth knelled into their ears by the funeral bellsfrom both sides of the ocean, --the plain conclusion that the physicianand the disease entered, hand in hand, into the chamber of theunsuspecting patient. 

That such series of cases have been observed in this country, and inthis neighborhood, I proceed to show. 

In Dr. Francis's "Notes to Denman's Midwifery, " a passage is cited fromDr. Hosack, in which he refers to certain puerperal cases which provedfatal to several lying-in women, and in some of which the disease wassupposed to be conveyed by the accoucheurs themselves. 

A writer in the "New York Medical and Physical Journal" for October, 1829, in speaking of the occurrence of puerperal fever, confined to oneman's practice, remarks, "We have known cases of this kind occur, thoughrarely, in New York. "

I mention these little hints about the occurrence of such cases, partly because they are the first I have met with in American medicalliterature, but more especially because they serve to remind us thatbehind the fearful array of published facts there lies a dark list ofsimilar events, unwritten in the records of science, but long rememberedby many a desolated fireside. 

Certainly nothing can be more open and explicit than the account givenby Dr. Peirson of Salem, of the cases seen by him. In the first nineteendays of January, 1829, he had five consecutive cases of puerperal fever, every patient he attended being attacked, and the three first casesproving fatal. In March of the same year he had two moderate cases, inJune, another case, and in July, another, which proved fatal. "Up tothis period, " he remarks, "I am not informed that a single case hadoccurred in the practice of any other physician. Since that periodI have had no fatal case in my practice, although I have had severaldangerous cases. I have attended in all twenty cases of this disease, ofwhich four have been fatal. I am not aware that there has been anyother case in the town of distinct puerperal peritonitis, although I amwilling to admit my information may be very defective on this point. I have been told of some I 'mixed cases, ' and 'morbid affections afterdelivery. '"

In the "Quarterly Summary of the Transactions of the College ofPhysicians of Philadelphia" may be found some most extraordinarydevelopments respecting a series of cases occurring in the practice of amember of that body. 

Dr. Condie called the attention of the Society to the prevalence, at thepresent time, of puerperal fever of a peculiarly insidious and malignantcharacter. "In the practice of one gentleman extensively engaged as anobstetrician, nearly every female he has attended in confinement, duringseveral weeks past, within the above limits" (the southern sections andneighboring districts), "had been attacked by the fever. "

"An important query presents itself, the Doctor observed, in referenceto the particular form of fever now prevalent. Is it, namely, capableof being propagated by contagion, and is a physician who has been inattendance upon a case of the disease warranted in continuing, withoutinterruption, his practice as an obstetrician? Dr. C. , although nota believer in the contagious character of many of those affectionsgenerally supposed to be propagated in this manner, has neverthelessbecome convinced by the facts that have fallen under his notice, thatthe puerperal fever now prevailing is capable of being communicated bycontagion. How otherwise can be explained the very curious circumstanceof the disease in one district being exclusively confined to thepractice of a single physician, a Fellow of this College, extensivelyengaged in obstetrical practice, --while no instance of the diseasehas occurred in the patients under the care of any other accoucheurpractising within the same district; scarcely a female that has beendelivered for weeks past has escaped an attack?"

Dr. Rutter, the practitioner referred to, "observed that, after theoccurrence of a number of cases of the disease in his practice, hehad left the city and remained absent for a week, but on returning, noarticle of clothing he then wore having been used by him before, oneof the very first cases of parturition he attended was followed byan attack of the fever, and terminated fatally; he cannot, readily, therefore, believe in the transmission of the disease from female tofemale, in the person or clothes of the physician. "

The meeting at which these remarks were made was held on the 3d of May, 1842. In a letter dated December 20, 1842, addressed to Dr. Meigs, andto be found in the "Medical Examiner, " he speaks of "those horriblecases of puerperal fever, some of which you did me the favor to see withme during the past summer, " and talks of his experience in the disease, "now numbering nearly seventy cases, all of which have occurred withinless than a twelvemonth past. "

And Dr. Meigs asserts, on the same page, "Indeed, I believe that hispractice in that department of the profession was greater than thatof any other gentleman, which was probably the cause of his seeing agreater number of the cases. " This from a professor of midwifery, whosome time ago assured a gentleman whom he met in consultation, that thenight on which they met was the eighteenth in succession that he himselfhad been summoned from his repose, seems hardly satisfactory. 

I must call the attention of the inquirer most particularly to theQuarterly Report above referred to, and the letters of Dr. Meigs and Dr. Rutter, to be found in the "Medical Examiner. " Whatever impression theymay produce upon his mind, I trust they will at least convince himthat there is some reason for looking into this apparently uninvitingsubject. 

At a meeting of the College of Physicians just mentioned, Dr. Warringtonstated, that a few days after assisting at an autopsy of puerperalperitonitis, in which he laded out the contents of the abdominal cavitywith his hands, he was called upon to deliver three women in rapidsuccession. All of these women were attacked with different forms ofwhat is commonly called puerperal fever. Soon after these he saw twoother patients, both on the same day, with the same disease. Of thesefive patients two died. 

At the same meeting, Dr. West mentioned a fact related to him by Dr. Samuel Jackson of Northumberland. Seven females, delivered by Dr. Jackson in rapid succession, while practising in Northumberland County, were all attacked with puerperal fever, and five of them died. "Women, "he said, "who had expected me to attend upon them, now becoming alarmed, removed out of my reach, and others sent for a physician residingseveral miles distant. These women, as well as those attended bymidwives; all did well; nor did we hear of any deaths in child-bedwithin a radius of fifty miles, excepting two, and these I afterwardsascertained to have been caused by other diseases. " He underwent, ashe thought, a thorough purification, and still his next patient wasattacked with the disease and died. He was led to suspect that thecontagion might have been carried in the gloves which he had worn inattendance upon the previous cases. Two months or more after this he hadtwo other cases. He could find nothing to account for these, unless itwere the instruments for giving enemata, which had been used in two ofthe former cases, and were employed by these patients. When thefirst case occurred, he was attending and dressing a limb extensivelymortified from erysipelas, and went immediately to the accouchement withhis clothes and gloves most thoroughly imbued with its efluvia. And hereI may mention, that this very Dr. Samuel Jackson of Northumberland isone of Dr. Dewees's authorities against contagion. 

The three following statements are now for the first time given to thepublic. All of the cases referred to occurred within this State, and twoof the three series in Boston and its immediate vicinity. 

I. The first is a series of cases which took place during the lastspring in a town at some distance from this neighborhood. A physician ofthat town, Dr. C. , had the following consecutive cases. 

 No. 1, delivered March 20, died March 24. " 2, " April 9, " April 14. " 3, " " 10, " " 14. " 4, " " 11, " " 18. " 5, " " 27, " May 3. " 6, " " 28, had some symptoms, (recovered. ) " 7, " May 8, had some symptoms, (also recovered. )

These were the only cases attended by this physician during the periodreferred to. "They were all attended by him until their termination, with the exception of the patient No. 6, who fell into the hands ofanother physician on the 2d of May. (Dr. C. Left town for a few daysat this time. ) Dr. C. Attended cases immediately before and after theabove-named periods, none of which, however, presented any peculiarsymptoms of the disease. "

About the 1st of July he attended another patient in a neighboringvillage, who died two or three days after delivery. 

The first patient, it is stated, was delivered on the 20th of March. "Onthe 19th, Dr. C. Made the autopsy of a man who died suddenly, sick onlyforty-eight hours; had oedema of the thigh, and gangrene extending froma little above the ankle into the cavity of the abdomen. " Dr. C. Woundedhimself, very slightly, in the right hand during the autopsy. The handwas quite painful the night following, during his attendance on thepatient No. 1. He did not see this patient after the 20th, beingconfined to the house, and very sick from the wound just mentioned, fromthis time until the 3d of April. 

Several cases of erysipelas occurred in the house where the autopsymentioned above took place, soon after the examination. There were alsomany cases of erysipelas in town at the time of the fatal puerperalcases which have been mentioned. 

The nurse who laid out the body of the patient No. 3 was taken on theevening of the same day with sore throat and erysipelas, and died in tendays from the first attack. 

The nurse who laid out the body of the patient No. 4 was taken on theday following with symptoms like those of this patient, and died in aweek, without any external marks of erysipelas. 

"No other cases of similar character with those of Dr. C. Occurred inthe practice of any of the physicians in the town or vicinity at thetime. Deaths following confinement have occurred in the practice ofother physicians during the past year, but they were not cases ofpuerperal fever. No post-mortem examinations were held in any of thesepuerperal cases. "

Some additional statements in this letter are deserving of insertion. 

"A physician attended a woman in the immediate neighborhood of the casesnumbered 2, 3, and 4. This patient was confined the morning of March1st, and died on the night of March 7th. It is doubtful whether thisshould be considered a case of puerperal fever. She had suffered fromcanker, indigestion, and diarrhoea for a year previous to her delivery. Her complaints were much aggravated for two or three months previousto delivery; she had become greatly emaciated, and weakened to such anextent that it had not been expected that she would long survive herconfinement, if indeed she reached that period. Her labor was easyenough; she flowed a good deal, seemed exceedingly prostrated, hadringing in the ears, and other symptoms of exhaustion; the pulse wasquick and small. On the second and third day there was some tendernessand tumefaction of the abdomen, which increased somewhat on the fourthand fifth. He had cases in midwifery before and after this, whichpresented nothing peculiar. "

It is also mentioned in the same letter, that another physician hada case during the last summer and another last fall, both of whichrecovered. 

Another gentleman reports a case last December, a second case fiveweeks, and another three weeks since. All these recovered. A case alsooccurred very recently in the practice of a physician in the villagewhere the eighth patient of Dr. C. Resides, which proved fatal. "Thispatient had some patches of erysipelas on the legs and arms. The samephysician has delivered three cases since, which have all done well. There have been no other cases in this town or its vicinity recently. There have been some few cases of erysipelas. " It deserves noticethat the partner of Dr. C. , who attended the autopsy of the man abovementioned and took an active part in it; who also suffered very slightlyfrom a prick under the thumb-nail received during the examination, hadtwelve cases of midwifery between March 26th and April 12th, all ofwhich did well, and presented no peculiar symptoms. It should also bestated, that during these seventeen days he was in attendance on all thecases of erysipelas in the house where the autopsy had been performed. 

I owe these facts to the prompt kindness of a gentleman whoseintelligence and character are sufficient guaranty for their accuracy. 

The two following letters were addressed to my friend Dr. Scorer, by thegentleman in whose practice the cases of puerperal fever occurred. His name renders it unnecessary to refer more particularly to thesegentlemen, who on their part have manifested the most perfect freedomand courtesy in affording these accounts of their painful experience. 

"January 28, 1843. 

II. . . . "The time to which you allude was in 1830. The first case was inFebruary, during a very cold time. She was confined the 4th, and diedthe 12th. Between the 10th and 28th of this month, I attended six womenin labor, all of whom did well except the last, as also two who wereconfined March 1st and 5th. Mrs. E. , confined February 28th, sickened, and died March 8th. The next day, 9th, I inspected the body, and thenight after attended a lady, Mrs. B. , who sickened, and died 16th. The10th, I attended another, Mrs. G. , who sickened, but recovered. March16th, I went from Mrs. G. 's room to attend a Mrs. H. , who sickened, anddied 21st. The 17th, I inspected Mrs. B. On the 19th, I went directlyfrom Mrs. H. 's room to attend another lady, Mrs. G. , who also sickened, and died 22d. While Mrs. B. Was sick, on 15th, I went directly from herroom a few rods, and attended another woman, who was not sick. Up to20th of this month I wore the same clothes. I now refused to attend anylabor, and did not till April 21st, when, having thoroughly cleansedmyself, I resumed my practice, and had no more puerperal fever. 

"The cases were not confined to a narrow space. The two nearest werehalf a mile from each other, and half that distance from my residence. The others were from two to three miles apart, and nearly that distancefrom my residence. There were no other cases in their immediate vicinitywhich came to my knowledge. The general health of all the women waspretty good, and all the labors as good as common, except the first. This woman, in consequence of my not arriving in season, and the childbeing half-born at some time before I arrived, was very much exposed tothe cold at the time of confinement, and afterwards, being confined in avery open, cold room. Of the six cases you perceive only one recovered. 

"In the winter of 1817 two of my patients had puerperal fever, one verybadly, the other not so badly. Both recovered. One other had swelledleg, or phlegmasia dolens, and one or two others did not recover as wellas usual. 

"In the summer of 1835 another disastrous period occurred in mypractice. July 1st, I attended a lady in labor, who was afterwards quiteill and feverish; but at the time I did not consider her case a decidedpuerperal fever. On the 8th, I attended one who did well. On the 12th, one who was seriously sick. This was also an equivocal case, apparentlyarising from constipation and irritation of the rectum. These women wereten miles apart and five from my residence. On 15th and 20th, two whodid well. On 25th, I attended another. This was a severe labor, andfollowed by unequivocal puerperal fever, or peritonitis. She recovered. August 2d and 3d, in about twenty-four hours I attended four persons. Two of them did very well; one was attacked with some of the commonsymptoms, which however subsided in a day or two, and the other haddecided puerperal fever, but recovered. This woman resided five milesfrom me. Up to this time I wore the same coat. All my other clothes hadfrequently been changed. On 6th, I attended two women, one of whom wasnot sick at all; but the other, Mrs. L. , was afterwards taken ill. On10th, I attended a lady, who did very well. I had previously changed allmy clothes, and had no garment on which had been in a puerperal room. On12th, I was called to Mrs. S. , in labor. While she was ill, I left herto visit Mrs. L. , one of the ladies who was confined on 6th. Mrs. L. Hadbeen more unwell than usual, but I had not considered her case anythingmore than common till this visit. I had on a surtout at this visit, which, on my return to Mrs. S. , I left in another room. Mrs. S. Wasdelivered on 13th with forceps. These women both died of decidedpuerperal fever. 

"While I attended these women in their fevers, I changed my clothes, andwashed my hands in a solution of chloride of lime after each visit. Iattended seven women in labor during this period, all of whom recoveredwithout sickness. 

"In my practice I have had several single cases of puerperal fever, someof whom have died and some have recovered. Until the year 1830 I hadno suspicion that the disease could be communicated from one patientto another by a nurse or midwife; but I now think the foregoing factsstrongly favor that idea. I was so much convinced of this fact, that Iadopted the plan before related. 

"I believe my own health was as good as usual at each of the aboveperiods. I have no recollections to the contrary. 

"I believe I have answered all your questions. I have been moreparticular on some points perhaps than necessary; but I thought youcould form your own opinion better than to take mine. In 1830 I wroteto Dr. Charming a more particular statement of my cases. If I have notanswered your questions sufficiently, perhaps Dr. C. May have my letterto him, and you can find your answer there. " [In a letter to myself, this gentleman also stated, "I do not recollect that there was anyerysipelas or any other disease particularly prevalent at the time. "]

"BOSTON, February 3, 1843. 

III. "MY DEAR SIR, --I received a note from you last evening, requestingme to answer certain questions therein proposed, touching the casesof puerperal fever which came under my observation the past summer. Itgives me pleasure to comply with your request, so far as it is in mypower so to do, but, owing to the hurry in preparing for a journey, thenotes of the cases I had then taken were lost or mislaid. The principalfacts, however, are too vivid upon my recollection to be soon forgotten. I think, therefore, that I shall be able to give you all the informationyou may require. 

"All the cases that occurred in my practice took place between the 7thof May and the 17th of June 1842. 

"They were not confined to any particular part of the city. The firsttwo cases were patients residing at the South End, the next was at theextreme North End, one living in Sea Street and the other in Roxbury. The following is the order in which they occurred:

"Case 1. Mrs. ______ was confined on the 7th of May, at 5 o'clock, P. M. , after a natural labor of six hours. At 12 o'clock at night, on the 9th(thirty-one hours after confinement), she was taken with severe chill, previous to which she was as comfortable as women usually are under thecircumstances. She died on the 10th. 

"Case 2. Mrs. ______ was confined on the 10th of June (four weeks afterMrs. C. ), at 11 A. M. , after a natural, but somewhat severe labor offive hours. At 7 o'clock, on the morning of the 11th, she had a chill. Died on the 12th. 

"Case 3. Mrs. ______, confined on the 14th of June, was comfortable untilthe 18th, when symptoms of puerperal fever were manifest. She died onthe 20th. 

"Case 4. Mrs. ______, confined June 17th, at 5 o'clock, A. M. , was doingwell until the morning of the 19th. She died on the evening of the 21st. 

"Case 5. Mrs. ______ was confined with her fifth child on the 17th ofJune, at 6 o'clock in the evening. This patient had been attacked withpuerperal fever, at three of her previous confinements, but the diseaseyielded to depletion and other remedies without difficulty. This time, Iregret to say, I was not so fortunate. She was not attacked, as were theother patients, with a chill, but complained of extreme pain in abdomen, and tenderness on pressure, almost from the moment of her confinement. In this as in the other cases, the disease resisted all remedies, andshe died in great distress on the 22d of the same month. Owing tothe extreme heat of the season, and my own indisposition, none of thesubjects were examined after death. Dr. Channing, who was in attendancewith me on the three last cases, proposed to have a post-mortemexamination of the subject of case No. 5, but from some cause which I donot now recollect it was not obtained. 

"You wish to know whether I wore the same clothes when attending thedifferent cases. I cannot positively say, but I should think I did not, as the weather became warmer after the first two cases; I thereforethink it probable that I made a change of at least a part of my dress. I have had no other case of puerperal fever in my own practice for threeyears, save those above related, and I do not remember to have lost apatient before with this disease. While absent, last July, I visitedtwo patients sick with puerperal fever, with a friend of mine in thecountry. Both of them recovered. 

"The cases that I have recorded were not confined to any particularconstitution or temperament, but it seized upon the strong and the weak, the old and the young, --one being over forty years, and the youngestunder eighteen years of age. . . . If the disease is of an erysipelatousnature, as many suppose, contagionists may perhaps find some ground fortheir belief in the fact, that, for two weeks previous to my first caseof puerperal fever, I had been attending a severe case of erysipelas, and the infection may have been conveyed through me to the patient; but, on the other hand, why is not this the case with other physicians, or with the same physician at all times, for since my return fromthe country I have had a more inveterate case of erysipelas than everbefore, and no difficulty whatever has attended any of my midwiferycases?"

I am assured, on unquestionable authority, that "About three yearssince, a gentleman in extensive midwifery business, in a neighboringState, lost in the course of a few weeks eight patients in child-bed, seven of them being undoubted cases of puerperal fever. No otherphysician of the town lost a single patient of this disease during thesame period. " And from what I have heard in conversation with some ofour most experienced practitioners, I am inclined to think many cases ofthe kind might be brought to light by extensive inquiry. 

This long catalogue of melancholy histories assumes a still darkeraspect when we remember how kindly nature deals with the parturientfemale, when she is not immersed in the virulent atmosphere of an impurelying-in hospital, or poisoned in her chamber by the unsuspected breathof contagion. From all causes together, not more than four deaths in athousand births and miscarriages happened in England and Wales duringthe period embraced by the first "Report of the Registrar-General. "In the second Report the mortality was shown to be about five in onethousand. In the Dublin Lying-in Hospital, during the seven years ofDr. Collins's mastership, there was one case of puerperal fever to 178deliveries, or less than six to the thousand, and one death from thisdisease in 278 cases, or between three and four to the thousand a yetduring this period the disease was endemic in the hospital, and mighthave gone on to rival the horrors of the pestilence of the Maternite, had not the poison been destroyed by a thorough purification. 

In private practice, leaving out of view the cases that are to beascribed to the self-acting system of propagation, it would seem thatthe disease must be far from common. Mr. White of Manchester says, "Outof the whole number of lying-in patients whom I have delivered (and Imay safely call it a great one), I have never lost one, nor to the bestof my recollection has one been greatly endangered, by the puerperal, miliary, low nervous, putrid malignant, or milk fever. " Dr. JosephClarke informed Dr. Collins, that in the course of forty-five years'most extensive practice he lost but four patients from this disease. Oneof the most eminent practitioners of Glasgow, who has been engaged invery extensive practice for upwards of a quarter of a century, testifies that he never saw more than twelve cases of real puerperalfever. [Lancet, May 4, 1833]

I have myself been told by two gentlemen practising in this city, andhaving for many years a large midwifery business, that they had neitherof them lost a patient from this disease, and by one of them that hehad only seen it in consultation with other physicians. In five hundredcases of midwifery, of which Dr. Storer has given an abstract in thefirst number of this Journal, there was only one instance of fatalpuerperal peritonitis. 

In the view of these facts, it does appear a singular coincidence, thatone man or woman should have ten, twenty, thirty, or seventy cases ofthis rare disease following his or her footsteps with the keenness ofa beagle, through the streets and lanes of a crowded city, while thescores that cross the same paths on the same errands know it onlyby name. It is a series of similar coincidences which has led us toconsider the dagger, the musket, and certain innocent-looking whitepowders as having some little claim to be regarded as dangerous. It isthe practical inattention to similar coincidences which has given riseto the unpleasant but often necessary documents called indictments, which has sharpened a form of the cephalotome sometimes employed inthe case of adults, and adjusted that modification of the fillet whichdelivers the world of those who happen to be too much in the way whilesuch striking coincidences are taking place. 

I shall now mention a few instances in which the disease appears to havebeen conveyed by the process of direct inoculation. 

Dr. Campbell of Edinburgh states that in October, 1821, he assisted atthe post-mortem examination of a patient who died with puerperal fever. He carried the pelvic viscera in his pocket to the class-room. The sameevening he attended a woman in labor without previously changing hisclothes; this patient died. The next morning he delivered a woman withthe forceps; she died also, and of many others who were seized with thedisease within a few weeks, three shared the same fate in succession. 

In June, 1823, he assisted some of his pupils at the autopsy of a caseof puerperal fever. He was unable to wash his hands with proper care, for want of the necessary accommodations. On getting home he found thattwo patients required his assistance. He went without further ablution, or changing his clothes; both these patients died with puerperal fever. This same Dr. Campbell is one of Dr. Churchill's authorities againstcontagion. 

Mr. Roberton says that in one instance within his knowledge apractitioner passed the catheter for a patient with puerperal fever latein the evening; the same night he attended a lady who had the symptomsof the disease on the second day. In another instance a surgeon wascalled while in the act of inspecting the body of a woman who had diedof this fever, to attend a labor; within forty-eight hours this patientwas seized with the fever. '

On the 16th of March, 1831, a medical practitioner examined the bodyof a woman who had died a few days after delivery, from puerperalperitonitis. On the evening of the 17th he delivered a patient, who wasseized with puerperal fever on the 19th, and died on the 24th. Betweenthis period and the 6th of April, the same practitioner attended twoother patients, both of whom were attacked with the same disease anddied. 

In the autumn of 1829 a physician was present at the examination ofa case of puerperal fever, dissected out the organs, and assisted insewing up the body. He had scarcely reached home when he was summoned toattend a young lady in labor. In sixteen hours she was attacked with thesymptoms of puerperal fever, and narrowly escaped with her life. 

In December, 1830, a midwife, who had attended two fatal cases ofpuerperal fever at the British Lying-in Hospital, examined a patientwho had just been admitted, to ascertain if labor had commenced. Thispatient remained two days in the expectation that labor would comeon, when she returned home and was then suddenly taken in labor anddelivered before she could set out for the hospital. She went onfavorably for two days, and was then taken with puerperal fever and diedin thirty-six hours. 

"A young practitioner, contrary to advice, examined the body of apatient who had died from puerperal fever; there was no epidemic at thetime; the case appeared to be purely sporadic. He delivered threeother women shortly afterwards; they all died with puerperal fever, thesymptoms of which broke out very soon after labor. The patients of hiscolleague did well, except one, where he assisted to remove some coagulafrom the uterus; she was attacked in the same manner as those whom hehad attended, and died also. " The writer in the "British and ForeignMedical Review, " from whom I quote this statement, --and who is noother than Dr. Rigby, adds, "We trust that this fact alone will foreversilence such doubts, and stamp the well-merited epithet of 'criminal, 'as above quoted, upon such attempts. " [Brit. And For. Medical Review forJan. 1842, p. 112. ]

From the cases given by Mr. Ingleby, I select the following. Twogentlemen, after having been engaged in conducting the post-mortemexamination of a case of puerperal fever, went in the same dress, eachrespectively, to a case of midwifery. "The one patient was seized withthe rigor about thirty hours afterwards. The other patient was seizedwith a rigor the third morning after delivery. One recovered, one died. "[Edin. Med. And Surg. Journal, April, 1838. ]

One of these same gentlemen attended another woman in the same clothestwo days after the autopsy referred to. "The rigor did not take placeuntil the evening of the fifth day from the first visit. Result fatal. "These cases belonged to a series of seven, the first of which wasthought to have originated in a case of erysipelas. "Several cases of amild character followed the foregoing seven, and their nature being nowmost unequivocal, my friend declined visiting all midwifery cases for atime, and there was no recurrence of the disease. " These cases occurredin 1833. Five of them proved fatal. Mr. Ingleby gives another series ofseven eases which occurred to a practitioner in 1836, the first of whichwas also attributed to his having opened several erysipelatous abscessesa short time previously. 

I need not refer to the case lately read before this Society, in which aphysician went, soon after performing an autopsy of a case of puerperalfever, to a woman in labor, who was seized with the same disease andperished. The forfeit of that error has been already paid. 

At a meeting of the Medical and Chirurgical Society before referred to, Dr. Merriman related an instance occurring in his own practice, whichexcites a reasonable suspicion that two lives were sacrificed to astill less dangerous experiment. He was at the examination of a caseof puerperal fever at two o'clock in the afternoon. He took care not totouch the body. At nine o'clock the same evening he attended a woman inlabor; she was so nearly delivered that he had scarcely anything to do. The next morning she had severe rigors, and in forty-eight hours she wasa corpse. Her infant had erysipelas and died in two days. [Lancet, May2, 1840. ]

In connection with the facts which have been stated, it seems proper toallude to the dangerous and often fatal effects which have followed fromwounds received in the post-mortem examination of patients who have diedof puerperal fever. The fact that such wounds are attended with peculiarrisk has been long noticed. I find that Chaussier was in the habit ofcautioning his students against the danger to which they were exposed inthese dissections. [Stein, L'Art d'Accoucher, 1794; Dict. Des SciencesMedicales, art. "Puerperal. "] The head pharmacien of the Hotel Dieu, inhis analysis of the fluid effused in puerperal peritonitis, says thatpractitioners are convinced of its deleterious qualities, and that it isvery dangerous to apply it to the denuded skin. [Journal de Pharmacie, January, 1836. ] Sir Benjamin Brodie speaks of it as being well knownthat the inoculation of lymph or pus from the peritoneum of a puerperalpatient is often attended with dangerous and even fatal symptoms. Threecases in confirmation of this statement, two of them fatal, have beenreported to this Society within a few months. 

Of about fifty cases of injuries of this kind, of various degrees ofseverity, which I have collected from different sources, at least twelvewere instances of infection from puerperal peritonitis. Some of theothers are so stated as to render it probable that they may have been ofthe same nature. Five other cases were of peritoneal inflammation;three in males. Three were what was called enteritis, in one instancecomplicated with erysipelas; but it is well known that this term hasbeen often used to signify inflammation of the peritoneum covering theintestines. On the other hand, no case of typhus or typhoid fever ismentioned as giving rise to dangerous consequences, with the exceptionof the single instance of an undertaker mentioned by Mr. Travers, whoseems to have been poisoned by a fluid which exuded from the body. The other accidents were produced by dissection, or some other mode ofcontact with bodies of patients who had died of various affections. They also differed much in severity, the cases of puerperal origin beingamong the most formidable and fatal. Now a moment's reflection willshow that the number of cases of serious consequences ensuing from thedissection of the bodies of those who had perished of puerperal feveris so vastly disproportioned to the relatively small number of autopsiesmade in this complaint as compared with typhus or pneumonia (from whichlast disease not one case of poisoning happened), and still more fromall diseases put together, that the conclusion is irresistible thata most fearful morbid poison is often generated in the course of thisdisease. Whether or not it is sui generis, confined to this disease, orproduced in some others, as, for instance, erysipelas, I need, not stopto inquire. 

In connection with this may be taken the following statement of Dr. Rigby. "That the discharges from a patient under puerperal fever are inthe highest degree contagious we have abundant evidence in the historyof lying-in hospitals. The puerperal abscesses are also contagious, andmay be communicated to healthy lying-in women by washing with the samesponge; this fact has been repeatedly proved in the Vienna Hospital; butthey are equally communicable to women not pregnant; on more thanone occasion the women engaged in washing the soiled bed-linen of theGeneral Lying-in Hospital have been attacked with abscess in the fingersor hands, attended with rapidly spreading inflammation of the cellulartissue. "

Now add to all this the undisputed fact, that within the walls oflying-in hospitals there is often generated a miasm, palpable as thechlorine used to destroy it, tenacious so as in some cases almost todefy extirpation, deadly in some institutions as the plague; which haskilled women in a private hospital of London so fast that they wereburied two in one coffin to conceal its horrors; which enabled Tonnelleto record two hundred and twenty-two autopsies at the Maternite ofParis; which has led Dr. Lee to express his deliberate conviction thatthe loss of life occasioned by these institutions completely defeats theobjects of their founders; and out of this train of cumulative evidence, the multiplied groups of cases clustering about individuals, the deadlyresults of autopsies, the inoculation by fluids from the living patient, the murderous poison of hospitals, --does there not result a conclusionthat laughs all sophistry to scorn, and renders all argument an insult?

I have had occasion to mention some instances in which there was anapparent relation between puerperal fever and erysipelas. The lengthto which this paper has extended does not allow me to enter into theconsideration of this most important subject. I will only say, thatthe evidence appears to me altogether satisfactory that some most fatalseries of puerperal fever have been produced by an infection originatingin the matter or effluvia of erysipelas. In evidence of some connectionbetween the two diseases, I need not go back to the older authors, asPouteau or Gordon, but will content myself with giving the followingreferences, with their dates; from which it will be seen that thetestimony has been constantly coming before the profession for the lastfew years. 

"London Cyclopaedia of Practical Medicine, " article Puerperal Fever, 1833. 

Mr. Ceeley's Account of the Puerperal Fever at Aylesbury. "Lancet, "1835. 

Dr. Ramsbotham's Lecture. "London Medical Gazette, " 1835. 

Mr. Yates Ackerly's Letter in the same Journal, 1838. 

Mr. Ingleby on Epidemic Puerperal Fever. "Edinburgh Medical and SurgicalJournal, " 1838. 

Mr. Paley's Letter. "London Medical Gazette, " 1839. 

Remarks at the Medical and Chirurgical Society. "Lancet, " 1840. 

Dr. Rigby's "System of Midwifery. " 1841. 

"Nunneley on Erysipelas, "--a work which contains a large number ofreferences on the subject. 1841. 

"British and Foreign Quarterly Review, " 1842. 

Dr. S. Jackson of Northumberland, as already quoted from the Summary ofthe College of Physicians, 1842. 

And lastly, a startling series of cases by Mr. Storrs of Doncaster, tobe, found in the "American Journal of the Medical Sciences" for January, 1843. 

The relation of puerperal fever with other continued fevers would seemto be remote and rarely obvious. Hey refers to two cases of synochusoccurring in the Royal Infirmary of Edinburgh, in women who had attendedupon puerperal patients. Dr. Collins refers to several instancesin which puerperal fever has appeared to originate from a continuedproximity to patients suffering with typhus. 

Such occurrences as those just mentioned, though most important to beremembered and guarded against, hardly attract our notice in the midstof the gloomy facts by which they are surrounded. Of these facts, at therisk of fatiguing repetitions, I have summoned a sufficient number, as Ibelieve, to convince the most incredulous that every attempt to disguisethe truth which underlies them all is useless. 

It is true that some of the historians of the disease, especiallyHulme, Hull, and Leake, in England; Tonnelle, Duges, and Baudelocque, in France, profess not to have found puerperal fever contagious. At themost they give us mere negative facts, worthless against an extent ofevidence which now overlaps the widest range of doubt, and doublesupon itself in the redundancy of superfluous demonstration. Examined indetail, this and much of the show of testimony brought up to starethe daylight of conviction out of countenance, proves to be in a greatmeasure unmeaning and inapplicable, as might be easily shown were itnecessary. Nor do I feel the necessity of enforcing the conclusionwhich arises spontaneously from the facts which have been enumerated, byformally citing the opinions of those grave authorities who have for thelast half-century been sounding the unwelcome truth it has cost so manylives to establish. 

"It is to the British practitioner, " says Dr. Rigby, "that we areindebted for strongly insisting upon this important and dangerouscharacter of puerperal fever. "

The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton, Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee, Ingleby, Locock, Abercrombie, Alison; Travers, Rigby, and Watson, manyof whose writings I have already referred to, may have some influencewith those who prefer the weight of authorities to the simple deductionsof their own reason from the facts laid before them. A few Continentalwriters have adopted similar conclusions. It gives me pleasure toremember, that while the doctrine has been unceremoniously discreditedin one of the leading Journals, and made very light of by teachers intwo of the principal Medical Schools, of this country, Dr. Channing hasfor many years inculcated, and enforced by examples, the danger tobe apprehended and the precautions to be taken in the disease underconsideration. 

I have no wish to express any harsh feeling with regard to the painfulsubject which has come before us. If there are any so far excited by thestory of these dreadful events that they ask for some word of indignantremonstrance to show that science does not turn the hearts of itsfollowers into ice or stone, let me remind them that such words havebeen uttered by those who speak with an authority I could not claim. Itis as a lesson rather than as a reproach that I call up the memoryof these irreparable errors and wrongs. No tongue can tell theheart-breaking calamity they have caused; they have closed the eyesjust opened upon a new world of love and happiness; they have bowed thestrength of manhood into the dust; they have cast the helplessness ofinfancy into the stranger's arms, or bequeathed it, with less cruelty, the death of its dying parent. There is no tone deep enough for regret, and no voice loud enough for warning. The woman about to become amother, or with her new-born infant upon her bosom, should be the objectof trembling care and sympathy wherever she bears her tender burden, or stretches her aching limbs. The very outcast of the streets has pityupon her sister in degradation, when the seal of promised maternity isimpressed upon her. The remorseless vengeance of the law, brought downupon its victim by a machinery as sure as destiny, is arrested in itsfall at a word which reveals her transient claim for mercy. The solemnprayer of the liturgy singles out her sorrows from the multiplied trialsof life, to plead for her in the hour of peril. God forbid that anymember of the profession to which she trusts her life, doubly preciousat that eventful period, should hazard it negligently, unadvisedly, orselfishly!

There may be some among those whom I address who are disposed to ask thequestion, What course are we to follow in relation to this matter? Thefacts are before them, and the answer must be left to their own judgmentand conscience. If any should care to know my own conclusions, they arethe following; and in taking the liberty to state them very freely andbroadly, I would ask the inquirer to examine them as freely in the lightof the evidence which has been laid before him. 

1. A physician holding himself in readiness to attend cases of midwiferyshould never take any active part in the post-mortem examination ofcases of puerperal fever. 

2. If a physician is present at such autopsies, he should use thoroughablution, change every article of dress, and allow twenty-four hours ormore to elapse before attending to any case of midwifery. It may be wellto extend the same caution to cases of simple peritonitis. 

3. Similar precautions should be taken after the autopsy or surgicaltreatment of cases of erysipelas, if the physician is obliged to unitesuch offices with his obstetrical duties, which is in the highest degreeinexpedient. 

4. On the occurrence of a single case of puerperal fever in hispractice, the physician is bound to consider the next female he attendsin labor, unless some weeks at least have elapsed, as in danger of beinginfected by him, and it is his duty to take every precaution to diminishher risk of disease and death. 

5. If within a short period two cases of puerperal fever happen closeto each other, in the practice of the same physician, the diseasenot existing or prevailing in the neighborhood, he would do wisely torelinquish his obstetrical practice for at least one month, and endeavorto free himself by every available means from any noxious influence hemay carry about with him. 

6. The occurrence of three or more closely connected cases, in thepractice of one individual, no others existing in the neighborhood, andno other sufficient cause being alleged for the coincidence, is primafacie evidence that he is the vehicle of contagion. 

7. It is the duty of the physician to take every precaution that thedisease shall not be introduced by nurses or other assistants, by makingproper inquiries concerning them, and giving timely warning of everysuspected source of danger. 

8. Whatever indulgence may be granted to those who have heretoforebeen the ignorant causes of so much misery, the time has come when theexistence of a private pestilence in the sphere of a single physicianshould be looked upon, not as a misfortune, but a crime; and in theknowledge of such occurrences the duties of the practitioner to hisprofession should give way to his paramount obligations to society. ADDITIONAL REFERENCES AND CASES. 

Fifth Annual Report of the Registrar-General of England. 

1843. Appendix. Letter from William Farr, Esq. --Several new series ofcases are given in the Letter of Mr. Stows, contained in the Appendix tothis Report. Mr. Stows suggests precautions similar to those I have laiddown, and these precautions are strongly enforced by Mr. Farr, who is, therefore, obnoxious to the same criticisms as myself. 

Hall and Dexter, in Am. Journal of Med. Sc. For January, 1844. --Cases ofpuerperal fever seeming to originate in erysipelas. 

Elkington, of Birmingham, in Provincial Med. Journal, cited in Am. Journ. Med. Sc. For April, 1844. --Six cases in less than a fortnight, seeming to originate in a case of erysipelas. 

West's Reports, in Brit. And For. Med. Review for October, 1845, andJanuary, 1847. --Affection of the arm, resembling malignant pustule, after removing the placenta of a patient who died from puerperal fever. Reference to cases at Wurzburg, as proving contagion, and to Keiller'scases in the Monthly Journal for February, 1846, as showing connectionof puerperal fever and erysipelas. 

Kneeland. --Contagiousness of Puerperal Fever. Am. Jour. Med. Se. , January, 1846. Also, Connection between Puerperal Fever and EpidemicErysipelas. Ibid. , April, 1846. 

Robert Storrs. --Contagious Effects of Puerperal Fever on the MaleSubject; or on Persons not Child-bearing. (From Provincial Med. AndSurg. Journal. ) Am. Jour. Med. Sc. , January, 184, 6. Numerous cases. Seealso Dr. Reid's case in same Journal for April, 1846. 

Routh's paper in Proc. Of Royal Med. Chir. Soc. , Am. Jour. Med. Sc. , April, 1849, also in B. And F. Med. Chir. Review, April, 1850. 

Hill, of Leuchars. --A Series of Cases illustrating the Contagious Natureof Erysipelas and of Puerperal Fever, and their Intimate PathologicalConnection. (From Monthly Journal of Med. Sc. ) Am. Jour. Med. Se. , July, 1850. 

Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, frominoculation with different morbid secretions. ) Am. Jour. Med. Se. , October, 1850. 

Arneth. Paper read before the National Academy of Medicine. Annalesd'Hygiene, Tome LXV. 2e Partie. (Means of Disinfection proposed by M. "Semmeliveis" (Semmelweiss. ) Lotions of chloride of lime and use ofnail-brush before admission to lying-in wards. Alleged sudden and greatdecrease of mortality from puerperal fever. Cause of disease attributedto inoculation with cadaveric matters. ) See also Routh's paper, mentioned above. 

Moir. Remarks at a meeting of the Edinburgh Medico-Chirurgical Society. Refers to cases of Dr. Kellie, of Leith. Sixteen in succession, allfatal. Also to several instances of individual pupils having had asuccession of cases in various quarters of the town, while others, practising as extensively in the same localities, had none. Also toseveral special cases not mentioned elsewhere. Am. Jour. Med. Se. ForOctober, 1851. (From New Monthly Journal of Med. Science. )

Simpson. --Observations at a Meeting of the Edinburgh ObstetricalSociety. (An "eminent gentleman, " according to Dr. Meigs, whose "nameis as well known in America as in (his) native land. " Obstetrics. Phil. 1852, pp. 368, 375. ) The student is referred to this paper fora valuable resume of many of the facts, and the necessary inferences, relating to this subject. Also for another series of cases, Mr. Sidey's, five or six in rapid succession. Dr. Simpson attended the dissectionof two of Dr. Sidey's cases, and freely handled the diseased parts. Hisnext four child-bed patients were affected with puerperal fever, andit was the first time he had seen it in practice. As Dr. Simpson is agentleman (Dr. Meigs, as above), and as "a gentleman's hands are clean"(Dr. Meigs' Sixth Letter), it follows that a gentleman with clean handsmay carry the disease. Am. Jour. Med. Sc. , October, 1851. 

Peddle. --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 examinedin Dr. Simpson's house, a portion of the uterus obtained from one ofthe patients, had immediately afterwards three fatal cases of puerperalfever. Dr. Veddie referred to two distinct series of consecutive casesin his own practice. He had since taken precautions, and not met withany such cases. Am. Jour. Med. Sc. , October, 1851. 

Copland. Considers it proved that puerperal fever maybe propagated bythe hands and the clothes, or either, of a third person, the bed-clothesor body-clothes of a patient. Mentions a new series of cases, one ofwhich he saw, with the practitioner who had attended them. She was thesixth he had had within a few days. All died. Dr. Copland insisted thatcontagion had caused these cases; advised precautionary measures, andthe practitioner had no other cases for a considerable time. Considersit criminal, after the evidence adduced, --which he could havequadrupled, --and the weight of authority brought forward, for apractitioner to be the medium of transmitting contagion and death tohis patients. Dr. Copland lays down rules similar to those suggestedby myself, and is therefore entitled to the same epithet for so doing. Medical Dictionary, New York, 1852. Article, Puerperal States andDiseases. 

If there is any appetite for facts so craving as to be yetunappeased, --Lesotho, necdum satiata, --more can be obtained. Dr. Hodgeremarks that "the frequency and importance of this singular circumstance(that the disease is occasionally more prevalent with one practitionerthan another) has been exceedingly overrated. " More than thirty stringsof cases, more than two hundred and fifty sufferers from puerperalfever, more than one hundred and thirty deaths appear as the results ofa sparing estimate of such among the facts I have gleaned as could benumerically valued. These facts constitute, we may take it for granted, but a small fraction of those that have actually occurred. The number ofthem might be greater, but "'t is enough, 't will serve, " in Mercutio'smodest phrase, so far as frequency is concerned. For a just estimateof the importance of the singular circumstance, it might be proper toconsult the languid survivors, the widowed husbands, and the motherlesschildren, as well as "the unfortunate accoucheur. "

CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE

An Address delivered before the Massachusetts Medical Society, at theAnnual Meeting, May 30, 1860. 

 "Facultate magis quam violentia. " HIPPOCRATES. 

Our Annual Meeting never fails to teach us at least one lesson. The artwhose province it is to heal and to save cannot protect its own ranksfrom the inroads of disease and the waste of the Destroyer. 

Seventeen of our associates have been taken from us since our lastAnniversary. Most of them followed their calling in the villages ortowns that lie among the hills or along the inland streams. Only thosewho have lived the kindly, mutually dependent life of the country, cantell how near the physician who is the main reliance in sickness of allthe families throughout a thinly settled region comes to the hearts ofthe people among whom he labors, how they value him while living, howthey cherish his memory when dead. For these friends of ours who havegone before, there is now no more toil; they start from their slumbersno 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; theirwheels are rusting on their axles or rolling with other burdens; theirwatchful eyes are closed to all the sorrows they lived to soothe. Notone of these was famous in the great world; some were almost unknownbeyond their own immediate circle. But they have left behind them thatloving remembrance which is better than fame, and if their epitaphs arechiselled briefly in stone, they are written at full length on livingtablets in a thousand homes to which they carried their ever-welcome aidand sympathy. 

One whom we have lost, very widely known and honored, was a leadingpractitioner of this city. His image can hardly be dimmed in yourrecollection, as he stood before you only three years ago, filling thesame place with which I am now honored. To speak of him at all worthily, would be to write the history of professional success, won withoutspecial aid at starting, by toil, patience, good sense, pure character, and pleasing manners; won in a straight uphill ascent, without onebreathing-space until he sat down, not to rest, but to die. If prayerscould have shielded him from the stroke, if love could have drawn forththe weapon, and skill could have healed the wound, this passing tributemight have been left to other lips and to another generation. 

Let us hope that our dead have at last found that rest which neithersummer nor winter, nor day nor night, had granted to their unendingearthly labors! And let us remember that our duties to our brethren donot cease when they become unable to share our toils, or leave behindthem in want and woe those whom their labor had supported. It ishonorable to the Profession that it has organized an Association a forthe relief of its suffering members and their families; it owesthis tribute to the ill-rewarded industry and sacrifices of its lessfortunate brothers who wear out health and life in the service ofhumanity. I have great pleasure in referring to this excellent movement, which gives our liberal profession a chance to show its liberality, andserves to unite us all, the successful and those whom fortune has castdown, in the bonds of a true brotherhood. 

A medical man, as he goes about his daily business after twenty years ofpractice, is apt to suppose that he treats his patients according to theteachings of his experience. No doubt this is true to some extent; towhat extent depending much on the qualities of the individual. But itis easy to prove that the prescriptions of even wise physicians arevery commonly founded on something quite different from experience. Experience must be based on the permanent facts of nature. But a glanceat the prevalent modes of treatment of any two successive generationswill show that there is a changeable as well as a permanent element inthe art of healing; not merely changeable as diseases vary, or as newremedies are introduced, but changeable by the going out of fashion ofspecial remedies, by the decadence of a popular theory from which theirfitness was deduced, or other cause not more significant. There is noreason to suppose that the present time is essentially different inthis respect from any other. Much, therefore, which is now very commonlyconsidered to be the result of experience, will be recognized in thenext, or in some succeeding generation, as no such result at all, but asa foregone conclusion, based on some prevalent belief or fashion of thetime. 

There are, of course, in every calling, those who go about the work ofthe day before them, doing it according to the rules of their craft, andasking no questions of the past or of the future, or of the aim and endto which their special labor is contributing. These often consider andcall themselves practical men. They pull the oars of society, and haveno leisure to watch the currents running this or that way; let theoristsand philosophers attend to them. In the mean time, however, thesecurrents are carrying the practical men, too, and all their work may bethrown away, and worse than thrown away, if they do not take knowledgeof them and get out of the wrong ones and into the right ones as soon asthey may. Sir Edward Parry and his party were going straight towards thepole in one of their arctic expeditions, travelling at the rate of tenmiles a day. But the ice over which they travelled was drifting straighttowards the equator, at the rate of twelve miles a day, and yet noman among them would have known that he was travelling two miles a daybackward unless he had lifted his eyes from the track in which he wasplodding. It is not only going backward that the plain practical workmanis liable to, if he will not look up and look around; he may go forwardto ends he little dreams of. It is a simple business for a mason tobuild up a niche in a wall; but what if, a hundred years afterwards whenthe wall is torn down, the skeleton of a murdered man drop out of theniche? It was a plain practical piece of carpentry for a Jewish artisanto fit two pieces of timber together according to the legal pattern inthe time of Pontius Pilate; he asked no questions, perhaps, but we knowwhat burden the cross bore on the morrow! And so, with subtler toolsthan trowels or axes, the statesman who works in policy withoutprinciple, the theologian who works in forms without a soul, thephysician who, calling himself a practical man, refuses to recognize thelarger laws which govern his changing practice, may all find that theyhave been building truth into the wall, and hanging humanity upon thecross. 

The truth is, that medicine, professedly founded on observation, is assensitive to outside influences, political, religious, philosophical, imaginative, as is the barometer to the changes of atmospheric density. Theoretically it ought to go on its own straightforward inductive path, without regard to changes of government or to fluctuations of publicopinion. But look a moment while I clash a few facts together, and seeif some sparks do not reveal by their light a closer relation betweenthe Medical Sciences and the conditions of Society and the generalthought of the time, than would at first be suspected. 

Observe the coincidences between certain great political andintellectual periods and the appearance of illustrious medical reformersand teachers. It was in the age of Pericles, of Socrates, of Plato, ofPhidias, that Hippocrates gave to medical knowledge the form which itretained for twenty centuries. With the world-conquering Alexander, theworld-embracing Aristotle, appropriating anatomy and physiology, amonghis manifold spoils of study, marched abreast of his royal pupil towider conquests. Under the same Ptolemies who founded the AlexandrianLibrary and Museum, and ordered the Septuagint version of the HebrewScriptures, the infallible Herophilus ["Contradicere Herophilo inanatomicis, est contradicere evangelium, " was a saying of Fallopius. ]made those six hundred dissections of which Tertullian accused him, andthe sagacious Erasistratus introduced his mild antiphlogistic treatmentin opposition to the polypharmacy and antidotal practice of his time. It is significant that the large-minded Galen should have been thephysician and friend of the imperial philosopher Marcus Aurelius. TheArabs gave laws in various branches of knowledge to those whom theirarms had invaded, or the terror of their spreading dominion 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 Vesalius, the contemporary of Luther. Who can fail to seeone common spirit in the radical ecclesiastic and the reformingcourt-physician? Both still to some extent under the dominion of theletter: Luther holding to the real presence; Vesalius actually causingto be drawn and engraved two muscles which he knew were not found inthe human subject, because they had been described by Galen, fromdissections of the lower animals. Both breaking through old traditionsin the search of truth; one, knife in hand, at the risk of life andreputation, the other at the risk of fire and fagot, with that mightierweapon which all the devils could not silence, though they had beenthicker than the tiles on the house-tops. How much the physician of theCatholic Charles V. Had in common with the great religious destructive, may be guessed by the relish with which he tells the story how certainPavian students exhumed the body of an "elegans scortum, " or lovely dameof ill repute, the favorite of a monk of the order of St. Anthony, whodoes not seem to have resisted temptation so well as the founder ofhis order. We have always ranked the physician Rabelais among the earlyreformers, but I do not know that Vesalius has ever been thanked for hishit at the morals of the religious orders, or for turning to the good ofscience what was intended for the "benefit of clergy. "

Our unfortunate medical brother, Michael Servetus, the spiritual patientto whom the theological moxa was applied over the entire surface forthe cure of his heresy, came very near anticipating Harvey. The samequickened thought of the time which led him to dispute the dogma of theChurch, opened his mind to the facts which contradicted the dogmas ofthe Faculty. 

Harvey himself was but the posthumous child of the great Elizabethanperiod. Bacon was at once his teacher and his patient. The founderof the new inductive philosophy had only been dead two years when thetreatise on the Circulation, the first-fruit of the Restoration ofScience, was given to the world. 

And is it to be looked at as a mere accidental coincidence, that whileNapoleon was modernizing the political world, Bichat was revolutionizingthe science of life and the art that is based upon it; that while theyoung general was scaling the Alps, the young surgeon was climbingthe steeper summits of unexplored nature; that the same year read theannouncement of those admirable "Researches on Life and Death, " and thebulletins of the battle of Marengo?

If we come to our own country, who can fail to recognize that BenjaminRush, the most conspicuous of American physicians, was the intellectualoffspring of the movement which produced the Revolution? "The samehand, " says one of his biographers, "which subscribed the declarationof the political independence of these States, accomplished theiremancipation from medical systems formed in foreign countries, andwholly unsuitable to the state of diseases in America. "

Following this general course of remark, I propose to indicate in a fewwords the direction of the main intellectual current of the time, andto point out more particularly some of the eddies which tend to keep thescience and art of medicine from moving with it, or even to carry thembackwards. 

The two dominant words of our time are law and average, both pointing tothe uniformity of the order of being in which we live. Statistics havetabulated everything, --population, growth, wealth, crime, disease. Wehave shaded maps showing the geographical distribution of larceny andsuicide. Analysis and classification have been at work upon all tangibleand visible objects. The Positive Philosophy of Comte has only givenexpression to the observing and computing mind of the nineteenthcentury. 

In the mean time, the great stronghold of intellectual conservatism, traditional belief, has been assailed by facts which would have beenindicted as blasphemy but a few generations ago. Those new tables ofthe law, placed in the hands of the geologist by the same living God whospoke from Sinai to the Israelites of old, have remodelled the beliefsof half the civilized world. The solemn scepticism of science hasreplaced the sneering doubts of witty philosophers. The more positiveknowledge we gain, the more we incline to question all that has beenreceived without absolute proof. 

As a matter of course, this movement has its partial reactions. Theprovince of faith is claimed as a port free of entry to unsupportedindividual convictions. The tendency to question is met by theunanalyzing instinct of reverence. The old church calls back itsfrightened truants. Some who have lost their hereditary religiousbelief find a resource in the revelations of Spiritualism. By a parallelmovement, some of those who have become medical infidels pass over tothe mystic band of believers in the fancied miracles of Homoeopathy. 

Under these influences transmitted to, or at least shared by, themedical profession, the old question between "Nature, " so called, and"Art, " or professional tradition, has reappeared with new interest. Isay the old question, for Hippocrates stated the case on the sideof "Nature" more than two thousand years ago. Miss FlorenceNightingale, --and if I name her next to the august Father of the HealingArt, its noblest daughter well deserves that place of honor, --MissFlorence Nightingale begins her late volume with a paraphrase of hisstatement. But from a very early time to this there has always beena strong party against "Nature. " Themison called the practice ofHippocrates "a meditation upon death. " Dr. Rush says: "It is impossibleto calculate the mischief which Hippocrates, has done, by first markingNature with his name and afterwards letting her loose upon sick people. Millions have perished by her hands in all ages and countries. " Sir JohnForbes, whose defence of "Nature" in disease you all know, and to thetestimonial in whose honor four of your Presidents have contributed, hasbeen recently greeted, on retiring from the profession, with a wish thathis retirement had been twenty years sooner, and the opinion that no manhad done so much to destroy the confidence of the public in the medicalprofession. 

In this Society we have had the Hippocratic and the Themisonic sidefairly represented. The treatise of one of your early Presidents on theMercurial Treatment is familiar to my older listeners. Others who haveheld 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 remarkablediscourse on Self-Limited Diseases, [On Self-Limited Diseases. ADiscourse delivered before the Massachusetts Medical Society, at theirAnnual Meeting, May 27, 1835. By Jacob Bigelow, M. D. ] which has giventhe key-note to the prevailing medical tendency of this neighborhood, atleast, for the quarter of a century since it was delivered. Nor havewe forgotten the address delivered at Springfield twenty years later, [Search out the Secrets, of Nature. By Augustus A. Gould, M. D. Readat the Annual Meeting, June 27, 1855. ] full of good sense and usefulsuggestions, to one of which suggestions we owe the learned, impartial, judicious, well-written Prize Essay of Dr. Worthington Hooker. [RationalTherapeutics. A Prize Essay. By Worthington Hooker, M. D. , of New Haven. Boston. 1857. ] We should not omit from the list the important address ofanother of our colleagues, [On the Treatment of Compound and ComplicatedFractures. By William J. Walker, M. D. Read at the Annual Meeting, May29, 1845. ] showing by numerous cases the power of Nature inhealing compound fractures to be much greater than is frequentlysupposed, --affording, indeed, more striking illustrations than can beobtained from the history of visceral disease, of the supreme wisdom, forethought, and adaptive dexterity of that divine Architect, as shownin repairing the shattered columns which support the living temple ofthe body. 

We who are on the side of "Nature" please ourselves with the idea thatwe are in the great current in which the true intelligence of the timeis moving. We believe that some who oppose, or fear, or denounce ourmovement are themselves caught in various eddies that set back againstthe truth. And we do most earnestly desire and most actively strive, that Medicine, which, it is painful to remember, has been spoken ofas "the withered branch of science" at a meeting of the BritishAssociation, shall be at length brought fully to share, if not to lead, the great wave of knowledge which rolls with the tides that circle theglobe. 

If there is any State or city which might claim to be the Americanheadquarters of the nature-trusting heresy, provided it be one, thatState is Massachusetts, and that city is its capital. The effect whichthese doctrines have upon the confidence reposed in the profession is amatter of opinion. For myself, I do not believe this confidence can beimpaired by any investigations which tend to limit the application oftroublesome, painful, uncertain, or dangerous remedies. Nay, I willventure to say this, that if every specific were to fail utterly, if thecinchona trees all died out, and the arsenic mines were exhausted, andthe sulphur regions were burned up, if every drug from the vegetable, animal, and mineral kingdom were to disappear from the market, a body ofenlightened men, organized as a distinct profession, would be requiredjust as much as now, and respected and trusted as now, whose provinceshould be to guard against the causes of disease, to eliminate them ifpossible when still present, to order all the conditions of the patientso as to favor the efforts of the system to right itself, and to givethose predictions of the course of disease which only experience canwarrant, and which in so many cases relieve the exaggerated fears ofsufferers and their friends, or warn them in season of impending danger. Great as the loss would be if certain active remedies could no longer beobtained, it would leave the medical profession the most essential partof it's duties, and all, and more than all, its present share of honors;for it would be the death-blow to charlatanism, which depends for itssuccess almost entirely on drugs, or at least on a nomenclature thatsuggests them. 

There is no offence, then, or danger in expressing the opinion, that, after all which has been said, the community is still overdosed: Thebest proof of it is, that "no families take so little medicine as thoseof doctors, except those of apothecaries, and that old practitioners aremore sparing of active medicines than younger ones. " [Dr. James Jacksonhas kindly permitted me to make the following extract from a letterjust received by him from Sir James Clark, and dated May 26, 1860: "As aphysician advances in age, he generally, I think, places less confidencein the ordinary medical treatment than he did, not only during hisearly, but even his middle period of life. "] The conclusion from thesefacts is one which the least promising of Dr. Howe's pupils in themental department could hardly help drawing. 

Part of the blame of over-medication must, I fear, rest with theprofession, for yielding to the tendency to self-delusion, which seemsinseparable from the practice of the art of healing. I need only touchon the common modes of misunderstanding or misapplying the evidence ofnature. 

First, there is the natural incapacity for sound observation, which islike a faulty ear in music. We see this in many persons who know a gooddeal about books, but who are not sharp-sighted enough to buy a horse ordeal with human diseases. 

Secondly, there is in some persons a singular inability to weigh thevalue of testimony; of which, I think, from a pretty careful examinationof his books, Hahnemann affords the best specimen outside the walls ofBedlam. 

The inveterate logical errors to which physicians have always beensubject are chiefly these:

The mode of inference per enumerationem simplicem, in scholastic phrase;that is, counting only their favorable cases. This is the old trickillustrated in Lord Bacon's story of the gifts of the shipwreckedpeople, hung up in the temple. --Behold! they vowed these gifts to thealtar, and the gods saved them. Ay, said a doubting bystander, buthow many made vows of gifts and were shipwrecked notwithstanding? Thenumerical system is the best corrective of this and similar errors. Thearguments commonly brought against its application to all matters ofmedical observation, treatment included, seem to apply rather to thetabulation of facts ill observed, or improperly classified, than to themethod itself. 

The post hoc ergo propter hoc error: he got well after taking mymedicine; therefore in consequence of taking it. 

The false induction from genuine facts of observation, leading to theconstruction of theories which are then deductively applied in theface of the results of direct observation. The school of Broussais hasfurnished us with a good example of this error. 

And lastly, the error which Sir Thomas Browne calls giving "a reason ofthe golden tooth;" that is, assuming a falsehood as a fact, and givingreasons for it, commonly fanciful ones, as is constantly done by thatclass of incompetent observers who find their "golden tooth" in thefabulous effects of the homoeopathie materia medica, --which consists ofsugar of milk and a nomenclature. 

Another portion of the blame rests with the public itself, which insistson being poisoned. Somebody buys all the quack medicines that buildpalaces for the mushroom, say rather, the toadstool millionaires. Who isit? These people have a constituency of millions. The popular belief isall but universal that sick persons should feed on noxious substances. One of our members was called not long since to a man with a terriblysore mouth. On inquiry he found that the man had picked up a box ofunknown pills, in Howard Street, and had proceeded to take them, ongeneral principles, pills being good for people. They happened tocontain mercury, and hence the trouble for which he consulted ourassociate. 

The outside pressure, therefore, is immense upon the physician, tending to force him to active treatment of some kind. Certain oldsuperstitions, still lingering in the mind of the public, and not yetutterly 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 isa malignant agency, or entity, to be driven out of the body by offensivesubstances, as the smoke of the fish's heart and liver drove the devilout of Tobit's bridal chamber, according to the Apochrypha. Epilepticsused to suck the blood from the wounds of dying gladiators. [PliniiHist. Mundi. Lib. Xxviii. C. 4. ] The Hon. Robert Boyle's little bookwas published some twenty or thirty years before our late President, Dr. Holyoke, was born. [A Collection of Choice and Safe Remedies. The FifthEdition, corrected. London, 1712. Dr. Holyoke was born in 1728. ] In ithe recommends, as internal medicines, most of the substances commonlyused as fertilizers of the soil. His "Album Graecum" is bestleft untranslated, and his "Zebethum Occidentale" is still moretranscendentally unmentionable except in a strange dialect. It soundsodiously to us to hear him recommend for dysentery a powder made from"the sole of an old shoe worn by some man that walks much. " Perhapsnobody here ever heard of tying a stocking, which had been worn duringthe day, round the neck at night for a sore throat. The same ideaof virtue in unlovely secretions! [The idea is very ancient. "Sordeshominis" "Sudore et oleo medicinam facientibus. "--Plin. Xxviii. 4. ]

Even now the Homoeopathists have been introducing the venom of serpents, under the learned title of Lachesis, and outraging human nature withinfusions of the pediculus capitis; that is, of course, as we understandtheir dilutions, the names of these things; for if a fine-tooth-combinsect were drowned in Lake Superior, we cannot agree with them inthinking that every drop of its waters would be impregnated with all thepedicular virtues they so highly value. They know what they are doing. They are appealing to the detestable old superstitious presumption infavor of whatever is nauseous and noxious as being good for the sick. 

Again, we all occasionally meet persons stained with nitrate of silver, given for epilepsy. Read what Dr. Martin says, about the way in whichit came to be used, in his excellent address before the Norfolk CountyMedical 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 presumptionsturns a white man as blue as the double-tattooed King of the CannibalIslands! [Note A. ]

If medical superstitions have fought their way down through all therationalism and scepticism of the nineteenth century, of course thetheories of the schools, supported by great names, adopted into thepopular belief and incorporated with the general mass of misapprehensionwith reference to disease, must be expected to meet us at every turn inthe shape of bad practice founded on false doctrine. A French patientcomplains that his blood heats him, and expects his doctor to bleedhim. An English or American one says he is bilious, and will not be easywithout a dose of calomel. A doctor looks at a patient's tongue, sees itcoated, and says the stomach is foul; his head full of the old saburralnotion which the extreme inflammation-doctrine of Broussais did somuch to root out, but which still leads, probably, to much needless andinjurious wrong of the stomach and bowels by evacuants, when all theywant is to be let alone. It is so hard to get anything out of the deadhand of medical tradition! The mortmain of theorists extinct in scienceclings as close as that of ecclesiastics defunct in law. 

One practical hint may not be out of place here. It seems to besometimes forgotten, by those who must know the fact, that the tongue isvery different, anatomically and physiologically, from the stomach. Its condition does not in the least imply a similar one of the stomach, which is a very different structure, covered with a different kindof epithelium, and furnished with entirely different secretions. Asilversmith will, for a dollar, make a small hoe, of solid silver, whichwill last for centuries, and will give a patient more comfort, usedfor the removal of the accumulated epithelium and fungous growths whichconstitute the "fur, " than many a prescription with a split-footed Rxbefore it, addressed to the parts out of reach. 

I think more of this little implement on account of its agency in savingthe Colony at Plymouth in the year 1623. Edward Winslow heard thatMassasoit was sick and like to die. He found him with a houseful ofpeople about him, women rubbing his arms and legs, and friends "makingsuch a hellish noise" as they probably thought would scare away thedevil of sickness. Winslow gave him some conserve, washed his mouth, scraped his tongue, which was in a horrid state, got down some drink, made him some broth, dosed him with an infusion of strawberry leaves andsassafras root, and had the satisfaction of seeing him rapidly recover. Massasoit, full of gratitude, revealed the plot which had been formedto destroy the colonists, whereupon the Governor ordered Captain MilesStandish to see to them; who thereupon, as everybody remembers, stabbedPecksuot with his own knife, broke up the plot, saved the colony, andthus rendered Massachusetts and the Massachusetts Medical Societya possibility, as they now are a fact before us. So much for thisparenthesis of the tongue-scraper, which helped to save the youngcolony from a much more serious scrape, and may save the Union yet, if aPresidential candidate should happen to be taken sick as Massasoit was, and his tongue wanted cleaning, --which process would not hurt a goodmany politicians, with or without a typhoid fever. 

Again, see how the "bilious" theory works in every-day life here andnow, illustrated by a case from actual life. A youthful practitioner, whose last molars have not been a great while cut, meets an experiencedand noted physician in consultation. This is the case. A slender, lymphatic young woman is suckling two lusty twins, the intervalsof suction being occupied on her part with palpitations, headaches, giddiness, throbbing in the head, and various nervous symptoms, hercheeks meantime getting bloodless, and her strength running awayin company with her milk. The old experienced physician, seeing theyellowish waxy look which is common in anaemic patients, considers it a"bilious" case, and is for giving a rousing emetic. Of course, he has tobe wheedled out of this, a recipe is written for beefsteaks and porter, the twins are ignominiously expelled from the anaemic bosom, and forcedto take prematurely to the bottle, and this prolific mother is saved forfuture usefulness in the line of maternity. 

The practice of making a profit on the medicine ordered has been held upto reprobation by one at least of the orators who have preceded me. Thatthe effect of this has been ruinous in English practice I cannotdoubt, and that in this country the standard of practice was in formergenerations lowered through the same agency is not unlikely. I have seenan old account-book in which the physician charged an extra price forgilding his rich patients' pills. If all medicine were very costly, and the expense of it always came out of the physician's fee, itwould really be a less objectionable arrangement than this other mostpernicious one. He would naturally think twice before he gave an emeticor cathartic which evacuated his own pocket, and be sparing of thecholagogues that emptied the biliary ducts of his own wallet, unless hewere sure they were needed. If there is any temptation, it should not bein favor of giving noxious agents, as it clearly must be in the case ofEnglish druggists and "General Practitioners. " The complaint againstthe other course is a very old one. Pliny, inspired with as truly Romanhorror of quackery as the elder Cato, --who declared that the Greekdoctors had sworn to exterminate all barbarians, including the Romans, with their drugs, but is said to have physicked his own wife to death, notwithstanding, --Pliny says, in so many words, that the cerates andcataplasms, plasters, collyria, and antidotes, so abundant in his time, as in more recent days, were mere tricks to make money. 

A pretty strong eddy, then, or rather many eddies, setting constantlyback from the current of sober observation of nature, in the directionof old superstitions and fancies, of exploded theories, of old ways ofmaking money, which are very slow to pass out of fashion. 

But there are other special American influences which we are bound totake cognizance of. If I wished to show a student the difficulties ofgetting at truth from medical experience, I would give him the historyof epilepsy to read. If I wished him to understand the tendencies of theAmerican medical mind, its sanguine enterprise, its self-confidence, itsaudacious handling of Nature, its impatience with her old-fashioned waysof taking time to get a sick man well, I would make him read the lifeand writings of Benjamin Rush. Dr. Rush thought and said that there weretwenty times more intellect and a hundred times more knowledge inthe country in 1799 than before the Revolution. His own mind was in aperpetual state of exaltation produced by the stirring scenes in whichhe had taken a part, and the quickened life of the time in which helived. It was not the state to favor sound, calm observation. He wasimpatient, and Nature is profoundly imperturbable. We may adjust thebeating of our hearts to her pendulum if we will and can, but we may bevery sure that she will not change the pendulum's rate of going becauseour hearts are palpitating. He thought he had mastered yellow-fever. "Thank God, " he said, "out of one hundred patients whom I have visitedor prescribed for this day, I have lost none. " Where was all his legacyof knowledge when Norfolk was decimated? Where was it when the blueflies were buzzing over the coffins of the unburied dead piled up inthe cemetery of New Orleans, at the edge of the huge trenches yawning toreceive them?

One such instance will do as well as twenty. Dr. Rush must have been acharming teacher, as he was an admirable man. He was observing, ratherthan a sound observer; eminently observing, curious, even, about allmanner of things. But he could not help feeling as if Nature had been agood deal shaken by the Declaration of Independence, and thatAmerican art was getting to be rather too much for her, --especiallyas illustrated in his own practice. He taught thousands of Americanstudents, he gave a direction to the medical mind of the country morethan any other one man; perhaps he typifies it better than any other. Ithas clearly tended to extravagance in remedies and trust in remedies, as in everything else. How could a people which has a revolution once infour years, which has contrived the Bowie-knife and the revolver, whichhas chewed the juice out of all the superlatives in the language inFourth of July orations, and so used up its epithets in the rhetoric ofabuse 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 couldsuch a people be content with any but "heroic" practice? What wonderthat the stars and stripes wave over doses of ninety grains of sulphateof quinine, [More strictly, ninety-six grains in two hours. Dunglison'sPractice, 1842, vol. Ii. P. 520. Eighty grains in one dose. Ibid. P. 536. Ninety-six grains of sulphate of quinine are equal to eight ouncesof good bark. --Wood & Bache. ] and that the American eagle screams withdelight to see three drachms of calomel given at a single mouthful?

Add to this the great number of Medical Journals, all useful, wehope, most of them necessary, we trust, many of them excellently wellconducted, but which must find something to fill their columns, and soprint all the new plans of treatment and new remedies they can get holdof, as the newspapers, from a similar necessity, print the shockingcatastrophes and terrible murders. 

Besides all this, here are we, the great body of teachers in thenumberless medical schools of the Union, some of us lecturing to crowdswho clap and stamp in the cities, some of us wandering over the country, like other professional fertilizers, to fecundate the minds of lessdemonstrative audiences at various scientific stations; all of ustalking habitually to those supposed to know less than ourselves, andloving to claim as much for our art as we can, not to say for our ownschools, and possibly indirectly for our own practical skill. Hence thatannual crop of introductory lectures; the useful blossoming into theornamental, as the cabbage becomes glorified in the cauliflower; thatlecture-room literature of adjectives, that declamatory exaggeration, that splendid show of erudition borrowed from D'Israeli, and creditedto Lord Bacon and the rest, which have suggested to our friends ofthe Medical Journals an occasional epigram at our expense. Hence thetendency in these productions, and in medical lectures generally, to overstate the efficacy of favorite methods of cure, and hence thepremium offered for showy talkers rather than sagacious observers, for the men of adjectives rather than of nouns substantive in the moreambitious of these institutions. 

Such are some of the eddies in which we are liable to become involvedand carried back out of the broad stream of philosophical, or, in otherwords, truth-loving, investigations. The causes of disease, in the meantime, have been less earnestly studied in the eagerness of the searchfor remedies. Speak softly! Women have been borne out from an old-worldhospital, two in one coffin, that the horrors of their prison-housemight not be known, while the very men who were discussing the treatmentof the disease were stupidly conveying the infection from bed to bed, as rat-killers carry their poisons from one household to another. Do notsome of you remember that I have had to fight this private-pestilencequestion against a scepticism which sneered in the face of a mass ofevidence such as the calm statisticians of the Insurance office couldnot listen to without horror and indignation? ["The Contagiousness ofPuerperal Fever. "--N. E. Quar. Jour. Of Medicine and Surgery, April, 1843. Reprinted, with Additions. Boston: Ticknor & Fields. 1855. ] Havewe forgotten what is told in one of the books published under our ownsanction, that a simple measure of ventilation, proposed by Dr. JohnClark, had saved more than sixteen thousand children's lives in asingle hospital? How long would it have taken small doses of calomel andrhubarb to save as many children? These may be useful in prudent hands, but how insignificant compared to the great hygienic conditions! Causes, causes, and again causes, --more and more we fall back on these as thechief objects of our attention. The shortest system of medical practicethat I know of is the oldest, but not the worst. It is older thanHippocrates, older than Chiron the Centaur. Nature taught it to thefirst mother when she saw her first-born child putting some ugly pebbleor lurid berry into its mouth. I know not in what language it wasspoken, but I know that in English it would sound thus: Spit it out!

Art can do something more than say this. It can sometimes reach thepebble or berry after it has been swallowed. But the great thing isto keep these things out of children's mouths, and as soon as they arebeyond our reach, to be reasonable and patient with Nature, who meanswell, 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 wasfit to be shown to the public. 

Suffer me now to lay down a few propositions, whether old or new itmatters little, not for your immediate acceptance, nor yet for yourhasty rejection, but for your calm consideration. 

But first, there are a number of terms which we are in the habit ofusing in a vague though not unintelligible way, and which it is as wellnow to define. These terms are the tools with which we are to work, andthe first thing is to sharpen them. It is nothing to us that they havebeen sharpened a thousand times before; they always get dull in theusing, and every new workman has a right to carry them to the grindstoneand sharpen them to suit himself. 

Nature, in medical language, as opposed to Art, means trust in thereactions of the living system against, ordinary normal impressions. 

Art, in the same language, as opposed to Nature, means an intentionalresort to extraordinary abnormal impressions for the relief of disease. 

The reaction of the living system is the essence of both. Food isnothing, if there is no digestive act to respond to it. We cannot raisea blister on a dead man, or hope that a carminative forced between hislips will produce its ordinary happy effect. 

Disease, dis-ease, --disturbed quiet, uncomfortableness, --means imperfector abnormal reaction of the living system, and its more or lesspermanent results. 

Food, in its largest sense, is whatever helps to build up the normalstructures, or to maintain their natural actions. 

Medicine, in distinction from food, is every unnatural or noxious agentapplied for the relief of disease. 

Physic means properly the Natural art, and Physician is only the Greeksynonyme of Naturalist. 

With these few explanations I proceed to unfold the propositions I havementioned. 

Disease and death, if we may judge by the records of creation, areinherently and essentially necessary in the present order of things. Aperfect intelligence, trained by a perfect education, could do no morethan keep the laws of the physical and spiritual universe. An imperfectintelligence, imperfectly taught, --and this is the condition of ourfinite humanity, --will certainly fail to keep all these laws perfectly. Disease is one of the penalties of one of the forms of such failure. Itis prefigured in the perturbations of the planets, in the disintegrationof the elemental masses; it has left its traces in the fossil organismsof extinct creations. [Professor Agassiz has kindly handed me thefollowing note: "There are abnormal structures in animals of all agesanterior to the creation of mankind. Malformed specimens of Crinoids areknown from the Triassic and Jurassic deposits. Malformed and diseasedbones of tertiary mammalia have been collected in the caverns ofGailenreuth with traces of healing. "]

But it is especially the prerogative, I had almost said privilege, ofeducated and domesticated beings, from man down to the potato, servingto teach them, and such as train them, the laws of life, and to get ridof those who will not mind or cannot be kept subject to these laws. 

Disease, being always an effect, is always in exact proportion to thesum of its causes, as much in the case of Spigelius, who dies of ascratch, as in that of the man who recovers after an iron bar has beenshot through his brain. The one prevalent failing of the medical art isto neglect the causes and quarrel with the effect. 

There are certain general facts which include a good deal of what iscalled and treated as disease. Thus, there are two opposite movements oflife to be seen in cities and elsewhere, belonging to races which, fromvarious persistent causes, are breeding down and tending to run out, and to races which are breeding up, or accumulating vital capital, --adescending and an ascending series. Let me give an example of each; andthat I may incidentally remove a common impression about this country ascompared with the Old World, an impression which got tipsy with conceitand staggered into the attitude of a formal proposition in the work ofDr. Robert Knox, I will illustrate the downward movement from Englishexperience, and the upward movement from a family history belonging tothis immediate neighborhood. 

Miss Nightingale speaks of "the fact so often seen of agreat-grandmother, who was a tower of physical vigor, descending into agrandmother perhaps a little less vigorous, but still sound as a bell, and healthy to the core, into a mother languid and confined to hercarriage and house; and lastly into a daughter sickly and confinedto her bed. " So much for the descending English series; now for theascending American series. 

Something more than one hundred and thirty years ago there graduated atHarvard College a delicate youth, who lived an invalid life and died atthe age of about fifty. His two children were both of moderate physicalpower, and one of them diminutive in stature. The next generation rosein physical development, and reached eighty years of age and morein some of its members. The fourth generation was of fair averageendowment. The fifth generation, great-great-grandchildren of theslender invalid, are several of, them of extraordinary bodily and mentalpower; large in stature, formidable alike with their brains and theirarms, organized on a more extensive scale than either of their parents. 

This brief account illustrates incidentally the fallacy of theuniversal-degeneration theory applied to American life; the same onwhich one of our countrymen has lately brought some very forcible factsto bear in a muscular discussion of which we have heard rather more thanis good for us. But the two series, American and English, ascending anddescending, were adduced with the main purpose of showing the immensedifference of vital endowments in different strains of blood; adifference to which all ordinary medication is in all probability amatter of comparatively trivial purport. Many affections which art hasto strive against might be easily shown to be vital to the well-being ofsociety. Hydrocephalus, tabes mesenterica, and other similar maladies, are natural agencies which cut off the children of races that aresinking below the decent minimum which nature has established as thecondition of viability, before they reach the age of reproduction. They are really not so much diseases, as manifestations of congenitalincapacity for life; the race would be ruined if art could ever learnalways to preserve the individuals subject to them. We must do the bestwe can for them, but we ought also to know what these "diseases" mean. 

Again, invalidism is the normal state of many organizations. It canbe changed to disease, but never to absolute health by medicinalappliances. There are many ladies, ancient and recent, who areperpetually taking remedies for irremediable pains and aches. They oughtto have headaches and back-aches and stomach-aches; they are not well ifthey do not have them. To expect them to live without frequent twingesis like expecting a doctor's old chaise to go without creaking; if itdid, we might be sure the springs were broken. There is no doubt thatthe constant demand for medicinal remedies from patients of this classleads to their over-use; often in the case of cathartics, sometimes inthat of opiates. I have been told by an intelligent practitioner ina Western town, that the constant prescription of opiates by certainphysicians in his vicinity has rendered the habitual use of that drugin all that region very prevalent; more common, I should think, thanalcoholic drunkenness in the most intemperate localities of which I haveknown anything. A frightful endemic demoralization betrays itself in thefrequency with which the haggard features and drooping shoulders of theopium-drunkards are met with in the streets. 

The next proposition I would ask you to consider is this: Thepresumption always is that every noxious agent, including medicinesproper, which hurts a well man, hurts a sick one. [ Note B. ]

Let me illustrate this proposition before you decide upon it. If it wereknown that a prize-fighter were to have a drastic purgative administeredtwo or three days before a contest, or a large blister applied to hisback, no one will question that it would affect the betting on his sideunfavorably; we will say to the amount of five per cent. Now the drainupon the resources of the system produced in such a case must be at itsminimum, for the subject is a powerful man, in the prime of life, andin admirable condition. If the drug or the blister takes five per cent. From his force of resistance, it will take at least as large a fractionfrom any invalid. But this invalid has to fight a champion who strikeshard but cannot be hit in return, who will press him sharply for breath, but will never pant himself while the wind can whistle through hisfleshless ribs. The suffering combatant is liable to want all hisstamina, and five per cent. May lose him the battle. 

All noxious agents, all appliances which are not natural food orstimuli, all medicines proper, cost a patient, on the average, fiveper cent. Of his vital force, let us say. Twenty times as much waste offorce produced by any of them, that is, would exactly kill him, nothingless than kill him, and nothing more. If this, or something like this, is true, then all these medications are, prima facie, injurious. 

In the game of Life-or-Death, Rouge et Noir, as played between theDoctor and the Sexton, this five per cent. , this certain small injuryentering into the chances is clearly the sexton's perquisite for keepingthe green table, over which the game is played, and where he hoardsup his gains. Suppose a blister to diminish a man's pain, effusion ordyspnoea to the saving of twenty per cent. In vital force; his profitfrom it is fifteen, in that case, for it always hurts him five to beginwith, according to our previous assumption. 

Presumptions are of vast importance in medicine, as in law. A man ispresumed innocent until he is proved guilty. A medicine--that is, a noxious agent, like a blister, a seton, an emetic, or a cathartic--should always be presumed to be hurtful. It always is directlyhurtful; it may sometimes be indirectly beneficial. If this presumptionwere established, and disease always assumed to be the innocent victimof circumstances, and not punishable by medicines, that is, noxiousagents, or poisons, until the contrary was shown, we should not sofrequently hear the remark commonly, perhaps erroneously, attributed toSir Astley Cooper, but often repeated by sensible persons, that, on thewhole, more harm than good is done by medication. Throw out opium, whichthe Creator himself seems to prescribe, for we often see the scarletpoppy growing in the cornfields, as if it were foreseen that whereverthere is hunger to be fed there must also be pain to be soothed; throwout a few specifics which our art did not discover, and is hardly neededto apply [ Note C. ]; throw out wine, which is a food, and the vaporswhich produce the miracle of anaesthesia, and I firmly believe that ifthe whole materia medica, as now used, could be sunk to the bottom ofthe sea, it would be all the better for mankind, --and all the worse forthe fishes. 

But to justify this proposition, I must add that the injuries inflictedby over-medication are to a great extent masked by disease. Dr. Hookerbelieves that the typhus syncopatia of a preceding generation inNew England "was often in fact a brandy and opium disease. " How is aphysician to distinguish the irritation produced by his blister fromthat caused by the inflammation it was meant to cure? How can he tellthe exhaustion produced by his evacuants from the collapse belonging tothe disease they were meant to remove?

Lastly, medication without insuring favorable hygienic conditions islike amputation without ligatures. I had a chance to learn this wellof old, when physician to the Broad Street district of the BostonDispensary. There, there was no help for the utter want of wholesomeconditions, and if anybody got well under my care, it must have beenin virtue of the rough-and-tumble constitution which emerges from thestruggle for life in the street gutters, rather than by the aid of myprescriptions. 

But if the materia medica were lost overboard, how much more pains wouldbe taken in ordering all the circumstances surrounding the patient (ascan be done everywhere out of the crowded pauper districts), than aretaken now by too many who think they do their duty and earn their moneywhen they write a recipe for a patient left in an atmosphere of domesticmalaria, or to the most negligent kind of nursing! I confess that Ishould think my chance of recovery from illness less with Hippocratesfor my physician and Mrs. Gamp for my nurse, than if I were in the handsof Hahnemann himself, with Florence Nightingale or good Rebecca Taylorto care for me. 

If I am right in maintaining that the presumption is always againstthe use of noxious agents in disease, and if any whom I might influenceshould adopt this as a principle of practice, they will often findthemselves embarrassed by the imperative demand of patients and theirfriends for such agents where a case is not made out against thisstanding presumption. I must be permitted to say, that I think theFrench, a not wholly uncivilized people, are in advance of the Englishand ourselves in the art of prescribing for the sick without hurtingthem. And I do confess that I think their varied ptisans and syrups areas 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 ofpreparing food for the table to the rude cookery of those hard-feedingand much-dosing islanders. We want a reorganized cuisine of invalidismperhaps as much as the culinary, reform, for which our lyceum lecturers, and others who live much at hotels and taverns, are so urgent. Will youthink I am disrespectful if I ask whether, even in Massachusetts, a doseof calomel is not sometimes given by a physician on the same principleas that upon which a landlord occasionally prescribes bacon andeggs, --because he cannot think of anything else quite so handy? I leavemy suggestion of borrowing a hint from French practice to your matureconsideration. 

I may, however, call your attention, briefly, to the singular fact, that English and American practitioners are apt to accuse French medicalpractice of inertness, and French surgical practice of unnecessaryactivity. Thus, Dr. Bostock considers French medical treatment, withcertain exceptions, as "decidedly less effective" than that of his owncountry. Mr. S. Cooper, again, defends the simple British practice ofprocuring union by the first intention against the attacks of M. Rouxand Baron Larrey. [Cooper's Surg. Diet. Art. "Wounds. " Yet Mr. JohnBell gives the French surgeons credit for introducing this doctrine ofadhesion, and accuses O'Halloran of "rudeness and ignorance, " and "bold, uncivil language, " in disputing their teaching. Princ. Of Surgery, vol. I. P. 42. Mr. Hunter succeeded at last in naturalizing the doctrine andpractice, but even he had to struggle against the perpetual jealousyof rivals, and died at length assassinated by an insult. ] We haveoften heard similar opinions maintained by our own countrymen. WhileAnglo-American criticism blows hot or cold on the two departments ofFrench practice, it is not, I hope, indecent to question whether all thewisdom is necessarily with us in both cases. 

Our art has had two or three lessons which have a deep meaning to thosewho are willing to read them honestly. The use of water-dressings insurgery completed the series of reforms by which was abolished the"coarse and cruel practice" of the older surgeons, who with theirdressings and acrid balsams, their tents and leaden tubes, "absolutelydelayed the cure. " The doctrine of Broussais, transient as was itsempire, reversed the practice of half of Christendom for a season, andtaught its hasty disciples to shun their old favorite remedies as mortalpoisons. This was not enough permanently to shift the presumption aboutdrugs where it belonged, and so at last, just as the sympathetic powderand the Unguentum Armarium came in a superstitious age to kill out theabuses of external over-medication, the solemn farce of Homoeopathy wasenacted in the face of our own too credulous civilization, that undershelter of its pretences the "inward bruises" of over-drugged visceramight be allowed to heal by the first intention. Its lesson we mustaccept, whether we will or not; its follies we are tired of talkingabout. The security of the medical profession against this and allsimilar fancies is in the average constitution of the human mind withregard to the laws of evidence. 

My friends and brothers in Art! There is nothing to be feared from theutterance of any seeming heresy to which you may have listened. I cannotcompromise your collective wisdom. If I have strained the truth onehair's breadth for the sake of an epigram or an antithesis, you areaccustomed to count the normal pulse-beats of sound judgment, and knowfull well how to recognize the fever-throbs of conceit and the nervouspalpitations of rhetoric. 

The freedom with which each of us speaks his thought in this presence, belongs in part to the assured position of the Profession in ourCommonwealth, to the attitude of Science, which is always fearless, andto the genius of the soil on which we stand, from which Nature withheldthe fatal gift of malaria only to fill it with exhalations that breedthe fever of inquiry in our blood and in our brain. But mainly we owethe large license of speech we enjoy to those influences and privilegescommon to us all as self-governing Americans. 

This Republic is the chosen home of minorities, of the less power inthe presence of the greater. It is a common error to speak of ourdistinction as consisting in the rule of the majority. Majorities, thegreater material powers, have always ruled before. The history of mostcountries has been that of majorities, mounted majorities, clad in iron, armed with death treading down the tenfold more numerous minorities. Inthe old civilizations they root themselves like oaks in the soil; menmust live in their shadow or cut them down. With us the majority is onlythe flower of the passing noon, and the minority is the bud which mayopen in the next morning's sun. We must be tolerant, for the thoughtwhich stammers on a single tongue today may organize itself in thegrowing consciousness of the time, and come back to us like the voice ofthe multitudinous waves of the ocean on the morrow. 

Twenty-five years have passed since one of your honored Presidents spoketo this Society of certain limitations to the power of our Art, now verygenerally conceded. Some were troubled, some were almost angry, thinkingthe Profession might suffer from such concessions. It has certainly notsuffered here; if, as some affirm, it has lost respect anywhere, it wasprobably for other, and no doubt sufficient reasons. 

Since that time the civilization of this planet has changed hands. Strike out of existence at this moment every person who was breathing onthat day, May 27, 1835, and every institution of society, every art andevery science would remain intact and complete in the living that wouldbe left. Every idea the world then held has been since dissolved andrecrystallized. 

We are repeating the same process. Not to make silver shrines for ourold divinities, even though by this craft we should have our wealth, wasthis Society organized and carried on by the good men and true who wentbefore us. Not for this, but to melt the gold out of the past, thoughits dross should fly in dust to all the winds of heaven, to save all ourold treasures of knowledge and mine deeply for new, to cultivate thatmutual respect of which outward courtesy is the sign, to work together, to feel together, to take counsel together, and to stand togetherfor the truth, now, always, here, everywhere; for this our fathersinstituted, and we accept, the offices and duties of this time-honoredSociety. 

BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE. 

An Introductory Lecture delivered before the Medical Class of HarvardUniversity, November 6, 1861. 

[This Lecture appears as it would have been delivered had the timeallowed been less strictly, limited. Passages necessarily omittedhave been restored, and points briefly touched have been more fullyconsidered. A few notes have been added for the benefit of that limitedclass of students who care to track an author through the highways andby-ways of his reading. I owe my thanks to several of my professionalbrethren who have communicated with me on subjects with which they arefamiliar; especially to Dr. John Dean, for the opportunity of profitingby his unpublished labors, and to Dr. Hasket Derby, for information andreferences to recent authorities relating to the anatomy and physiologyof the eye. ]

The entrance upon a new course of Lectures is always a period ofinterest to instructors and pupils. As the birth of a child to a parent, so is the advent of a new class to a teacher. As the light of theuntried world to the infant, so is the dawning of the light restingover the unexplored realms of science to the student. In the name of theFaculty I welcome you, Gentlemen of the Medical Class, new-born babes ofscience, or lustier nurslings, to this morning of your medical life, andto the arms and the bosom of this ancient University. Fourteen years agoI stood in this place for the first time to address those who occupiedthese benches. As I recall these past seasons of our joint labors, Ifeel that they have been on the whole prosperous, and not undeserving oftheir prosperity. 

For it has been my privilege to be associated with a body of true andfaithful workers; I cannot praise them freely to their faces, or Ishould be proud to discourse of the harmonious diligence and the noblespirit in which they have toiled together, not merely to teach theirseveral branches, but to elevate the whole standard of teaching. 

I may speak with less restraint of those gentlemen who have aided me inthe most laborious part of my daily duties, the Demonstrators, to whomthe successive classes have owed so much of their instruction. They risebefore me, the dead and the living, in the midst of the most gratefulrecollections. The fair, manly face and stately figure of my friend, Dr. Samuel Parkman, himself fit for the highest offices of teaching, yetwilling to be my faithful assistant in the time of need, come back tome with the long sigh of regret for his early loss to our earthlycompanionship. Every year I speak the eulogy of Dr. Ainsworth's patienttoil as I show his elaborate preparations: When I take down my "AmericanCyclopaedia" and borrow instruction from the learned articles of Dr. Kneeland, I cease to regret that his indefatigable and intelligentindustry was turned into a broader channel. And what can I say toocordial of my long associated companion and friend, Dr. Hodges, whoseadmirable skill, working through the swiftest and surest fingers thatever held a scalpel among us, has delighted class after class, andfilled our Museum with monuments which will convey his name to unborngenerations?

This day belongs, however, not to myself and my recollections, but toall of us who teach and all of you who listen, whether experts inour specialties or aliens to their mysteries, or timid neophytes justentering the portals of the hall of science. Look in with me, then, while I attempt to throw some rays into its interior, which shallilluminate a few of its pillars and cornices, and show at the same timehow many niches and alcoves remain in darkness. 

SCIENCE is the topography of ignorance. From a few elevated points wetriangulate vast spaces, inclosing infinite unknown details. We cast thelead, and draw up a little sand from abysses we may never reach with ourdredges. 

The best part of our knowledge is that which teaches us where knowledgeleaves off and ignorance begins. Nothing more clearly separates a vulgarfrom a superior mind, than the confusion in the first between the littlethat it truly knows, on the one hand, and what it half knows and what itthinks it knows on the other. 

That which is true of every subject is especially true of the branch ofknowledge which deals with living beings. Their existence is a perpetualdeath and reanimation. Their identity is only an idea, for we put offour bodies many times during our lives, and dress in new suits of bonesand muscles. 

 "Thou art not thyself; For thou exist'st on many a thousand grains That issue out of dust. "

If it is true that we understand ourselves but imperfectly in health, this truth is more signally manifested in disease, where natural actionsimperfectly understood, disturbed in an obscure way by half-seen causes, are creeping and winding along in the dark toward their destined issue, sometimes using our remedies as safe stepping-stones, occasionally, itmay be, stumbling over them as obstacles. 

I propose in this lecture to show you some points of contact between ourignorance and our knowledge in several of the branches upon the studyof which you are entering. I may teach you a very little directly, but Ihope much more from the trains of thought I shall suggest. Do not expecttoo much ground to be covered in this rapid survey. Our task is onlythat of sending out a few pickets under the starry flag of science tothe edge of that dark domain where the ensigns of the obstinate rebel, Ignorance, are flying undisputed. We are not making a reconnoissancein force, still less advancing with the main column. But here are a fewroads along which we have to march together, and we wish to see clearlyhow far our lines extend, and where the enemy's outposts begin. 

Before touching the branches of knowledge that deal with organizationand vital functions, let us glance at that science which meets you atthe threshold of your study, and prepares you in some measure to dealwith the more complex problems of the living laboratory. 

CHEMISTRY. Includes the art of separating and combining the elements ofmatter, and the study of the changes produced by these operations. Wecan hardly say too much of what it has contributed to our knowledge ofthe universe and our power of dealing with its materials. It has givenus a catalogue raisonne of the substances found upon our planet, andshown how everything living and dead is put together from them. It isaccomplishing wonders before us every day, such as Arabian story-tellersused to string together in their fables. It spreads the sensitive filmon the artificial retina which looks upon us through the optician's lensfor a few seconds, and fixes an image that will outlive its original. It questions the light of the sun, and detects the vaporized metalsfloating around the great luminary, --iron, sodium, lithium, andthe rest, --as if the chemist of our remote planet could fill hisbell-glasses from its fiery atmosphere. It lends the power which flashesour messages in thrills that leave the lazy chariot of day behind them. It seals up a few dark grains in iron vases, and lo! at the touch of asingle spark, rises in smoke and flame a mighty Afrit with a voicelike thunder and an arm that shatters like an earthquake. The dreams ofOriental fancy have become the sober facts of our every-day life, andthe chemist is the magician to whom we owe them. 

To return to the colder scientific aspect of chemistry. It has shownus how bodies stand affected to each other through an almost boundlessrange of combinations. It has given us a most ingenious theory toaccount for certain fixed relations in these combinations. It hassuccessfully eliminated a great number of proximate compounds, more orless stable, from organic structures. It has invented others which formthe basis of long series of well-known composite substances. In fact, weare perhaps becoming overburdened with our list of proximate principles, demonstrated and hypothetical. 

How much nearer have we come to the secret of force than Lully and Geberand the whole crew of juggling alchemists? We have learned a great dealabout the how, what have we learned about the why?

Why does iron rust, while gold remains untarnished, and gold amalgamate, while iron refuses the alliance of mercury?

The alchemists called gold Sol, the sun, and iron Mars, and pleasedthemselves with fancied relations between these substances and theheavenly bodies, by which they pretended to explain the facts theyobserved. Some of their superstitions have lingered in practicalmedicine to the present day, but chemistry has grown wise enough toconfess the fact of absolute ignorance. 

What is it that makes common salt crystallize in the form of cubes, and saltpetre in the shape of six-sided prisms? We see no reason why itshould not have been just the other way, salt in prisms and saltpetre incubes, or why either should take an exact geometrical outline, any morethan coagulating albumen. 

But although we had given up attempting to explain the essential natureof affinities and of crystalline types, we might have supposed that wehad at least fixed the identity of the substances with which we deal, and determined the laws of their combination. All at once we find that asimple substance changes face, puts off its characteristic qualities andresumes them at will;--not merely when we liquefy or vaporize a solid, or reverse the process; but that a solid is literally transformed intoanother solid under our own eyes. We thought we knew phosphorus. We warma portion of it sealed in an empty tube, for about a week. It hasbecome a brown infusible substance, which does not shine in the darknor oxidate in the air. We heat it to 500 F. , and it becomes commonphosphorus again. We transmute sulphur in the same singular way. Nature, you know, gives us carbon in the shape of coal and in that of thediamond. It is easy to call these changes by the name allotropism, butnot the less do they confound our hasty generalizations. 

These facts of allotropism have some corollaries connected with themrather startling to us of the nineteenth century. There may be othertransmutations possible besides those of phosphorus and sulphur. WhenDr. Prout, in 1840, talked about azote and carbon being "formed" in theliving system, it was looked upon as one of those freaks of fancy towhich philosophers, like other men, are subject. But when ProfessorFaraday, in 1851, says, at a meeting of the British Association, that"his hopes are in the direction of proving that bodies called simplewere really compounds, and may be formed artificially as soon as weare masters of the laws influencing their combinations, "--when he comesforward and says that he has tried experiments at transmutation, and means, if his life is spared, to try them again, --how can webe surprised at the popular story of 1861, that Louis Napoleon hasestablished a gold-factory and is glutting the mints of Europe withbullion of his own making?

And so with reference to the law of combinations. The old maxim was, Corpora non agunt nisi soluta. If two substances, a and b, are inclosedin a glass vessel, c, we do not expect the glass to change them, unlessa or b or the compound a b has the power of dissolving the glass. Butif for a I take oxygen, for b hydrogen, and for c a piece of spongyplatinum, I find the first two combine with the common signs ofcombustion and form water, the third in the mean time undergoing noperceptible change. It has played the part of the unwedded priest, whomarries a pair without taking a fee or having any further relation withthe parties. We call this catalysis, catalytic action, the action ofpresence, or by what learned name we choose. Give what name to it wewill, it is a manifestation of power which crosses our established lawsof combination at a very open angle of intersection. I think we mayfind an analogy for it in electrical induction, the disturbance of theequilibrium of the electricity of a body by the approach of a chargedbody to it, without interchange of electrical conditions between thetwo bodies. But an analogy is not an explanation, and why a few dropsof yeast should change a saccharine mixture to carbonic acid andalcohol, --a little leaven leavening the whole lump, --not by combiningwith it, but by setting a movement at work, we not only cannot explain, but the fact is such an exception to the recognized laws of combinationthat Liebig is unwilling to admit the new force at all to whichBerzelius had given the name so generally accepted. 

The phenomena of isomerism, or identity of composition and proportionsof constituents with difference of qualities, and of isomorphism, oridentity of form in crystals which have one element substituted foranother, were equally surprises to science; and although the mechanismby which they are brought about can be to a certain extent explainedby a reference to the hypothetical atoms of which the elements areconstituted, yet this is only turning the difficulty into a fractionwith an infinitesimal denominator and an infinite numerator. 

So far we have studied the working of force and its seeming anomaliesin purely chemical phenomena. But we soon find that chemical force isdeveloped by various other physical agencies, --by heat, by light, byelectricity, by magnetism, by mechanical agencies; and, vice versa, thatchemical action develops heat, light, electricity, magnetism, mechanicalforce, as we see in our matches, galvanic batteries, and explosivecompounds. Proceeding with our experiments, we find that every kindof force is capable of producing all other kinds, or, in Mr. Faraday'slanguage, that "the various forms under which the forces of matter aremade manifest have a common origin, or, in other words, are so directlyrelated and mutually dependent that they are convertible one intoanother. "

Out of this doctrine naturally springs that of the conservation offorce, so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr. Faraday. This idea is no novelty, though it seems so at first sight. It wasmaintained and disputed among the giants of philosophy. Des Cartes andLeibnitz denied that any new motion originated in nature, or that anyever ceased to exist; all motion being in a circle, passing from onebody to another, one losing what the other gained. Newton, on theother hand, believed that new motions were generated and existing onesdestroyed. On the first supposition, there is a fixed amount of forcealways circulating in the universe. On the second, the total amount maybe increasing or diminishing. You will find in the "Annual of ScientificDiscovery" for 1858 a very interesting lecture by Professor Helmholtz ofBonn, in which it is maintained that a certain portion of force is lostin every natural process, being converted into unchangeable heat, sothat the universe will come to a stand-still at last, all force passinginto heat, and all heat into a state of equilibrium. 

The doctrines of the convertibility or specific equivalence of thevarious forms of force, and of its conservation, which is its logicalconsequence, are very generally accepted, as I believe, at the presenttime, among physicists. We are naturally led to the question, What isthe nature of force? The three illustrious philosophers just referredto agree in attributing the general movements of the universe to theimmediate Divine action. The doctrine of "preestablished harmony" wasan especial contrivance of Leibnitz to remove the Creator from unworthyassociation with the less divine acts of living beings. Obsolete as thisexpression sounds to our ears, the phrase laws of the universe, whichwe use so constantly with a wider application, appears to me essentiallyidentical with it. 

Force does not admit of explanation, nor of proper definition, any morethan the hypothetical substratum of matter. If we assume the Infinite asomnipresent, omniscient, omnipotent, we cannot suppose Him excluded fromany part of His creation, except from rebellious souls which voluntarilyexclude Him by the exercise of their fatal prerogative of free-will. Force, then, is the act of immanent Divinity. I find no meaning inmechanical explanations. Newton's hypothesis of an ether filling theheavenly spaces does not, I confess, help my conceptions. I will, andthe muscles of my vocal organs shape my speech. God wills, and theuniverse articulates His power, wisdom, and goodness. That is all Iknow. There is no bridge my mind can throw from the "immaterial" causeto the "material" effect. 

The problem of force meets us everywhere, and I prefer to encounterit in the world of physical phenomena before reaching that of livingactions. It is only the name for the incomprehensible cause of certainchanges known to our consciousness, and assumed to be outside of it. Forme it is the Deity Himself in action. 

I can therefore see a large significance in the somewhat bold languageof Burdach: "There is for me but one miracle, that of infiniteexistence, and but one mystery, the manner in which the finite proceedsfrom the infinite. So soon as we recognize this incomprehensible act asthe general and primordial miracle, of which our reason perceives thenecessity, but the manner of which our intelligence cannot grasp, sosoon as we contemplate the nature known to us by experience in thislight, there is for us no other impenetrable miracle or mystery. "

Let us turn to a branch of knowledge which deals with certainties up tothe limit of the senses, and is involved in no speculations beyond them. In certain points of view, HUMAN ANATOMY may be considered an almostexhausted science. From time to time some small organ which had escapedearlier observers has been pointed out, --such parts as the tensortarsi, the otic ganglion, or the Pacinian bodies; but some of our bestanatomical works are those which have been classic for many generations. The plates of the bones in Vesalius, three centuries old, are stillmasterpieces of accuracy, as of art. The magnificent work of Albinus onthe muscles, published in 1747, is still supreme in its department, as the constant references of the most thorough recent treatise onthe subject, that of Theile, sufficiently show. More has been done inunravelling the mysteries of the fasciae, but there has been a tendencyto overdo this kind of material analysis. Alexander Thomson split themup into cobwebs, as you may see in the plates to Velpeau's SurgicalAnatomy. I well remember how he used to shake his head over the coarsework of Scarpa and Astley Cooper, --as if Denner, who painted theseparate hairs of the beard and pores of the skin in his portraits, hadspoken lightly of the pictures of Rubens and Vandyk. 

Not only has little been added to the catalogue of parts, but somethings long known had become half-forgotten. Louis and others confoundedthe solitary glands of the lower part of the small intestine with thosewhich "the great Brunner, " as Haller calls him, described in 1687 asbeing found in the duodenum. The display of the fibrous structure of thebrain seemed a novelty as shown by Spurzheim. One is startled to findthe method anticipated by Raymond Vieussens nearly two centuries ago. Ican hardly think Gordon had ever looked at his figures, though he namestheir author, when he wrote the captious and sneering article whichattracted so much attention in the pages of the "Edinburgh Review. "

This is the place, if anywhere, to mention any observations I couldpretend to have made in the course of my teaching the structure of thehuman body. I can make no better show than most of my predecessors inthis well-reaped field. The nucleated cells found connected with thecancellated structure of the bones, which I first pointed out and hadfigured in 1847, and have shown yearly from that time to the present, and the fossa masseterica, a shallow concavity on the ramus of thelower jaw, for the lodgment of the masseter muscle, which acquiressignificance when examined by the side of the deep cavity on thecorresponding part in some carnivora to which it answers, may perhaps beclaimed as deserving attention. I have also pleased myself by making aspecial group of the six radiating muscles which diverge from the spineof the axis, or second cervical vertebra, and by giving to it the namestella musculosa nuchaee. But this scanty catalogue is only an evidencethat one may teach long and see little that has not been noted by thosewho have gone before him. Of course I do not think it necessary toinclude rare, but already described anomalies, such as the episternalbones, the rectus sternalis, and other interesting exceptionalformations I have encountered, which have shown a curious tendency topresent themselves several times in the same season, perhaps because thefirst specimen found calls our attention to any we may subsequently meetwith. 

The anatomy of the scalpel and the amphitheatre was, then, becoming anexhausted branch of investigation. But during the present century thestudy of the human body has changed its old aspect, and become fertilein new observations. This rejuvenescence was effected by means of twoprincipal agencies, --new methods and a new instrument. 

Descriptive anatomy, as known from an early date, is to the body whatgeography is to the planet. Now geography was pretty well known so longago as when Arrowsmith, who was born in 1750, published his admirablemaps. But in that same year was born Werner, who taught a new way ofstudying the earth, since become familiar to us all under the name ofGeology. 

What geology has done for our knowledge of the earth, has been done forour knowledge of the body by that method of study to which is given thename of General Anatomy. It studies, not the organs as such, but theelements out of which the organs are constructed. It is the geology ofthe body, as that is the general anatomy of the earth. The extraordinarygenius of Bichat, to whom more than any other we owe this new methodof study, does not require Mr. Buckle's testimony to impress thepractitioner with the importance of its achievements. I have heard avery wise physician question whether any important result had accruedto practical medicine from Harvey's discovery of the circulation. ButAnatomy, Physiology, and Pathology have received a new light from thisnovel method of contemplating the living structures, which has had avast influence in enabling the practitioner at least to distinguishand predict the course of disease. We know as well what differencesto expect in the habits of a mucous and of a serous membrane, as whatmineral substances to look for in the chalk or the coal measures. Youhave only to read Cullen's description of inflammation of the lungs orof the bowels, and compare it with such as you may find in Laennecor Watson, to see the immense gain which diagnosis and prognosis havederived from general anatomy. 

The second new method of studying the human structure, beginning withthe labors of Scarpa, Burns, and Colles, grew up principally during thefirst third of this century. It does not deal with organs, as did theearlier anatomists, nor with tissues, after the manner of Bichat. Itmaps the whole surface of the body into an arbitrary number of regions, and studies each region successively from the surface to the bone, orbeneath it. This hardly deserves the name of a science, althoughVelpeau has dignified it with that title, but it furnishes an admirablepractical way for the surgeon who has to operate on a particular regionof the body to study that region. If we are buying a farm, we are notcontent with the State map or a geological chart including the estate inquestion. We demand an exact survey of that particular property, so thatwe may know what we are dealing with. This is just what regional, or, as it is sometimes called, surgical anatomy, does for the surgeon withreference to the part on which his skill is to be exercised. It enableshim to see with the mind's eye through the opaque tissues down to thebone on which they lie, as if the skin were transparent as the cornea, and the organs it covers translucent as the gelatinous pulp of a medusa. 

It is curious that the Japanese should have anticipated Europe in a kindof rude regional anatomy. I have seen a manikin of Japanese make tracedall over with lines, and points marking their intersection. By thistheir doctors are guided in the performance of acupuncture, marking thesafe places to thrust in needles, as we buoy out our ship-channels, anddoubtless indicating to learned eyes the spots where incautious meddlinghad led to those little accidents of shipwreck to which patients areunfortunately liable. 

A change of method, then, has given us General and Regional Anatomy. These, too, have been worked so thoroughly, that, if not exhausted, theyhave at least become to a great extent fixed and positive branches ofknowledge. But the first of them, General Anatomy, would never, havereached this positive condition but for the introduction of that, instrument which I have mentioned as the second great aid to modernprogress. 

This instrument is the achromatic microscope. For the history of thesuccessive steps by which it became the effective scientific implementwe now possess, I must refer you to the work of Mr. Quekett, to anexcellent article in the "Penny Cyclopaedia, " or to that of Sir DavidBrewster in the "Encyclopaedia Britannica. " It is a most interestingpiece of scientific history, which shows how the problem which Biot in1821 pronounced insolvable was in the course of a few years practicallysolved, with a success equal to that which Dollond had long beforeobtained with the telescope. It is enough for our purpose that weare now in possession of an instrument freed from all confusions andillusions, which magnifies a thousand diameters, --a million times insurface, --without serious distortion or discoloration of its object. 

A quarter of a century ago, or a little more, an instructor would nothave hesitated to put John Bell's "Anatomy" and Bostock's "Physiology"into a student's hands, as good authority on their respective subjects. Let us not be unjust to either of these authors. John Bell is theliveliest medical writer that I can remember who has written since thedays of delightful old Ambroise Pare. His picturesque descriptions andbold figures are as good now as they ever were, and his book can neverbecome obsolete. But listen to what John Bell says of the microscope:

"Philosophers of the last age had been at infinite pains to find theultimate fibre of muscles, thinking to discover its properties in itsform; but they saw just in proportion to the glasses which they used, orto their practice and skill in that art, which is now almost forsaken. "

Dr. Bostock's work, neglected as it is, is one which I value very highlyas a really learned compilation, full of original references. ButDr. Bostock says: "Much as the naturalist has been indebted to themicroscope, by bringing into view many beings of which he could nototherwise have ascertained the existence, the physiologist has not yetderived any great benefit from the instrument. "

These are only specimens of the manner in which the microscope and itsresults were generally regarded by the generation just preceding ourown. 

I have referred you to the proper authorities for the account of thoseimprovements which about the year 1830 rendered the compound microscopean efficient and trustworthy instrument. It was now for the first timethat a true general anatomy became possible. As early as 1816 Treviranushad attempted to resolve the tissues, of which Bichat had admitted noless than twenty-one, into their simple microscopic elements. Howcould such an attempt succeed, Henle well asks, at a time when the mostextensively diffused of all the tissues, the areolar, was not at allunderstood? All that method could do had been accomplished by Bichat andhis followers. It was for the optician to take the next step. The futureof anatomy and physiology, as an enthusiastic micrologist of the timesaid, was in the hands of Messrs. Schieck and Pistor, famous opticiansof Berlin. 

In those earlier days of which I am speaking, all the points of minuteanatomy were involved in obscurity. Some found globules everywhere, some fibres. Students disputed whether the conjunctiva extended overthe cornea or not, and worried themselves over Gaultier de Claubry'sstratified layers of the skin, or Breschet's blennogenous andchromatogenous organs. The dartos was a puzzle, the central spinal canala myth, the decidua clothed in fable as much as the golden fleece. Thestructure of bone, now so beautifully made out, --even that of the teeth, in which old Leeuwenhoek, peeping with his octogenarian eyes through theminute lenses wrought with his own hands, had long ago seen the "pipes, "as he called them, --was hardly known at all. The minute structure ofthe viscera lay in the mists of an uncertain microscopic vision. Theintimate recesses of the animal system were to the students of anatomywhat the anterior of Africa long was to geographers, and the stories ofmicroscopic explorers were as much sneered at as those of Bruce or DuChailly, and with better reason. 

Now what have we come to in our own day? In the first place, the minutestructure of all the organs has been made out in the most satisfactoryway. The special arrangements of the vessels and the ducts of all theglands, of the air-tubes and vesicles of the lungs, of the parts whichmake up the skin and other membranes, all the details of those complexparenchymatous organs which had confounded investigation so long, havebeen lifted out of the invisible into the sight of all observers. Itis fair to mention here, that we owe a great deal to the art of minuteinjection, by which we are enabled to trace the smallest vessels in themidst of the tissues where they are distributed. This is an old artificeof anatomists. The famous Ruysch, who died a hundred and thirty yearsago, showed that each of the viscera has its terminal vessels arrangedin its own peculiar way; the same fact which you may see illustrated inGerber's figures after the minute injections of Berres. I hope to showyou many specimens of this kind in the microscope, the work of Englishand American hands. Professor Agassiz allows me also to make use ofa very rich collection of injected preparations sent him by ProfessorHyrtl, formerly of Prague, now of Vienna, for the proper exhibitionof which I had a number of microscopes made expressly, by Mr. Grunow, during the past season. All this illustrates what has been done for theelucidation of the intimate details of formation of the organs. 

But the great triumph of the microscope as applied to anatomy hasbeen in the resolution of the organs and the tissues into their simpleconstituent anatomical elements. It has taken up general anatomy whereBichat left it. He had succeeded in reducing the structural language ofnature to syllables, if you will permit me to use so bold an image. Themicroscopic observers who have come after him have analyzed these intoletters, as we may call them, --the simple elements by the combination ofwhich Nature spells out successively tissues, which are her syllables, organs which are her words, systems which are her chapters, and so goeson from the simple to the complex, until she binds up in one livingwhole that wondrous volume of power and wisdom which we call the humanbody. 

The alphabet of the organization is so short and simple, that I willrisk fatiguing your attention by repeating it, according to the plan Ihave long adopted. 

A. Cells, either floating, as in the blood, or fixed, like those in thecancellated structure of bone, already referred to. Very commonly theyhave undergone a change of figure, most frequently a flattening whichreduces them to scales, as in the epidermis and the epithelium. 

B. Simple, translucent, homogeneous solid, such as is found at the backof the cornea, or forming the intercellular substance of cartilage. 

C. The white fibrous element, consisting of very delicate, tenaciousthreads. This is the long staple textile substance of the body. It is tothe organism what cotton is pretended to be to our Southern States. It pervades the whole animal fabric as areolar tissue, which is theuniversal packing and wrapping material. It forms the ligaments whichbind the whole frame-work together. It furnishes the sinews, which arethe channels of power. It enfolds every muscle. It wraps the brain inits hard, insensible folds, and the heart itself beats in a purse thatis made of it. 

D. The yellow elastic, fibrous element, the caoutchouc of the animalmechanism, which pulls things back into place, as the India-rubber bandshuts the door we have opened. 

E. The striped muscular fibre, --the red flesh, which shortens itself inobedience to the will, and thus produces all voluntary active motion. 

F. The unstriped muscular fibre, more properly the fusiform-cell fibre, which carries on the involuntary internal movements. 

G. The nerve-cylinder, a glassy tube, with a pith of some firmness, which conveys sensation to the brain and the principle which inducesmotion from it. 

H. The nerve-corpuscle, the centre of nervous power. 

I. The mucous tissue, as Virchow calls it, common in embryonicstructures, seen in the vitreous humor of the adult. 

To these add X, granules, of indeterminate shape and size, Y, forinorganic matters, such as the salts of bone and teeth, and Z, to standas a symbol of the fluids, and you have the letters of what I haveventured to call the alphabet of the body. 

But just as in language certain diphthongs and syllables are frequentlyrecurring, so we have in the body certain secondary and tertiarycombinations, which we meet more frequently than the solitary elementsof which they are composed. 

Thus A B, or a collection of cells united by simple structurelesssolid, is seen to be extensively employed in the body under the name ofcartilage. Out of this the surfaces of the articulations and the springsof the breathing apparatus are formed. But when Nature came to thebuffers of the spinal column (intervertebral disks) and the washers ofthe joints (semilunar fibrocartilages of the knee, etc. ), she requiredmore tenacity than common cartilage possessed. What did she do? Whatdoes man do in a similar case of need? I need hardly tell you. The masonlays his bricks in simple mortar. But the plasterer works some hair intothe mortar which he is going to lay in large sheets on the walls. Thechildren of Israel complained that they had no straw to make theirbricks with, though portions of it may still be seen in the crumblingpyramid of Darshour, which they are said to have built. I visited theold house on Witch Hill in Salem a year or two ago, and there I foundthe walls coated with clay in which straw was abundantly mingled;--theold Judaizing witch-hangers copied the Israelites in a good many things. The Chinese and the Corsicans blend the fibres of amianthus in theirpottery to give it tenacity. Now to return to Nature. To make herbuffers and washers hold together in the shocks to which they wouldbe subjected, she took common cartilage and mingled the white fibroustissue with it, to serve the same purpose as the hair in the mortar, the straw in the bricks and in the plaster of the old wall, and theamianthus in the earthen vessels. Thus we have the combination A B C, orfibro-cartilage. Again, the bones were once only gristle or cartilage, A B. To give them solidity they were infiltrated with stone, in the formof salts of lime, an inorganic element, so that bone would be spelt outby the letters A, B, and Y. 

If from these organic syllables we proceed to form organic words, weshall find that Nature employs three principal forms; namely, Vessels, Membranes, and Parenchyma, or visceral tissue. The most complex ofthem can be resolved into a combination of these few simple anatomicalconstituents. 

Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we findthe same elements in morbid growths that we have met with in normalstructures. The pus-corpuscle and the white blood-corpuscle can onlybe distinguished by tracing them to their origin. A frequent form ofso-called malignant disease proves to be only a collection of alteredepithelium-cells. Even cancer itself has no specific anatomical element, and the diagnosis of a cancerous tumor by the microscope, thoughtolerably sure under the eye of an expert, is based upon accidental, andnot essential points, --the crowding together of the elements, the sizeof the cell-nuclei, and similar variable characters. 

Let us turn to PHYSIOLOGY. The microscope, which has made a new scienceof the intimate structure of the organs, has at the same time cleared upmany uncertainties concerning the mechanism of the special functions. Upto the time of the living generation of observers, Nature had kept overall her inner workshops the forbidding inscription, No Admittance! Ifany prying observer ventured to spy through his magnifying tubes intothe mysteries of her glands and canals and fluids, she covered up herwork in blinding mists and bewildering halos, as the deities of oldconcealed their favored heroes in the moment of danger. 

Science has at length sifted the turbid light of her lenses, andblanched their delusive rainbows. 

Anatomy studies the organism in space. Physiology studies it also intime. After the study of form and composition follows close that ofaction, and this leads us along back to the first moment of the germ, and forward to the resolution of the living frame into its lifelesselements. In this way Anatomy, or rather that branch of it which we callHistology, has become inseparably blended with the study of function. The connection between the science of life and that of intimatestructure on the one hand, and composition on the other, is illustratedin the titles of two recent works of remarkable excellence, --"thePhysiological Anatomy" of Todd and Bowman, and the "PhysiologicalChemistry" of Lehmann. 

Let me briefly recapitulate a few of our acquisitions in Physiology, duein large measure to our new instruments and methods of research, andat the same time indicate the limits which form the permanent or thetemporary boundaries of our knowledge. I will begin with the largestfact and with the most absolute and universally encountered limitation. 

The "largest truth in Physiology" Mr. Paget considers to be "thedevelopment of ova through multiplication and division of their cells. "I would state it more broadly as the agency of the cell in all livingprocesses. It seems at present necessary to abandon the original idea ofSchwann, that we can observe the building up of a cell from the simplegranules of a blastema, or formative fluid. The evidence points rathertowards the axiom, Omnis cellula a cellula; that is, the germ of a newcell is always derived from a preexisting cell. The doctrine of Schwann, as I remarked long ago (1844), runs parallel with the nebular theory inastronomy, and they may yet stand or fall together. 

As we have seen Nature anticipating the plasterer in fibro-cartilage, so we see her beforehand with the glassblower in her dealings with thecell. The artisan blows his vitreous bubbles, large or small, to be usedafterwards as may be wanted. So Nature shapes her hyaline vesicles andmodifies them to serve the needs of the part where they are found. Theartisan whirls his rod, and his glass bubble becomes a flattened disk, with its bull's-eye for a nucleus. These lips of ours are all glazedwith microscopic tiles formed of flattened cells, each one of them withits nucleus still as plain and relatively as prominent, to the eye ofthe microscopist, as the bull's-eye in the old-fashioned windowpane. Everywhere we find cells, modified or unchanged. They roll ininconceivable multitudes (five millions and more to the cubicmillimetre, according to Vierordt) as blood-disks through our vessels. A close-fitting mail of flattened cells coats our surface with a panoplyof imbricated scales (more than twelve thousand millions), as Hartinghas computed, as true a defence against our enemies as the buckler ofthe armadillo or the carapace of the tortoise against theirs. The samelittle protecting organs pave all the great highways of the interiorsystem. Cells, again, preside over the chemical processes whichelaborate the living fluids; they change their form to become the agentsof voluntary and involuntary motion; the soul itself sits on a throneof nucleated cells, and flashes its mandates through skeins of glassyfilaments which once were simple chains of vesicles. And, as if toreduce the problem of living force to its simplest expression, we seethe yolk of a transparent egg dividing itself in whole or in part, andagain dividing and subdividing, until it becomes a mass of cells, outof which the harmonious diversity of the organs arranges itself, worm orman, as God has willed from the beginning. 

This differentiation having been effected, each several part assumes itsspecial office, having a life of its own adjusted to that of other partsand the whole. "Just as a tree constitutes a mass arranged in a definitemanner, in which, in every single part, in the leaves as in the root, in the trunk as in the blossom, cells are discovered to be the ultimateelements, so is it also with the forms of animal life. Every animalpresents itself as a sum of vital unities, every one of which manifestsall the characteristics of life. "

The mechanism is as clear, as unquestionable, as absolutely settled anduniversally accepted, as the order of movement of the heavenly bodies, which we compute backward to the days of the observatories on the plainsof Shinar, and on the faith of which we regulate the movements of warand trade by the predictions of our ephemeris. 

The mechanism, and that is all. We see the workman and the tools, butthe skill that guides the work and the power that performs it are asinvisible as ever. I fear that not every listener took thesignificance of those pregnant words in the passage I quoted fromJohn Bell, --"thinking to discover its properties in its form. " We havediscovered the working bee in this great hive of organization. We havedetected the cell in the very act of forming itself from a nucleus, oftransforming itself into various tissues, of selecting the elements ofvarious secretions. But why one cell becomes nerve and another muscle, why one selects bile and another fat, we can no more pretend to tell, than why one grape sucks out of the soil the generous juice whichprinces hoard in their cellars, and another the wine which it takesthree men to drink, --one to pour it down, another to swallow it, and athird to hold him while it is going down. Certain analogies betweenthis selecting power and the phenomena of endosmosis in the electiveaffinities of chemistry we can find, but the problem of force remainshere, as everywhere, unsolved and insolvable. 

Do we gain anything by attempting to get rid of the idea of a specialvital force because we find certain mutually convertible relationsbetween forces in the body and out of it? I think not, any more than weshould gain by getting rid of the idea and expression Magnetism becauseof its correlation with electricity. We may concede the unity of allforms of force, but we cannot overlook the fixed differences of itsmanifestations according to the conditions under which it acts. It is amistake, however, to think the mystery is greater in an organized bodythan in any other. We see a stone fall or a crystal form, and there isnothing stranger left to wonder at, for we have seen the Infinite inaction. 

Just so far as we can recognize the ordinary modes of operation of thecommon forces of nature, --gravity, cohesion, elasticity, transudation, chemical action, and the rest, --we see the so-called vital acts inthe light of a larger range of known facts and familiar analogies. Matteuecci's well-remembered lectures contain many and striking examplesof the working of physical forces in physiological processes. Whereverrigid experiment carries us, we are safe in following this lead; butthe moment we begin to theorize beyond our strict observation, we are indanger of falling into those mechanical follies which true science haslong outgrown. 

Recognizing the fact, then, that we have learned nothing but themachinery of life, and are no nearer to its essence, what is it that wehave gained by this great discovery of the cell formation and function?

It would have been reward enough to learn the method Nature pursuesfor its own sake. If the sovereign Artificer lets us into his ownlaboratories and workshops, we need not ask more than the privilegeof looking on at his work. We do not know where we now stand in thehierarchy of created intelligences. We were made a little lower than theangels. I speak it not irreverently; as the lower animals surpass manin some of their attributes, so it may be that not every angel's eyecan see as broadly and as deeply into the material works of God asman himself, looking at the firmament through an equatorial of fifteeninches' aperture, and searching into the tissues with a twelfth of aninch objective. 

But there are other positive gains of a more practical character. Thuswe are no longer permitted to place the seat of the living actions inthe extreme vessels, which are only the carriers from which each parttakes what it wants by the divine right of the omnipotent nucleatedcell. The organism has become, in the words already borrowed fromVirchow, "a sum of vital unities. " The strictum and laxum, the increasedand diminished action of the vessels, out of which medical theoriesand methods of treatment have grown up, have yielded to the doctrineof local cell-communities, belonging to this or that vascular district, from which they help themselves, as contractors are wont to do from thenational treasury. 

I cannot promise to do more than to select a few of the points ofcontact between our ignorance and our knowledge which present particularinterest in the existing state of our physiological acquisitions. Some of them involve the microscopic discoveries of which I havebeen speaking, some belong to the domain of chemistry, and some haverelations with other departments of physical science. 

If we should begin with the digestive function, we should find that thelong-agitated question of the nature of the acid of the gastric juice isbecoming settled in favor of the lactic. But the whole solvent agency ofthe digestive fluid enters into the category of that exceptional mode ofaction already familiar to us in chemistry as catalysis. It is thereforedoubly difficult of explanation; first, as being, like all reactions, a fact not to be accounted for except by the imaginative appeal to"affinity, " and secondly, as being one of those peculiar reactionsprovoked by an element which stands outside and looks on withoutcompromising itself. 

The doctrine of Mulder, so widely diffused in popular and scientificbelief, of the existence of a common base of all albuminous substances, the so-called protein, has not stood the test of rigorous analysis. Thedivision of food into azotized and non-azotized is no doubt important, but the attempt to show that the first only is plastic or nutritive, while the second is simply calorifacient, or heat-producing, failsentirely in the face of the facts revealed by the study of man indifferent climates, and of numerous experiments in the feedingof animals. I must return to this subject in connection with therespiratory function. 

The sugar-making faculty of the liver is another "catalytic" mystery, asgreat as the rest of them, and no greater. Liver-tissue brings sugar outof the blood, or out of its own substance;--why?

 Quia est in eo Virtus saccharitiva. 

Just what becomes of the sugar beyond the fact of its disappearancebefore it can get into the general circulation and sweeten our tempers, it is hard to say. 

The pancreatic fluid makes an emulsion of the fat contained in our food, but just how the fatty particles get into the villi we must leave Bruckeand Kolliker to settle if they can. 

No one has shown satisfactorily the process by which theblood-corpuscles are formed out of the lymph-corpuscles, nor whatbecomes of them. These two questions are like those famous householdpuzzles, --Where do the flies come from? and, Where do the pins go to?

There is a series of organs in the body which has long puzzledphysiologists, --organs of glandular aspect, but having no ducts, --thespleen, the thyroid and thymus bodies, and the suprarenal capsules. Wecall them vascular glands, and we believe that they elaborate coloredand uncolored blood-cells; but just what changes they effect, andjust how they effect them, it has proved a very difficult matter todetermine. So of the noted glandules which form Peyer's patches, theirprecise office, though seemingly like those of the lymphatic glands, cannot be positively assigned, so far as I know, at the present time. It is of obvious interest to learn it with reference to the pathology oftyphoid fever. It will be remarked that the coincidence of their changesin this disease with enlargement of the spleen suggests the idea of asimilarity of function in these two organs. 

The theories of the production of animal heat, from the times of Black, Lavoisier, and Crawford to those of Liebig, are familiar to all who havepaid any attention to physiological studies. The simplicity of Liebig'sviews, and the popular form in which they have been presented, havegiven them wide currency, and incorporated them in the common belief andlanguage of our text-books. Direct oxidation or combustion of the carbonand hydrogen contained in the food, or in the tissues themselves; thedivision of alimentary substances into respiratory, or non-azotized, and azotized, --these doctrines are familiar even to the classes in ourhigh-schools. But this simple statement is boldly questioned. Nothingproves that oxygen combines (in the system) with hydrogen and carbonin particular, rather than with sulphur and azote. Such is thewell-grounded statement of Robin and Verdeil. "It is very probable thatanimal heat is entirely produced by the chemical actions which takeplace in the organism, but the phenomenon is too complex to admit of ourcalculating it according to the quality of oxygen consumed. " These lastare the words of Regnault, as cited by Mr. Lewes, whose intelligentdiscussion of this and many of the most interesting physiologicalproblems I strongly recommend to your attention. 

This single illustration covers a wider ground than the special functionto which it belongs. We are learning that the chemistry of the body mustbe studied, not simply by its ingesta and egesta, but that there is along intermediate series of changes which must be investigated in theirown light, under their own special conditions. The expression "sum ofvital unities" applies to the chemical actions, as well as to otheractions localized in special parts; and when the distinguished chemistswhom I have just cited entitle their work a treatise on the immediateprinciples of the body, they only indicate the nature of thatprofound and subtile analysis which must take the place of all hastygeneralizations founded on a comparison of the food with residualproducts. 

I will only call your attention to the fact, that the exceptionalphenomenon of the laboratory is the prevailing law of the organism. Nutrition itself is but one great catalytic process. As the bloodtravels its rounds, each part selects its appropriate element andtransforms it to its own likeness. Whether the appropriating agentbe cell or nucleus, or a structureless solid like the intercellularsubstance of cartilage, the fact of its presence determines theseparation of its proper constituents from the circulating fluid, sothat even when we are wounded bone is replaced by bone, skin by skin, and nerve by nerve. 

It is hardly without a smile that we resuscitate the old question ofthe 'vis insita' of the muscular fibre, so famous in the discussions ofHaller and his contemporaries. Speaking generally, I think we may saythat Haller's doctrine is the one now commonly received; namely, thatthe muscles contract in virtue of their own inherent endowments. Itis true that Kolliker says no perfectly decisive fact has been broughtforward to prove that the striated muscles contract without having beenacted on by nerves. Yet Mr. Bowman's observations on the contractionof isolated fibres appear decisive enough (unless we consider theminvalidated by Dr. Lionel Beale's recent researches), tending to showthat each elementary fibre is supplied with nerves; and as to thesmooth muscular fibres, we have Virchow's statement respecting thecontractility of those of the umbilical cord, where there is not a traceof any nerves. 

In the investigation of the nervous system, anatomy and physiology havegone hand in hand. It is very singular that so important, and seeminglysimple, a fact as the connection of the nerve-tubes, at their origin orin their course, with the nerve-cells, should have so long remained opento doubt, as you may see that it did by referring to the very completework of Sharpey and Quain (edition of 1849), the histological portion ofwhich is cordially approved by Kolliker himself. 

Several most interesting points of the minute anatomy of the nervouscentres have been laboriously and skilfully worked out by a recentgraduate of this Medical School, in a monograph worthy to stand in linewith those of Lockhart Clarke, Stilling, and Schroder van der Kolk. Ihave had the privilege of examining and of showing some of you a numberof Dr. Dean's skilful preparations. I have no space to give even anabstract of his conclusions. I can only refer to his proof of the fact, that a single cell may send its processes into several different bundlesof nerve-roots, and to his demonstration of the curved ascending anddescending fibres from the posterior nerveroots, to reach what he hascalled the longitudinal columns of the cornea. I must also mention Dr. Dean's exquisite microscopic photographs from sections of the medullaoblongata, which appear to me to promise a new development, if not a newepoch, in anatomical art. 

It having been settled that the nerve-tubes can very commonly be traceddirectly to the nerve-cells, the object of all the observers in thisdepartment of anatomy is to follow these tubes to their origin. We havean infinite snarl of telegraph wires, and we may be reasonably sure, that, if we can follow them up, we shall find each of them ends in abattery somewhere. One of the most interesting problems is to find theganglionic origin of the great nerves of the medulla oblongata, and thisis the end to which, by the aid of the most delicate sections, coloredso as to bring out their details, mounted so as to be imperishable, magnified by the best instruments, and now self-recorded in the lightof the truth-telling sunbeam, our fellow-student is making a steadyprogress in a labor which I think bids fair to rank with the mostvaluable contributions to histology that we have had from this side ofthe Atlantic. 

It is interesting to see how old questions are incidentally settled inthe course of these new investigations. Thus, Mr. Clarke's dissections, confirmed by preparations of Mr. Dean's which I have myself examined, placed the fact of the decussation of the pyramids--denied by Haller, byMorgagni, and even by Stilling--beyond doubt. So the spinal canal, theexistence of which, at least in the adult, has been so often disputed, appears as a coarse and unequivocal anatomical fact in many of thepreparations referred to. 

While these studies of the structure of the cord have been going on, the ingenious and indefatigable Brown-Sequard has been investigating thefunctions of its different parts with equal diligence. The microscopicanatomists had shown that the ganglionic corpuscles of the gray matterof the cord are connected with each other by their processes, as wellas with the nerve-roots. M. Brown-Sequard has proved by numerousexperiments that the gray substance transmits sensitive impressions andmuscular stimulation. The oblique ascending and descending fibres fromthe posterior nerve-roots, joining the "longitudinal columns of thecornua, " account for the results of Brown-Sequard's sections of theposterior columns. The physiological experimenter has also made itevident that the decussation of the conductors of sensitive impressionshas its seat in the spinal core, and not in the encephalon, as had beensupposed. Not less remarkable than these results are the facts, whichI with others of my audience have had the opportunity of observing, asshown by M. Brown-Sequard, of the artificial production of epilepsy inanimals by injuring the spinal cord, and the induction of the paroxysmby pinching a certain portion of the skin. I would also call thestudent's attention to his account of the relations of the nervouscentres to nutrition and secretion, the last of which relations has beenmade the subject of an extended essay by our fellow countryman, Dr. H. F. Campbell of Georgia. 

The physiology of the spinal cord seems a simple matter as you study itin Longet. The experiments of Brown-Sequard have shown the problem tobe a complex one, and raised almost as many doubts as they have solvedquestions; at any rate, I believe all lecturers on physiology agree thatthere is no part of their task they dread so much as the analysis of theevidence relating to the special offices of the different portions ofthe medulla spinalis. In the brain we are sure that we do not knowhow to localize functions; in the spinal cord, we think we do knowsomething; but there are so many anomalies, and seeming contradictions, and sources of fallacy, that beyond the facts of crossed paralysis ofsensation, and the conducting agency of the gray substance, I am afraidwe retain no cardinal principles discovered since the development of thereflex function took its place by Sir Charles Bell's great discovery. 

By the manner in which I spoke of the brain, you will see that I amobliged to leave phrenology sub Jove, --out in the cold, --as not one ofthe household of science. I am not one of its haters; on the contrary, Iam grateful for the incidental good it has done. I love to amuse myselfin its plaster Golgothas, and listen to the glib professor, as hediscovers by his manipulations

 "All that disgraced my betters met in me. "

I loved of old to see square-headed, heavy-jawed Spurzheim make a brainflower out into a corolla of marrowy filaments, as Vieussens had donebefore him, and to hear the dry-fibred but human-hearted George Combeteach good sense under the disguise of his equivocal system. But thepseudo-sciences, phrenology and the rest, seem to me only appeals toweak minds and the weak points of strong ones. There is a pica or falseappetite in many intelligences; they take to odd fancies in place ofwholesome truth, as girls gnaw at chalk and charcoal. Phrenology juggleswith nature. It is so adjusted as to soak up all evidence that helpsit, and shed all that harms it. It crawls forward in all weathers, likeRichard Edgeworth's hygrometer. It does not stand at the boundary of ourignorance, it seems to me, but is one of the will-o'-the-wisps of itsundisputed central domain of bog and quicksand. Yet I should not havedevoted so many words to it, did I not recognize the light it has thrownon human actions by its study of congenital organic tendencies. Its mapsof the surface of the head are, I feel sure, founded on a delusion, but its studies of individual character are always interesting andinstructive. 

The "snapping-turtle" strikes after its natural fashion when it firstcomes out of the egg. Children betray their tendencies in their way ofdealing with the breasts that nourish them; nay, lean venture to affirm, that long before they are born they teach their mothers something oftheir turbulent or quiet tempers. 

 "Castor gaudet equis, ovo proanatus eodem Pugnis. "

Strike out the false pretensions of phrenology; call it anthropology;let it study man the individual in distinction from man the abstraction, the metaphysical or theological lay-figure; and it becomes "the properstudy of mankind, " one of the noblest and most interesting of pursuits. 

The whole physiology of the nervous system, from the simplestmanifestation of its power in an insect up to the supreme act of thehuman intelligence working through the brain, is full of the mostdifficult yet profoundly interesting questions. The singular relationsbetween electricity and nerve-force, relations which it has beenattempted to interpret as meaning identity, in the face of palpabledifferences, require still more extended studies. You may be interestedby Professor Faraday's statement of his opinion on the matter. "ThoughI am not satisfied that the nervous fluid is only electricity, still Ithink that the agent in the nervous system maybe an inorganic force; andif there be reason for supposing that magnetism is a higher relationof force than electricity, so it may well be imagined that the nervouspower may be of a still more exalted character, and yet within the reachof experiment. "

In connection with this statement, it is interesting to refer to theexperiments of Helmholtz on the rapidity of transmission of the nervousactions. The rate is given differently in Valentin's report of theseexperiments and in that found in the "Scientific Annual" for 1858. One hundred and eighty to three hundred feet per second is the rateof movement assigned for sensation, but all such results must be veryvaguely approximative. Boxers, fencers, players at the Italian gameof morn, "prestidigitators, " and all who depend for their success onrapidity of motion, know what differences there are in the personalequation of movement. 

Reflex action, the mechanical sympathy, if I may so call it, of distantparts; Instinct, which is crystallized intelligence, --an absolute lawwith its invariable planes and angles introduced into the sphere ofconsciousness, as raphides are inclosed in the living cells of plants;Intellect, --the operation of the thinking principle through materialorgans, with an appreciable waste of tissue in every act of thought, sothat our clergymen's blood has more phosphates to get rid of on Mondaythan on any other day of the week; Will, --theoretically the absolutedetermining power, practically limited in different degrees by thevarying organization of races and individuals, annulled or pervertedby different ill-understood organic changes; on all these subjects ourknowledge is in its infancy, and from the study of some of them theinterdict of the Vatican is hardly yet removed. 

I must allude to one or two points in the histology and physiology ofthe organs of sense. The anterior continuation of the retina beyondthe ora serrata has been a subject of much discussion. If H. Muller andKolliker can be relied upon, this question is settled by recognizingthat a layer of cells, continued from the retina, passes over thesurface of the zonula Zinnii, but that no proper nervous element is soprolonged forward. 

I observe that Kolliker calls the true nervous elements of the retina"the layer of gray cerebral substance. " In fact, the ganglioniccorpuscles of each eye may be considered as constituting a little brain, connected with the masses behind by the commissure, commonly called theoptic nerve. We are prepared, therefore, to find these two little brainsin the most intimate relations with each other, as we find the cerebralhemispheres. We know that they are directly connected by fibres thatarch round through the chiasma. 

I mention these anatomical facts to introduce a physiologicalobservation of my own, first announced in one of the lectures before theMedical Class, subsequently communicated to the American Academy of Artsand Sciences, and printed in its "Transactions" for February 14, 1860. I refer to the apparent transfer of impressions from one retina tothe other, to which I have given the name reflex vision. The idea wassuggested to me in consequence of certain effects noticed in employingthe stereoscope. Professor William B. Rodgers has since called theattention of the American Scientific Association to some facts bearingon the subject, and to a very curious experiment of Leonardo da Vinci's, which enables the observer to look through the palm of his hand (or seemto), as if it had a hole bored through it. As he and others hesitatedto accept my explanation, I was not sorry to find recently the followingwords in the "Observations on Man" of that acute observer and thinker, David Hartley. "An impression made on the right eye alone by a singleobject may propagate itself into the left, and there raise up an imagealmost equal in vividness to itself; and consequently when we see withone eye only, we may, however, have pictures in both eyes. " Hartley, in 1784, had anticipated many of the doctrines which have since beensystematized into the theory of reflex actions, and with which I haveattempted to associate this act of reflex vision. My sixth experiment, however, in the communication referred to, appears to me to be a crucialone, proving the correctness of my explanation, and I am not aware thatit has been before instituted. 

Another point of great interest connected with the physiology ofvision, and involved for a long time in great obscurity, is that of theadjustment of the eye to different distances. Dr. Clay Wallace of NewYork, who published a very ingenious little book on the eye about twentyyears ago, with vignettes reminding one of Bewick, was among the first, if not the first, to describe the ciliary muscle, to which the power ofadjustment is generally ascribed. It is ascertained, by exact experimentwith the phacueidoscope, that accommodation depends on change of form ofthe crystalline lens. Where the crystalline is wanting, as Mr. Ware longago taught, no power of accommodation remains. The ciliary muscle isgenerally thought to effect the change of form of the crystalline. Thepower of accommodation is lost after the application of atropine, inconsequence, as is supposed, of the paralysis of this muscle. This, I believe, is the nearest approach to a demonstration we have on thispoint. 

I have only time briefly to refer to Professor Draper's most ingenioustheory as to the photographic nature of vision, for an account of whichI must refer to his original and interesting Treatise on Physiology. 

It were to be wished that the elaborate and very interesting researchesof the Marquis Corti, which have revealed such singular complexityof structure in the cochlea of the ear, had done more to clear up itsdoubtful physiology; but I am afraid we have nothing but hypotheses forthe special part it plays in the act of hearing, and that we must saythe same respecting the office of the semicircular canals. 

The microscope has achieved some of its greatest triumphs in teachingus the changes which occur in the development of the embryo. No moreinteresting discovery stands recorded in the voluminous literatureof this subject than the one originally announced by Martin Barry, afterwards discredited, and still later confirmed by Mr. Newport andothers; namely the fact that the fertilizing filament reaches theinterior of the ovum in various animals;--a striking parallel to theaction of the pollen-tube in the vegetable. But beyond the mechanicalfacts all is mystery in the movements of organization, as profound as inthe fall of a stone or the formation of a crystal. 

To the chemist and the microscopist the living body presents the samedifficulties, arising from the fact that everything is in perpetualchange in the organism. The fibrine of the blood puzzles the one as muchas its globules puzzle the other. The difference between the branches ofscience which deal with space only, and those which deal with space andtime, is this: we have no glasses that can magnify time. The figure Ihere show you a was photographed from an object (pleurosigma angulatum)magnified a thousand diameters, or presenting a million times itsnatural surface. This other figure of the same object, enlarged fromthe one just shown, is magnified seven thousand diameters, or forty-ninemillion times in surface. When we can make the forty-nine millionth ofa second as long as its integer, physiology and chemistry will approachnearer the completeness of anatomy. 

Our reverence becomes more worthy, or, if you will, less unworthy of itsInfinite Object in proportion as our intelligence is lifted and expandedto a higher and broader understanding of the Divine methods of action. If Galen called his heathen readers to admire, the power, the wisdom, the providence, the goodness of the "Framer of the animal body, "--if Mr. Boyle, the student of nature, as Addison and that friend of his who hadknown him for forty years tell us, never uttered the name of the SupremeBeing without making a distinct pause in his speech, in token of hisdevout recognition of its awful meaning, --surely we, who inherit theaccumulated wisdom of nearly two hundred years since the time ofthe British philosopher, and of almost two thousand since the Greekphysician, may well lift our thoughts from the works we study to theirgreat Artificer. These wonderful discoveries which we owe to that mightylittle instrument, the telescope of the inner firmament with allits included worlds; these simple formulae by which we condense theobservations of a generation in a single axiom; these logical analysesby which we fence out the ignorance we cannot reclaim, and fix thelimits of our knowledge, --all lead us up to the inspiration of theAlmighty, which gives understanding to the world's great teachers. Tofear science or knowledge, lest it disturb our old beliefs, is to fearthe influx of the Divine wisdom into the souls of our fellow-men; forwhat is science but the piecemeal revelation, --uncovering, --of the planof creation, by the agency of those chosen prophets of nature whom Godhas illuminated from the central light of truth for that single purpose?

The studies which we have glanced at are preliminary in youreducation to the practical arts which make use of them, --the arts ofhealing, --surgery and medicine. The more you examine the structure ofthe organs and the laws of life, the more you will find how resolutelyeach of the cell-republics which make up the E pluribus unum of the bodymaintains its independence. Guard it, feed it, air it, warm it, exerciseor rest it properly, and the working elements will do their best to keepwell or to get well. What do we do with ailing vegetables? Dr. Warren, my honored predecessor in this chair, bought a country-place, includinghalf of an old orchard. A few years afterwards I saw the trees on hisside of the fence looking in good health, while those on the other sidewere scraggy and miserable. How do you suppose this change was broughtabout? By watering them with Fowler's solution? By digging in calomelfreely about their roots? Not at all; but by loosening the soilround them, and supplying them with the right kind of food in fittingquantities. 

Now a man is not a plant, or, at least, he is a very curious one, forhe carries his soil in his stomach, which is a kind--of portableflower-pot, and he grows round it, instead of out of it. He has, besides, a singularly complex nutritive apparatus and a nervous system. But recollect the doctrine already enunciated in the language ofVirchow, that an animal, like a tree, is a sum of vital unities, ofwhich the cell is the ultimate element. Every healthy cell, whether ina vegetable or an animal, necessarily performs its function properlyso long as it is supplied with its proper materials and stimuli. A cellmay, it is true, be congenitally defective, in which case disease is, so to speak, its normal state. But if originally sound and subsequentlydiseased, there has certainly been some excess, deficiency, or wrongquality in the materials or stimuli applied to it. You remove thisinjurious influence and substitute a normal one; remove the bakedcoal-ashes, for instance, from the roots of a tree, and replace themwith loam; take away the salt meat from the patient's table, and replaceit with fresh meat and vegetables, and the cells of the tree or the manreturn to their duty. 

I do not know that we ever apply to a plant any element which is nota natural constituent of the vegetable structure, except perhapsexternally, for the accidental purpose of killing parasites. The wholeart of cultivation consists in learning the proper food and conditionsof plants, and supplying them. We give them water, earths, salts ofvarious kinds such as they are made of, with a chance to help themselvesto air and light. The farmer would be laughed at who undertook tomanure his fields or his trees with a salt of lead or of arsenic. Theseelements are not constituents of healthy plants. The gardener uses thewaste of the arsenic furnaces to kill the weeds in his walks. 

If the law of the animal cell, and of the animal organism, which isbuilt up of such cells, is like that of the vegetable, we might expectthat we should treat all morbid conditions of any of the vital unitiesbelonging to an animal in the same way, by increasing, diminishing, orchanging its natural food or stimuli. 

That is an aliment which nourishes; whatever we find in the organism, asa constant and integral element, either forming part of its structure, or one of the conditions of vital processes, that and that only deservesthe name of aliment. I see no reason, therefore, why iron, phosphate oflime, sulphur, should not be considered food for man, as much as guanoor poudrette for vegetables. Whether one or another of them is best inany given case, --whether they shall be taken alone or in combination, inlarge or small quantities, are separate questions. But they are elementsbelonging to the body, and even in moderate excess will produce littledisturbance. There is no presumption against any of this class ofsubstances, any more than against water or salt, provided they are usedin fitting combinations, proportions, and forms. 

But when it comes to substances alien to the healthy system, which neverbelong to it as normal constituents, the case is very different. Thereis a presumption against putting lead or arsenic into the human body, asagainst putting them into plants, because they do not belong there, any more than pounded glass, which, it is said, used to be given as apoison. The same thing is true of mercury and silver. What becomes ofthese alien substances after they get into the system we cannot alwaystell. But in the case of silver, from the accident of its changing colorunder the influence of light, we do know what happens. It is thrownout, in part at least, under the epidermis, and there it remains to thepatient's dying day. This is a striking illustration of the difficultywhich the system finds in dealing with non-assimilable elements, andjustifies in some measure the vulgar prejudice against mineral poisons. 

I trust the youngest student on these benches will not commit thechildish error of confounding a presumption against a particular classof agents with a condemnation of them. Mercury, for instance, is aliento the system, and eminently disturbing in its influence. Yet itsefficacy in certain forms of specific disease is acknowledged by allbut the most sceptical theorists. Even the esprit moqueur of Ricord, the Voltaire of pelvic literature, submits to the time-honoredconstitutional authority of this great panacea in the class of casesto which he has devoted his brilliant intelligence. Still, there isno telling what evils have arisen from the abuse of this mineral. Dr. Armstrong long ago pointed out some of them, and they have becomematters of common notoriety. I am pleased, therefore, when I find soable and experienced a practitioner as Dr. Williams of this city provingthat iritis is best treated without mercury, and Dr. Vanderpoel showingthe same thing to be true for pericarditis. 

Whatever elements nature does not introduce into vegetables, thenatural food of all animal life, --directly of herbivorous, indirectly ofcarnivorous animals, --are to be regarded with suspicion. Arsenic-eatingmay seem to improve the condition of horses for a time, --and even ofhuman beings, if Tschudi's stories can be trusted, --but it soon appearsthat its alien qualities are at war with the animal organization. So ofcopper, antimony, and other non-alimentary simple substances; everyoneof them is an intruder in the living system, as much as a constablewould be, quartered in our household. This does not mean that they maynot, any of them, be called in for a special need, as we send for theconstable when we have good reason to think we have a thief under ourroof; but a man's body is his castle, as well as his house, and thepresumption is that we are to keep our alimentary doors bolted againstthese perturbing agents. 

Now the feeling is very apt to be just contrary to this. The habit hasbeen very general with well-taught practitioners, to have recourse tothe introduction of these alien elements into the system on the occasionof any slight disturbance. The tongue was a little coated, and mercurymust be given; the skin was a little dry, and the patient must takeantimony. It was like sending for the constable and the posse comitatuswhen there is only a carpet to shake or a refuse-barrel to empty. [Dr. James Johnson advises persons not ailing to take five grains of bluepill with one or two of aloes twice a week for three or four months inthe year, with half a pint of compound decoction of sarsaparilla everyday for the same period, to preserve health and prolong life. Pract. Treatise on Dis. Of Liver, etc. P. 272. ] The constitution bears slowpoisoning a great deal better than might be expected; yet the mostintelligent men in the profession have gradually got out of the habit ofprescribing these powerful alien substances in the old routine way. Mr. Metcalf will tell you how much more sparingly they are given by ourpractitioners at the present time, than when he first inauguratedthe new era of pharmacy among us. Still, the presumption in favor ofpoisoning out every spontaneous reaction of outraged nature isnot extinct in those who are trusted with the lives of theirfellow-citizens. "On examining the file of prescriptions at thehospital, I discovered that they were rudely written, and indicated atreatment, as they consisted chiefly of tartar emetic, ipecacuanha, andepsom salts, hardly favorable to the cure of the prevailing diarrhoeaand dysenteries. " In a report of a poisoning case now on trial, where weare told that arsenic enough was found in the stomach to produce deathin twenty-four hours, the patient is said to have been treated byarsenic, phosphorus, bryonia, aconite, nux vomica, and muriaticacid, --by a practitioner of what school it may be imagined. 

The traditional idea of always poisoning out disease, as we smoke outvermin, is now seeking its last refuge behind the wooden cannon andpainted port-holes of that unblushing system of false scientificpretences which I do not care to name in a discourse addressed to anaudience devoted to the study of the laws of nature in the light of thelaws of evidence. It is extraordinary to observe that the system which, by its reducing medicine to a name and a farce, has accustomed all whohave sense enough to see through its thin artifices to the idea thatdiseases get well without being "cured, " should now be the main supportof the tottering poison-cure doctrine. It has unquestionably helpedto teach wise people that nature heals most diseases without help frompharmaceutic art, but it continues to persuade fools that art can arrestthem all with its specifics. 

It is worse than useless to attempt in any way to check the freestexpression of opinion as to the efficacy of any or all of the "heroic"means of treatment employed by practitioners of different schools andperiods. Medical experience is a great thing, but we must not forgetthat there is a higher experience, which tries its results in a courtof a still larger jurisdiction; that, namely, in which the laws of humanbelief are summoned to the witness-box, and obliged to testify to thesources of error which beset the medical practitioner. The verdict is asold as the father of medicine, who announces it in the words, "judgmentis difficult. " Physicians differed so in his time, that some denied thatthere was any such thing as an art of medicine. 

One man's best remedies were held as mischievous by another. The art ofhealing was like soothsaying, so the common people said; "the same birdwas lucky or unlucky, according as he flew to the right or left. "

The practice of medicine has undergone great changes within the periodof my own observation. Venesection, for instance, has so far gone outof fashion, that, as I am told by residents of the New York Bellevueand the Massachusetts General Hospitals, it is almost obsolete inthese institutions, at least in medical practice. The old Brunonianstimulating treatment has come into vogue again in the practice of Dr. Todd and his followers. The compounds of mercury have yielded theirplace as drugs of all work, and specifics for that very frequentsubjective complaint, nescio quid faciam, --to compounds of iodine. [SirAstley Cooper has the boldness, --or honesty, --to speak of medicineswhich "are given as much to assist the medical man as his patient. "Lectures (London, 1832), p. 14. ] Opium is believed in, and quinine, and "rum, " using that expressive monosyllable to mean all alcoholiccordials. If Moliere were writing now, instead of saignare, purgare, and the other, he would be more like to say, Stimulare, opium dare etpotassio-iodizare. 

I have been in relation successively with the English and Americanevacuant and alterative practice, in which calomel and antimony figuredso largely that, as you may see in Dr. Jackson's last "Letter, " Dr. Holyoke, a good representative of sterling old-fashioned medical art, counted them with opium and Peruvian bark as his chief remedies; withthe moderately expectant practice of Louis; the blood-letting "coupsur coup" of Bouillaud; the contra-stimulant method of Rasori and hisfollowers; the anti-irritant system of Broussais, with its leechingand gum-water; I have heard from our own students of the simple opiumpractice of the renowned German teacher, Oppolzer; and now I find themedical community brought round by the revolving cycle of opinion tothat same old plan of treatment which John Brown taught in Edinburghin the last quarter of the last century, and Miner and Tully fiercelyadvocated among ourselves in the early years of the present. Theworthy physicians last mentioned, and their antagonist Dr. Gallup, usedstronger language than we of these degenerate days permit ourselves. "The lancet is a weapon which annually slays more than the sword, " saysDr. Tully. "It is probable that, for forty years past, opium andits preparations have done seven times the injury they have renderedbenefit, on the great scale of the world, " says Dr. Gallup. 

What is the meaning of these perpetual changes and conflicts of medicalopinion and practice, from an early antiquity to our own time? Simplythis: all "methods" of treatment end in disappointment of thoseextravagant expectations which men are wont to entertain of medical art. The bills of mortality are more obviously affected by drainage, than bythis or that method of practice. The insurance companies do not commonlycharge a different percentage on the lives of the patients of this orthat physician. In the course of a generation, more or less, physiciansthemselves are liable to get tired of a practice which has so littleeffect upon the average movement of vital decomposition. Then they areready for a change, even if it were back again to a method which hasalready been tried, and found wanting. 

Our practitioners, or many of them, have got back to the ways of old Dr. Samuel Danforth, who, as it is well known, had strong objections tothe use of the lancet. By and by a new reputation will be made by somediscontented practitioner, who, tired of seeing patients die with theirskins full of whiskey and their brains muddy with opium, returns to abold antiphlogistic treatment, and has the luck to see a few patientsof note get well under it. So of the remedies which have gone out offashion and been superseded by others. It can hardly be doubted thatthey will come into vogue again, more or less extensively, under theinfluence of that irresistible demand for change just referred to. 

Then will come the usual talk about a change in the characterof disease, which has about as much meaning as that concerning"old-fashioned snow-storms. " "Epidemic constitutions" of disease meansomething, no doubt; a great deal as applied to malarious affections;but that the whole type of diseases undergoes such changes that thepractice must be reversed from depleting to stimulating, and vice versa, is much less likely than that methods of treatment go out of fashion andcome in again. If there is any disease which claims its percentage withreasonable uniformity, it is phthisis. Yet I remember that the reverendand venerable Dr. Prince of Salem told me one Commencement day, as I wasjogging along towards Cambridge with him, that he recollected the timewhen that disease was hardly hardly known; and in confirmation of hisstatement mentioned a case in which it was told as a great event, thatsomebody down on "the Cape" had died of "a consumption. " This story doesnot sound probable to myself, as I repeat it, yet I assure you it istrue, and it shows how cautiously we must receive all popular stories ofgreat changes in the habits of disease. 

Is there no progress, then, but do we return to the same beliefs andpractices which our forefathers wore out and threw away? I trust andbelieve that there is a real progress. We may, for instance, return ina measure to the Brunonian stimulating system, but it must be in amodified way, for we cannot go back to the simple Brunonian pathology, since we have learned too much of diseased action to accept itsconvenient dualism. So of other doctrines, each new Avatar strips themof some of their old pretensions, until they take their fitting placeat last, if they have any truth in them, or disappear, if they were merephantasms of the imagination. 

In the mean time, while medical theories are coming in and going out, there is a set of sensible men who are never run away with by them, butpractise their art sagaciously and faithfully in much the same way fromgeneration to generation. From the time of Hippocrates to that of ourown medical patriarch, there has been an apostolic succession of wiseand good practitioners. If you will look at the first aphorism of theancient Master you will see that before all remedies he places theproper conduct of the patient and his attendants, and the fit orderingof all the conditions surrounding him. The class of practitioners I havereferred to have always been the most faithful in attending to thesepoints. No doubt they have sometimes prescribed unwisely, in compliancewith the prejudices of their time, but they have grown wiser as theyhave grown older, and learned to trust more in nature and less in theirplans of interference. I believe common opinion confirms Sir JamesClark's observation to this effect. 

The experience of the profession must, I think, run parallel with thatof the wisest of its individual members. Each time a plan of treatmentor a particular remedy comes up for trial, it is submitted to a sharperscrutiny. When Cullen wrote his Materia Medica, he had seriously toassail the practice of giving burnt toad, which was still countenancedby at least one medical authority of note. I have read recently in somemedical journal, that an American practitioner, whose name is known tothe country, is prescribing the hoof of a horse for epilepsy. It wasdoubtless suggested by that old fancy of wearing a portion of elk's hoofhung round the neck or in a ring, for this disease. But it is hardto persuade reasonable people to swallow the abominations of a formerperiod. The evidence which satisfied Fernelius will not serve one of ourhospital physicians. 

In this way those articles of the Materia Medica which had nothing butloathsomeness to recommend them have been gradually dropped, and are notlike to obtain any general favor again with civilized communities. Thenext culprits to be tried are the poisons. I have never been in theleast sceptical as to the utility of some of them, when properlyemployed. Though I believe that at present, taking the world at large, and leaving out a few powerful agents of such immense value that theyrank next to food in importance, the poisons prescribed for disease domore hurt than good, I have no doubt, and never professed to have any, that they do much good in prudent and instructed hands. But I am verywilling to confess a great jealousy of many agents, and I could almostwish to see the Materia Medica so classed as to call suspicion uponcertain ones among them. 

Thus the alien elements, those which do not properly enter intothe composition of any living tissue, are the most to be suspected, --mercury, lead, antimony, silver, and the rest, for the reasons I havebefore mentioned. Even iodine, which, as it is found in certain plants, seems less remote from the animal tissues, gives unequivocal proofsfrom time to time that it is hostile to some portions of the glandularsystem. 

There is, of course, less prima facie objection to those agents whichconsist of assimilable elements, such as are found making a partof healthy tissues. These are divisible into three classes, --foods, poisons, and inert, mostly because insoluble, substances. The food ofone animal or of one human being is sometimes poison to another, andvice versa; inert substances may act mechanically, so as to producethe effect of poisons; but this division holds exactly enough for ourpurpose. 

Strictly speaking, every poison consisting of assimilable elements maybe considered as unwholesome food. It is rejected by the stomach, or itproduces diarrhoea, or it causes vertigo or disturbance of the heart'saction, or some other symptom for which the subject of it would consultthe physician, if it came on from any other cause than taking it underthe name of medicine. Yet portions of this unwholesome food whichwe call medicine, we have reason to believe, are assimilated; thus, castor-oil appears to be partially digested by infants, so that theyrequire large doses to affect them medicinally. Even that deadliest ofpoisons, hydrocyanic acid, is probably assimilated, and helps to makeliving tissue, if it do not kill the patient, for the assimilableelements which it contains, given in the separate forms of amygdalin andemulsin, produce no disturbance, unless, as in Bernard's experiments, they are suffered to meet in the digestive organs. A medicine consistingof assimilable substances being then simply unwholesome food, weunderstand what is meant by those cumulative effects of such remediesoften observed, as in the case of digitalis and strychnia. They areprecisely similar to the cumulative effects of a salt diet in producingscurvy, or of spurred rye in producing dry gangrene. As the effects ofsuch substances are a violence to the organs, we should exercise thesame caution with regard to their use that we would exercise aboutany other kind of poisonous food, --partridges at certain seasons, forinstance. Even where these poisonous kinds of food seem to be useful, weshould still regard them with great jealousy. Digitalis lowers the pulsein febrile conditions. Veratrum viride does the same thing. How do weknow that a rapid pulse is not a normal adjustment of nature to thecondition it accompanies? Digitalis has gone out of favor; how sure arewe that Veratrum viride will not be found to do more harm than good ina case of internal inflammation, taking the whole course of the diseaseinto consideration? Think of the change of opinion with regard to theuse of opium in delirium tremens (which you remember is sometimes calleddelirium vigilans), where it seemed so obviously indicated, since thepublication of Dr. Ware's admirable essay. I respect the evidence ofmy contemporaries, but I cannot forget the sayings of the Father ofmedicine, --Ars longa, judicium difficile. 

I am not presuming to express an opinion concerning Veratrum viride, which was little heard of when I was still practising medicine. I amonly appealing to that higher court of experience which sits in judgmenton all decisions of the lower medical tribunals, and which requires morethan one generation for its final verdict. 

Once change the habit of mind so long prevalent among practitioners ofmedicine; once let it be everywhere understood that the presumption isin favor of food, and not of alien substances, of innocuous, and notof unwholesome food, for the sick; that this presumption requires verystrong evidence in each particular case to overcome it; but that, whensuch evidence is afforded, the alien substance or the unwholesome foodshould be given boldly, in sufficient quantities, in the same spirit asthat with which the surgeon lifts his knife against a patient, --thatis, with the same reluctance and the same determination, --and I thinkwe shall have and hear much less of charlatanism in and out of theprofession. The disgrace of medicine has been that colossal system ofself-deception, in obedience to which mines have been emptied of theircankering minerals, the vegetable kingdom robbed of all its noxiousgrowths, the entrails of animals taxed for their impurities, the poison-bags of reptiles drained of their venom, and all theinconceivable abominations thus obtained thrust down the throats ofhuman beings suffering from some fault of organization, nourishment, orvital stimulation. 

Much as we have gained, we have not yet thoroughly shaken off the notionthat poison is the natural food of disease, as wholesome aliment isthe support of health. Cowper's lines, in "The Task, " show thematter-of-course practice of his time:

 "He does not scorn it, who has long endured A fever's agonies, and fed on drugs. "

Dr. Kimball of Lowell, who has been in the habit of seeing a greatdeal more of typhoid fever than most practitioners, and whose surgicalexploits show him not to be wanting in boldness or enterprise, can tellyou whether he finds it necessary to feed his patients on drugs or not. His experience is, I believe, that of the most enlightened and advancedportion of the profession; yet I think that even in typhoid fever, andcertainly in many other complaints, the effects of ancient habitsand prejudices may still be seen in the practice of some educatedphysicians. 

To you, young men, it belongs to judge all that has gone before you. You come nearer to the great fathers of modern medicine than some of youimagine. Three of my own instructors attended Dr. Rush's Lectures. Theillustrious Haller mentions Rush's inaugural thesis in his "BibliothecaAnatomica;" and this same Haller, brought so close to us, tells us heremembers Ruysch, then an old man, and used to carry letters between himand Boerhaave. Look through the history of medicine from Boerhaaveto this present day. You will see at once that medical doctrine andpractice have undergone a long series of changes. You will see thatthe doctrine and practice of our own time must probably change in theirturn, and that, if we can trust at all to the indications of theircourse, it will be in the direction of an improved hygiene and asimplified treatment. Especially will the old habit of violating theinstincts of the sick give place to a judicious study of these sameinstincts. It will be found that bodily, like mental insanity, is bestmanaged, for the most part, by natural soothing agencies. Two centuriesago there was a prescription for scurvy containing "stercoris tauriniet anserini par, quantitas trium magnarum nucum, " of the hell-brothcontaining which "guoties-cumque sitit oeger, large bibit. " When Ihave recalled the humane common-sense of Captain Cook in the matterof preventing this disease; when I have heard my friend, Mr. Dana, describing the avidity with which the scurvy-stricken sailors snuffed upthe earthy fragrance of fresh raw potatoes, the food which was to supplythe elements wanting to their spongy tissues, I have recognized that theperfection of art is often a return to nature, and seen in this singleinstance the germ of innumerable beneficent future medical reforms. 

I cannot help believing that medical curative treatment will by andby resolve itself in great measure into modifications of the food, swallowed and breathed, and of the natural stimuli, and that less willbe expected from specifics and noxious disturbing agents, either alienor assimilable. The noted mineral-waters containing iron, sulphur, carbonic acid, supply nutritious or stimulating materials to the bodyas much as phosphate of lime and ammoniacal compounds do to the cerealplants. The effects of a milk and vegetable diet, of gluten breadin diabetes, of cod-liver oil in phthisis, even of such audaciousinnovations as the water-cure and the grape-cure, are only hints ofwhat will be accomplished when we have learned to discover what organicelements are deficient or in excess in a case of chronic disease, and the best way of correcting the abnormal condition, just as anagriculturist ascertains the wants of his crops and modifies thecomposition of his soil. In acute febrile diseases we have long agodiscovered that far above all drug-medication is the use of mild liquiddiet in the period of excitement, and of stimulant and nutritious foodin that of exhaustion. Hippocrates himself was as particular about hisbarley-ptisan as any Florence Nightingale of our time could be. 

The generation to which you, who are just entering the profession, belong, will make a vast stride forward, as I believe, in the directionof treatment by natural rather than violent agencies. What is it thatmakes the reputation of Sydenham, as the chief of English physicians?His prescriptions consisted principally of simples. An aperient or anopiate, a "cardiac" or a tonic, may be commonly found in the midst ofa somewhat fantastic miscellany of garden herbs. It was not by hispharmaceutic prescriptions that he gained his great name. It wasby daring to order fresh air for small-pox patients, and riding onhorseback for consumptives, in place of the smothering system, andthe noxious and often loathsome rubbish of the established schools. Ofcourse Sydenham was much abused by his contemporaries, as he frequentlytakes occasion to remind his reader. "I must needs conclude, " he says, "either that I am void of merit, or that the candid and ingenuous partof mankind, who are formed with so excellent a temper of mind as to beno strangers to gratitude, make a very small part of the whole. " If inthe fearless pursuit of truth you should find the world as ungracious inthe nineteenth century as he found it in the seventeenth, you may learna lesson of self-reliance from another utterance of the same illustriousphysician: "'T is none of my business to inquire what other personsthink, but to establish my own observations; in order to which, I ask nofavor of the reader but to peruse my writings with temper. "

The physician has learned a great deal from the surgeon, who isnaturally in advance of him, because he has a better opportunity ofseeing the effects of his remedies. Let me shorten one of AmbroisePare's stories for you. There had been a great victory at the pass ofSusa, and they were riding into the city. The wounded cried out as thehorses trampled them under their hoofs, which caused good Ambroise greatpity, and made him wish himself back in Paris. Going into a stable hesaw four dead soldiers, and three desperately wounded, placed with theirbacks against the wall. An old campaigner came up. --"Can these fellowsget well?" he said. "No!" answered the surgeon. Thereupon, the oldsoldier walked up to them and cut all their throats, sweetly, andwithout wrath (doulcement et sans cholere). Ambroise told him he was abad man to do such a thing. "I hope to God;" he said, "somebody willdo as much for me if I ever get into such a scrape" (accoustre de tellefacon). "I was not much salted in those days" (bien doux de sel), saysAmbroise, "and little acquainted with the treatment of wounds. " However, as he tells us, he proceeded to apply boiling oil of Sambuc (elder)after the approved fashion of the time, --with what torture to thepatient may be guessed. At last his precious oil gave out, and he usedinstead an insignificant mixture of his own contrivance. He could notsleep that night for fear his patients who had not been scalded withthe boiling oil would be poisoned by the gunpowder conveyed into theirwounds by the balls. To his surprise, he found them much better than theothers the next morning, and resolved never again to burn his patientswith hot oil for gun-shot wounds. 

This was the beginning, as nearly as we can fix it, of that reform whichhas introduced plain water-dressings in the place of the farrago ofexternal applications which had been a source of profit to apothecariesand disgrace to art from, and before, the time when Pliny complainedof them. A young surgeon who was at Sudley Church, laboring among thewounded of Bull Run, tells me they had nothing but water for dressing, and he (being also doux de sel) was astonished to see how well thewounds did under that simple treatment. 

Let me here mention a fact or two which may be of use to some of you whomean to enter the public service. You will, as it seems, have gun-shotwounds almost exclusively to deal with. Three different surgeons, theone just mentioned and two who saw the wounded of Big Bethel, assured methat they found no sabre-cuts or bayonet wounds. It is the rifle-bulletfrom a safe distance which pierces the breasts of our soldiers, and notthe gallant charge of broad platoons and sweeping squadrons, such aswe have been in the habit of considering the chosen mode of warfareof ancient and modern chivalry. [Sir Charles James Napier had the sameexperience in Virginia in 1813. "Potomac. We have nasty sort of fightinghere, amongst creeks and bushes, and lose men without show. " "Yankeenever shows himself, he keeps in the thickest wood, fires and runsoff. "--"These five thousand in the open field might be attacked, but behind works it would be throwing away lives. " He calls it "aninglorious warfare, "--says one of the leaders is "a little deficient ingumption, --but--still my opinion is, that if we tuck up our sleeves andlay our ears back we might thrash them; that is, if we caught them outof their trees, so as to slap at them with the bayonet. "--Life, etc. Vol. I. P. 218 et seq. ]

Another fact parallels the story of the old campaigner, and may teachsome of you caution in selecting your assistants. A chaplain told itto two of our officers personally known to myself. He overheard theexamination of a man who wished to drive one of the "avalanche" wagons, as they call them. The man was asked if he knew how to deal with woundedmen. "Oh yes, " he answered; "if they're hit here, " pointing to theabdomen, "knock 'em on the head, --they can't get well. "

In art and outside of it you will meet the same barbarisms that AmbroisePare met with, --for men differ less from century to century than we areapt to suppose; you will encounter the same opposition, if you attackany prevailing opinion, that Sydenham complained of. So far as possible, let not such experiences breed in you a contempt for those who are thesubjects of folly or prejudice, or foster any love of dispute for itsown sake. Should you become authors, express your opinions freely;defend them rarely. It is not often that an opinion is worth expressing, which cannot take care of itself. Opposition is the best mordant to fixthe color of your thought in the general belief. 

It is time to bring these crowded remarks to a close. The day has beenwhen at the beginning of a course of Lectures I should have thought itfitting to exhort you to diligence and entire devotion to your tasksas students. It is not so now. The young man who has not heard theclarion-voices of honor and of duty now sounding throughout the land, will heed no word of mine. In the camp or the city, in the field or thehospital, under sheltering roof, or half-protecting canvas, or opensky, shedding our own blood or stanching that of our wounded defenders, students or teachers, whatever our calling and our ability, we belong, not to ourselves, but to our imperilled country, whose danger is ourcalamity, whose ruin would be our enslavement, whose rescue shall be ourearthly salvation!

SCHOLASTIC AND BEDSIDE TEACHING. 

An Introductory Lecture delivered before the Medical Class of HarvardUniversity, November 6, 1867. 

The idea is entertained by some of our most sincere professionalbrethren, that to lengthen and multiply our Winter Lectures will beof necessity to advance the cause of medical education. It is a fairsubject for consideration whether they do not overrate the relativeimportance of that particular mode of instruction which forms the largerpart of these courses. 

As this School could only lengthen its lecture term at the expenseof its "Summer Session, " in which more direct, personal, and familiarteaching takes the place of our academic discourses, and in which moretime can be given to hospitals, infirmaries, and practical instructionin various important specialties, whatever might be gained, a good dealwould certainly be lost in our case by the exchange. 

The most essential part of a student's instruction is obtained, as Ibelieve, not in the lecture-room, but at the bedside. Nothing seen thereis lost; the rhythms of disease are learned by frequent repetition; itsunforeseen occurrences stamp themselves indelibly in the memory. Beforethe student is aware of what he has acquired, he has learned the aspectsand course and probable issue of the diseases he has seen with histeacher, and the proper mode of dealing with them, so far as his masterknows it. On the other hand, our ex cathedra prelections have a strongtendency to run into details which, however interesting they may be toourselves and a few of our more curious listeners, have nothing in themwhich will ever be of use to the student as a practitioner. It is aperfectly fair question whether I and some other American Professors donot teach quite enough that is useless already. Is it not well to remindthe student from time to time that a physician's business is to avertdisease, to heal the sick, to prolong life, and to diminish suffering?Is it not true that the young man of average ability will find it asmuch as he can do to fit himself for these simple duties? Is it notbest to begin, at any rate, by making sure of such knowledge as he willrequire in his daily walk, by no means discouraging him from any studyfor which his genius fits him when he once feels that he has becomemaster of his chosen art. 

I know that many branches of science are of the greatest value asfeeders of our medical reservoirs. But the practising physician's officeis to draw the healing waters, and while he gives his time to thislabor he can hardly be expected to explore all the sources that spreadthemselves over the wide domain of science. The traveller who would notdrink of the Nile until he had tracked it to its parent lakes, would belike to die of thirst; and the medical practitioner who would not usethe results of many laborers in other departments without sharing theirspecial toils, would find life far too short and art immeasurably toolong. 

We owe much to Chemistry, one of the most captivating as well asimportant of studies; but the medical man must as a general rule contenthimself with a clear view of its principles and a limited acquaintancewith its facts; such especially as are pertinent to his pursuits. I amin little danger of underrating Anatomy or Physiology; but as each ofthese branches splits up into specialties, any one of which may take upa scientific life-time, I would have them taught with a certain judgmentand reserve, so that they shall not crowd the more immediatelypractical branches. So of all the other ancillary and auxiliary kindsof knowledge, I would have them strictly subordinated to that particularkind of knowledge for which the community looks to its medical advisers. 

A medical school is not a scientific school, except just so far asmedicine itself is a science. On the natural history side, medicine isa science; on the curative side, chiefly an art. This is implied inHufeland's aphorism: "The physician must generalize the disease andindividualize the patient. "

The coordinated and classified results of empirical observation, indistinction from scientific experiment, have furnished almost all weknow about food, the medicine of health, and medicine, the food ofsickness. We eat the root of the Solanum tuberosum and throw away itsfruit; we eat the fruit of the Solanum Lycopersicum and throw away itsroot. Nothing but vulgar experience has taught us to reject the potatoball and cook the tomato. So of most of our remedies. The subchlorideof mercury, calomel, is the great British specific; the protochloride ofmercury, corrosive sublimate, kills like arsenic, but no chemist couldhave told us it would be so. 

From observations like these we can obtain certain principles from whichwe can argue deductively to facts of a like nature, but the processis limited, and we are suspicious of all reasoning in that directionapplied to the processes of healthy and diseased life. We arecontinually appealing to special facts. We are willing to give Liebig'sartificial milk when we cannot do better, but we watch the childanxiously whose wet-nurse is a chemist's pipkin. A pair of substantialmammary glands has the advantage over the two hemispheres of the mostlearned Professor's brain, in the art of compounding a nutritious fluidfor infants. 

The bedside is always the true centre of medical teaching. Certainbranches must be taught in the lecture-room, and will necessarilyinvolve a good deal that is not directly useful to the futurepractitioner. But the over ambitious and active student must not be ledaway by the seduction of knowledge for its own sake from his principalpursuit. The humble beginner, who is alarmed at the vast fields ofknowledge opened to him, may be encouraged by the assurance that with avery slender provision of science, in distinction from practical skill, he may be a useful and acceptable member of the profession to which thehealth of the community is intrusted. 

To those who are not to engage in practice, the various pursuitsof science hardly require to be commended. Only they must not bedisappointed if they find many subjects treated in our courses as amedical class requires, rather than as a scientific class would expect, that is, with special limitations and constant reference to practicalends. Fortunately they are within easy reach of the highest scientificinstruction. The business of a school like this is to make usefulworking physicians, and to succeed in this it is almost as important notto overcrowd the mind of the pupil with merely curious knowledge as itis to store it with useful information. 

In this direction I have written my lecture, not to undervalue any formof scientific labor in its place, an unworthy thought from which I hopeI need not defend myself, --but to discourage any undue inflation of thescholastic programme, which even now asks more of the student than theteacher is able to obtain from the great majority of those who presentthemselves for examination. I wish to take a hint in education from theSecretary of the Massachusetts Board of Agriculture, who regards thecultivation of too much land as a great defect in our New Englandfarming. I hope that our Medical Institutions may never lay themselvesopen to the kind of accusation Mr. Lowe brings against the EnglishUniversities, when he says that their education is made up "of wordsthat few understand and most will shortly forget; of arts that can neverbe used, if indeed they can even be learnt; of histories inapplicable toour times; of languages dead and even mouldy; of grammatical rulesthat never had living use and are only post mortem examinations; and ofstatements fagoted with utter disregard of their comparative value. "

This general thought will be kept in view throughout my somewhatdiscursive address, which will begin with an imaginary clinical lessonfrom the lips of an historical personage, and close with the portraitfrom real life of one who, both as teacher and practitioner, was longloved and honored among us. If I somewhat overrun my hour, you mustpardon me, for I can say with Pascal that I have not had the time tomake my lecture shorter. 

In the year 1647, that good man John Eliot, commonly called the ApostleEliot, writing to Mr. Thomas Shepherd, the pious minister of Cambridge, referring to the great need of medical instruction for the Indians, usedthese words:

"I have thought in my heart that it were a singular good work, ifthe Lord would stirre up the hearts of some or other of his peoplein England to give some maintenance toward some Schoole or Collegiateexercise this way, wherein there should be Anatomies and otherinstructions that way, and where there might be some recompence given toany that should bring in any vegetable or other thing that is vertuousin the way of Physick. 

"There is another reason which moves my thought and desires this way, namely that our young students in Physick may be trained up better thenthey yet bee, who have onely theoreticall knowledge, and are forced tofall to practise before ever they saw an Anatomy made, or duely trainedup in making experiments, for we never had but one Anatomy in thecountrey, which Mr. Giles Firman [Firmin] now in England, did make andread upon very well, but no more of that now. "

Since the time of the Apostle Eliot the Lord has stirred up the heartsof our people to the building of many Schools and Colleges wheremedicine is taught in all its branches. Mr. Giles Firmin's "Anatomy" maybe considered the first ancestor of a long line of skeletons which havebeen dangling and rattling in our lecture-rooms for more than a century. 

Teaching in New England in 1647 was a grave but simple matter. A singleperson, combining in many cases, as in that of Mr. Giles Firmin, the offices of physician and preacher, taught what he knew to a fewdisciples whom he gathered about him. Of the making of that "Anatomy" onwhich my first predecessor in the branch I teach "did read very well"we can know nothing. The body of some poor wretch who had swung upon thegallows, was probably conveyed by night to some lonely dwelling at theoutskirts of the village, and there by the light of flaring torcheshastily dissected by hands that trembled over the unwonted task. And ever and anon the master turned to his book, as he laid bare themysteries of the hidden organs; to his precious Vesalius, it might be, or his figures repeated in the multifarious volume of Ambroise Pare; tothe Aldine octavo in which Fallopius recorded his fresh observations; orthat giant folio of Spigelius just issued from the press of Amsterdam, in which lovely ladies display their viscera with a coquettish graceimplying that it is rather a pleasure than otherwise to show thelace-like omentum, and hold up their appendices epiploicae as if theywere saying "these are our jewels. "

His teaching of medicine was no doubt chiefly clinical, and receivedwith the same kind of faith as that which accepted his words from thepulpit. His notions of disease were based on what he had observed, seenalways in the light of the traditional doctrines in which he was bred. His discourse savored of the weighty doctrines of Hippocrates, dilutedby the subtle speculations of Galen, reinforced by the curious commentsof the Arabian schoolmen as they were conveyed in the mellifluouslanguage of Fernelius, blended, it may be, with something of the loftymysticism of Van Helmont, and perhaps stealing a flavor of that earlierform of Homoeopathy which had lately come to light in Sir Kenelm Digby's"Discourse concerning the Cure of Wounds by the Sympathetic Powder. "

His Pathology was mythology. A malformed foetus, as the readers ofWinthrop's Journal may remember, was enough to scare the colonists fromtheir propriety, and suggest the gravest fears of portended disaster. The student of the seventeenth century opened his Licetus and sawfigures of a lion with the head of a woman, and a man with the head ofan elephant. He had offered to his gaze, as born of a human mother, the effigy of a winged cherub, a pterocephalous specimen, which ourProfessor of Pathological Anatomy would hardly know whether to treatwith the reverence due to its celestial aspect, or to imprison in one ofhis immortalizing jars of alcohol. 

His pharmacopoeia consisted mainly of simples, such as the venerable"Herball" of Gerard describes and figures in abounding affluence. St. John's wort and Clown's All-heal, with Spurge and Fennel, Saffron andParsley, Elder and Snake-root, with opium in some form, and roastedrhubarb and the Four Great Cold Seeds, and the two Resins, of which itused to be said that whatever the Tacamahaca has not cured, the Carannawill, with the more familiar Scammony and Jalap and Black Hellebore, made up a good part of his probable list of remedies. He would haveordered Iron now and then, and possibly an occasional dose of Antimony. He would perhaps have had a rheumatic patient wrapped in the skin of awolf or a wild cat, and in case of a malignant fever with "purples" orpetechiae, or of an obstinate king's evil, he might have prescribeda certain black powder, which had been made by calcining toads inan earthen pot; a choice remedy, taken internally, or applied to anyoutward grief. 

Except for the toad-powder and the peremptory drastics, one might haveborne up against this herb doctoring as well as against some more modernstyles of medication. Barbeyrac and his scholar Sydenham had not yetcleansed the Pharmacopoeia of its perilous stuff, but there is no doubtthat the more sensible physicians of that day knew well enough that agood honest herb-tea which amused the patient and his nurses was allthat was required to carry him through all common disorders. 

The student soon learned the physiognomy of disease by going about withhis master; fevers, pleurisies, asthmas, dropsies, fluxes, small-pox, sore-throats, measles, consumptions. He saw what was done for them. Heput up the medicines, gathered the herbs, and so learned something ofmateria medico and botany. He learned these few things easily and well, for he could give his whole attention to them. Chirurgery was a separatespecialty. Women in child-birth were cared for by midwives. There wasno chemistry deserving the name to require his study. He did not learn agreat deal, perhaps, but what he did learn was his business, namely, howto take care of sick people. 

Let me give you a picture of the old=fashioned way of instruction, bycarrying you with me in imagination in the company of worthy MasterGiles Firmin as he makes his round of visits among the good folk ofIpswich, followed by his one student, who shall answer to the scripturalname of Luke. It will not be for entertainment chiefly, but toillustrate the one mode of teaching which can never be superseded, and which, I venture to say, is more important than all the rest puttogether. The student is a green hand, as you will perceive. 

In the first dwelling they come to, a stout fellow is bellowing withcolic. 

"He will die, Master, of a surety, methinks, " says the timid youth in awhisper. 

"Nay, Luke, " the Master answers, "'t is but a dry belly-ache. Didstthou not mark that he stayed his roaring when I did press hard over thelesser bowels? Note that he hath not the pulse of them with fevers, andby what Dorcas telleth me there hath been no long shutting up of thevice naturales. We will steep certain comforting herbs which I will shewthee, and put them in a bag and lay them on his belly. Likewise he shallhave my cordial julep with a portion of this confection which we do callTheriaca Andromachi, which hath juice of poppy in it, and is a greatstayer of anguish. This fellow is at his prayers to-day, but I warrantthee he shall be swearing with the best of them to-morrow. "

They jog along the bridle-path on their horses until they come toanother lowly dwelling. They sit a while with a delicate looking girlin whom the ingenuous youth naturally takes a special interest. The goodphysician talks cheerfully with her, asks her a few questions. Then toher mother: "Good-wife, Margaret hath somewhat profited, as she telleth, by the goat's milk she hath taken night and morning. Do thou pluck amaniple--that is an handful--of the plant called Maidenhair, and makea syrup therewith as I have shewed thee. Let her take a cup full ofthe same, fasting, before she sleepeth, also before she riseth from herbed. " And so they leave the house. 

"What thinkest thou, Luke, of the maid we have been visiting?" "Sheseemeth not much ailing, Master, according to my poor judgment. For shedid say she was better. And she had a red cheek and a bright eye, andshe spake of being soon able to walk unto the meeting, and did seemgreatly hopeful, but spare of flesh, methought, and her voice somethinghoarse, as of one that hath a defluxion, with some small coughing froma cold, as she did say. Speak I not truly, Master, that she will be wellspeedily?"

"Yea, Luke, I do think she shall be well, and mayhap speedily. But it isnot here with us she shall be well. For that redness of the cheek isbut the sign of the fever which, after the Grecians, we do call thehectical; and that shining of the eyes is but a sickly glazing, and theywhich do every day get better and likewise thinner and weaker shall findthat way leadeth to the church-yard gate. This is the malady which theancients did call tubes, or the wasting disease, and some do name theconsumption. A disease whereof most that fall ailing do perish. ThisMargaret is not long for earth--but she knoweth it not, and stillhopeth. "

"Why, then, Master, didst thou give her of thy medicine, seeing that herail is unto death?"

"Thou shalt learn, boy, that they which are sick must have somewhatwherewith to busy their thoughts. There be some who do give these tabidor consumptives a certain posset made with lime-water and anise andliquorice and raisins of the sun, and there be other some who do givethe juice of craw-fishes boiled in barley-water with chicken-broth, but these be toys, as I do think, and ye shall find as good virtue, naybetter, in this syrup of the simple called Maidenhair. "

Something after this manner might Master Giles Firmin have delivered hisclinical instructions. Somewhat in this way, a century and a half later, another New England physician, Dr. Edward Augustus Holyoke, taught ayoung man who came to study with him, a very diligent and intelligentyouth, James Jackson by name, the same whose portrait in his advancedyears hangs upon this wall, long the honored Professor of Theory andPractice in this Institution, of whom I shall say something in thisLecture. Our venerated Teacher studied assiduously afterwards in thegreat London Hospitals, but I think he used to quote his "old Master"ten times where he quoted Mr. Cline or Dr. Woodville once. 

When I compare this direct transfer of the practical experience of awise man into the mind of a student, --every fact one that he can usein the battle of life and death, --with the far off, unserviceable"scientific" truths that I and some others are in the habit of teaching, I cannot help asking myself whether, if we concede that our forefatherstaught too little, there is not--a possibility that we may sometimesattempt to teach too much. I almost blush when I think of myself asdescribing the eight several facets on two slender processes of thepalate bone, or the seven little twigs that branch off from the minutetympanic nerve, and I wonder whether my excellent colleague feels in thesame way when he pictures himself as giving the constitution ofneurin, which as he and I know very well is that of the hydrate oftrimethyle-oxethyle-ammonium, or the formula for the production ofalloxan, which, though none but the Professors and older students canbe expected to remember it, is C10 H4 N4 O6+ 2HO, NO5=C8 H4 N2O10+2CO2+N2+NH4 O, NO5. 

I can bear the voice of some rough iconoclast addressing the Anatomistand the Chemist in tones of contemptuous indignation: "What is thisstuff with which you are cramming the brains of young men who are tohold the lives of the community in their hands? Here is a man fallen ina fit; you can tell me all about the eight surfaces of the two processesof the palate bone, but you have not had the sense to loosen that man'sneck-cloth, and the old women are all calling you a fool? Here is afellow that has just swallowed poison. I want something to turn hisstomach inside out at the shortest notice. Oh, you have forgotten thedose of the sulphate of zinc, but you remember the formula for theproduction of alloxan!"

"Look you, Master Doctor, --if I go to a carpenter to come and stopa leak in my roof that is flooding the house, do you suppose I carewhether he is a botanist or not? Cannot a man work in wood withoutknowing all about endogens and exogens, or must he attend ProfessorGray's Lectures before he can be trusted to make a box-trap? If my horsecasts a shoe, do you think I will not trust a blacksmith to shoe himuntil I have made sure that he is sound on the distinction between thesesquioxide and the protosesquioxide of iron?"

--But my scientific labor is to lead to useful results by and by, in thenext generation, or in some possible remote future. --

"Diavolo!" as your Dr. Rabelais has it, --answers the iconoclast, --"whatis that to me and my colic, to me and my strangury? I pay the Captain ofthe Cunard steamship to carry me quickly and safely to Liverpool, notto make a chart of the Atlantic for after voyagers! If Professor Peirceundertakes to pilot me into Boston Harbor and runs me on Cohasset rocks, what answer is it to tell me that he is Superintendent of the CoastSurvey? No, Sir! I want a plain man in a pea-jacket and a sou'wester, who knows the channel of Boston Harbor, and the rocks of Boston Harbor, and the distinguished Professor is quite of my mind as to the matter, for I took the pains to ask him before I ventured to use his name in theway of illustration. "

I do not know how the remarks of the image-breaker may strike others, but I feel that they put me on my defence with regard to much of myteaching. Some years ago I ventured to show in an introductory Lecturehow very small a proportion of the anatomical facts taught in a regularcourse, as delivered by myself and others, had any practical bearingwhatever on the treatment of disease. How can I, how can any medicalteacher justify himself in teaching anything that is not like to be ofpractical use to a class of young men who are to hold in their handsthe balance in which life and death, ease and anguish, happiness andwretchedness are to be daily weighed?

I hope we are not all wrong. Oftentimes in finding how sadly ignorantof really essential and vital facts and rules were some of those whomwe had been larding with the choicest scraps of science, I have doubtedwhether the old one-man system of teaching, when the one man was of theright sort, did not turn out better working physicians than our moreelaborate method. The best practitioner I ever knew was mainly shapedto excellence in that way. I can understand perfectly the regrets of myfriend Dr. John Brown of Edinburgh, for the good that was lost with theold apprenticeship system. I understand as well Dr. Latham's fear "thatmany men of the best abilities and good education will be deterred fromprosecuting physic as a profession, in consequence of the necessityindiscriminately laid upon all for impossible attainments. "

I feel therefore impelled to say a very few words in defence ofthat system of teaching adopted in our Colleges, by which we wish tosupplement and complete the instruction given by private individuals orby what are often called Summer Schools. 

The reason why we teach so much that is not practical and in itselfuseful, is because we find that the easiest way of teaching what ispractical and useful. If we could in any way eliminate all that wouldhelp a man to deal successfully with disease, and teach it by itselfso that it should be as tenaciously rooted in the memory, as easilysummoned when wanted, as fertile in suggestion of related facts, assatisfactory to the peremptory demands of the intelligence as if taughtin its scientific connections, I think it would be our duty so to teachthe momentous truths of medicine, and to regard all useless additions asan intrusion on the time which should be otherwise occupied. 

But we cannot successfully eliminate and teach by itself that which ispurely practical. The easiest and surest why of acquiring facts is tolearn them in groups, in systems, and systematized knowledge is science. You can very often carry two facts fastened together more easily thanone by itself, as a housemaid can carry two pails of water with a hoopmore easily than one without it. You can remember a man's face, madeup of many features, better than you can his nose or his mouth or hiseye-brow. Scores of proverbs show you that you can remember two linesthat rhyme better than one without the jingle. The ancients, who knewthe laws of memory, grouped the seven cities that contended for thehonor of being Homer's birthplace in a line thus given by Aulus Gellius:

Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai. 

I remember, in the earlier political days of Martin Van Buren, that Colonel Stone, of the "New York Commercial, " or one of hiscorrespondents, said that six towns of New York would claim in the sameway to have been the birth-place of the "Little Magician, " as he wasthen called; and thus he gave their names, any one of which I shouldlong ago have forgotten, but which as a group have stuck tight in mymemory from that day to this;

Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac. 

If the memory gains so much by mere rhythmical association, how muchmore will it gain when isolated facts are brought together under lawsand principles, when organs are examined in their natural connections, when structure is coupled with function, and healthy and diseased actionare studied as they pass one into the other! Systematic, or scientificstudy is invaluable as supplying a natural kind of mnemonics, if fornothing else. You cannot properly learn the facts you want from Anatomyand Chemistry in any way so easily as by taking them in their regularorder, with other allied facts, only there must be common senseexercised in leaving out a great deal which belongs to each of the twobranches as pure science. The dullest of teachers is the one who doesnot know what to omit. 

The larger aim of scientific training is to furnish you with principlesto which you will be able to refer isolated facts, and so bring thesewithin the range of recorded experience. See what the "London Times"said about the three Germans who cracked open John Bull Chatwood'sstrong-box at the Fair the other day, while the three Englishmenhammered away in vain at Brother Jonathan Herring's. The Englishmenrepresented brute force. The Germans had been trained to appreciateprinciple. The Englishman "knows his business by rote and rule ofthumb"--science, which would "teach him to do in an hour what hashitherto occupied him two hours, " "is in a manner forbidden to him. " Tothis cause the "Times" attributes the falling off of English workmen incomparison with those of the Continent. 

Granting all this, we must not expect too much from "science"as distinguished from common experience. There are ten thousandexperimenters without special apparatus for every one in the laboratory. Accident is the great chemist and toxicologist. Battle is the greatvivisector. Hunger has instituted researches on food such as no Liebig, no Academic Commission has ever recorded. 

Medicine, sometimes impertinently, often ignorantly, often carelesslycalled "allopathy, " appropriates everything from every source that canbe of the slightest use to anybody who is ailing in any way, or like tobe ailing from any cause. It learned from a monk how to use antimony, from a Jesuit how to cure agues, from a friar how to cut for stone, froma soldier how to treat gout, from a sailor how to keep off scurvy, froma postmaster how to sound the Eustachian tube, from a dairy-maid howto prevent small-pox, and from an old market-woman how to catch theitch-insect. It borrowed acupuncture and the moxa from the Japaneseheathen, and was taught the use of lobelia by the American savage. It stands ready to-day to accept anything from any theorist, from anyempiric who can make out a good case for his discovery or his remedy. "Science" is one of its benefactors, but only one, out of many. Ask thewisest practising physician you know, what branches of science helphim habitually, and what amount of knowledge relating to each branch herequires for his professional duties. He will tell you that scientifictraining has a value independent of all the special knowledge acquired. He will tell you that many facts are explained by studying them in thewider range of related facts to which they belong. He will gratefullyrecognize that the anatomist has furnished him with indispensable data, that the physiologist has sometimes put him on the track of new modesof treatment, that the chemist has isolated the active principles ofhis medicines, has taught him how to combine them, has from time to timeoffered him new remedial agencies, and so of others of his allies. Buthe will also tell you, if I am not mistaken, that his own branch ofknowledge is so extensive and so perplexing that he must accept mostof his facts ready made at their hands. He will own to you that in thestruggle for life which goes on day and night in our thoughts as in theoutside world of nature, much that he learned under the name of sciencehas died out, and that simple homely experience has largely taken theplace of that scholastic knowledge to which he and perhaps some of hisinstructors once attached a paramount importance. 

This, then, is my view of scientific training as conducted in coursessuch as you are entering on. Up to a certain point I believe in setLectures as excellent adjuncts to what is far more important, practicalinstruction at the bedside, in the operating room, and under the eye ofthe Demonstrator. But I am so far from wishing these courses extended, that I think some of them--suppose I say my own--would almost bearcurtailing. Do you want me to describe more branches of the sciatic andcrural nerves? I can take Fischer's plates, and lecturing on that scalefill up my whole course and not finish the nerves alone. We must stopsomewhere, and for my own part I think the scholastic exercises of ourcolleges have already claimed their full share of the student's timewithout our seeking to extend them. 

I trust I have vindicated the apparent inconsequence of teaching youngstudents a good deal that seems at first sight profitless, but whichhelps them to learn and retain what is profitable. But this is aninquisitive age, and if we insist on piling up beyond a certain heightknowledge which is in itself mere trash and lumber to a man whose lifeis to be one long fight with death and disease, there will be some sharpquestions asked by and by, and our quick-witted people will perhaps findthey can get along as well without the professor's cap as without thebishop's mitre and the monarch's crown. 

I myself have nothing to do with clinical teaching. Yet I do nothesitate to say it is more essential than all the rest put together, sofar as the ordinary practice of medicine is concerned; and this is byfar the most important thing to be learned, because it deals with somany more lives than any other branch of the profession. So of personalinstruction, such as we give and others give in the interval oflectures, much of it at the bedside, some of it in the laboratory, somein the microscope-room, some in the recitation-room, I think it has manyadvantages of its own over the winter course, and I do not wish to seeit shortened for the sake of prolonging what seems to me long enoughalready. 

If I am jealous of the tendency to expand the time given to theacquisition of curious knowledge, at the expense of the plainold-fashioned bedside teachings, I only share the feeling which Sydenhamexpressed two hundred years ago, using an image I have already borrowed. "He would be no honest and successful pilot who was to apply himselfwith less industry to avoid rocks and sands and bring his vessel safelyhome, than to search into the causes of the ebbing and flowing of thesea, which, though very well for a philosopher, is foreign to him whosebusiness it is to secure the ship. So neither will a physician, whoseprovince it is to cure diseases, be able to do so, though he be a personof great genius, who bestows less time on the hidden and intricatemethod of nature, and adapting his means thereto, than on curious andsubtle speculation. "

"Medicine is my wife and Science is my mistress, " said Dr. Rush. I donot think that the breach of the seventh commandment can be shown tohave been of advantage to the legitimate owner of his affections. Readwhat Dr. Elisha Bartlett says of him as a practitioner, or ask one ofour own honored ex-professors, who studied under him, whether Dr. Rushhad ever learned the meaning of that saying of Lord Bacon, that manis the minister and interpreter of Nature, or whether he did not speakhabitually of Nature as an intruder in the sick room, from which his artwas to expel her as an incompetent and a meddler. 

All a man's powers are not too much for such a profession as Medicine. "He is a learned man, " said old Parson Emmons of Franklin, "whounderstands one subject, and he is a very learned man who understandstwo subjects. " Schonbein says he has been studying oxygen for thirtyyears. Mitscherlich said it took fourteen years to establish a new factin chemistry. Aubrey says of Harvey, the discoverer of the circulation, that "though all his profession would allow him to be an excellentanatomist, I have never heard of any who admired his therapeuticway. " My learned and excellent friend before referred to, Dr. Brownof Edinburgh, from whose very lively and sensible Essay, "Locke andSydenham, " I have borrowed several of my citations, contrasts SirCharles Bell, the discoverer, the man of science, with Dr. Abercrombie, the master in the diagnosis and treatment of disease. It is through oneof the rarest of combinations that we have in our Faculty a teacheron whom the scientific mantle of Bell has fallen, and who yet standspreeminent in the practical treatment of the class of diseases whichhis inventive and ardent experimental genius has illustrated. M. Brown-Sequard's example is as, eloquent as his teaching in proof ofthe advantages of well directed scientific investigation. But those whoemulate his success at once as a discoverer and a practitioner must becontent like him to limit their field of practice. The highest geniuscannot afford in our time to forget the ancient precept, Divide etimpera. 

"I suppose I must go and earn this guinea, " said a medical man who wassent for while he was dissecting an animal. I should not have cared tobe his patient. His dissection would do me no good, and his thoughtswould be too much upon it. I want a whole man for my doctor, not a halfone. I would have sent for a humbler practitioner, who would have givenhimself entirely to me, and told the other--who was no less a man thanJohn Hunter--to go on and finish the dissection of his tiger. 

Sydenham's "Read Don Quixote" should be addressed not to the student, but to the Professor of today. Aimed at him it means, "Do not be toolearned. "

Do not think you are going to lecture to picked young men who aretraining themselves to be scientific discoverers. They are of fairaverage capacity, and they are going to be working doctors. 

These young men are to have some very serious vital facts to deal with. I will mention a few of them. 

Every other resident adult you meet in these streets is or will be moreor less tuberculous. This is not an extravagant estimate, as verynearly one third of the deaths of adults in Boston last year were fromphthisis. If the relative number is less in our other northern cities, it is probably in a great measure because they are more unhealthy; thatis, they have as much, or nearly as much, consumption, but they havemore fevers or other fatal diseases. 

These heavy-eyed men with the alcoholized brains, these pallid youthswith the nicotized optic ganglia and thinking-marrows brown as theirown meerschaums, of whom you meet too many, --will ask all your wisdom todeal with their poisoned nerves and their enfeebled wills. 

Nearly seventeen hundred children under five years of age died lastyear in this city. A poor human article, no doubt, in many cases, still, worth an attempt to save them, especially when we remember the effectof Dr. Clarke's suggestion at the Dublin Hospital, by which sometwenty-five or thirty thousand children's lives have probably been savedin a single city. 

Again, the complaint is often heard that the native population is notincreasing so rapidly as in former generations. The breeding and nursingperiod of American women is one of peculiar delicacy and frequentinfirmity. Many of them must require a considerable interval between thereproductive efforts, to repair damages and regain strength. This matteris not to be decided by an appeal to unschooled nature. It is the samequestion as that of the deformed pelvis, --one of degree. The factsof mal-vitalization are as much to be attended to as those ofmal-formation. If the woman with a twisted pelvis is to be considered anexempt, the woman with a defective organization should be recognized asbelonging to the invalid corps. We shudder to hear what is alleged asto the prevalence of criminal practices; if back of these there can beshown organic incapacity or overtaxing of too limited powers, the factsbelong to the province of the practical physician, as well as of themoralist and the legislator, and require his gravest consideration. 

Take the important question of bleeding. Is venesection done withforever? Six years ago it was said here in an introductory Lecture thatit would doubtless come back again sooner or later. A fortnight agoI found myself in the cars with one of the most sensible and esteemedpractitioners in New England. He took out his wallet and showed me twolancets, which he carried with him; he had never given up their use. This is a point you will have to consider. 

Or, to mention one out of many questionable remedies, shall you giveVeratrum Viride in fevers and inflammations? It makes the pulse slowerin these affections. Then the presumption would naturally be that itdoes harm. The caution with reference to it on this ground was longago recorded in the Lecture above referred to. See what Dr. John HughesBennett says of it in the recent edition of his work on Medicine. Nothing but the most careful clinical experience can settle this andsuch points of treatment. 

These are all practical questions--questions of life and death, andevery day will be full of just such questions. Take the problem ofclimate. A patient comes to you with asthma and wants to know where hecan breathe; another comes to you with phthisis and wants to know wherehe can live. What boy's play is nine tenths of all that is taught inmany a pretentious course of lectures, compared with what an accurateand extensive knowledge of the advantages and disadvantages of differentresidences in these and other complaints would be to a practisingphysician. 

I saw the other day a gentleman living in Canada, who had spent sevensuccessive winters in Egypt, with the entire relief of certain obscurethoracic symptoms which troubled him while at home. I saw, two monthsago, another gentleman from Minnesota, an observer and a man of sense, who considered that State as the great sanatorium for all pulmonarycomplaints. If half our grown population are or will be more or lesstuberculous, the question of colonizing Florida assumes a new aspect. Even within the borders of our own State, the very interestingresearches of Dr. Bowditch show that there is a great variation in theamount of tuberculous disease in different towns, apparently connectedwith local conditions. The hygienic map of a State is quite as valuableas its geological map, and it is the business of every practisingphysician to know it thoroughly. They understand this in England, andsend a patient with a dry irritating cough to Torquay or Penzance, while they send another with relaxed bronchial membranes to Clifton orBrighton. Here is another great field for practical study. 

So as to the all-important question of diet. "Of all the means of cureat our command, " says Dr. Bennett, "a regulation of the quantity andquality of the diet is by far the most powerful. " Dr. MacCormac wouldperhaps except the air we breathe, for he thinks that impure air, especially in sleeping rooms, is the great cause of tubercle. Itis sufficiently proved that the American, --the New Englander, --theBostonian, can breed strong and sound children, generation aftergeneration, --nay, I have shown by the record of a particular family thatvital losses may be retrieved, and a feeble race grow to lusty vigor inthis very climate and locality. Is not the question why our young menand women so often break down, and how they can be kept from breakingdown, far more important for physicians to settle than whether there isone cranial vertebra, or whether there are four, or none?

--But I have a taste for the homologies, I want to go deeply into thesubject of embryology, I want to analyze the protonihilates precipitatedfrom pigeon's milk by the action of the lunar spectrum, --shall I notfollow my star, --shall I not obey my instinct, --shall I not give myselfto the lofty pursuits of science for its own sake?

Certainly you may, if you like. But take down your sign, or never putit up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz andDr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled thedifficulty. We all admire the achievements of this band of distinguisheddoctors who do not practise. But we say of their work and of all purescience, as the French officer said of the charge of the six hundred atBalaclava, "C'est magnifique, mais ce n'est pas la guerre, "--it is verysplendid, but it is not a practising doctor's business. His patient hasa right to the cream of his life and not merely to the thin milk that isleft after "science" has skimmed it off. The best a physician can giveis never too good for the patient. 

It is often a disadvantage to a young practitioner to be known for anyaccomplishment outside of his profession. Haller lost his election asPhysician to the Hospital in his native city of Berne, principally onthe ground that he was a poet. In his later years the physician mayventure more boldly. Astruc was sixty-nine years old when he publishedhis "Conjectures, " the first attempt, we are told, to decide theauthorship of the Pentateuch showing anything like a discerningcriticism. Sir Benjamin Brodie was seventy years old before he lefthis physiological and surgical studies to indulge in psychologicalspeculations. The period of pupilage will be busy enough in acquiringthe knowledge needed, and the season of active practice will leavelittle leisure for any but professional studies. 

Dr. Graves of Dublin, one of the first clinical teachers of ourtime, always insisted on his students' beginning at once to visit thehospital. At the bedside the student must learn to treat disease, andjust as certainly as we spin out and multiply our academic prelectionswe shall work in more and more stuffing, more and more rubbish, more andmore irrelevant, useless detail which the student will get rid of justas soon as he leaves us. Then the next thing will be a new organization, with an examining board of first-rate practical men, who will ask thecandidate questions that mean business, --who will make him operate ifhe is to be a surgeon, and try him at the bedside if he is to be aphysician, --and not puzzle him with scientific conundrums which not morethan one of the questioners could answer himself or ever heard of sincehe graduated. 

Or these women who are hammering at the gates on which is written "Noadmittance for the mothers of mankind, " will by and by organize aninstitution, which starting from that skilful kind of nursing whichFlorence Nightingale taught so well, will work backwards throughanodynes, palliatives, curatives, preventives, until with little showof science it imparts most of what is most valuable in those branches ofthe healing art it professes to teach. When that time comes, the fitnessof women for certain medical duties, which Hecquet advocated in 1708, which Douglas maintained in 1736, which Dr. John Ware, long the honoredProfessor of Theory and Practice in this Institution, upheld withinour own recollection in the face of his own recorded opinion to thecontrary, will very possibly be recognized. 

My advice to every teacher less experienced than myself would be, therefore: Do not fret over the details you have to omit; you probablyteach altogether too many as it is. Individuals may learn a thingwith once hearing it, but the only way of teaching a whole class is byenormous repetition, representation, and illustration in all possibleforms. Now and then you will have a young man on your benches like thelate Waldo Burnett, --not very often, if you lecture half a century. Youcannot pretend to lecture chiefly for men like that, --a Mississippi raftmight as well take an ocean-steamer in tow. To meet his wants you wouldhave to leave the rest of your class behind and that you must not do. President Allen of Jefferson College says that his instruction hasbeen successful in proportion as it has been elementary. It may be ahumiliating statement, but it is one which I have found true in my ownexperience. 

To the student I would say, that however plain and simple may be ourteaching, he must expect to forget much which he follows intelligentlyin the lecture-room. But it is not the same as if he had never learnedit. A man must get a thing before he can forget it. There is a greatworld of ideas we cannot voluntarily recall, --they are outside thelimits of the will. But they sway our conscious thought as the unseenplanets influence the movements of those within the sphere of vision. Noman knows how much he knows, --how many ideas he has, --any more thanhe knows how many blood-globules roll in his veins. Sometimes accidentbrings back here and there one, but the mind is full of irrevocableremembrances and unthinkable thoughts, which take a part in allits judgments as indestructible forces. Some of you must feel yourscientific deficiencies painfully after your best efforts. But every onecan acquire what is most essential. A man of very moderate ability maybe a good physician, if he devotes himself faithfully to the work. Morethan this, a positively dull man, in the ordinary acceptation of theterm, sometimes makes a safer practitioner than one who has, we willsay, five per cent. More brains than his average neighbor, but whothinks it is fifty per cent. More. Skulls belonging to this last varietyof the human race are more common, I may remark, than specimens like theNeanderthal cranium, a cast of which you will find on the table in theMuseum. 

Whether the average talent be high or low, the Colleges of the land mustmake the best commodity they can out of such material as the country andthe cities furnish them. The community must have Doctors as it musthave bread. It uses up its Doctors just as it wears out its shoes, andrequires new ones. All the bread need not be French rolls, all the shoesneed not be patent leather ones; but the bread must be something thatcan be eaten, and the shoes must be something that can be worn. Lifemust somehow find food for the two forces that rub everything topieces, or burn it to ashes, --friction and oxygen. Doctors are oxydableproducts, and the schools must keep furnishing new ones as the oldones turn into oxyds; some of first-rate quality that burn with a greatlight, some of a lower grade of brilliancy, some honestly, unmistakably, by the grace of God, of moderate gifts, or in simpler phrase, dull. 

The public will give every honest and reasonably competent worker inthe healing art a hearty welcome. It is on the whole very loyal to theMedical Profession. Three successive years have borne witness to thefeeling with which this Institution, representing it in its educationalaspect, is regarded by those who are themselves most honored andesteemed. The great Master of Natural Science bade the last year's classfarewell in our behalf, in those accents which delight every audience. The Head of our ancient University honored us in the same way in thepreceding season. And how can we forget that other occasion when theChief Magistrate of the Commonwealth, that noble citizen whom we havejust lost, large-souled, sweet-natured, always ready for every kindoffice, came among us at our bidding, and talked to us of our duties inwords as full of wisdom as his heart was of goodness?

You have not much to fear, I think, from the fancy practitioners. Thevulgar quackeries drop off, atrophied, one after another. Homoeopathyhas long been encysted, and is carried on the body medical as quietly asan old wen. Every year gives you a more reasoning and reasonable peopleto deal with. See how it is in Literature. The dynasty of Britishdogmatists, after lasting a hundred years and more, is on its last legs. Thomas Carlyle, third in the line of descent, finds an audience verydifferent from those which listened to the silver speech of SamuelTaylor Coleridge and the sonorous phrases of Samuel Johnson. Weread him, we smile at his clotted English, his "swarmery" and otherpicturesque expressions, but we lay down his tirade as we do one of Dr. Cumming's interpretations of prophecy, which tells us that the world iscoming to an end next week or next month, if the weather permits, --nototherwise, --feeling very sure that the weather will be unfavorable. 

It is the same common-sense public you will appeal to. The lesspretension you make, the better they will like you in the long run. Ihope we shall make everything as plain and as simple to you as we can. I would never use a long word, even, where a short one would answerthe purpose. I know there are professors in this country who "ligate"arteries. Other surgeons only tie them, and it stops the bleeding justas well. It is the familiarity and simplicity of bedside instructionwhich makes it so pleasant as well as so profitable. A good clinicalteacher is himself a Medical School. We need not wonder that our youngmen are beginning to announce themselves not only as graduates of thisor that College, but also as pupils of some one distinguished master. 

I wish to close this Lecture, if you will allow me a few moments longer, with a brief sketch of an instructor and practitioner whose characterwas as nearly a model one in both capacities as I can find anywhererecorded. 

Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicinein this University from 1812 to 1846, and whose name has been sinceretained on our rolls as Professor Emeritus, died on the 27th of Augustlast, in the ninetieth year of his age. He studied his profession, asI have already mentioned, with Dr. Holyoke of Salem, one of the fewphysicians who have borne witness to their knowledge of the laws of lifeby living to complete their hundredth year. I think the student tookhis Old Master, as he always loved to call him, as his model; each wasworthy of the other, and both were bright examples to all who come afterthem. 

I remember that in the sermon preached by Dr. Grazer after Dr. Holyoke'sdeath, one of the points most insisted upon as characteristic of thatwise and good old man was the perfect balance of all his faculties. Thesame harmonious adjustment of powers, the same symmetrical arrangementof life, the same complete fulfilment of every day's duties, withouthaste and without needless delay, which characterized the master, equally distinguished the scholar. A glance at the life of our own OldMaster, if I can do any justice at all to his excellences, will giveyou something to carry away from this hour's meeting not unworthy to beremembered. 

From December, 1797, to October, 1799, he remained with Dr. Holyoke as astudent, a period which he has spoken of as a most interesting andmost gratifying part of his life. After this he passed eight monthsin London, and on his return, in October, 1800, he began business inBoston. 

He had followed Mr. Cline, as I have mentioned, and was competent topractise Surgery. But he found Dr. John Collins Warren had alreadyoccupied the ground which at that day hardly called for more thanone leading practitioner, and wisely chose the Medical branch of theprofession. He had only himself to rely upon, but he had confidence inhis prospects, conscious, doubtless, of his own powers, knowing hisown industry and determination, and being of an eminently cheerful andhopeful disposition. No better proof of his spirit can be giventhan that, just a year from the time when he began to practise as aphysician, he took that eventful step which in such a man implies thathe sees his way clear to a position; he married a lady blessed with manygifts, but not bringing him a fortune to paralyze his industry. 

He had not miscalculated his chances in life. He very soon rose into agood practice, and began the founding of that reputation which grew withhis years, until he stood by general consent at the head of his chosenbranch of the profession, to say the least, in this city and in all thisregion of country. His skill and wisdom were the last tribunal to whichthe sick and suffering could appeal. The community trusted and lovedhim, the profession recognized him as the noblest type of the physician. The young men whom he had taught wandered through foreign hospitals;where they learned many things that were valuable, and many that werecurious; but as they grew older and began to think more of their abilityto help the sick than their power of talking about phenomena, they beganto look back to the teaching of Dr. Jackson, as he, after his Londonexperience, looked back to that of Dr. Holyoke. And so it came to be atlast that the bare mention of his name in any of our medical assemblieswould call forth such a tribute of affectionate regard as is onlyyielded to age when it brings with it the record of a life spent in welldoing. 

No accident ever carries a man to eminence such as his in the medicalprofession. He who looks for it must want it earnestly and work for itvigorously; Nature must have qualified him in many ways, and educationmust have equipped him with various knowledge, or his reputation willevaporate before it reaches the noon-day blaze of fame. How did Dr. Jackson gain the position which all conceded to him? In the answer tothis question some among you may find a key that shall unlock the gateopening on that fair field of the future of which all dream but whichnot all will ever reach. 

First of all, he truly loved his profession. He had no intellectualambitions outside of it, literary, scientific or political. To him itwas occupation enough to apply at the bedside the best of all that heknew for the good of his patient; to protect the community against theinroads of pestilence; to teach the young all that he himself had beentaught, with all that his own experience had added; to leave on recordsome of the most important results of his long observation. 

With his patients he was so perfect at all points that it is hard tooverpraise him. I have seen many noted British and French and Americanpractitioners, but I never saw the man so altogether admirable at thebedside of the sick as Dr. James Jackson. His smile was itself a remedybetter than the potable gold and the dissolved pearls that comforted thepraecordia of mediaeval monarchs. Did a patient, alarmed without cause, need encouragement, it carried the sunshine of hope into his heart andput all his whims to flight, as David's harp cleared the haunted chamberof the sullen king. Had the hour come, not for encouragement, but forsympathy, his face, his voice, his manner all showed it, because hisheart felt it. So gentle was he, so thoughtful, so calm, so absorbedin the case before him, not to turn round and look for a tribute to hissagacity, not to bolster himself in a favorite theory, but to find outall he could, and to weigh gravely and cautiously all that he found, that to follow him in his morning visit was not only to take a lesson inthe healing art, it was learning how to learn, how to move, how to look, how to feel, if that can be learned. To visit with Dr. Jackson was amedical education. 

He was very firm, with all his kindness. He would have the truth abouthis patients. The nurses found it out; and the shrewder ones neverventured to tell him anything but a straight story. A clinical dialoguebetween Dr. Jackson and Miss Rebecca Taylor, sometime nurse in theMassachusetts General Hospital, a mistress in her calling, was as goodquestioning and answering as one would be like to hear outside of thecourt-room. 

Of his practice you can form an opinion from his book called "Letters toa Young Physician. " Like all sensible men from the days of Hippocratesto the present, he knew that diet and regimen were more importantthan any drug or than all drugs put together. Witness his treatment ofphthisis and of epilepsy. He retained, however, more confidence in someremedial agents than most of the younger generation would concede tothem. Yet his materia medica was a simple one. 

"When I first went to live with Dr. Holyoke, " he says, "in 1797, showingme his shop, he said, 'There seems to you to be a great variety ofmedicines here, and that it will take you long to get acquainted withthem, but most of them are unimportant. There are four which are equalto all the rest, namely, Mercury, Antimony, Bark and Opium. '" And Dr. Jackson adds, "I can only say of his practice, the longer I have lived, I have thought better and better of it. " When he thought it necessary togive medicine, he gave it in earnest. He hated half-practice--givinga little of this or that, so as to be able to say that one had donesomething, in case a consultation was held, or a still more ominousevent occurred. He would give opium, for instance, as boldly as the lateDr. Fisher of Beverly, but he followed the aphorism of the Father ofMedicine, and kept extreme remedies for extreme cases. 

When it came to the "non-naturals, " as he would sometimes call them, after the old physicians, --namely, air, meat and drink, sleep andwatching, motion and rest, the retentions and excretions, and theaffections of the mind, --he was, as I have said, of the school ofsensible practitioners, in distinction from that vast community ofquacks, with or without the diploma, who think the chief end of man isto support apothecaries, and are never easy until they can get everypatient upon a regular course of something nasty or noxious. Nobodywas so precise in his directions about diet, air, and exercise, as Dr. Jackson. He had the same dislike to the a peu pres, the about so much, about so often, about so long, which I afterwards found among thepunctilious adherents of the numerical system at La Pitie. 

He used to insist on one small point with a certain philologicalprecision, namely, the true meaning of the word "cure. " He would haveit that to cure a patient was simply to care for him. I refer to itas showing what his idea was of the relation of the physician to thepatient. It was indeed to care for him, as if his life were bound upin him, to watch his incomings and outgoings, to stand guard at everyavenue that disease might enter, to leave nothing to chance; not merelyto throw a few pills and powders into one pan of the scales of Fate, while Death the skeleton was seated in the other, but to lean with hiswhole weight on the side of life, and shift the balance in its favorif it lay in human power to do it. Such devotion as this is only to belooked for in the man who gives himself wholly up to the business ofhealing, who considers Medicine itself a Science, or if not a science, is willing to follow it as an art, --the noblest of arts, which the godsand demigods of ancient religions did not disdain to practise and toteach. 

The same zeal made him always ready to listen to any new suggestionwhich promised to be useful, at a period of life when many men findit hard to learn new methods and accept new doctrines. Few ofhis generation became so accomplished as he in the arts of directexploration; coming straight from the Parisian experts, I have examinedmany patients with him, and have had frequent opportunities of observinghis skill in percussion and auscultation. 

One element in his success, a trivial one compared with others, but notto be despised, was his punctuality. He always carried two watches, --Idoubt if he told why, any more than Dr. Johnson told what he did withthe orange-peel, --but probably with reference to this virtue. He was asmuch to be depended upon at the appointed time as the solstice orthe equinox. There was another point I have heard him speak of as animportant rule with him; to come at the hour when he was expected; ifhe had made his visit for several days successively at ten o'clock, forinstance, not to put it off, if he could possibly help it, until eleven, and so keep a nervous patient and an anxious family waiting for himthrough a long, weary hour. 

If I should attempt to characterize his teaching, I should say thatwhile it conveyed the best results of his sagacious and extendedobservation, it was singularly modest, cautious, simple, sincere. Nothing was for show, for self-love; there was no rhetoric, nodeclamation, no triumphant "I told you so, " but the plain statement ofa clear-headed honest man, who knows that he is handling one of thegravest subjects that interest humanity. His positive instructions werefull of value, but the spirit in which he taught inspired that loyallove of truth which lies at the bottom of all real excellence. 

I will not say that, during his long career, Dr. Jackson never madean enemy. I have heard him tell how, in his very early days, old Dr. Danforth got into a towering passion with him about some professionalconsultation, and exploded a monosyllable or two of the more energetickind on the occasion. I remember that that somewhat peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson succeeded to his placeas Professor of Theory and Practice. A young man of Dr. Jackson's talentand energy could hardly take the position that belonged to him withoutcrowding somebody in a profession where three in a bed is the commonrule of the household. But he was a peaceful man and a peace-maker allhis days. No man ever did more, if so much, to produce and maintainthe spirit of harmony for which we consider our medical community assomewhat exceptionally distinguished. 

If this harmony should ever be threatened, I could wish that everyimpatient and irritable member of the profession would read thatbeautiful, that noble Preface to the "Letters, " addressed to JohnCollins Warren. I know nothing finer in the medical literature of alltime than this Prefatory Introduction. It is a golden prelude, fit togo with the three great Prefaces which challenge the admiration ofscholars, --Calvin's to his Institutes, De Thou's to his History, andCasaubon's to his Polybius, --not because of any learning or rhetoric, though it is charmingly written, but for a spirit flowing through it towhich learning and rhetoric are but as the breath that is wasted on theair to the Mood that warms the heart. 

Of a similar character is this short extract which I am permittedto make from a private letter of his to a dear young friend. He waseighty-three years old at the time of writing it. 

"I have not loved everybody whom I have known, but I have striven to seethe good points in the characters of all men and women. At first I musthave done this from something in my own nature, for I was not aware ofit, and yet was doing it without any plan, when one day, sixty yearsago, a friend whom I loved and respected said this to me, 'Ah, James, Isee that you are destined to succeed in the world, and to make friends, because you are so ready to see the good point in the characters ofthose you meet. '"

I close this imperfect notice of some features in the character of thismost honored and beloved of physicians by applying to him the wordswhich were written of William Heberden, whose career was not unlike hisown, and who lived to the same patriarchal age. 

"From his early youth he had always entertained a deep sense ofreligion, a consummate love of virtue, an ardent thirst after knowledge, and an earnest desire to promote the welfare and happiness of allmankind. By these qualities, accompanied with great sweetness ofmanners, he acquired the love and esteem of all good men, in a degreewhich perhaps very few have experienced; and after passing an activelife with the uniform testimony of a good conscience, he became aneminent example of its influence, in the cheerfulness and serenity ofhis latest age. "

Such was the man whom I offer to you as a model, young gentlemen, at theoutset of your medical career. I hope that many of you will recognizesome traits of your own special teachers scattered through various partsof the land in the picture I have drawn. Let me assure you that whateveryou may learn in this or any other course of public lectures, --andI trust you will learn a great deal, --the daily guidance, counsel, example, of your medical father, for such the Oath of Hippocrates tellsyou to consider your preceptor, will, if he is in any degree like himof whom I have spoken, be the foundation on which all that we teach isreared, and perhaps outlive most of our teachings, as in Dr. Jackson'smemory the last lessons that remained with him were those of his OldMaster. 

THE MEDICAL PROFESSION IN MASSACHUSETTS. 

A Lecture of a Course by members of the Massachusetts HistoricalSociety, delivered before the Lowell Institute, January 29, 1869. 

The medical history of eight generations, told in an hour, must be inmany parts a mere outline. The details I shall give will relate chieflyto the first century. I shall only indicate the leading occurrences, with the more prominent names of the two centuries which follow, andadd some considerations suggested by the facts which have been passed inreview. 

A geographer who was asked to describe the tides of MassachusettsBay, would have to recognize the circumstance that they are a limitedmanifestation of a great oceanic movement. To consider them apart fromthis, would be to localize a planetary phenomenon, and to provincializea law of the universe. The art of healing in Massachusetts has sharedmore or less fully and readily the movement which, with its periods ofebb and flow, has been raising its level from age to age throughout thebetter part of Christendom. Its practitioners brought with them much ofthe knowledge and many of the errors of the Old World; they have alwaysbeen in communication with its wisdom and its folly; it is notwithout interest to see how far the new conditions in which they foundthemselves have been favorable or unfavorable to the growth of soundmedical knowledge and practice. 

The state of medicine is an index of the civilization of an age andcountry, --one of the best, perhaps, by which it can be judged. Surgeryinvokes the aid of all the mechanical arts. From the rude violencesof the age of stone, --a relic of which we may find in the practice ofZipporah, the wife of Moses, --to the delicate operations of to-dayupon patients lulled into temporary insensibility, is a progress whichpresupposes a skill in metallurgy and in the labors of the workshop andthe laboratory it has taken uncounted generations to accumulate. Beforethe morphia which deadens the pain of neuralgia, or the quinine whicharrests the fit of an ague, can find their place in our pharmacies, commerce must have perfected its machinery, and science must haverefined its processes, through periods only to be counted by the life ofnations. Before the means which nature and art have put in the hands ofthe medical practitioner can be fairly brought into use, the prejudicesof the vulgar must be overcome, the intrusions of false philosophy mustbe fenced out, and the partnership with the priesthood dissolved. Allthis implies that freedom and activity of thought which belong only tothe most advanced conditions of society; and the progress towards thisis by gradations as significant of wide-spread changes, as are thevarying states of the barometer of far-extended conditions of theatmosphere. 

Apart, then, from its special and technical interest, my subject has ameaning which gives a certain importance, and even dignity, to detailsin themselves trivial and almost unworthy of record. A medical entry inGovernor Winthrop's journal may seem at first sight a mere curiosity;but, rightly interpreted, it is a key to his whole system of beliefas to the order of the universe and the relations between man and hisMaker. Nothing sheds such light on the superstitions of an age as theprevailing interpretation and treatment of disease. When the touch ofa profligate monarch was a cure for one of the most inveterate ofmaladies, when the common symptoms of hysteria were prayed over as marksof demoniacal possession, we might well expect the spiritual realms ofthought to be peopled with still stranger delusions. 

Let us go before the Pilgrims of the Mayflower, and look at the shoreson which they were soon to land. A wasting pestilence had so thinnedthe savage tribes that it was sometimes piously interpreted as havingprovidentially prepared the way for the feeble band of exiles. CottonMather, who, next to the witches, hated the "tawnies, " "wild beasts, ""blood-hounds, " "rattlesnakes, " "infidels, " as in different places hecalls the unhappy Aborigines, describes the condition of things in hislively way, thus: "The Indians in these Parts had newly, even about aYear or Two before, been visited with such a prodigious Pestilence; ascarried away not a Tenth, but Nine Parts of Ten (yea't is said Nineteenof Twenty) among them so that the Woods were almost cleared of thosepernicious Creatures to make Room for a better Growth. "

What this pestilence was has been much discussed. It is variouslymentioned by different early writers as "the plague, " "a great andgrievous plague, " "a sore consumption, " as attended with spots whichleft unhealed places on those who recovered, as making the "wholesurface yellow as with a garment. " Perhaps no disease answers all theseconditions so well as smallpox. We know from different sources whatfrightful havoc it made among the Indians in after years, --in 1631, for instance, when it swept away the aboriginal inhabitants of "wholetowns, " and in 1633. We have seen a whole tribe, the Mandans, extirpatedby it in our own day. The word "plague" was used very vaguely, as inthe description of the "great sickness" found among the Indians by theexpedition of 1622. This same great sickness could hardly have beenyellow fever, as it occurred in the month of November. I cannot think, therefore, that either the scourge of the East or our Southernmalarial pestilence was the disease that wasted the Indians. As for theyellowness like a garment, that is too familiar to the eyes of all whohave ever looked on the hideous mask of confluent variola. 

Without the presence or the fear of these exotic maladies, the forlornvoyagers of the Mayflower had sickness enough to contend with. At theirfirst landing at Cape Cod, gaunt and hungry and longing for fresh food, they found upon the sandy shore "great mussel's, and very fat andfull of sea-pearl. " Sailors and passengers indulged in the treacherousdelicacy; which seems to have been the sea-clam; and found that thesemollusks, like the shell the poet tells of, remembered their augustabode, and treated the way-worn adventurers to a gastric reminiscence ofthe heaving billows. In the mean time it blew and snowed and froze. The water turned to ice on their clothes, and made them many times likecoats of iron. Edward Tilley had like to have "sounded" with cold. Thegunner, too, was sick unto death, but "hope of trucking" kept him on hisfeet, --a Yankee, it should seem, when he first touched the shore of NewEngland. Most, if not all, got colds and coughs, which afterwards turnedto scurvy, whereof many died. 

How can we wonder that the crowded and tempest-tossed voyagers, manyof them already suffering, should have fallen before the trials of thefirst winter in Plymouth? Their imperfect shelter, their insufficientsupply of bread, their salted food, now in unwholesome condition, account too well for the diseases and the mortality that marked thisfirst dreadful season; weakness, swelling of the limbs, and other signsof scurvy, betrayed the want of proper nourishment and protection fromthe elements. In December six of their number died, in January eight, inFebruary, seventeen, in March thirteen. With the advance of springthe mortality diminished, the sick and lame began to recover, and thecolonists, saddened but not disheartened, applied themselves to thelabors of the opening year. 

One of the most pressing needs of the early colonists must have beenthat of physicians and surgeons. In Mr. Savage's remarkable GenealogicalDictionary of the first settlers who came over before 1692 and theirdescendants to the third generation, I find scattered through thefour crowded volumes the names of one hundred and thirty-four medicalpractitioners. Of these, twelve, and probably many more, practisedsurgery; three were barber-surgeons. A little incident throws a glimmerfrom the dark lantern of memory upon William Direly, one of thesepractitioners with the razor and the lancet. He was lost between Bostonand Roxbury in a violent tempest of wind and snow; ten days afterwardsa son was born to his widow, and with a touch of homely sentiment, I hadalmost said poetry, they called the little creature "Fathergone" Direly. Six or seven, probably a larger number, were ministers as well asphysicians, one of whom, I am sorry to say, took to drink and tumbledinto the Connecticut River, and so ended. One was not only doctor, butalso schoolmaster and poet. One practised medicine and kept a tavern. One was a butcher, but calls himself a surgeon in his will, a union ofcallings which suggests an obvious pleasantry. One female practitioner, employed by her own sex, --Ann Moore, --was the precursor of that intrepidsisterhood whose cause it has long been my pleasure and privilege toadvocate on all fitting occasions. 

Outside of this list I must place the name of Thomas Wilkinson, who wascomplained of, is 1676, for practising contrary to law. 

Many names in the catalogue of these early physicians have beenassociated, in later periods, with the practice of the profession, --among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge, Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams, Woodward. Touton was a Huguenot, Burchsted a German from Silesia, Lunerus a German or a Pole; "Pighogg Churrergeon, " I hope, for the honorof the profession, was only Peacock disguised under this alias, whichwould not, I fear, prove very attractive to patients. 

What doctrines and practice were these colonists likely to bring, withthem?

Two principal schools of medical practice prevailed in the Old Worldduring the greater part of the seventeenth century. The first held tothe old methods of Galen: its theory was that the body, the microcosm, like the macrocosm, was made up of the four elements--fire, air, water, earth; having respectively the qualities hot, dry, moist, cold. The bodywas to be preserved in health by keeping each of these qualities in itsnatural proportion; heat, by the proper temperature; moisture, by thedue amount of fluid; and so as to the rest. Diseases which arose fromexcess of heat were to be attacked by cooling remedies; those fromexcess of cold, by heating ones; and so of the other derangements ofbalance. This was truly the principle of contraries contrariis, whichill-informed persons have attempted to make out to be the generaldoctrine of medicine, whereas there is no general dogma other than this:disease is to be treated by anything that is proved to cure it. Themeans the Galenist employed were chiefly diet and vegetable remedies, with the use of the lancet and other depleting agents. He attributed thefour fundamental qualities to different vegetables, in four differentdegrees; thus chicory was cold in the fourth degree, pepper was hot inthe fourth, endive was cold and dry in the second, and bitter almondswere hot in the first and dry in the second degree. When we say "cool asa cucumber, " we are talking Galenism. The seeds of that vegetable rankedas one of "the four greater cold seeds" of this system. 

Galenism prevailed mostly in the south of Europe and France. The readersof Moliere will have no difficulty in recalling some of its favoritemodes of treatment, and the abundant mirth he extracted from them. 

These Galenists were what we should call "herb-doctors" to-day. Theirinsignificant infusions lost credit after a time; their absurdlycomplicated mixtures excited contempt, and their nauseous prescriptionsprovoked loathing and disgust. A simpler and bolder practice foundwelcome in Germany, depending chiefly on mineral remedies, mercury, antimony, sulphur, arsenic, and the use, sometimes the secret use, of opium. Whatever we think of Paracelsus, the chief agent in theintroduction of these remedies, and whatever limits we may assign to theuse of these long-trusted mineral drugs, there can be no doubt thatthe chemical school, as it was called, did a great deal towards theexpurgation of the old, overloaded, and repulsive pharmacopoeia. Weshall find evidence in the practice of our New-England physicians of thefirst century, that they often employed chemical remedies, and that, bythe early part of the following century, their chief trust was in thefew simple, potent drugs of Paracelsus. 

We have seen that many of the practitioners of medicine, during thefirst century of New England, were clergymen. This relation betweenmedicine and theology has existed from a very early period; from theEgyptian priest to the Indian medicine-man, the alliance has beenmaintained in one form or another. The partnership was very common amongour British ancestors. Mr. Ward, the Vicar of Stratford-on-Avon, himselfa notable example of the union of the two characters, writing about1660, says, "The Saxons had their blood-letters, but under the Normans physicke, begunne in England; 300 years agoe itt was not a distinct profession byitself, but practised by men in orders, witness Nicholas de Ternham, the chief English physician and Bishop of Durham; Hugh of Evesham, aphysician and cardinal; Grysant, physician and pope; John Chambers, Dr. Of Physick, was the first Bishop of Peterborough; Paul Bush, a bachelorof divinitie in Oxford, was a man well read in physick as well asdivinitie, he was the first bishop of Bristol. "

"Again in King Richard the Second's time physicians and divines were notdistinct professions; for one Tydeman, Bishop of Landaph and Worcester, was physician to King Richard the Second. "

This alliance may have had its share in creating and keeping up the manysuperstitions which have figured so largely in the history of medicine. It is curious to see that a medical work left in manuscript by the Rev. Cotton Mather and hereafter to be referred to, is running overwith follies and superstitious fancies; while his contemporary andfellow-townsman, William Douglass, relied on the same few simpleremedies which, through Dr. Edward Holyoke and Dr. James Jackson, havecome down to our own time, as the most important articles of the materiamedica. 

Let us now take a general glance at some of the conditions of theearly settlers; and first, as to the healthfulness of the climate. Themortality of the season that followed the landing of the Pilgrims atPlymouth has been sufficiently accounted for. After this, the colonistsseem to have found the new country agreeing very well with their Englishconstitutions. Its clear air is the subject of eulogy. Its daintysprings of sweet water are praised not only by Higginson and Wood, buteven the mischievous Morton says, that for its delicate waters "Canaancame not near this country. " There is a tendency to dilate on thesesimple blessings, which reminds one a little of the Marchioness inDickens's story, with her orange-peel-and-water beverage. Still moredoes one feel the warmth of coloring, --such as we expect from convertsto a new faith, and settlers who want to entice others over to theirclearings, when Winslow speaks, in 1621, of "abundance of roses, white, red, and damask; single, but very sweet indeed;" a most of all, however, when, in the same connection, he says, "Here are grapes white andred, and very sweet and strong also. " This of our wild grape, a littlevegetable Indian, which scalps a civilized man's mouth, as his animalrepresentative scalps his cranium. But there is something quite charmingin Winslow's picture of the luxury in which they are living. Lobsters, oysters, eels, mussels, fish and fowl, delicious fruit, including thegrapes aforesaid, --if they only had "kine, horses, and sheep, " he makesno question but men would live as contented here as in any part of theworld. We cannot help admiring the way in which they took their trials, and made the most of their blessings. 

"And how Content they were, " says Cotton Mather, "when an Honest Man, asI have heard, inviting his Friends to a Dish of Clams, at the Table gaveThanks to Heaven, who had given them to suck the abundance of the Seas, and of the Treasures Aid in the Sands!"

Strangely enough, as it would seem, except for this buoyantdetermination to make the best of everything, they hardly appear torecognize the difference of the climate from that which they had left. After almost three years' experience, Winslow says, he can scarcedistinguish New England from Old England, in respect of heat and cold, frost, snow, rain, winds, etc. The winter, he thinks (if there is adifference), is sharper and longer; but yet he may be deceived by thewant of the comforts he enjoyed at home. He cannot conceive anyclimate to agree better with the constitution of the English, not beingoppressed with extremity of heats, nor nipped by biting cold:

"By which means, blessed be God, we enjoy our health, notwithstandingthose difficulties we have undergone, in such a measure as would havebeen admired, if we had lived in England with the like means. "

Edward Johnson, after mentioning the shifts to which they were put forfood, says, --

"And yet, methinks, our children are as cheerful, fat, and lusty, withfeeding upon those mussels, clams, and other fish, as they were inEngland with their fill of bread. "

Higginson, himself a dyspeptic, "continually in physic, " as he says, andaccustomed to dress in thick clothing, and to comfort his stomach withdrink that was "both strong and stale, "--the "jolly good ale and old, " Isuppose, of free and easy Bishop Still's song, --found that he both couldand did oftentimes drink New England water very well, --which he seemsto look upon as a remarkable feat. He could go as lightclad as any, too, with only a light stuff cassock upon his shirt, and stuff breecheswithout linings. Two of his children were sickly: one, --little misshapenMary, --died on the passage, and, in her father's words, "was the firstin our ship that was buried in the bowels of the great Atlantic sea;"the other, who had been "most lamentably handled" by disease, recoveredalmost entirely "by the very wholesomeness of the air, altering, digesting, and drying up the cold and crude humors of the body. "Wherefore, he thinks it a wise course for all cold complexions to cometo take physic in New England, and ends with those often quoted words, that "a sup of New England's air is better than a whole draught of OldEngland's ale. " Mr. Higginson died, however, "of a hectic fever, " alittle more than a year after his arrival. 

The medical records which I shall cite show that the colonists were notexempt from the complaints of the Old World. Besides the common diseasesto which their descendants are subject, there were two others, tosay nothing of the dreaded small-pox, which later medical science hasdisarmed, --little known among us at the present day, but frequentamong the first settlers. The first of these was the scurvy, alreadymentioned, of which Winthrop speaks in 1630, saying, that it provedfatal to those who fell into discontent, and lingered after their formerconditions in England; the poor homesick creatures in fact, whom we soforget in our florid pictures of the early times of the little band inthe wilderness. Many who were suffering from scurvy got well whenthe Lyon arrived from England, bringing store of juice of lemons. TheGovernor speaks of another case in 1644; and it seems probable that thedisease was not of rare occurrence. 

The other complaint from which they suffered, but which has nearlydisappeared from among us, was intermittent fever, or fever and ague. I investigated the question as to the prevalence of this disease in NewEngland, in a dissertation, which was published in a volume with otherpapers, in the year 1838. I can add little to the facts there recorded. One which escaped me was, that Joshua Scottow, in "Old Men's Tears, "dated 1691, speaks of "shaking agues, " as among the trials to which theyhad been subjected. The outline map of New England, accompanying thedissertation above referred to, indicates all the places where I hadevidence that the disease had originated. It was plain enough thatit used to be known in many localities where it has long ceased tobe feared. Still it was and is remarkable to see what a clean bill ofhealth in this particular respect our barren soil inherited with itssterility. There are some malarious spots on the edge of Lake Champlain, and there have been some temporary centres of malaria, within thememory of man, on one or more of our Massachusetts rivers, but these areharmless enough, for the most part, unless the millers dam them, whenthey are apt to retaliate with a whiff from their meadows, that sets thewhole neighborhood shaking with fever and ague. 

The Pilgrims of the Mayflower had with them a good physician, a man ofstanding, a deacon of their church, one whom they loved and trusted, Dr. Samuel Fuller. But no medical skill could keep cold and hunger andbad food, and, probably enough, desperate homesickness in some of thefeebler sort, from doing their work. No detailed record remains of whatthey suffered or what was attempted for their relief during the firstsad winter. The graves of those who died were levelled and sowed withgrain that the losses of the little band might not be suspected by thesavage tenants of the wilderness, and their story remains untold. 

Of Dr. Fuller's practice, at a later period, we have an account in aletter of his to Governor Bradford, dated June, 1630. "I have been toMatapan" (now Dorchester), he says, "and let some twenty of those peopleblood. " Such wholesale depletion as this, except with avowed homicidalintent, is quite unknown in these days; though I once saw the notedFrench surgeon, Lisfranc, in a fine phlebotomizing frenzy, order someten or fifteen patients, taken almost indiscriminately, to be bled in asingle morning. 

Dr. Fuller's two visits to Salem, at the request of Governor Endicott, seem to have been very satisfactory to that gentleman. Morton, thewild fellow of Merry Mount, gives a rather questionable reason for theGovernor's being so well pleased with the physician's doings. The namesunder which he mentions the two personages, it will be seen, are notintended to be complimentary. "Dr. Noddy did a great cure for CaptainLittleworth. He cured him of a disease called a wife. " William Gager, who came out with Winthrop, is spoken of as "a right godly man andskilful chyrurgeon, but died of a malignant fever not very long afterhis arrival. "

Two practitioners of the ancient town of Newbury are entitled to specialnotice, for different reasons. The first is Dr. John Clark, who is saidby tradition to have been the first regularly educated physician whoresided in New England. His portrait, in close-fitting skull-cap, withlong locks and venerable flowing beard, is familiar to our eyes on thewall of our Society's antechamber. His left hand rests upon a skull, hisright hand holds an instrument which deserves a passing comment. It isa trephine, a surgical implement for cutting round pieces out of brokenskulls, so as to get at the fragments which have been driven in, andlift them up. It has a handle like that of a gimlet, with a claw likea hammer, to lift with, I suppose, which last contrivance I do notsee figured in my books. But the point I refer to is this: the oldinstrument, the trepan, had a handle like a wimble, what we call a braceor bit-stock. The trephine is not mentioned at all in Peter Lowe's book, London, 1634; nor in Wiseman's great work on Surgery, London, 1676; norin the translation of Dionis, published by Jacob Tonson, in 1710. Infact it was only brought into more general use by Cheselden and Sharpeso late as the beginning of the last century. As John Clark diedin 1661, it is remarkable to see the last fashion in the way ofskull-sawing contrivances in his hands, --to say nothing of the claw onthe handle, and a Hey's saw, so called in England, lying on the tableby him, and painted there more than a hundred years before Hey was born. This saw is an old invention, perhaps as old as Hippocrates, and may beseen figured in the "Armamentarium Chirurgicum" of Scultetus, or in theWorks of Ambroise Pare. 

Dr. Clark is said to have received a diploma before he came, for skillin lithotomy. He loved horses, as a good many doctors do, and left agood property, as they all ought to do. His grave and noble presence, with the few facts concerning him, told with more or less traditionalauthority, give us the feeling that the people of Newbury, andafterwards of Boston, had a wise and skilful medical adviser and surgeonin Dr. John Clark. 

The venerable town of Newbury had another physician who was lessfortunate. The following is a court record of 1652:

"This is to certify whom it may concern, that we the subscribers, beingcalled upon to testify against doctor William Snelling for words by himuttered, affirm that being in way of merry discourse, a health beingdrank to all friends, he answered, "I'll pledge my friends, And for my foes A plague for their heels And, '----

[a similar malediction on the other extremity of their feet. ]

"Since when he hath affirmed that he only intended the proverb used inthe west country, nor do we believe he intended otherwise. 

"[Signed] WILLIAM THOMAS. 

"THOMAS MILWARD. "

"March 12th 1651, All which I acknowledge, and am sorry I did notexpresse my intent, or that I was so weak as to use so foolish aproverb. 

"[Signed] GULIELMUS SNELLING. "

Notwithstanding this confession and apology, the record tells us that"William Snelling in his presentment for cursing is fined ten shillingsand the fees of court. "

I will mention one other name among those of the Fathers of the medicalprofession in New England. The "apostle" Eliot says, writing in 1647, "We never had but one anatomy in the country, which Mr. Giles Firman, now in England, did make and read upon very well. "

Giles Firmin, as the name is commonly spelled, practised physic in thiscountry for a time. He seems to have found it a poor business; for, in aletter to Governor Winthrop, he says, "I am strongly sett upon to studyedivinitie: my studyes else must be lost, for physick is but a meenehelpe. "

Giles Firmin's Lectures on Anatomy were the first scientific teachingsof the New World. While the Fathers were enlightened enough to permitsuch instructions, they were severe in dealing with quackery; for, in1631, our court records show that one Nicholas Knopp, or Knapp, wassentenced to be fined or whipped "for taking upon him to cure thescurvey by a water of noe worth nor value, which he solde att a verydeare rate. " Empty purses or sore backs would be common with us to-dayif such a rule were enforced. 

Besides the few worthies spoken of, and others whose names I have notspace to record, we must remember that there were many clergymen whotook charge of the bodies as well as the souls of their patients, amongthem two Presidents of Harvard College, Charles Chauncy and LeonardHoar, --and Thomas Thacher, first minister of the "Old South, " author ofthe earliest medical treatises printed in the country, [A Brief Rule toGuide the Common People in Small pox and Measles. 1674. ] whose epitaphin Latin and Greek, said to have been written by Eleazer, an "IndianYouth" and a member of the Senior Class of Harvard College, may be foundin the "Magnalia. " I miss this noble savage's name in our triennialcatalogue; and as there is many a slip between the cup and lip, one istempted to guess that he may have lost his degree by some display of hisnative instinct, --possibly a flourish of the tomahawk or scalping-knife. However this may have been, the good man he celebrated was a notableinstance of the Angelical Conjunction, as the author of the "Magnalia"calls it, of the offices of clergyman and medical practitioner. 

Michael Wigglesworth, author of the "Day of Doom, " attended the sick, "not only as a Pastor, but as a Physician too, and this, not only inhis own town, but also in all those of the vicinity. " Mather says of thesons of Charles Chauncy, "All of these did, while they had Opportunity, Preach the Gospel; and most, if not all of them, like their excellentFather before them, had an eminent skill in physick added unto theirother accomplishments, " etc. Roger Williams is said to have saved manyin a kind of pestilence which swept away many Indians. 

To these names must be added, as sustaining a certain relation to thehealing art, that of the first Governor Winthrop, who is said by JohnCotton to have been "Help for our Bodies by Physick [and] for ourEstates by Law, " and that of his son, the Governor of Connecticut, who, as we shall see, was as much physician as magistrate. 

I had submitted to me for examination, in 1862, a manuscript found amongthe Winthrop Papers, marked with the superscription, "For my worthyfriend Mr. Wintrop, " dated in 1643, London, signed Edward Stafford, andcontaining medical directions and prescriptions. It may be remembered bysome present that I wrote a report on this paper, which was publishedin the "Proceedings" of this Society. Whether the paper was written forGovernor John Winthrop of Massachusetts, or for his son, Governor Johnof Connecticut, there is no positive evidence that I have been ableto obtain. It is very interesting, however, as giving short and simplepractical directions, such as would be most like to be wanted and mostuseful, in the opinion of a physician in repute of that day. 

The diseases prescribed for are plague, small-pox, fevers, king's evil, insanity, falling-sickness, and the like; with such injuries as brokenbones, dislocations, and burning with gunpowder. The remedies are ofthree kinds: simples, such as St. John's wort, Clown's all-heal, elder, parsley, maidenhair, mineral drugs, such as lime, saltpetre, Armenianbole, crocus metallorum, or sulphuret of antimony; and thaumaturgic ormystical, of which the chief is, "My black powder against the plague, small-pox; purples, all sorts of feavers; Poyson; either, by Way ofPrevention or after Infection. " This marvellous remedy was made byputting live toads into an earthen pot so as to half fill it, and bakingand burning them "in the open ayre, not in an house, "--concerning whichlatter possibility I suspect Madam Winthrop would have had something tosay, --until they could be reduced by pounding, first into a brown, andthen into a black, powder. Blood-letting in some inflammations, fastingin the early stage of fevers, and some of those peremptory drugs withwhich most of us have been well acquainted in our time, the infragrantmemories of which I will not pursue beyond this slight allusion, areamong his remedies. 

The Winthrops, to one of whom Dr. Stafford's directions wereaddressed, were the medical as well as the political advisers of theirfellow-citizens for three or four successive generations. One of them, Governor John of Connecticut, practised so extensively, that, but forhis more distinguished title in the State, he would have been rememberedas the Doctor. The fact that he practised in another colony, for themost part, makes little difference in the value of the records we haveof his medical experience, which have fortunately been preserved, andgive a very fair idea, in all probability, of the way in which patientswere treated in Massachusetts, when they fell into intelligent andsomewhat educated hands, a little after the middle of the seventeenthcentury:

I have before me, while writing, a manuscript collection of the medicalcases treated by him, and recorded at the time in his own hand, whichhas been intrusted to me by our President, his descendant. 

They are generally marked Hartford, and extend from the year 1657 to1669. From these, manuscripts, and from the letters printed in theWinthrop Papers published by our Society, I have endeavored to obtainsome idea of the practice of Governor John Winthrop, Junior. The learnedeye of Mr. Pulsifer would have helped me, no doubt, as it has done inother cases; but I have ventured this time to attempt finding my ownway among the hieroglyphics of these old pages. By careful comparisonof many prescriptions, and by the aid of Schroder, Salmon, Culpeper, andother old compilers, I have deciphered many of his difficult paragraphswith their mysterious recipes. 

The Governor employed a number of the simples dear to ancient women, --elecampane and elder and wormwood and anise and the rest; but he alsoemployed certain mineral remedies, which he almost always indicates bytheir ancient symbols, or by a name which should leave them a mysteryto the vulgar. I am now prepared to reveal the mystic secrets of theGovernor's beneficent art, which rendered so many good and great as wellas so many poor and dependent people his debtors, --at least, in theirsimple belief, --for their health and their lives. 

His great remedy, which he gave oftener than any other, was nitre; whichhe ordered in doses of twenty or thirty grains to adults, and of threegrains to infants. Measles, colics, sciatica, headache, giddiness, andmany other ailments, all found themselves treated, and I trust bettered, by nitre; a pretty safe medicine in moderate doses, and one not likelyto keep the good Governor awake at night, thinking whether it might notkill, if it did not cure. We may say as much for spermaceti, which heseems to have considered "the sovereign'st thing on earth" for inwardbruises, and often prescribes after falls and similar injuries. 

One of the next remedies, in point of frequency, which he was in thehabit of giving, was (probably diaphoretic) antimony; a mild form ofthat very active metal, and which, mild as it was, left his patientsvery commonly with a pretty strong conviction that they had been takingsomething that did not exactly agree with them. Now and then he gavea little iron or sulphur or calomel, but very rarely; occasionally, agood, honest dose of rhubarb or jalap; a taste of stinging horseradish, oftener of warming guiacum; sometimes an anodyne, in the shape ofmithridate, --the famous old farrago, which owed its virtue to poppyjuice; [This is the remedy which a Boston divine tried to simplify. SeeElectuarium Novum Alexipharmacum, by Rev. Thomas Harward, lecturerat the Royal Chappell. Boston, 1732. This tract is in our Society'slibrary. ] very often, a harmless powder of coral; less frequently, aninert prescription of pleasing amber; and (let me say it softly withinpossible hearing of his honored descendant), twice or oftener, --let ushope as a last resort, --an electuary of millipedes, --sowbugs, if we mustgive them their homely English name. One or two other prescriptions, of the many unmentionable ones which disgraced the pharmacopoeia of theseventeenth century, are to be found, but only in very rare instances, in the faded characters of the manuscript. 

The excellent Governor's accounts of diseases are so brief, that we getonly a very general notion of the complaints for which he prescribed. Measles and their consequences are at first more prominent than anyother one affection, but the common infirmities of both sexes and of allages seem to have come under his healing hand. Fever and ague appears tohave been of frequent occurrence. 

His published correspondence shows that many noted people were incommunication with him as his patients. Roger Williams wants a littleof his medicine for Mrs. Weekes's daughter; worshipful John Haynes isin receipt of his powders; troublesome Captain Underhill wants "a littlewhite vitterall" for his wife, and something to cure his wife's friend'sneuralgia, (I think his wife's friend's husband had a little rather havehad it sent by the hands of Mrs. Underhill, than by those of the gallantand discursive captain); and pious John Davenport says, his wife "tookebut one halfe of one of the papers" (which probably contained themedicine he called rubila), "but could not beare the taste of it, andis discouraged from taking any more;" and honored William Leete asks formore powders for his "poore little daughter Graciana, " though he foundit "hard to make her take it, " delicate, and of course sensitive, childas she was, languishing and dying before her time, in spite of all thebitter things she swallowed, --God help all little children in the handsof dosing doctors and howling dervishes! Restless Samuel Gorton, nowtamed by the burden of fourscore and two years, writes so touching anaccount of his infirmities, and expresses such overflowing gratitude forthe relief he has obtained from the Governor's prescriptions, wonderinghow "a thing so little in quantity, so little in sent, so little intaste, and so little to sence in operation, should beget and bring forthsuch efects, " that we repent our hasty exclamation, and bless the memoryof the good Governor, who gave relief to the worn-out frame of ourlong-departed brother, the sturdy old heretic of Rhode Island. 

What was that medicine which so frequently occurs in the printed lettersunder the name of "rubila"? It is evidently a secret remedy, and, sofar as I know, has not yet been made out. I had almost given it up indespair, when I found what appears to be a key to the mystery. In thevast multitude of prescriptions contained in the manuscripts, most ofthem written in symbols, I find one which I thus interpret:

"Four grains of (diaphoretic) antimony, with twenty grains of nitre, with a little salt of tin, making rubila. " Perhaps something wasadded to redden the powder, as he constantly speaks of "rubifying" or"viridating" his prescriptions; a very common practice of prescribers, when their powders look a little too much like plain salt or sugar. 

Waitstill Winthrop, the Governor's son, "was a skilful physician, " saysMr. Sewall, in his funeral sermon; "and generously gave, not only hisadvice, but also his Medicines, for the healing of the Sick, which, bythe Blessing of God, were made successful for the recovery of many. ""His son John, a member of the Royal Society, speaks of himself as 'Dr. Winthrop, ' and mentions one of his own prescriptions in a letter toCotton Mather. " Our President tells me that there was an heirloom of theancient skill in his family, within his own remembrance, in the form ofa certain precious eye-water, to which the late President John QuincyAdams ascribed rare virtue, and which he used to obtain from thepossessor of the ancient recipe. 

These inherited prescriptions are often treasured in families, I donot doubt, for many generations. When I was yet of trivial age, andsuffering occasionally, as many children do, from what one of myCambridgeport schoolmates used to call the "ager, "--meaning therebytoothache or face-ache, --I used to get relief from a certain plasterwhich never went by any other name in the family than "Dr. Oliver. "

Dr. James Oliver was my great-great-grandfather, graduated in 1680, anddied in 1703. This was, no doubt, one of his nostrums; for nostrum, as is well known, means nothing more than our own or my own particularmedicine, or other possession or secret, and physicians in old timesused to keep their choice recipes to themselves a good deal, as we havehad occasion to see. 

Some years ago I found among my old books a small manuscript marked"James Oliver. This Book Begun Aug. 12, 1685. " It is a rough sort ofaccount-book, containing among other things prescriptions for patients, and charges for the same, with counter-charges for the purchase ofmedicines and other matters. Dr. Oliver practised in Cambridge, wheremay be seen his tomb with inscriptions, and with sculptured figures thatlook more like Diana of the Ephesians, as given in Calmet's Dictionary, than like any angels admitted into good society here or elsewhere. 

I do not find any particular record of what his patients suffered from, but I have carefully copied out the remedies he mentions, and findthat they form a very respectable catalogue. Besides the usual simples, elder, parsley, fennel, saffron, snake-root, wormwood, I find the ElixirProprietatis, with other elixire and cordials, as if he rather fanciedwarming medicines; but he called in the aid of some of the moreenergetic remedies, including iron, and probably mercury, as he boughttwo pounds of it at one time. 

The most interesting item is his bill against the estate of SamuelPason of Roxbury, for services during his last illness. He attended thisgentleman, --for such he must have been, by the amount of physic which hetook, and which his heirs paid for, --from June 4th, 1696, to September3d of the same year, three months. I observe he charges for visits aswell as for medicines, which is not the case in most of his bills. Heopens the attack with a carminative appeal to the visceral conscience, and follows it up with good hard-hitting remedies for dropsy, --as Isuppose the disease would have been called, --and finishes off with arallying dose of hartshorn and iron. 

It is a source of honest pride to his descendant that his bill, whichwas honestly paid, as it seems to have been honorably earned, amountedto the handsome total of seven pounds and two shillings. Let me add thathe repeatedly prescribes plaster, one of which was very probably the"Dr. Oliver" that soothed my infant griefs, and for which I blush to saythat my venerated ancestor received from Goodman Hancock the painfullyexiguous sum of no pounds, no shillings, and sixpence. 

I have illustrated the practice of the first century, from the twomanuscripts I have examined, as giving an impartial idea of itsevery-day methods. The Governor, Johannes Secundus, it is fair toremember, was an amateur practitioner, while my ancestor was a professedphysician. Comparing their modes of treatment with the many scientificfollies still prevailing in the Old World, and still more with theextraordinary theological superstitions of the community in which theylived, we shall find reason, I think, to consider the art of healingas in a comparatively creditable state during the first century of NewEngland. 

In addition to the evidence as to methods of treatment furnished by themanuscripts I have cited, I subjoin the following document, to whichmy attention was called by Dr. Shurtleff, our present Mayor. This is aletter of which the original is to be found in vol. Lxix. Page 10 of the"Archives" preserved at the State House in Boston. It will be seenthat what the surgeon wanted consisted chiefly of opiates, stimulants, cathartics, plasters, and materials for bandages. The complex and variedformulae have given place to simpler and often more effective forms ofthe same remedies; but the list and the manner in which it is made outare proofs of the good sense and schooling of the surgeon, who, it maybe noted, was in such haste that he neglected all his stops. He mightwell be in a hurry, as on the very day upon which he wrote, a greatbody of Indians--supposed to be six or seven hundred--appeared beforeHatfield; and twenty-five resolute young men of Hadley, from which townhe wrote, crossed the river and drove them away. 

HADLY May 30: 76

Mr RAWSON Sr

What we have recd by Tho: Houey the past month is not the chiefest ofour wants as you have love for poor wounded I pray let us not want forthese following medicines if you have not a speedy conveyance of them Ipray send on purpose they are those things mentioned in my former letterbut to prevent future mistakes I have wrote them att large wee havegreat want with the greatest halt and speed let us be supplyed. Sr YrSert WILL LOCHS. 

(Endorsed)

Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye Councilwith it but could not obtaine any thing to be sent in answer thereto. 13June 1676. 

I have given some idea of the chief remedies used by our earlierphysicians, which were both Galenic and chemical; that is, vegetable andmineral. They, of course, employed the usual perturbing medicineswhich Montaigne says are the chief reliance of their craft. There were, doubtless, individual practitioners who employed special remedies withexceptional boldness and perhaps success. Mr. Eliot is spoken of, ina letter of William Leete to Winthrop, Junior, as being under Mr. Greenland's mercurial administrations. The latter was probably enoughone of these specialists. 

There is another class of remedies which appears to have been employedoccasionally, but, on the whole, is so little prominent as to imply agood deal of common sense among the medical practitioners, as comparedwith the superstitions prevailing around them. I have said that I havecaught the good Governor, now and then, prescribing the electuary ofmillipedes; but he is entirely excused by the almost incredible factthat they were retained in the materia medica so late as when Rees'sCyclopaedia was published, and we there find the directions formerlygiven by the College of Edinburgh for their preparation. Once or twicewe have found him admitting still more objectionable articles into hismateria medica; in doing which, I am sorry to say that he couldplead grave and learned authority. But these instances are very rareexceptions in a medical practice of many years, which is, on the whole, very respectable, considering the time and circumstances. 

Some remedies of questionable though not odious character appearoccasionally to have been employed by the early practitioners, but theywere such as still had the support of the medical profession. GovernorJohn Winthrop, the first, sends for East Indian bezoar, with othercommodities he is writing for. Governor Endicott sends him one he had ofMr. Humfrey. I hope it was genuine, for they cheated infamously inthe matter of this concretion, which ought to come out of an animal'sstomach, but the real history of which resembles what is sometimes toldof modern sausages. 

There is a famous law-case of James the First's time, in which agoldsmith sold a hundred pounds' worth of what he called bezoar, whichwas proved to be false, and the purchaser got a verdict against him. Governor Endicott also sends Winthrop a unicorn's horn, which was theproperty of a certain Mrs. Beggarly, who, in spite of her name, seems tohave been rich in medical knowledge and possessions. The famous ThomasBartholinus wrote a treatise on the virtues of this fabulous-soundingremedy, which was published in 1641, and republished in 1678. 

The "antimonial cup, " a drinking vessel made of that metal, which, likeour quassia-wood cups, might be filled and emptied in saecula saeculorumwithout exhausting its virtues, is mentioned by Matthew Cradock, in aletter to the elder Winthrop, but in a doubtful way, as it was thought, he says, to have shortened the days of Sir Nathaniel Riche; and Winthrophimself, as I think, refers to its use, calling it simply "the cup. " Anantimonial cup is included in the inventory of Samuel Seabury, who died1680, and is valued at five shillings. There is a treatise entitled "TheUniversall Remedy, or the Vertues of the Antimoniall Cup, By John Evans, Minister and Preacher of God's Word, London, 1634, " in our own Society'slibrary. 

One other special remedy deserves notice, because of native growth. Ido not know when Culver's root, Leptandra Virginica of our NationalPharmacopoeia, became noted, but Cotton Mather, writing in 1716 toJohn Winthrop of New London, speaks of it as famous for the cure ofconsumptions, and wishes to get some of it, through his mediation, forKatharine, his eldest daughter. He gets it, and gives it to the"poor damsel, " who is languishing, as he says, and who dies the nextmonth, --all the sooner, I have little doubt, for this uncertain andviolent drug, with which the meddlesome pedant tormented her in thatspirit of well-meant but restless quackery, which could touch nothingwithout making mischief, not even a quotation, and yet proved at lengththe means of bringing a great blessing to our community, as we shall seeby and by; so does Providence use our very vanities and infirmities forits wise purposes. 

Externally, I find the practitioners on whom I have chiefly reliedused the plasters of Paracelsus, of melilot, diachylon, and probablydiaphoenicon, all well known to the old pharmacopoeias, and some of themto the modern ones, --to say nothing of "my yellow salve, " of GovernorJohn, the second, for the composition of which we must apply to hisrespected descendant. 

The authors I find quoted are Barbette's Surgery, Camerarius on Gout, and Wecherus, of all whom notices may be found in the pages of Hallerand Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper'sPractice of Physic and Anatomy, the last as belonging to Samuel Seabury, chirurgeon, before mentioned. Nicholas Culpeper was a shrewd charlatan, and as impudent a varlet as ever prescribed for a colic; but knew verywell what he was about, and badgers the College with great vigor. A copyof Spigelius's famous Anatomy, in the Boston Athenaeum, has the namesof Increase and Samuel Mather written in it, and was doubtless earlyoverhauled by the youthful Cotton, who refers to the great anatomist'ssingular death, among his curious stories in the "Magnalia, " and quoteshim among nearly a hundred authors whom he cites in his manuscript"The Angel of Bethesda. " Dr. John Clark's "books and instruments, with several chirurgery materials in the closet, " a were valued in hisinventory at sixty pounds; Dr. Matthew Fuller, who died in 1678, left alibrary valued at ten pounds; and a surgeon's chest and drugs valued atsixteen pounds. '

Here we leave the first century and all attempts at any further detailedaccounts of medicine and its practitioners. It is necessary to show in abrief glance what had been going on in Europe during the latter part ofthat century, the first quarter of which had been made illustrious inthe history of medical science by the discovery of the circulation. 

Charles Barbeyrac, a Protestant in his religion, was a practitionerand teacher of medicine at Montpellier. His creed was in the way ofhis obtaining office; but the young men followed his instructions withenthusiasm. Religious and scientific freedom breed in and in, until itbecomes hard to tell the family of one from that of the other. Barbeyracthrew overboard the old complex medical farragos of the pharmacopoeias, as his church had disburdened itself of the popish ceremonies. 

Among the students who followed his instructions were two Englishmen:one of them, John Locke, afterwards author of an "Essay on the HumanUnderstanding, " three years younger than his teacher; the other, ThomasSydenham, five years older. Both returned to England. Locke, whosemedical knowledge is borne witness to by Sydenham, had the goodfortune to form a correct opinion on a disease from which the Earl ofShaftesbury was suffering, which led to an operation that savedhis life. Less felicitous was his experience with a certain ancillaculinaria virgo, --which I am afraid would in those days havebeen translated kitchen-wench, instead of lady of the culinarydepartment, --who turned him off after she had got tired of him, andcalled in another practitioner. [Locke and Sydenham, p. 124. ByJohn Brown, M. D. Edinburgh, 1866. ] This helped, perhaps, to spoil apromising doctor, and make an immortal metaphysician. At any rate, Lockelaid down the professional wig and cane, and took to other studies. 

The name of Thomas Sydenham is as distinguished in the history ofmedicine as that of John Locke in philosophy. As Barbeyrac was found inopposition to the established religion, as Locke took the rational sideagainst orthodox Bishop Stillingfleet, so Sydenham went with Parliamentagainst Charles, and was never admitted a Fellow by the College ofPhysicians, which, after he was dead, placed his bust in their hall bythe side of that of Harvey. 

What Sydenham did for medicine was briefly this he studied the course ofdiseases carefully, and especially as affected by the particular season;to patients with fever he gave air and cooling drinks, instead ofsmothering and heating them, with the idea of sweating out theirdisease; he ordered horseback exercise to consumptives; he, like histeacher, used few and comparatively simple remedies; he did not give anydrug at all, if he thought none was needed, but let well enough alone. He was a sensible man, in short, who applied his common sense todiseases which he had studied with the best light of science that hecould obtain. 

The influence of the reform he introduced must have been more orless felt in this country, but not much before the beginning of theeighteenth century, as his great work was not published until 1675, andthen in Latin. I very strongly suspect that there was not so much toreform in the simple practice of the physicians of the new community, asthere was in that of the learned big-wigs of the "College, " who valuedtheir remedies too much in proportion to their complexity, and theextravagant and fantastic ingredients which went to their making. 

During the memorable century which bred and bore the Revolution, themedical profession gave great names to our history. But John Brooksbelonged to the State, and Joseph Warren belongs to the country andmankind, and to speak of them would lead me beyond my limited--subject. There would be little pleasure in dwelling on the name of BenjaminChurch; and as for the medical politicians, like Elisha Cooke in theearly part of the century, or Charles Jarvis, the bald eagle of Boston, in its later years, whether their practice was heroic or not, theirpatients were, for he is a bold man who trusts one that is makingspeeches and coaxing voters, to meddle with the internal politics of hiscorporeal republic. 

One great event stands out in the medical history of this eighteenthcentury; namely, the introduction of the practice of inoculation forsmall-pox. Six epidemics of this complaint had visited Boston in thecourse of a hundred years. Prayers had been asked in the churches formore than a hundred sick in a single day, and this many times. About athousand persons had died in a twelvemonth, we are told, and, as we mayinfer, chiefly from this cause. 

In 1721, this disease, after a respite of nineteen years, again appearedas an epidemic. In that year it was that Cotton Mather, browsing, aswas his wont, on all the printed fodder that came within reach ofhis ever-grinding mandibles, came upon an account of inoculation aspractised in Turkey, contained in the "Philosophical Transactions. " Hespoke of it to several physicians, who paid little heed to his story;for they knew his medical whims, and had probably been bored, as we saynow-a-days, many of them, with listening to his "Angel of Bethesda, " andsatiated with his speculations on the Nishmath Chajim. 

The Reverend Mather, --I use a mode of expression he often employed whenspeaking of his honored brethren, --the Reverend Mather was right thistime, and the irreverent doctors who laughed at him were wrong. One onlyof their number disputes his claim to giving the first impulse to thepractice, in Boston. This is what that person says: "The Small-Poxspread in Boston, New England, A. 1721, and the Reverend Dr. CottonMather, having had the use of these Communications from Dr. WilliamDouglass (that is, the writer of these words); surreptitiously, withoutthe knowledge of his Informer, that he might have the honour of a Newfangled notion, sets an Undaunted Operator to work, and in this Countryabout 290 were inoculated. "

All this has not deprived Cotton Mather of the credit of suggesting, anda bold and intelligent physician of the honor of carrying out, the newpractice. On the twenty-seventh day of June, 1721, Zabdiel Boylstonof Boston inoculated his only son for smallpox, --the first person eversubmitted to the operation in the New World. The story of the fierceresistance to the introduction of the practice; of how Boylston wasmobbed, and Mather had a hand-grenade thrown in at his window; ofhow William Douglass, the Scotchman, "always positive, and sometimesaccurate, " as was neatly said of him, at once depreciated the practiceand tried to get the credit of suggesting it, and how Lawrence Dalhonde, the Frenchman, testified to its destructive consequences; of how EdmundMassey, lecturer at St. Albans, preached against sinfully endeavoring toalter the course of nature by presumptuous interposition, which he wouldleave to the atheist and the scoffer, the heathen and unbeliever, whilein the face of his sermon, afterwards reprinted in Boston, many of ourNew England clergy stood up boldly in defence of the practice, --all thishas been told so well and so often that I spare you its details. Setthis good hint of Cotton Mather against that letter of his to JohnRichards, recommending the search after witch-marks, and the applicationof the water-ordeal, which means throw your grandmother into the water, if she has a mole on her arm;--if she swims, she is a witch and must behanged; if she sinks, the Lord have mercy on her soul!

Thus did America receive this great discovery, destined to savethousands of lives, via Boston, from the hands of one of our ownMassachusetts physicians. 

The year 1735 was rendered sadly memorable by the epidemic of theterrible disease known as "throat distemper, " and regarded by many asthe same as our "diphtheria. " Dr. Holyoke thinks the more general useof mercurials in inflammatory complaints dates from the time of theiremployment in this disease, in which they were thought to have provedspecially useful. 

At some time in the course of this century medical practice had settleddown on four remedies as its chief reliance. I must repeat an incidentwhich I have related in another of these Essays. When Dr. Holyoke, nearly seventy years ago, received young Mr. James Jackson as hisstudent, he showed him the formidable array of bottles, jars, anddrawers around his office, and then named the four remedies referred toas being of more importance than all the rest put together. These were"Mercury, Antimony, Opium, and Peruvian Bark. " I doubt if either ofthem remembered that, nearly seventy years before, in 1730, Dr. William Douglass, the disputatious Scotchman, mentioned those same fourremedies, in the dedication of his quarrelsome essay on inoculation, asthe most important ones in the hands of the physicians of his time. 

In the "Proceedings" of this Society for the year 1863 is a verypleasant paper by the late Dr. Ephraim Eliot, giving an account ofthe leading physicians of Boston during the last quarter of the lastcentury. The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch, Danforth, John Warren, Jeffries, are all famous in local history, and arecommemorated in our medical biographies. One of them, at least, appearsto have been more widely known, not only as one of the first aerialvoyagers, but as an explorer in the almost equally hazardous realm ofmedical theory. Dr. John Jeffries, the first of that name, is consideredby Broussais as a leader of medical opinion in America, and so referredto in his famous "Examen des Doctrines Medicales. "

Two great movements took place in this eighteenth century, the effect ofwhich has been chiefly felt in our own time; namely, the establishmentof the Massachusetts Medical Society, and the founding of the MedicalSchool of Harvard University. 

The third century of our medical history began with the introduction ofthe second great medical discovery of modern times, --of all time up tothat date, I may say, --once more via Boston, if we count the Universityvillage as its suburb, and once more by one of our Massachusettsphysicians. In the month of July, 1800, Dr. Benjamin Waterhouse ofCambridge submitted four of his own children to the new process ofvaccination, --the first persons vaccinated, as Dr. Zabdiel Boylston'sson had been the first person inoculated in the New World. 

A little before the first half of this century was completed, in theautumn of 1846, the great discovery went forth from the MassachusettsGeneral Hospital, which repaid the debt of America to the science of theOld World, and gave immortality to the place of its origin in the memoryand the heart of mankind. The production of temporary insensibility atwill--tuto, cito, jucunde, safely, quickly, pleasantly--is one of thosetriumphs over the infirmities of our mortal condition which change theaspect of life ever afterwards. Rhetoric can add nothing to its glory;gratitude, and the pride permitted to human weakness, that our Bethlehemshould have been chosen as the birthplace of this new embodiment of thedivine mercy, are all we can yet find room for. 

The present century has seen the establishment of all those greatcharitable institutions for the cure of diseases of the body and of themind, which our State and our city have a right to consider as among thechief ornaments of their civilization. 

The last century had very little to show, in our State, in the way ofmedical literature. The worthies who took care of our grandfathers andgreat-grandfathers, like the Revolutionary heroes, fought (with disease)and bled (their patients) and died (in spite of their own remedies); buttheir names, once familiar, are heard only at rare intervals. Honoredin their day, not unremembered by a few solitary students of the past, their memories are going sweetly to sleep in the arms of the patientold dry-nurse, whose "blackdrop" is the never-failing anodyne ofthe restless generations of men. Except the lively controversy oninoculation, and floating papers in journals, we have not much of valuefor that long period, in the shape of medical records. 

But while the trouble with the last century is to find authors tomention, the trouble of this would be to name all that we find. Ofthese, a very few claim unquestioned preeminence. 

Nathan Smith, born in Rehoboth, Mass. , a graduate of the Medical Schoolof our University, did a great work for the advancement of medicine andsurgery in New England, by his labors as teacher and author, greater, it is claimed by some, than was ever done by any other man. The twoWarrens, of our time, each left a large and permanent record of a mostextended surgical practice. James Jackson not only educated a wholegeneration by his lessons of wisdom, but bequeathed some of the mostvaluable results of his experience to those who came after him, in aseries of letters singularly pleasant and kindly as well as instructive. John Ware, keen and cautious, earnest and deliberate, wrote the tworemarkable essays which have identified his name, for all time, withtwo important diseases, on which he has shed new light by his originalobservations. 

I must do violence to the modesty of the living by referring to the manyimportant contributions to medical science by Dr. Jacob Bigelow, andespecially to his discourse on "Self-limited Diseases, " an address whichcan be read in a single hour, but the influence of which will be feltfor a century. 

Nor would the profession forgive me if I forgot to mention the admirablemuseum of pathological anatomy, created almost entirely by the handsof Dr. John Barnard Swett Jackson, and illustrated by his own printeddescriptive catalogue, justly spoken of by a distinguished professor inthe University of Pennsylvania as the most important contribution whichhad ever been made in this country to the branch to which it relates. 

When we look at the literature of mental disease, as seen in hospitalreports and special treatises, we can mention the names of Wyman, Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts orplaced at the head of her institutions for the treatment of the insane. 

We have a right to claim also one who is known all over the civilizedworld as a philanthropist, to us as a townsman and a graduate of our ownMedical School, Dr. Samuel Gridley Howe, the guide and benefactor ofa great multitude who were born to a world of inward or of outwarddarkness. 

I cannot pass over in silence the part taken by our own physiciansin those sanitary movements which are assuming every year greaterimportance. Two diseases especially have attracted attention, aboveall others, with reference to their causes and prevention; cholera, the "black death" of the nineteenth century, and consumption, the whiteplague of the North, both of which have been faithfully studied andreported on by physicians of our own State and city. The cultivation ofmedical and surgical specialties, which is fast becoming prevalent, isbeginning to show its effects in the literature of the profession, which is every year growing richer in original observations andinvestigations. 

To these benefactors who have labored for us in their peaceful vocation, we must add the noble army of surgeons, who went with the soldiers whofought the battles of their country, sharing many of their dangers, notrarely falling victims to fatigue, disease, or the deadly volleys towhich they often exposed themselves in the discharge of their duties. 

The pleasant biographies of the venerable Dr. Thacher, and the worthyand kind-hearted gleaner, Dr. Stephen W. Williams, who came after him, are filled with the names of men who served their generation well, andrest from their labors, followed by the blessing of those for whomthey endured the toils and fatigues inseparable from their calling. Thehardworking, intelligent country physician more especially deservesthe gratitude of his own generation, for he rarely leaves any permanentrecord in the literature of his profession. Books are hard to obtain;hospitals, which are always centres of intelligence, are remote;thoroughly educated and superior men are separated by wide intervals;and long rides, though favorable to reflection, take up much of the timewhich might otherwise be given to the labors of the study. So it is thatmen of ability and vast experience, like the late Dr. Twitchell, forinstance, make a great and deserved reputation, become the oracles oflarge districts, and yet leave nothing, or next to nothing, by whichtheir names shall be preserved from blank oblivion. 

One or two other facts deserve mention, as showing the readiness of ourmedical community to receive and adopt any important idea or discovery. The new science of Histology, as it is now called, was first broughtfully before the profession of this country by the translation ofBichat's great work, "Anatomie Generale, " by the late Dr. GeorgeHayward. 

The first work printed in this country on Auscultation, --that wonderfulart of discovering disease, which, as it were, puts a window in thebreast, through which the vital organs can be seen, to all intentsand purposes, was the manual published anonymously by "A Member of theMassachusetts Medical Society. "

We are now in some slight measure prepared to weigh the record of themedical profession in Massachusetts, and pass our judgment upon it. Butin-order to do justice to the first generation of practitioners, we mustcompare what we know of their treatment of disease with the state of theart in England, and the superstitions which they saw all around them inother departments of knowledge or belief. 

English medical literature must have been at a pretty low ebbwhen Sydenham recommended Don Quixote to Sir Richard Blackmore forprofessional reading. The College Pharmacopoeia was loaded with the mostabsurd compound mixtures, one of the most complex of which (the samewhich the Reverend Mr. Harward, "Lecturer at the Royal Chappel inBoston, " tried to simplify), was not dropped until the year 1801. SirKenelm Digby was playing his fantastic tricks with the Sympatheticpowder, and teaching Governor Winthrop, the second, how to cure feverand ague, which some may like to know. "Pare the patient's nails; putthe parings in a little bag, and hang the bag round the neck of a liveeel, and put him in a tub of water. The eel will die, and the patientwill recover. "

Wiseman, the great surgeon, was discoursing eloquently on the efficacyof the royal touch in scrofula. The founder of the Ashmolean Museum atOxford, consorting with alchemists and astrologers, was treasuringthe manuscripts of the late pious Dr. Richard Napier, in which certainletters (Rx Ris) were understood to mean Responsum Raphaelis, --theanswer of the angel Raphael to the good man's medical questions. Theillustrious Robert Boyle was making his collection of choice and saferemedies, including the sole of an old shoe, the thigh bone of a hangedman, and things far worse than these, as articles of his materia medica. Dr. Stafford, whose paper of directions to his "friend, Mr. Wintrop, " Icited, was probably a man of standing in London; yet toad-powder was hissovereign remedy. 

See what was the state of belief in other matters among the mostintelligent persons of the colonies, magistrates and clergymen. JonathanBrewster, son of the church-elder, writes the wildest letters to JohnWinthrop about alchemy, --"mad for making gold as the Lynn rock-borersare for finding it. "

Remember the theology and the diabology of the time. Mr. Cotton'sTheocracy was a royal government, with the King of kings as its nominalhead, but with an upper chamber of saints, and a tremendous oppositionin the lower house; the leader of which may have been equalled, butcannot have been surpassed by any of our earth-born politicians. Thedemons were prowling round the houses every night, as the foxes weresneaking about the hen-roosts. The men of Gloucester fired whole flasksof gunpowder at devils disguised as Indians and Frenchmen. 

How deeply the notion of miraculous interference with the course ofnature was rooted, is shown by the tenacity of the superstition aboutearthquakes. We can hardly believe that our Professor Winthrop, fatherof the old judge and the "squire, " whom many of us Cambridge peopleremember so well, had to defend himself against the learned andexcellent Dr. Prince, of the Old South Church, for discussing theirphenomena as if they belonged to the province of natural science:

Not for the sake of degrading the aspect of the noble men who foundedour State, do I refer to their idle beliefs and painful delusions, but to show against what influences the common sense of the medicalprofession had to assert itself. 

Think, then, of the blazing stars, that shook their horrid hair in thesky; the phantom ship, that brought its message direct from the otherworld; the story of the mouse and the snake at Watertown; of the miceand the prayer-book; of the snake in church; of the calf with two heads;and of the cabbage in the perfect form of a cutlash, --all which innocentoccurrences were accepted or feared as alarming portents. 

We can smile at these: but we cannot smile at the account of unhappyMary Dyer's malformed offspring; or of Mrs. Hutchinson's domesticmisfortune of similar character, in the story of which the physician, Dr. John Clark of Rhode Island, alone appears to advantage; or aswe read the Rev. Samuel Willard's fifteen alarming pages about anunfortunate young woman suffering with hysteria. Or go a littledeeper into tragedy, and see poor Dorothy Talby, mad as Ophelia, firstadmonished, then whipped; at last, taking her own little daughter'slife; put on trial, and standing mute, threatened to be pressed todeath, confessing, sentenced, praying to be beheaded; and none the lesspitilessly swung from the fatal ladder. 

The cooper's crazy wife--crazy in the belief that she has committed theunpardonable sin--tries to drown her child, to save it from misery;and the poor lunatic, who would be tenderly cared for to-day in a quietasylum, is judged to be acting under the instigation of Satan himself. Yet, after all, what can we say, who put Bunyan's "Pilgrim's Progress, "full of nightmare dreams of horror, into all our children's hands; astory in which the awful image of the man in the cage might well turnthe nursery where it is read into a madhouse?

The miserable delusion of witchcraft illustrates, in a still moreimpressive way, the false ideas which governed the supposed relation ofmen with the spiritual world. I have no doubt many physicians shared inthese superstitions. Mr. Upham says they--that is, some of them--werein the habit of attributing their want of success to the fact, that an"evil hand" was on their patient. The temptation was strong, no doubt, when magistrates and ministers and all that followed their lead werecontented with such an explanation. But how was it in Salem, accordingto Mr. Upham's own statement? Dr. John Swinnerton was, he says, formany years the principal physician of Salem. And he says, also, "TheSwinnerton family were all along opposed to Mr. Parris, and keptremarkably clear from the witchcraft delusion. " Dr. John Swinnerton--thesame, by the way, whose memory is illuminated by a ray from the geniusof Hawthorne--died the very year before the great witchcraft explosiontook place. But who can doubt that it was from him that the family hadlearned to despise and to resist the base superstition; or that BridgetBishop, whose house he rented, as Mr. Upham tells me, the first personhanged in the time of the delusion, would have found an efficientprotector in her tenant, had he been living, to head the opposition ofhis family to the misguided clergymen and magistrates?

I cannot doubt that our early physicians brought with them manyOld-World medical superstitions, and I have no question that they weremore or less involved in the prevailing errors of the community in whichthey lived. But, on the whole, their record is a clean one, so far as wecan get at it; and where it is questionable we must remember that theremust have been many little-educated persons among them; and that allmust have felt, to some extent, the influence of those sincere anddevoted but unsafe men, the physic-practising clergymen, who often usedspiritual means as a substitute for temporal ones, who looked upon ahysteric patient as possessed by the devil, and treated a fracturedskull by prayers and plasters, following the advice of a ruling elder inopposition to the "unanimous opinion of seven surgeons. "

To what results the union of the two professions was liable to lead, maybe seen by the example of a learned and famous person, who has left onrecord the product of his labors in the double capacity of clergyman andphysician. 

I have had the privilege of examining a manuscript of Cotton Mather'srelating to medicine, by the kindness of the librarian of the AmericanAntiquarian Society, to which society it belongs. A brief notice of thiscurious document may prove not uninteresting. 

It is entitled "The Angel of Bethesda: an Essay upon the Common Maladiesof Mankind, offering, first, the sentiments of Piety, " etc. , etc. , and "a collection of plain but potent and Approved REMEDIES for theMaladies. " There are sixty-six "Capsula's, " as he calls them, orchapters, in his table of contents; of which, five--from the fifteenthto the nineteenth, inclusive--are missing. This is a most unfortunateloss, as the eighteenth capsula treated of agues, and we could havelearned from it something of their degree of frequency in this part ofNew England. There is no date to the manuscript; which, however, refersto a case observed Nov. 14, 1724. 

The divine takes precedence of the physician in this extraordinaryproduction. He begins by preaching a sermon at his unfortunate patient. Having thrown him into a cold sweat by his spiritual sudorific, heattacks him with his material remedies, which are often quite asunpalatable. The simple and cleanly practice of Sydenham, with whoseworks he was acquainted, seems to have been thrown away upon him. Everything he could find mentioned in the seventy or eighty authors hecites, all that the old women of both sexes had ever told him of, getsinto his text, or squeezes itself into his margin. 

Evolving disease out of sin, he hates it, one would say, as he hates itscause, and would drive it out of the body with all noisome appliances. "Sickness is in Fact Flagellum Dei pro peccatis mundi. " So saying, heencourages the young mother whose babe is wasting away upon her breastwith these reflections:

"Think; oh the grievous Effects of Sin! This wretched Infant has notarrived unto years of sense enough, to sin after the similitude of thetransgression committed by Adam. Nevertheless the Transgression of Adam, who had all mankind Foederally, yea, Naturally, in him, has involvedthis Infant in the guilt of it. And the poison of the old serpent, whichinfected Adam when he fell into his Transgression, by hearkening to theTempter, has corrupted all mankind, and is a seed unto such diseases asthis Infant is now laboring under. Lord, what are we, and what are ourchildren, but a Generation of Vipers?"

Many of his remedies are at least harmless, but his pedantry andutter want of judgment betray themselves everywhere. He piles hisprescriptions one upon another, without the least discrimination. He isrun away with by all sorts of fancies and superstitions. He prescribeseuphrasia, eye-bright, for disease of the eyes; appealing confidently tothe strange old doctrine of signatures, which inferred its use from theresemblance of its flower to the organ of vision. For the scattering ofwens, the efficacy of a Dead Hand has been out of measure wonderful. Butwhen he once comes to the odious class of remedies, he revels in themlike a scarabeus. This allusion will bring us quite near enough to theinconceivable abominations with which he proposed to outrage the sinfulstomachs of the unhappy confederates and accomplices of Adam. 

It is well that the treatise was never printed, yet there are passagesin it worth preserving. He speaks of some remedies which have sincebecome more universally known:

"Among the plants of our soyl, Sir William Temple singles out Five [Six]as being of the greatest virtue and most friendly to health: and hisfavorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and Elder. "

"But these Five [Six] plants may admitt of some competitors. TheQUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!"

Of Ipecacuanha, he says, --"This is now in its reign; the mostfashionable vomit. "

"I am not sorry that antimonial emetics begin to be disused. "

He quotes "Mr. Lock" as recommending red poppy-water and abstinence fromflesh as often useful in children's diseases. 

One of his "Capsula's" is devoted to the animalcular origin of diseases, at the end of which he says, speaking of remedies for this supposedsource of our distempers:

"Mercury we know thee: But we are afraid thou wilt kill us too, if weemploy thee to kill them that kill us. 

"And yett, for the cleansing of the small Blood Vessels, and making wayfor the free circulation of the Blood and Lymph--there is nothing likeMercurial Deobstruents. "

From this we learn that mercury was already in common use, and thesubject of the same popular prejudice as in our own time. 

His poetical turn shows itself here and there:

"O Nightingale, with a Thorn at thy Breast; Under the trouble of aCough, what can be more proper than such thoughts as these?". . . 

If there is pathos in this, there is bathos in his apostrophe to themillipede, beginning "Poor sowbug!" and eulogizing the healing virtuesof that odious little beast; of which he tells us to take "half a pound, putt 'em alive into a quart or two of wine, " with saffron and otherdrugs, and take two ounces twice a day. 

The "Capsula" entitled "Nishmath Chajim" was printed in 1722, at NewLondon, and is in the possession of our own Society. He means, by thesewords, something like the Archxus of Van Helmont, of which he discoursesin a style wonderfully resembling that of Mr. Jenkinson in the "Vicarof Wakefield. " "Many of the Ancients thought there was much of a RealHistory in the Parable, and their Opinion was that there is, DIAPHORAKATA TAS MORPHAS, A Distinction (and so a Resemblance) of men asto their Shapes after Death. " And so on, with Ireaeus, Tertullian, Thespesius, and "the TA TONE PSEUCONE CROMATA, " in the place of"Sanconiathon, Manetho, Berosus, " and "Anarchon ara kai ateleutaion topan. "

One other passage deserves notice, as it relates to the single medicalsuggestion which does honor to Cotton Mather's memory. It does notappear that he availed himself of the information which he says, heobtained from his slave, for such I suppose he was. 

In his appendix to "Variolae Triumphatae, " he says, --

"There has been a wonderful practice lately used in several parts of theworld, which indeed is not yet become common in our nation. 

"I was first informed of it by a Garamantee servant of my own, longbefore I knew that any Europeans or Asiaticks had the least acquaintancewith it, and some years before I was enriched with the communicationsof the learned Foreigners, whose accounts I found agreeing with what Ireceived of my servant, when he shewed me the Scar of the Wound made forthe operation; and said, That no person ever died of the smallpox, intheir countrey, that had the courage to use it. 

"I have since met with a considerable Number of these Africans, whoall agree in one story; That in their countrey grandy-many dy of thesmall-pox: But now they learn this way: people take juice of smallpoxand cutty-skin and put in a Drop; then by'nd by a little sicky, sicky:then very few little things like small-pox; and nobody dy of it;and nobody have small-pox any more. Thus, in Africa, where the poorcreatures dy of the smallpox like Rotten Sheep, a merciful God hastaught them an Infallible preservative. 'T is a common practice, and isattended with a constant success. "

What has come down to us of the first century of medical practice, in the hands of Winthrop and Oliver, is comparatively simple andreasonable. I suspect that the conditions of rude, stern life, in whichthe colonists found themselves in the wilderness, took the nonsense outof them, as the exigencies of a campaign did out of our physiciansand surgeons in the late war. Good food and enough of it, pure airand water, cleanliness, good attendance, an anaesthetic, an opiate, a stimulant, quinine, and two or three common drugs, proved to be themarrow of medical treatment; and the fopperies of the pharmacopoeia wentthe way of embroidered shirts and white kid gloves and malacca joints, in their time of need. "Good wine is the best cordiall for her, " saidGovernor John Winthrop, Junior, to Samuel Symonds, speaking of thatgentleman's wife, --just as Sydenham, instead of physic, once ordered aroast chicken and a pint of canary for his patient in male hysterics. 

But the profession of medicine never could reach its full developmentuntil it became entirely separated from that of divinity. The spiritualguide, the consoler in affliction, the confessor who is admitted intothe secrets of our souls, has his own noble sphere of duties; but thehealer of men must confine himself solely to the revelations of Godin nature, as he sees their miracles with his own eyes. No doctrineof prayer or special providence is to be his excuse for not lookingstraight at secondary causes, and acting, exactly so far as experiencejustifies him, as if he were himself the divine agent which antiquityfabled him to be. While pious men were praying--humbly, sincerely, rightly, according to their knowledge--over the endless successionof little children dying of spasms in the great Dublin Hospital, asagacious physician knocked some holes in the walls of the ward, letGod's blessed air in on the little creatures, and so had already savedin that single hospital, as it was soberly calculated thirty years ago, more than sixteen thousand lives of these infant heirs of immortality. [Collins's Midwifery, p. 312. Published by order of the MassachusettsMedical Society. Boston, 1841. ]

Let it be, if you will, that the wise inspiration of the physician wasgranted in virtue of the clergyman's supplications. Still, the habitof dealing with things seen generates another kind of knowledge, andanother way of thought, from that of dealing with things unseen; whichknowledge and way of thought are special means granted by Providence, and to be thankfully accepted. 

The mediaeval ecclesiastics expressed a great truth in that saying, so often quoted, as carrying a reproach with it: "Ubi tres medici, duoathei, "--"Where there are three physicians, there are two atheists. "

It was true then, it is true to-day, that the physician very commonly, if not very generally, denies and repudiates the deity of ecclesiasticalcommerce. The Being whom Ambroise Pare meant when he spoke thosememorable words, which you may read over the professor's chair in theFrench School of Medicine, "Te le pensay, et Dieu le guarit, " "I dressedhis wound, and God healed it, "--is a different being from the God thatscholastic theologians have projected from their consciousness, orshaped even from the sacred pages which have proved so plastic intheir hands. He is a God who never leaves himself without witness, whorepenteth him of the evil, who never allows a disease or an injury, compatible with the enjoyment of life, to take its course withoutestablishing an effort, limited by certain fixed conditions, it is true, but an effort, always, to restore the broken body or the shattered mind. In the perpetual presence of this great Healing Agent, who staysthe bleeding of wounds, who knits the fractured bone, who expels thesplinter by a gentle natural process, who walls in the inflammation thatmight involve the vital organs, who draws a cordon to separate the deadpart from the living, who sends his three natural anaesthetics to theover-tasked frame in due order, according to its need, --sleep, fainting, death; in this perpetual presence, it is doubtless hard for thephysician to realize the theological fact of a vast and permanent sphereof the universe, where no organ finds itself in its natural medium, where no wound heals kindly, where the executive has abrogated thepardoning power, and mercy forgets its errand; where the omnipotent isunfelt save in malignant agencies, and the omnipresent is unseen andunrepresented; hard to accept the God of Dante's "Inferno, " and ofBunyan's caged lunatic. If this is atheism, call three, instead of twoof the trio, atheists, and it will probably come nearer the truth. 

I am not disposed to deny the occasional injurious effect of thematerializing influences to which the physician is subjected. Aspiritual guild is absolutely necessary to keep him, to keep us all, from becoming the "fingering slaves" that Wordsworth treats with suchshrivelling scorn. But it is well that the two callings have beenseparated, and it is fitting that they remain apart. In settling theaffairs of the late concern, I am afraid our good friends remain alittle in our debt. We lent them our physician Michael Servetus infair condition, and they returned him so damaged by fire as to be quiteuseless for our purposes. Their Reverend Samuel Willard wrote us a notover-wise report of a case of hysteria; and our Jean Astruc gavethem (if we may trust Dr. Smith's Dictionary of the Bible) the firstdiscerning criticism on the authorship of the Pentateuch. Our JohnLocke enlightened them with his letters concerning toleration; and theirCotton Mather obscured our twilight with his "Nishmath Chajim. "

Yet we must remember that the name of Basil Valentine, the monk, isassociated with whatever good and harm we can ascribe to antimony;and that the most remarkable of our specifics long bore the name of"Jesuit's Bark, " from an old legend connected with its introduction. "Frere Jacques, " who taught the lithotomists of Paris, owes hisecclesiastical title to courtesy, as he did not belong to a religiousorder. 

Medical science, and especially the study of mental disease, isdestined, I believe, to react to much greater advantage on the theologyof the future than theology has acted on medicine in the past. Theliberal spirit very generally prevailing in both professions, and thegood understanding between their most enlightened members, promise wellfor the future of both in a community which holds every point of humanbelief, every institution in human hands, and every word written in ahuman dialect, open to free discussion today, to-morrow, and to the endof time. Whether the world at large will ever be cured of trustingto specifics as a substitute for observing the laws of health, and tomechanical or intellectual formula as a substitute for character, mayadmit of question. Quackery and idolatry are all but immortal. 

We can find most of the old beliefs alive amongst us to-day, only havingchanged their dresses and the social spheres in which they thrive. We think the quarrels of Galenists and chemists belong to the past, forgetting that Thomsonism has its numerous apostles in our community;that it is common to see remedies vaunted as purely vegetable, andthat the prejudice against "mineral poisons, " especially mercury, isas strong in many quarters now as it was at the beginning of theseventeenth century. Names are only air, and blow away with a change ofwind; but beliefs are rooted in human wants and weakness, and die hard. The oaks of Dodona are prostrate, and the shrine of Delphi is desolate;but the Pythoness and the Sibyl may be consulted in Lowell Street for avery moderate compensation. Nostradamus and Lilly seem impossible in ourtime; but we have seen the advertisements of an astrologer in our Bostonpapers year after year, which seems to imply that he found believers andpatrons. You smiled when I related Sir Kenelm Digby's prescription withthe live eel in it; but if each of you were to empty his or her pockets, would there not roll out, from more than one of them, a horse-chestnut, carried about as a cure for rheumatism? The brazen head of Roger Baconis mute; but is not "Planchette" uttering her responses in a hundredhouses of this city? We think of palmistry or chiromancy as belonging tothe days of Albertus Magnus, or, if existing in our time, as given overto the gypsies; but a very distinguished person has recently shown methe line of life, and the line of fortune, on the palm of his hand, witha seeming confidence in the sanguine predictions of his career whichhad been drawn from them. What shall we say of the plausible andwell-dressed charlatans of our own time, who trade in false pretences, like Nicholas Knapp of old, but without any fear of being fined orwhipped; or of the many follies and inanities, imposing on the credulouspart of the community, each of them gaping with eager, open mouth fora gratuitous advertisement by the mention of its foolish name in anyrespectable connection?

I turn from this less pleasing aspect of the common intelligence whichrenders such follies possible, to close the honorable record of themedical profession in this, our ancient Commonwealth. 

We have seen it in the first century divided among clergymen, magistrates, and regular practitioners; yet, on the whole, for thetime, and under the circumstances, respectable, except where it invokedsupernatural agencies to account for natural phenomena. 

In the second century it simplified its practice, educated manyintelligent practitioners, and began the work of organizing forconcerted action, and for medical teaching. 

In this, our own century, it has built hospitals, perfected andmultiplied its associations and educational institutions, enlarged andcreated museums, and challenged a place in the world of science by itsliterature. 

In reviewing the whole course of its history we read a long list ofhonored names, and a precious record written in private memories, inpublic charities, in permanent contributions to medical science, ingenerous sacrifices for the country. We can point to our capital as theport of entry for the New World of the great medical discoveries of twosuccessive centuries, and we can claim for it the triumph over the mostdreaded foe that assails the human body, --a triumph which the annals ofthe race can hardly match in three thousand years of medical history. 

THE YOUNG PRACTITIONER

[A Valedictory Address delivered to the Graduating Class of the BellevueHospital College, March 2, 1871. ]

The occasion which calls us together reminds us not a little of thatother ceremony which unites a man and woman for life. The banns havealready been pronounced which have wedded our young friends to theprofession of their choice. It remains only to address to them somefriendly words of cheering counsel, and to bestow upon them the partingbenediction. 

This is not the time for rhetorical display or ambitious eloquence. Wemust forget ourselves, and think only of them. To us it is an occasion;to them it is an epoch. The spectators at the wedding look curiously atthe bride and bridegroom; at the bridal veil, the orange-flower garland, the giving and receiving of the ring; they listen for the tremulous"I will, " and wonder what are the mysterious syllables the clergymanwhispers in the ear of the married maiden. But to the newly-wedded pairwhat meaning in those words, "for better, for worse, " "in sickness andin health, " "till death us do part!" To the father, to the mother, whoknow too well how often the deadly nightshade is interwoven with thewreath of orange-blossoms, how empty the pageant, how momentous thereality!

You will not wonder that I address myself chiefly to those who are justleaving academic life for the sterner struggle and the larger tasks ofmatured and instructed manhood. The hour belongs to them; if others findpatience to listen, they will kindly remember that, after all, they arebut as the spectators at the wedding, and that the priest is thinkingless of them than of their friends who are kneeling at the altar. 

I speak more directly to you, then, gentlemen of the graduating class. The days of your education, as pupils of trained instructors, are over. Your first harvest is all garnered. Henceforth you are to be sowers aswell as reapers, and your field is the world. How does your knowledgestand to-day? What have you gained as a permanent possession? Whatmust you expect to forget? What remains for you yet to learn? These arequestions which it may interest you to consider. 

There is another question which must force itself on the thoughtsof many among you: "How am I to obtain patients and to keep theirconfidence?" You have chosen a laborious calling, and made manysacrifices to fit yourselves for its successful pursuit. You wish to beemployed that you may be useful, and that you may receive the reward ofyour industry. I would take advantage of these most receptive momentsto give you some hints which may help you to realize your hopes andexpectations. Such is the outline of the familiar talk I shall offeryou. 

Your acquaintance with some of the accessory branches is probablygreater now than it will be in a year from now, --much greater than itwill by ten years from now. The progress of knowledge, it may be feared, or hoped, will have outrun the text-books in which you studied thesebranches. Chemistry, for instance, is very apt to spoil on one's hands. "Nous avons change tout cela" might serve as the standing motto of manyof our manuals. Science is a great traveller, and wears her shoes outpretty fast, as might be expected. 

You are now fresh from the lecture-room and the laboratory. You can passan examination in anatomy, physiology, chemistry, materia medica, which the men in large practice all around you would find a more potentsudorific than any in the Pharmacopceia. These masters of the art ofhealing were once as ready with their answers as you are now, but theyhave got rid of a great deal of the less immediately practical part oftheir acquisitions, and you must undergo the same depleting process. Hard work will train it off, as sharp exercise trains off the fat of aprize-fighter. 

Yet, pause a moment before you infer that your teachers must havebeen in fault when they furnished you with mental stores not directlyconvertible to practical purposes, and likely in a few years to losetheir place in your memory. All systematic knowledge involves much thatis not practical, yet it is the only kind of knowledge which satisfiesthe mind, and systematic study proves, in the long-run, the easiest wayof acquiring and retaining facts which are practical. There are manythings which we can afford to forget, which yet it was well to learn. Your mental condition is not the same as if you had never known whatyou now try in vain to recall. There is a perpetual metempsychosis ofthought, and the knowledge of to-day finds a soil in the forgotten factsof yesterday. You cannot see anything in the new season of the guanoyou placed last year about the roots of your climbing plants, but it isblushing and breathing fragrance in your trellised roses; it has scaledyour porch in the bee-haunted honey-suckle; it has found its way wherethe ivy is green; it is gone where the woodbine expands its luxuriantfoliage. 

Your diploma seems very broad to-day with your list of accomplishments, but it begins to shrink from this hour like the Peau de Chagrin ofBalzac's story. Do not worry about it, for all the while there will bemaking out for you an ampler and fairer parchment, signed by old FatherTime himself as President of that great University in which experienceis the one perpetual and all-sufficient professor. 

Your present plethora of acquirements will soon cure itself. Knowledgethat is not wanted dies out like the eyes of the fishes of the MammothCave. When you come to handle life and death as your daily business, your memory will of itself bid good-by to such inmates as thewell-known foramina of the sphenoid bone and the familiar oxides ofmethyl-ethylamyl-phenyl-ammonium. Be thankful that you have once knownthem, and remember that even the learned ignorance of a nomenclatureis something to have mastered, and may furnish pegs to hang factsupon which would otherwise have strewed the floor of memory in loosedisorder. 

But your education has, after all, been very largely practical. You havestudied medicine and surgery, not chiefly in books, but at the bedsideand in the operating amphitheatre. It is the special advantage oflarge cities that they afford the opportunity of seeing a great deal ofdisease in a short space of time, and of seeing many cases of the samekind of disease brought together. Let us not be unjust to the claims ofthe schools remote from the larger centres of population. Who among ushas taught better than Nathan Smith, better than Elisha Bartlett? whoteaches better than some of our living contemporaries who divide theirtime between city and country schools? I am afraid we do not always dojustice to our country brethren, whose merits are less conspicuouslyexhibited than those of the great city physicians and surgeons, such especially as have charge of large hospitals. There are modestpractitioners living in remote rural districts who are gifted by naturewith such sagacity and wisdom, trained so well in what is most essentialto the practice of their art, taught so thoroughly by varied experience, forced to such manly self-reliance by their comparative isolation, that, from converse with them alone, from riding with them on their longrounds as they pass from village to village, from talking over caseswith them, putting up their prescriptions, watching their expedients, listening to their cautions, marking the event of their predictions, hearing them tell of their mistakes, and now and then glory a littlein the detection of another's blunder, a young man would find himselfbetter fitted for his real work than many who have followed longcourses of lectures and passed a showy examination. But the young man isexceptionally fortunate who enjoys the intimacy of such a teacher. And it must be confessed that the great hospitals, infirmaries, anddispensaries of large cities, where men of well-sifted reputations arein constant attendance, are the true centres of medical education. Nostudents, I believe, are more thoroughly aware of this than those whohave graduated at this institution. Here, as in all our larger cityschools, the greatest pains are taken to teach things as well as names. You have entered into the inheritance of a vast amount of transmittedskill and wisdom, which you have taken, warm, as it were, with the lifeof your well-schooled instructors. You have not learned all that art hasto teach you, but you are safer practitioners to-day than were many ofthose whose names we hardly mention without a genuflection. I hadrather be cared for in a fever by the best-taught among you than by therenowned Fernelius or the illustrious Boerhaave, could they come back tous from that better world where there are no physicians needed, and, ifthe old adage can be trusted, not many within call. I had rather haveone of you exercise his surgical skill upon me than find myself in thehands of a resuscitated Fabricius Hildanus, or even of a wise AmbroisePare, revisiting earth in the light of the nineteenth century. 

You will not accuse me of underrating your accomplishments. You knowwhat to do for a child in a fit, for an alderman in an apoplexy, fora girl that has fainted, for a woman in hysterics, for a leg that isbroken, for an arm that is out of joint, for fevers of every color, forthe sailor's rheumatism, and the tailor's cachexy. In fact you do reallyknow so much at this very hour, that nothing but the searching test oftime can fully teach you the limitations of your knowledge. 

Of some of these you will permit me to remind you. You will never haveoutgrown the possibility of new acquisitions, for Nature is endless inher variety. But even the knowledge which you may be said to possesswill be a different thing after long habit has made it a part of yourexistence. The tactus eruditus extends to the mind as well as to thefinger-ends. Experience means the knowledge gained by habitual trial, and an expert is one who has been in the habit of trying. This is thekind of knowledge that made Ulysses wise in the ways of men. Manycities had he seen, and known the minds of those who dwelt in them. Thisknowledge it was that Chaucer's Shipman brought home with him from thesea--

 "In many a tempest had his berd be shake. "

This is the knowledge we place most confidence in, in the practicalaffairs of life. 

Our training has two stages. The first stage deals with ourintelligence, which takes the idea of what is to be done with themost charming ease and readiness. Let it be a game of billiards, forinstance, which the marker is going to teach us. We have nothing to dobut to make this ball glance from that ball and hit that other ball, and to knock that ball with this ball into a certain caecal sacculus ordiverticulum which our professional friend calls a pocket. Nothing canbe clearer; it is as easy as "playing upon this pipe, " for which Hamletgives Guildenstern such lucid directions. But this intelligent Me, whosteps forward as the senior partner in our dual personality, turnsout to be a terrible bungler. He misses those glancing hits which thehard-featured young professional person calls "carroms, " and insists onpocketing his own ball instead of the other one. 

It is the unintelligent Me, stupid as an idiot, that has to try a thinga thousand times before he can do it, and then never knows how he doesit, that at last does it well. We have to educate ourselves through thepretentious claims of intellect, into the humble accuracy of instinct, and we end at last by acquiring the dexterity, the perfection, thecertainty, which those masters of arts, the bee and the spider, inheritfrom Nature. 

Book-knowledge, lecture-knowledge, examination-knowledge, are all in thebrain. But work-knowledge is not only in the brain, it is in the senses, in the muscles, in the ganglia of the sympathetic nerves, --all over theman, as one may say, as instinct seems diffused through every part ofthose lower animals that have no such distinct organ as a brain. Seea skilful surgeon handle a broken limb; see a wise old physician smileaway a case that looks to a novice as if the sexton would soon be sentfor; mark what a large experience has done for those who were fittedto profit by it, and you will feel convinced that, much as you know, something is still left for you to learn. 

May I venture to contrast youth and experience in medical practice, something in the way the man painted the lion, that is, the lion under?

The young man knows the rules, but the old man knows-the exceptions. Theyoung man knows his patient, but the old man knows also his patient'sfamily, dead and alive, up and down for generations. He can tellbeforehand what diseases their unborn children will be subject to, whatthey will die of if they live long enough, and whether they had betterlive at all, or remain unrealized possibilities, as belonging to a stocknot worth being perpetuated. The young man feels uneasy if he isnot continually doing something to stir up his patient's internalarrangements. The old man takes things more quietly, and is much morewilling to let well enough alone: All these superiorities, if such theyare, 'you must wait for time to bring you. In the meanwhile (if we willlet the lion be uppermost for a moment), the young man's sensesare quicker than those of his older rival. His education in all theaccessory branches is more recent, and therefore nearer the existingcondition of knowledge. He finds it easier than his seniors to acceptthe improvements which every year is bringing forward. New ideas buildtheir nests in young men's brains. "Revolutions are not made by men inspectacles, " as I once heard it remarked, and the first whispers ofa new truth are not caught by those who begin to feel the need of anear-trumpet. Granting all these advantages to the young man, heought, nevertheless, to go on improving, on the whole, as a medicalpractitioner, with every year, until he has ripened into a well-mellowedmaturity. But, to improve, he must be good for something at the start. If you ship a poor cask of wine to India and back, if you keep it a halfa century, it only grows thinner and sharper. 

You are soon to enter into relations with the public, to expend yourskill and knowledge for its benefit, and find your support in therewards of your labor. What kind of a constituency is this which is tolook to you as its authorized champions in the struggle of life againstits numerous enemies?

In the first place, the persons who seek the aid of the physician arevery honest and sincere in their wish to get rid of their complaints, and, generally speaking, to live as long as they can. Howeverattractively the future is painted to them, they are attached to theplanet with which they are already acquainted. They are addicted to thedaily use of this empirical and unchemical mixture which we call air;and would hold on to it as a tippler does to his alcoholic drinks. Thereis nothing men will not do, there is nothing they have not done, torecover their health and save their lives. They have submitted to behalf-drowned in water, and half-choked with gases, to be buried up totheir chins in earth, to be seared with hot irons like galley-slaves, tobe crimped with knives, like cod-fish, to have needles thrust intotheir flesh, and bonfires kindled on their skin, to swallow all sortsof abominations, and to pay for all this, as if to be singed and scaldedwere a costly privilege, as if blisters were a blessing, and leecheswere a luxury. What more can be asked to prove their honesty andsincerity?

This same community is very intelligent with respect to a great manysubjects-commerce, mechanics, manufactures, politics. But with regard tomedicine it is hopelessly ignorant and never finds it out. I do not knowthat it is any worse in this country than in Great Britain, where Mr. Huxley speaks very freely of "the utter ignorance of the simplest lawsof their own animal life, which prevails among even the most highlyeducated persons. " And Cullen said before him "Neither the acutestgenius nor the soundest judgment will avail in judging of a particularscience, in regard to which they have not been exercised. I have beenobliged to please my patients sometimes with reasons, and I have foundthat any will pass, even with able divines and acute lawyers; the samewill pass with the husbands as with the wives. " If the community couldonly be made aware of its own utter ignorance, and incompetence to formopinions on medical subjects, difficult enough to those who give theirlives to the study of them, the practitioner would have an easier task. But it will form opinions of its own, it cannot help it, and we cannotblame it, even though we know how slight and deceptive are theirfoundations. 

This is the way it happens: Every grown-up person has either beenill himself or had a friend suffer from illness, from which he hasrecovered. Every sick person has done something or other by somebody'sadvice, or of his own accord, a little before getting better. Thereis an irresistible tendency to associate the thing done, and theimprovement which followed it, as cause and effect. This is the greatsource of fallacy in medical practice. But the physician has some chanceof correcting his hasty inference. He thinks his prescription cured asingle case of a particular complaint; he tries it in twenty similarcases without effect, and sets down the first as probably nothing morethan a coincidence. The unprofessional experimenter or observer hasno large experience to correct his hasty generalization. He wants tobelieve that the means he employed effected his cure. He feels gratefulto the person who advised it, he loves to praise the pill or potionwhich helped him, and he has a kind of monumental pride in himself asa living testimony to its efficacy. So it is that you will find thecommunity in which you live, be it in town or country, full of brandsplucked from the burning, as they believe, by some agency which, withyour better training, you feel reasonably confident had nothing todo with it. Their disease went out of itself, and the stream from themedical fire-annihilator had never even touched it. 

You cannot and need not expect to disturb the public in the possessionof its medical superstitions. A man's ignorance is as much his privateproperty, and as precious in his own eyes, as his family Bible. You haveonly to open your own Bible at the ninth chapter of St. John's Gospel, and you will find that the logic of a restored patient was very simplethen, as it is now, and very hard to deal with. My clerical friendswill forgive me for poaching on their sacred territory, in return for anoccasional raid upon the medical domain of which they have now and thenbeen accused. 

A blind man was said to have been restored to sight by a young personwhom the learned doctors of the Jewish law considered a sinner, and, assuch, very unlikely to have been endowed with a divine gift of healing. They visited the patient repeatedly, and evidently teased him with theirquestions about the treatment, and their insinuations about the youngman, until he lost his temper. At last he turned sharply upon them:"Whether he be a sinner or no, I know not: one thing I know, that, whereas I was blind, now I see. "

This is the answer that always has been and always will be given by mostpersons when they find themselves getting well after doing anything, nomatter what, --recommended by anybody, no matter whom. Lord Bacon, RobertBoyle, Bishop Berkeley, all put their faith in panaceas which we shouldlaugh to scorn. They had seen people get well after using them. Are weany wiser than those great men? Two years ago, in a lecture before theMassachusetts Historical Society, I mentioned this recipe of Sir KenelmDigby for fever and ague: Pare the patient's nails; put the parings in alittle bag, and hang the bag round the neck of a live eel, and place himin a tub of water. The eel will die, and the patient will recover. 

Referring to this prescription in the course of the same lecture, Isaid: "You smiled when I related Sir Kenehn Digby's prescription, withthe live eel in it; but if each of you were to empty his or her pockets, would there not roll out, from more than one of them, a horse-chestnut, carried about as a cure for rheumatism?" Nobody saw fit to empty his orher pockets, and my question brought no response. But two months agoI was in a company of educated persons, college graduates every one ofthem, when a gentleman, well known in our community, a man of superiorability and strong common-sense, on the occasion of some talk arisingabout rheumatism, took a couple of very shiny horse-chestnuts from hisbreeches-pocket, and laid them on the table, telling us how, havingsuffered from the complaint in question, he had, by the advice of afriend, procured these two horse-chestnuts on a certain time a year ormore ago, and carried them about him ever since; from which very day hehad been entirely free from rheumatism. 

This argument, from what looks like cause and effect, whether it be soor not, is what you will have to meet wherever you go, and you need notthink you can answer it. In the natural course of things some thousandsof persons must be getting well or better of slight attacks of colds, of rheumatic pains, every week, in this city alone. Hundreds of them dosomething or other in the way of remedy, by medical or other advice, orof their own motion, and the last thing they do gets the credit of therecovery. Think what a crop of remedies this must furnish, if it wereall harvested!

Experience has taught, or will teach you, that most of the wonderfulstories patients and others tell of sudden and signal cures are likeOwen Glendower's story of the portents that announced his birth. Theearth shook at your nativity, did it? Very likely, and

 "So it would have done, At the same season, if your mother's cat Had kittened, though yourself had ne'er been born. "

You must listen more meekly than Hotspur did to the babbling Welshman, for ignorance is a solemn and sacred fact, and, like infancy, which itresembles, should be respected. Once in a while you will have a patientof sense, born with the gift of observation, from whom you may learnsomething. When you find yourself in the presence of one who is fertileof medical opinions, and affluent in stories of marvellous cures, --ofa member of Congress whose name figures in certificates to the value ofpatent medicines, of a voluble dame who discourses on the miracles shehas wrought or seen wrought with the little jokers of the sugar-of-milkglobule-box, take out your watch and count the pulse; also note the timeof day, and charge the price of a visit for every extra fifteen, or, ifyou are not very busy, every twenty minutes. In this way you will turnwhat seems a serious dispensation into a double blessing, for this classof patients loves dearly to talk, and it does them a deal of good, andyou feel as if you had earned your money by the dose you have taken, quite as honestly as by any dose you may have ordered. 

You must take the community just as it is, and make the best of it. You wish to obtain its confidence; there is a short rule for doing thiswhich you will find useful, --deserve it. But, to deserve it in fullmeasure, you must unite many excellences, natural and acquired. 

As the basis of all the rest, you must have all those traits ofcharacter which fit you to enter into the most intimate and confidentialrelations with the families of which you are the privileged friend andcounsellor. Medical Christianity, if I may use such a term, is of veryearly date. By the oath of Hippocrates, the practitioner of ancienttimes bound himself to enter his patient's house with the sole purposeof doing him good, and so to conduct himself as to avoid the veryappearance of evil. Let the physician of to-day begin by coming up tothis standard, and add to it all the more recently discovered virtuesand graces. 

A certain amount of natural ability is requisite to make you a goodphysician, but by no means that disproportionate development of somespecial faculty which goes by the name of genius. A just balance of themental powers is a great deal more likely to be useful than any singletalent, even were it the power of observation; in excess. For a mereobserver is liable to be too fond of facts for their own sake, so that, if he told the real truth, he would confess that he takes more pleasurein a post-mortem examination which shows him what was the matter with apatient, than in a case which insists on getting well and leaving him inthe dark as to its nature. Far more likely to interfere with the soundpractical balance of the mind is that speculative, theoretical tendencywhich has made so many men noted in their day, whose fame has passedaway with their dissolving theories. Read Dr. Bartlett's comparison ofthe famous Benjamin Rush with his modest fellow-townsman Dr. WilliamCurrie, and see the dangers into which a passion for grandiosegeneralizations betrayed a man of many admirable qualities. 

I warn you against all ambitious aspirations outside of your profession. Medicine is the most difficult of sciences and the most laborious ofarts. It will task all your powers of body and mind if you are faithfulto it. Do not dabble in the muddy sewer of politics, nor linger bythe enchanted streams of literature, nor dig in far-off fields for thehidden waters of alien sciences. The great practitioners are generallythose who concentrate all their powers on their business. If thereare here and there brilliant exceptions, it is only in virtue ofextraordinary gifts, and industry to which very few are equal. 

To get business a man mast really want it; and do you suppose that whenyou are in the middle of a heated caucus, or half-way through a delicateanalysis, or in the spasm of an unfinished ode, your eyes rolling in thefine frenzy of poetical composition, you want to be called to a teethinginfant, or an ancient person groaning under the griefs of a lumbago?I think I have known more than one young man whose doctor's signproclaimed his readiness to serve mankind in that capacity, but whohated the sound of a patient's knock, and as he sat with his book or hismicroscope, felt exactly as the old party expressed himself in my friendMr. Brownell's poem--

 "All I axes is, let me alone. "

The community soon finds out whether you are in earnest, and really meanbusiness, or whether you are one of those diplomaed dilettanti who likethe amusement of quasi medical studies, but have no idea of wastingtheir precious time in putting their knowledge in practice for thebenefit of their suffering fellow-creatures. 

The public is a very incompetent judge of your skill and knowledge, butit gives its confidence most readily to those who stand well with theirprofessional brethren, whom they call upon when they themselves or theirfamilies are sick, whom they choose to honorable offices, whose writingsand teachings they hold in esteem. A man may be much valued by theprofession and yet have defects which prevent his becoming a favoritepractitioner, but no popularity can be depended upon as permanent whichis not sanctioned by the judgment of professional experts, and withthese you will always stand on your substantial merits. 

What shall I say of the personal habits you must form if you wish forsuccess? Temperance is first upon the list. Intemperance in a physicianpartakes of the guilt of homicide, for the muddled brain may easilymake a fatal blunder in a prescription and the unsteady hand transfixan artery in an operation. Tippling doctors have been too common in thehistory of medicine. Paracelsus was a sot, Radcliffe was much too fondof his glass, and Dr. James Hurlbut of Wethersfield, Connecticut, afamous man in his time, used to drink a square bottle of rum a day, with a corresponding allowance of opium to help steady his nerves. Wecommonly speak of a man as being the worse for liquor, but I was askingan Irish laborer one day about his doctor, who, as he said, was somewhatgiven to drink. "I like him best when he's a little that way, " he said;"then I can spake to him. " I pitied the poor patient who could notventure to allude to his colic or his pleurisy until his physician wastipsy. 

There are personal habits of less gravity than the one I havementioned which it is well to guard against, or, if they are formed, to relinquish. A man who may be called at a moment's warning intothe fragrant boudoir of suffering loveliness should not unsweeten itsatmosphere with reminiscences of extinguished meerschaums. He shouldremember that the sick are sensitive and fastidious, that they love thesweet odors and the pure tints of flowers, and if his presence is notlike the breath of the rose, if his hands are not like the leaf of thelily, his visit may be unwelcome, and if he looks behind him he may seea window thrown open after he has left the sick-chamber. I remember toowell the old doctor who sometimes came to help me through those inwardgriefs to which childhood is liable. "Far off his coming "--shall I say"shone, " and finish the Miltonic phrase, or leave the verb to the happyconjectures of my audience? Before him came a soul-subduing whiffof ipecacuanha, and after him lingered a shuddering consciousness ofrhubarb. He had lived so much among his medicaments that he had at lastbecome himself a drug, and to have him pass through a sick-chamber was astronger dose than a conscientious disciple of Hahnemann would think itsafe to administer. 

Need I remind you of the importance of punctuality in your engagements, and of the worry and distress to patients and their friends which thewant of it occasions? One of my old teachers always carried two watches, to make quite sure of being exact, and not only kept his appointmentswith the regularity of a chronometer, but took great pains to be athis patient's house at the time when he had reason to believe he wasexpected, even if no express appointment was made. It is a good rule;if you call too early, my lady's hair may not be so smooth as could bewished, and, if you keep her waiting too long, her hair may be smooth, but her temper otherwise. 

You will remember, of course, always to get the weather-gage of yourpatient. I mean, to place him so that the light falls on his face andnot on yours. It is a kind of, ocular duel that is about to takeplace between you; you are going to look through his features into hispulmonary and hepatic and other internal machinery, and he is goingto look into yours quite as sharply to see what you think about hisprobabilities for time or eternity. 

No matter how hard he stares at your countenance, he should never beable to read his fate in it. It should be cheerful as long as there ishope, and serene in its gravity when nothing is left but resignation. The face of a physician, like that of a diplomatist, should beimpenetrable. Nature is a benevolent old hypocrite; she cheats the sickand the dying with illusions better than any anodynes. If there arecogent reasons why a patient should be undeceived, do it deliberatelyand advisedly, but do not betray your apprehensions through yourtell-tale features. 

We had a physician in our city whose smile was commonly reckoned asbeing worth five thousand dollars a year to him, in the days, too, ofmoderate incomes. You cannot put on such a smile as that any more thanyou can get sunshine without sun; there was a tranquil and kindly natureunder it that irradiated the pleasant face it made one happier to meeton his daily rounds. But you can cultivate the disposition, and it willwork its way through to the surface, nay, more, --you can try to wear aquiet and encouraging look, and it will react on your disposition andmake you like what you seem to be, or at least bring you nearer to itsown likeness. 

Your patient has no more right to all the truth you know than he hasto all the medicine in your saddlebags, if you carry that kind ofcartridge-box for the ammunition that slays disease. He should get onlyjust so much as is good for him. I have seen a physician examining apatient's chest stop all at once, as he brought out a particular soundwith a tap on the collarbone, in the attitude of a pointer who has justcome on the scent or sight of a woodcock. You remember the Spartan boy, who, with unmoved countenance, hid the fox that was tearing his vitalsbeneath his mantle. What he could do in his own suffering you mustlearn to do for others on whose vital organs disease has fastened itsdevouring teeth. It is a terrible thing to take away hope, even earthlyhope, from a fellow-creature. Be very careful what names you let fallbefore your patient. He knows what it means when you tell him he hastubercles or Bright's disease, and, if he hears the word carcinoma, he will certainly look it out in a medical dictionary, if he doesnot interpret its dread significance on the instant. Tell him he hasasthmatic symptoms, or a tendency to the gouty diathesis, and he willat once think of all the asthmatic and gouty old patriarchs he has everheard of, and be comforted. You need not be so cautious in speakingof the health of rich and remote relatives, if he is in the line ofsuccession. 

Some shrewd old doctors have a few phrases always on hand for patientsthat will insist on knowing the pathology of their complaints withoutthe slightest capacity of understanding the scientific explanation. Ihave known the term "spinal irritation" serve well on such occasions, but I think nothing on the whole has covered so much ground, and meantso little, and given such profound satisfaction to all parties, as themagnificent phrase "congestion of the portal system. "

Once more, let me recommend you, as far as possible, to keep yourdoubts to yourself, and give the patient the benefit of your decision. Firmness, gentle firmness, is absolutely necessary in this and certainother relations. Mr. Rarey with Cruiser, Richard with Lady Ann, Pinelwith his crazy people, show what steady nerves can do with the mostintractable of animals, the most irresistible of despots, and the mostunmanageable of invalids. 

If you cannot acquire and keep the confidence of your patient, it istime for you to give place to some other practitioner who can. If youare wise and diligent, you can establish relations with the best of themwhich they will find it very hard to break. But, if they wish to employanother person, who, as they think, knows more than you do, do not takeit as a personal wrong. A patient believes another man can save hislife, can restore him to health, which, as he thinks, you have not theskill to do. No matter whether the patient is right or wrong, it is agreat impertinence to think you have any property in him. Your estimateof your own ability is not the question, it is what the patient thinksof it. All your wisdom is to him like the lady's virtue in Raleigh'ssong:

 "If she seem not chaste to me, What care I how chaste she be?"

What I call a good patient is one who, having found a good physician, sticks to him till he dies. But there are many very good people who arenot what I call good patients. I was once requested to call on alady suffering from nervous and other symptoms. It came out in thepreliminary conversational skirmish, half medical, half social, thatI was the twenty-sixth member of the faculty into whose arms, professionally speaking, she had successively thrown herself. Notbeing a believer in such a rapid rotation of scientific crops, I gentlydeposited the burden, commending it to the care of number twenty-seven, and, him, whoever he might be, to the care of Heaven. 

If there happened to be among my audience any person who wished to knowon what principles the patient should choose his physician, I shouldgive him these few precepts to think over:

Choose a man who is personally agreeable, for a daily visit from anintelligent, amiable, pleasant, sympathetic person will cost you no morethan one from a sloven or a boor, and his presence will do more for youthan any prescription the other will order. 

Let him be a man of recognized good sense in other matters, and thechance is that he will be sensible as a practitioner. 

Let him be a man who stands well with his professional brethren, whomthey approve as honest, able, courteous. 

Let him be one whose patients are willing to die in his hands, not onewhom they go to for trifles, and leave as soon as they are in danger, and who can say, therefore, that he never loses a patient. 

Do not leave the ranks of what is called the regular profession, unlessyou wish to go farther and fare worse, for you may be assured thatits members recognize no principle which hinders their accepting anyremedial agent proved to be useful, no matter from what quarter itcomes. The difficulty is that the stragglers, organized under fantasticnames in pretentious associations, or lurking in solitary dens behinddoors left ajar, make no real contributions to the art of healing. Whenthey bring forward a remedial agent like chloral, like the bromideof potassium, like ether, used as an anesthetic, they will find nodifficulty in procuring its recognition. 

Some of you will probably be more or less troubled by the pretensionsof that parody of mediaeval theology which finds its dogma of hereditarydepravity in the doctrine of psora, its miracle of transubstantiation inthe mystery of its triturations and dilutions, its church in the peoplewho have mistaken their century, and its priests in those who havemistaken their calling. You can do little with persons who are disposedto accept these curious medical superstitions. The saturation-pointof individual minds with reference to evidence, and especially medicalevidence, differs, and must always continue to differ, very widely. There are those whose minds are satisfied with the decillionth dilutionof a scientific proof. No wonder they believe in the efficacy of asimilar attenuation of bryony or pulsatilla. You have no fulcrum youcan rest upon to lift an error out of such minds as these, often highlyendowed with knowledge and talent, sometimes with genius, but commonlyricher in the imaginative than the observing and reasoning faculties. 

Let me return once more to the young graduate. Your relations to yourprofessional brethren may be a source of lifelong happiness and growthin knowledge and character, or they may make you wretched and endby leaving you isolated from those who should be your friends andcounsellors. The life of a physician becomes ignoble when he suffershimself to feed on petty jealousies and sours his temper in perpetualquarrels. You will be liable to meet an uncomfortable man here and therein the profession, --one who is so fond of being in hot water that it isa wonder all the albumen in his body is not coagulated. There are commonbarrators among doctors as there are among lawyers, --stirrers up ofstrife under one pretext and another, but in reality because they likeit. They are their own worst enemies, and do themselves a mischief eachtime they assail their neighbors. In my student days I remember a gooddeal of this Donnybrook-Fair style of quarrelling, more especially inParis, where some of the noted surgeons were always at loggerheads, andin one of our lively Western cities. Soon after I had set up an office, I had a trifling experience which may serve to point a moral in thisdirection. I had placed a lamp behind the glass in the entry to indicateto the passer-by where relief from all curable infirmities was to besought and found. Its brilliancy attracted the attention of a deviousyouth, who dashed his fist through the glass and upset my modestluminary. All he got by his vivacious assault was that he left portionsof integument from his knuckles upon the glass, had a lame hand, wasvery easily identified, and had to pay the glazier's bill. The moral isthat, if the brilliancy of another's reputation excites your belligerentinstincts, it is not worth your while to strike at it, withoutcalculating which of you is likely to suffer most, if you do. 

You may be assured that when an ill-conditioned neighbor is alwayscomplaining of a bad taste in his mouth and an evil atmosphere abouthim, there is something wrong about his own secretions. In suchcases there is an alterative regimen of remarkable efficacy: it is astarvation-diet of letting alone. The great majority of the professionare peacefully inclined. Their pursuits are eminently humanizing, andthey look with disgust on the personalities which intrude themselvesinto the placid domain of an art whose province it is to heal and not towound. 

The intercourse of teacher and student in a large school is necessarilylimited, but it should be, and, so far as my experience goes, it is, eminently cordial and kindly. You will leave with regret, and holdin tender remembrance, those who have taken you by the hand at yourentrance on your chosen path, and led you patiently and faithfully, until the great gates at its end have swung upon their hinges, and theworld lies open before you. That venerable oath to which I have beforereferred bound the student to regard his instructor in the light of aparent, to treat his children like brothers, to succor him in his day ofneed. I trust the spirit of the oath of Hippocrates is not dead in thehearts of the students of to-day. They will remember with gratitudeevery earnest effort, every encouraging word, which has helped them intheir difficult and laborious career of study. The names they read ontheir diplomas will recall faces that are like family-portraits in theirmemory, and the echo of voices they have listened to so long will lingerin their memories far into the still evening of their lives. 

One voice will be heard no more which has been familiar to many amongyou. It is not for me, a stranger to these scenes, to speak his eulogy. I have no right to sadden this hour by dwelling on the deep regretsof friendship, or to bid the bitter tears of sorrow flow afresh. Yet Icannot help remembering what a void the death of such a practitioner asyour late instructor must leave in the wide circle of those who leanedupon his counsel and assistance in their hour of need, in a communitywhere he was so widely known and esteemed, in a school where he bore soimportant a part. There is no exemption from the common doom for himwho holds the shield to protect others. The student is called from hisbench, the professor from his chair, the practitioner in his busiestperiod hears a knock more peremptory than any patient's midnightsummons, and goes on that unreturning visit which admits of no excuse, and suffers no delay. The call of such a man away from us is thebereavement of a great family. Nor can we help regretting the lossfor him of a bright and cheerful earthly future; for the old age of aphysician is one of the happiest periods of his life. He is loved andcherished for what he has been, and even in the decline of his facultiesthere are occasions when his experience is still appealed to, and histrembling hands are looked to with renewing hope and trust, as being yetable to stay the arm of the destroyer. 

But if there is so much left for age, how beautiful, how inspiring isthe hope of youth! I see among those whom I count as listeners one bywhose side I have sat as a fellow-teacher, and by whose instructionsI have felt myself not too old to profit. As we borrowed him fromyour city, I must take this opportunity of telling you that his zeal, intelligence, and admirable faculty as an instructor were heartily anduniversally recognized among us. We return him, as we trust, uninjured, to the fellow-citizens who have the privilege of claiming him as theirown. 

And now, gentlemen of the graduating class, nothing remains but forme to bid you, in the name of those for whom I am commissioned andprivileged to speak, farewell as students, and welcome as practitioners. I pronounce the two benedictions in the same breath, as the late king'sdemise and the new king's accession are proclaimed by the same voice atthe same moment. You would hardly excuse me if I stooped to any meanerdialect than the classical and familiar language of your prescriptions, the same in which your title to the name of physician is, if, likeour own institution, you follow the ancient usage, engraved upon yourdiplomas. 

Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete, filii!

Salvete, VIRI, artis medicae magister; Salvete amici; salvete fratres!

MEDICAL LIBRARIES. 

[Dedicatory Address at the opening of the Medical Library in Boston, December 3, 1878. ]

It is my appointed task, my honorable privilege, this evening, to speakof what has been done by others. No one can bring his tribute of wordsinto the presence of great deeds, or try with them to embellish thememory of any inspiring achievement, without feeling and leavingwith others a sense of their insufficiency. So felt Alexander when hecompared even his adored Homer with the hero the poet had sung. So feltWebster when he contrasted the phrases of rhetoric with the eloquenceof patriotism and of self-devotion. So felt Lincoln when on the field ofGettysburg he spoke those immortal words which Pericles could not havebettered, which Aristotle could not have criticised. So felt he whowrote the epitaph of the builder of the dome which looks down on thecrosses and weathercocks that glitter over London. 

We are not met upon a battle-field, except so far as every laboriousachievement means a victory over opposition, indifference, selfishness, faintheartedness, and that great property of mind as well asmatter, --inertia. We are not met in a cathedral, except so far as everybuilding whose walls are lined with the products of useful and ennoblingthought is a temple of the Almighty, whose inspiration has given usunderstanding. But we have gathered within walls which bear testimony tothe self-sacrificing, persevering efforts of a few young men, to whomwe owe the origin and development of all that excites our admiration inthis completed enterprise; and I might consider my task as finished if Icontented myself with borrowing the last word of the architect's epitaphand only saying, Look around you!

The reports of the librarian have told or will tell you, in some detail, what has been accomplished since the 21st of December, 1874, when sixgentlemen met at the house of Dr. Henry Ingersoll Bowditch to discussdifferent projects for a medical library. In less than four years fromthat time, by the liberality of associations and of individuals, thiscollection of nearly ten thousand volumes, of five thousand pamphlets, and of one hundred and twenty-five journals, regularly received, --allworthily sheltered beneath this lofty roof, --has come into being underour eyes. It has sprung up, as it were; in the night like a mushroom; itstands before us in full daylight as lusty as an oak, and promising togrow and flourish in the perennial freshness of an evergreen. 

To whom does our profession owe this already large collection of books, exceeded in numbers only by four or five of the most extensive medicallibraries in the country, and lodged in a building so well adapted toits present needs? We will not point out individually all those youngermembers of the profession who have accomplished what their fathers andelder brethren had attempted and partially achieved. We need not writetheir names on these walls, after the fashion of those civic dignitarieswho immortalize themselves on tablets of marble and gates of iron. Buttheir contemporaries know them well, and their descendants will notforget them, --the men who first met together, the men who have giventheir time and their money, the faithful workers, worthy associates ofthe strenuous agitator who gave no sleep to his eyes, no slumber tohis eyelids, until he had gained his ends; the untiring, imperturbable, tenacious, irrepressible, all-subduing agitator who neither restednor let others rest until the success of the project was assured. If, against his injunctions, I name Dr. James Read Chadwick, it is only myrevenge for his having kept me awake so often and so long while he wasurging on the undertaking in which he has been preeminently active andtriumphantly successful. 

We must not forget the various medical libraries which preceded this:that of an earlier period, when Boston contained about seventy regularpractitioners, the collection afterwards transferred to the BostonAthenaeum; the two collections belonging to the University; theTreadwell Library at the Massachusetts General Hospital; the collectionsof the two societies, that for Medical Improvement and that for MedicalObservation; and more especially the ten thousand volumes relating tomedicine belonging to our noble public city library, --too many blossomson the tree of knowledge, perhaps, for the best fruit to ripen. But theMassachusetts Medical Society now numbers nearly four hundred members inthe city of Boston. The time had arrived for a new and larger movement. There was needed a place to which every respectable member of themedical profession could obtain easy access; where, under one roof, allmight find the special information they were seeking; where the latestmedical intelligence should be spread out daily as the shipping news isposted on the bulletins of the exchange; where men engaged in a commonpursuit could meet, surrounded by the mute oracles of science and art;where the whole atmosphere should be as full of professional knowledgeas the apothecary's shop is of the odor of his medicaments. This waswhat the old men longed for, --the prophets and kings of the profession, who

 "Desired it long, But died without the sight. "

This is what the young men and those who worked under their guidanceundertook to give us. And now such a library, such a reading-room, suchan exchange, such an intellectual and social meeting place, we be holda fact, plain before us. The medical profession of our city, and, letus add, of all those neighboring places which it can reach with its ironarms, is united as never before by the commune vinculum, the common bondof a large, enduring, ennobling, unselfish interest. It breathes a newair of awakened intelligence. It marches abreast of the otherlearned professions, which have long had their extensive and valuablecentralized libraries; abreast of them, but not promising to be contentwith that position. What glorifies a town like a cathedral? Whatdignifies a province like a university? What illuminates a countrylike its scholarship, and what is the nest that hatches scholars but alibrary?

The physician, some may say, is a practical man and has little use forall this book-learning. Every student has heard Sydenham's reply to SirRichard Blackmore's question as to what books he should read, --meaningmedical books. "Read Don Quixote, " was his famous answer. But Sydenhamhimself made medical books and may be presumed to have thought those atleast worth reading. Descartes was asked where was his library, and inreply held up the dissected body of an animal. But Descartes made books, great books, and a great many of them. A physician of common sensewithout erudition is better than a learned one without common sense, butthe thorough master of his profession must have learning added to hisnatural gifts. 

It is not necessary to maintain the direct practical utility of allkinds of learning. Our shelves contain many books which only a certainclass of medical scholars will be likely to consult. There is a deadmedical literature, and there is a live one. The dead is not allancient, the live is not all modern. There is none, modern or ancient, which, if it has no living value for the student, will not teach himsomething by its autopsy. But it is with the live literature of hisprofession that the medical practitioner is first of all concerned. 

Now there has come a great change in our time over the form inwhich living thought presents itself. The first printed books, --theincunabula, --were inclosed in boards of solid oak, with brazen claspsand corners; the boards by and by were replaced by pasteboard coveredwith calf or sheepskin; then cloth came in and took the place ofleather; then the pasteboard was covered with paper instead of cloth;and at this day the quarterly, the monthly, the weekly periodical in itsflimsy unsupported dress of paper, and the daily journal, naked asit came from the womb of the press, hold the larger part of the freshreading we live upon. We must have the latest thought in its latestexpression; the page must be newly turned like the morning bannock; thepamphlet must be newly opened like the ante-prandial oyster. 

Thus a library, to meet the need of our time, must take, and must spreadout in a convenient form, a great array of periodicals. Our activepractitioners read these by preference over almost everything else. Ourspecialists, more particularly, depend on the month's product, on theyearly crop of new facts, new suggestions, new contrivances, as muchas the farmer on the annual yield of his acres. One of the first wants, then, of the profession is supplied by our library in its great array ofperiodicals from many lands, in many languages. Such a number of medicalperiodicals no private library would have room for, no private personwould pay for, or flood his tables with if they were sent him fornothing. These, I think, with the reports of medical societies and thepapers contributed to them, will form the most attractive part ofour accumulated medical treasures. They will be also one of our chiefexpenses, for these journals must be bound in volumes and they requirea great amount of shelf-room; all this, in addition to the cost ofsubscription for those which are not furnished us gratuitously. 

It is true that the value of old scientific periodicals is, other thingsbeing equal, in the inverse ratio of their age, for the obvious reasonthat what is most valuable in the earlier volumes of a series is drainedoff into the standard works with which the intelligent practitioner issupposed to be familiar. But no extended record of facts grows too oldto be useful, provided only that we have a ready and sure way of gettingat the particular fact or facts we are in search of. 

And this leads me to speak of what I conceive to be one of the principaltasks to be performed by the present and the coming generation ofscholars, not only in the medical, but in every department of knowledge. I mean the formation of indexes, and more especially of indexes toperiodical literature. 

This idea has long been working in the minds of scholars, and all whohave had occasion to follow out any special subject. I have a right tospeak of it, for I long ago attempted to supply the want of indexes insome small measure for my own need. I had a very complete set of the"American Journal of the Medical Sciences;" an entire set of the "NorthAmerican Review, " and many volumes of the reprints of the three leadingBritish quarterlies. Of what use were they to me without generalindexes? I looked them all through carefully and made classified listsof all the articles I thought I should most care to read. But they soonoutgrew my lists. The "North American Review" kept filling up shelfafter shelf, rich in articles which I often wanted to consult, but whata labor to find them, until the index of Mr. Gushing, published a fewmonths since, made the contents of these hundred and twenty volumes aseasily accessible as the words in a dictionary! I had a copy of good Dr. Abraham Rees's Cyclopaedia, a treasure-house to my boyhood which hasnot lost its value for me in later years. But where to look for what Iwanted? I wished to know, for instance, what Dr. Burney had to say aboutsinging. Who would have looked for it under the Italian word cantare? Iwas curious to learn something of the etchings of Rembrandt, andwhere should I find it but under the head "Low Countries, Engraversof the, "--an elaborate and most valuable article of a hundreddouble-columned close-printed quarto pages, to which no reference, even, is made under the title Rembrandt. 

There was nothing to be done, if I wanted to know where that which Ispecially cared for was to be found in my Rees's Cyclopaedia, but tolook over every page of its forty-one quarto volumes and make outa brief list of matters of interest which I could not find by theirtitles, and this I did, at no small expense of time and trouble. 

Nothing, therefore, could be more pleasing to me than to see theattention which has been given of late years to the great work ofindexing. It is a quarter of a century since Mr. Poole published his"Index to Periodical Literature, " which it is much to be hoped is soonto appear in a new edition, grown as it must be to formidable dimensionsby the additions of so long a period. The "British and Foreign MedicalReview, " edited by the late Sir John Forties, contributed to by Huxley, Carpenter, Laycock, and others of the most distinguished scientific menof Great Britain, has an index to its twenty-four volumes, and by itsaid I find this valuable series as manageable as a lexicon. The lastedition of the "Encyclopaedia Britannica" had a complete index in aseparate volume, and the publishers of Appletons' "American Cyclopaedia"have recently issued an index to their useful work, which must greatlyadd to its value. I have already referred to the index to the "NorthAmerican Review, " which to an American, and especially to a NewEnglander, is the most interesting and most valuable addition of itskind to our literary apparatus since the publication of Mr. Allibone's"Dictionary of Authors. " I might almost dare to parody Mr. Webster'swords in speaking of Hamilton, to describe what Mr. Gushing did for thesolemn rows of back volumes of our honored old Review which had beenlong fossilizing on our shelves: "He touched the dead corpse of the'North American, ' and it sprang to its feet. " A library of the bestthought of the best American scholars during the greater portion of thecentury was brought to light by the work of the indexmaker as truly aswere the Assyrian tablets by the labors of Layard. 

A great portion of the best writing and reading literary, scientific, professional, miscellaneous--comes to us now, at stated intervals, inpaper covers. The writer appears, as it were, in his shirt-sleeves. Assoon as he has delivered his message the book-binder puts a coat onhis back, and he joins the forlorn brotherhood of "back volumes, " thanwhich, so long as they are unindexed, nothing can be more exasperating. Who wants a lock without a key, a ship without a rudder, a binnaclewithout a compass, a check without a signature, a greenback without agoldback behind it?

I have referred chiefly to the medical journals, but I would includewith these the reports of medical associations, and those separatepublications which, coming in the form of pamphlets, heap themselvesinto chaotic piles and bundles which are worse than useless, taking up agreat deal of room, and frightening everything away but mice and mousingantiquarians, or possibly at long intervals some terebrating specialist. 

Arranged, bound, indexed, all these at once become accessible andvaluable. I will take the first instance which happens to suggestitself. How many who know all about osteoblasts and the experiments ofOllier, and all that has grown out of them, know where to go for a paperby the late Dr. A. L. Peirson of Salem, published in the year 1840, under the modest title, Remarks on Fractures? And if any practitionerwho has to deal with broken bones does not know that most excellentand practical essay, it is a great pity, for it answers very numerousquestions which will be sure to suggest themselves to the surgeon andthe patient as no one of the recent treatises, on my own shelves, atleast, can do. 

But if indexing is the special need of our time in medical literature, as in every department of knowledge, it must be remembered that itis not only an immense labor, but one that never ends. It requires, therefore, the cooperation of a large number of individuals to do thework, and a large amount of money to pay for making its results publicthrough the press. When it is remembered that the catalogue of thelibrary of the British Museum is contained in nearly three thousandlarge folios of manuscript, and not all its books are yet included, thetask of indexing any considerable branch of science or literature looksas if it were well nigh impossible. But many hands make light work. An"Index Society" has been formed in England, already numbering about onehundred and seventy members. It aims at "supplying thorough indexesto valuable works and collections which have hitherto lacked them; atissuing indexes to the literature of special subjects; and at gatheringmaterials for a general reference index. " This society has published alittle treatise setting forth the history and the art of indexing, whichI trust is in the hands of some of our members, if not upon our shelves. 

Something has been done in the same direction by individuals in our owncountry, as we have already seen. The need of it in the department ofmedicine is beginning to be clearly felt. Our library has already anadmirable catalogue with cross references, the work of a number of itsyounger members cooperating in the task. A very intelligent medicalstudent, Mr. William D. Chapin, whose excellent project is indorsed bywell-known New York physicians and professors, proposes to publish ayearly index to original communications in the medical journals of theUnited States, classified by authors and subjects. But it is from theNational Medical Library at Washington that we have the best promiseand the largest expectations. That great and growing collection of fiftythousand volumes is under the eye and hand of a librarian who knowsbooks and how to manage them. For libraries are the standing armiesof civilization, and an army is but a mob without a general who canorganize and marshal it so as to make it effective. The "SpecimenFasciculus of a Catalogue of the National Medical Library, " preparedunder the direction of Dr. Billings, the librarian, would have excitedthe admiration of Haller, the master scholar in medical science ofthe last century, or rather of the profession in all centuries, and ifcarried out as it is begun will be to the nineteenth all and morethan all that the three Bibliothecae--Anatomica, Chirurgica, andMedicinae-Practicae--were to the eighteenth century. I cannot forgetthe story that Agassiz was so fond of telling of the king of Prussia andFichte. It was after the humiliation and spoliation of the kingdom byNapoleon that the monarch asked the philosopher what could be doneto regain the lost position of the nation. "Found a great university, Sire, " was the answer, and so it was that in the year 1810 theworld-renowned University of Berlin came into being. I believe that wein this country can do better than found a national university, whoseprofessors shall be nominated in caucuses, go in and out, perhaps, likepostmasters, with every change of administration, and deal with sciencein the face of their constituency as the courtier did with time whenhis sovereign asked him what o'clock it was: "Whatever hour your majestypleases. " But when we have a noble library like that at Washington, anda librarian of exceptional qualifications like the gentleman who nowholds that office, I believe that a liberal appropriation by Congressto carry out a conscientious work for the advancement of sound knowledgeand the bettering of human conditions, like this which Dr. Billingshas so well begun, would redound greatly to the honor of the nation. Itought to be willing to be at some charge to make its treasures useful toits citizens, and, for its own sake, especially to that class which hascharge of health, public and private. This country abounds in whatare called "self-made men, " and is justly proud of many whom it thusdesignates. In one sense no man is self-made who breathes the air of acivilized community. In another sense every man who is anything otherthan a phonograph on legs is self-made. But if we award his just praiseto the man who has attained any kind of excellence without having hadthe same advantages as others whom, nevertheless, he has equalled orsurpassed, let us not be betrayed into undervaluing the mechanic'scareful training to his business, the thorough and laborious educationof the scholar and the professional man. 

Our American atmosphere is vocal with the flippant loquacity of halfknowledge. We must accept whatever good can be got out of it, and keepit under as we do sorrel and mullein and witchgrass, by enriching thesoil, and sowing good seed in plenty; by good teaching and good books, rather than by wasting our time in talking against it. Half knowledgedreads nothing but whole knowledge. 

I have spoken of the importance and the predominance of periodicalliterature, and have attempted to do justice to its value. But thealmost exclusive reading of it is not without its dangers. The journalscontain much that is crude and unsound; the presumption; it might bemaintained, is against their novelties, unless they come from observersof established credit. Yet I have known a practitioner, --perhaps morethan one, --who was as much under the dominant influence of the lastarticle he had read in his favorite medical journal as a milliner underthe sway of the last fashion-plate. The difference between green andseasoned knowledge is very great, and such practitioners never hold longenough to any of their knowledge to have it get seasoned. 

It is needless to say, then, that all the substantial and permanentliterature of the profession should be represented upon our shelves. Much of it is there already, and as one private library after anotherfalls into this by the natural law of gravitation, it will graduallyacquire all that is most valuable almost without effort. A scholarshould not be in a hurry to part with his books. They are probablymore valuable to him than they can be to any other individual. WhatSwedenborg called "correspondence" has established itself betweenhis intelligence and the volumes which wall him within their sacredinclosure. Napoleon said that his mind was as if furnished withdrawers, --he drew out each as he wanted its contents, and closed itat will when done with them. The scholar's mind, to use a similarcomparison, is furnished with shelves, like his library. Each book knowsits place in the brain as well as against the wall or in the alcove. Hisconsciousness is doubled by the books which encircle him, as the treesthat surround a lake repeat themselves in its unruffled waters. Men talkof the nerve that runs to the pocket, but one who loves his books, andhas lived long with them, has a nervous filament which runs from hissensorium to every one of them. Or, if I may still let my fancy drawits pictures, a scholar's library is to him what a temple is to theworshipper who frequents it. There is the altar sacred to his holiestexperiences. There is the font where his new-born thought was baptizedand first had a name in his consciousness. There is the monumentaltablet of a dead belief, sacred still in the memory of what it was whileyet alive. No visitor can read all this on the lettered backs of thebooks that have gathered around the scholar, but for him, from the Alduson the lowest shelf to the Elzevir on the highest, every volume hasa language which none but he can interpret. Be patient with thebook-collector who loves his companions too well to let them go. Booksare not buried with their owners, and the veriest book-miser that everlived was probably doing far more for his successors than his moreliberal neighbor who despised his learned or unlearned avarice. Letthe fruit fall with the leaves still clinging round it. Who would havestripped Southey's walls of the books that filled them, when, his mindno longer capable of taking in their meaning, he would still pat andfondle them with the vague loving sense of what they had once beento him, --to him, the great scholar, now like a little child among hisplaythings?

We need in this country not only the scholar, but the virtuoso, whohoards the treasures which he loves, it may be chiefly for their rarityand because others who know more than he does of their value set a highprice upon them. As the wine of old vintages is gently decanted outof its cobwebbed bottles with their rotten corks into clean newreceptacles, so the wealth of the New World is quietly emptying manyof the libraries and galleries of the Old World into its newly formedcollections and newly raised edifices. And this process must go on in anaccelerating ratio. No Englishman will be offended if I say that beforethe New Zealander takes his stand on a broken arch of London Bridgeto sketch the ruins of St. Paul's in the midst of a vast solitude, thetreasures of the British Museum will have found a new shelter in thehalls of New York or Boston. No Catholic will think hardly of my sayingthat before the Coliseum falls, and with it the imperial city, whosedoom prophecy has linked with that of the almost eternal amphitheatre, the marbles, the bronzes, the paintings, the manuscripts of the Vaticanwill have left the shores of the Tiber for those of the Potomac, theHudson, the Mississippi, or the Sacramento. And what a delight in thepursuit of the rarities which the eager book-hunter follows with thescent of a beagle!

Shall I ever forget that rainy day in Lyons, that dingy bookshop, whereI found the Aetius, long missing from my Artis bledicae Principes, andwhere I bought for a small pecuniary consideration, though it was markedrare, and was really tres rare, the Aphorisms of Hippocrates, editedby and with a preface from the hand of Francis Rabelais? And thevellum-bound Tulpius, which I came upon in Venice, afterwards my onlyreading when imprisoned in quarantine at Marseilles, so that the twohundred and twenty-eight cases he has recorded are, many of them, tothis day still fresh in my memory. And the Schenckius, --the folio filledwith casus rariores, which had strayed in among the rubbish of thebookstall on the boulevard, --and the noble old Vesalius with its grandfrontispiece not unworthy of Titian, and the fine old Ambroise Pare, long waited for even in Paris and long ago, and the colossal Spigeliuswith his eviscerated beauties, and Dutch Bidloo with its miracles offine engraving and bad dissection, and Italian Mascagni, the despair ofall would-be imitators, and pre-Adamite John de Ketam, and antediluvianBerengarius Carpensis, --but why multiply names, every one of whichbrings back the accession of a book which was an event almost like thebirth of an infant?

A library like ours must exercise the largest hospitality. A great manybooks may be found in every large collection which remind us of thoseapostolic looking old men who figure on the platform at our politicaland other assemblages. Some of them have spoken words of wisdom in theirday, but they have ceased to be oracles; some of them never had anyparticularly important message for humanity, but they add dignity to themeeting by their presence; they look wise, whether they are so or not, and no one grudges them their places of honor. Venerable figure-heads, what would our platforms be without you?

Just so with our libraries. Without their rows of folios in creamyvellum, or showing their black backs with antique lettering of tarnishedgold, our shelves would look as insufficient and unbalanced as a columnwithout its base, as a statue without its pedestal. And do not thinkthey are kept only to be spanked and dusted during that dreadful periodwhen their owner is but too thankful to become an exile and a wandererfrom the scene of single combats between dead authors and livinghousemaids. Men were not all cowards before Agamemnon or all foolsbefore the days of Virchow and Billroth. And apart from any practicaluse to be derived from the older medical authors, is there not a truepleasure in reading the accounts of great discoverers in their ownwords? I do not pretend to hoist up the Bibliotheca Anatomica ofMangetus and spread it on my table every day. I do not get out my greatAlbinus before every lecture on the muscles, nor disturb the majesticrepose of Vesalius every time I speak of the bones he has so admirablydescribed and figured. But it does please me to read the firstdescriptions of parts to which the names of their discoverers or thosewho have first described them have become so joined that not even modernscience can part them; to listen to the talk of my old volume as Willisdescribes his circle and Fallopius his aqueduct and Varolius his bridgeand Eustachius his tube and Monro his foramen, --all so well known tous in the human body; it does please me to know the very words in whichWinslow described the opening which bears his name, and Glisson hiscapsule and De Graaf his vesicle; I am not content until I know in whatlanguage Harvey announced his discovery of the circulation, and howSpigelius made the liver his perpetual memorial, and Malpighi found amonument more enduring than brass in the corpuscles of the spleen andthe kidney. 

But after all, the readers who care most for the early records ofmedical science and art are the specialists who are dividing up thepractice of medicine and surgery as they were parcelled out, accordingto Herodotus, by the Egyptians. For them nothing is too old, nothing istoo new, for to their books of all others is applicable the saying ofD'Alembert that the author kills himself in lengthening out what thereader kills himself in trying to shorten. 

There are practical books among these ancient volumes which can nevergrow old. Would you know how to recognize "male hysteria" and totreat it, take down your Sydenham; would you read the experience ofa physician who was himself the subject of asthma, and who, notwithstanding that, in the words of Dr. Johnson, "panted on tillninety, " you will find it in the venerable treatise of Sir John Floyer;would you listen to the story of the King's Evil cured by the royaltouch, as told by a famous chirurgeon who fully believed in it, goto Wiseman; would you get at first hand the description of the spinaldisease which long bore his name, do not be startled if I tell you to goto Pott, --to Percival Pott, the great surgeon of the last century. 

There comes a time for every book in a library when it is wantedby somebody. It is but a few weeks since one of the most celebratedphysicians in the country wrote to me from a great centre of medicaleducation to know if I had the works of Sanctorius, which he had triedin vain to find. I could have lent him the "Medicina Statica, " with itsfrontispiece showing Sanctorius with his dinner on the table beforehim, in his balanced chair which sunk with him below the level of hisbanquet-board when he had swallowed a certain number of ounces, --anearly foreshadowing of Pettenkofer's chamber and quantitativephysiology, --but the "Opera Omnia" of Sanctorius I had never met with, and I fear he had to do without it. 

I would extend the hospitality of these shelves to a class of workswhich we are in the habit of considering as being outside of the paleof medical science, properly so called, and sometimes of coupling witha disrespectful name. Such has always been my own practice. I havewelcomed Culpeper and Salmon to my bookcase as willingly as Dioscoridesor Quincy, or Paris or Wood and Bache. I have found a place for St. John Long, and read the story of his trial for manslaughter with asmuch interest as the laurel-water case in which John Hunter figured asa witness. I would give Samuel Hahnemann a place by the side of SamuelThomson. Am I not afraid that some student of imaginative turn andnot provided with the needful cerebral strainers without which all therefuse of gimcrack intelligences gets into the mental drains and chokesthem up, --am I not afraid that some such student will get hold ofthe "Organon" or the "Maladies Chroniques" and be won over by theirdelusions, and so be lost to those that love him as a man of commonsense and a brother in their high calling? Not in the least. If heshowed any symptoms of infection I would for once have recourse tothe principle of similia similibus. To cure him of Hahnemann I wouldprescribe my favorite homoeopathic antidote, Okie's Bonninghausen. If that failed, I would order Grauvogl as a heroic remedy, and if hesurvived that uncured, I would give him my blessing, if I thoughthim honest, and bid him depart in peace. For me he is no longer anindividual. He belongs to a class of minds which we are bound to bepatient with if their Maker sees fit to indulge them with existence. Wemust accept the conjuring ultra-ritualist, the dreamy second adventist, the erratic spiritualist, the fantastic homoeopathist, as not unworthyof philosophic study; not more unworthy of it than the squarers of thecircle and the inventors of perpetual motion, and the other whimsicalvisionaries to whom De Morgan has devoted his most instructive andentertaining "Budget of Paradoxes. " I hope, therefore, that our librarywill admit the works of the so-called Eclectics, of the Thomsonians, ifany are in existence, of the Clairvoyants, if they have a literature, and especially of the Homoeopathists. This country seems to be the placefor such a collection, which will by and by be curious and of more valuethan at present, for Homoeopathy seems to be following the pathologicallaw of erysipelas, fading out where it originated as it spreads to newregions. At least I judge so by the following translated extract froma criticism of an American work in the "Homoeopatische Rundschau" ofLeipzig for October, 1878, which I find in the "Homoeopathic Bulletin"for the month of November just passed: "While we feel proud ofthe spread and rise of Homoeopathy across the ocean, and while theHomoeopathic works reaching us from there, and published in a stylesuch as is unknown in Germany, bear eloquent testimony to the eminentactivity of our transatlantic colleagues, we are overcome by sorrowfulregrets at the position Homoeopathy occupies in Germany. Such a work [asthe American one referred to] with us would be impossible; it would lackthe necessary support. "

By all means let our library secure a good representation of theliterature of Homoeopathy before it leaves us its "sorrowful regrets"and migrates with its sugar of milk pellets, which have taken the placeof the old pilulae micae panis, to Alaska, to "Nova Zembla, or the Lordknows where. "

What shall I say in this presence of the duties of a Librarian? Wherehave they ever been better performed than in our own public citylibrary, where the late Mr. Jewett and the living Mr. Winsor have shownus what a librarian ought to be, --the organizing head, the vigilantguardian, the seeker's index, the scholar's counsellor? His work is notmerely that of administration, manifold and laborious as its duties are. He must have a quick intelligence and a retentive memory. He is apublic carrier of knowledge in its germs. His office is like that whichnaturalists attribute to the bumble-bee, --he lays up little honey forhimself, but he conveys the fertilizing pollen from flower to flower. 

Our undertaking, just completed, --and just begun--has come at the righttime, not a day too soon. Our practitioners need a library like this, for with all their skill and devotion there is too little genuineerudition, such as a liberal profession ought to be able to claim formany of its members. In reading the recent obituary notices of the lateDr. Geddings of South Carolina, I recalled what our lamented friend Dr. Coale used to tell me of his learning and accomplishments, and I couldnot help reflecting how few such medical scholars we had to show inBoston or New England. We must clear up this unilluminated atmosphere, and here, --here is the true electric light which will irradiate itsdarkness. 

The public will catch the rays reflected from the same source oflight, and it needs instruction on the great subjects of health anddisease, --needs it sadly. It is preyed upon by every kind of impositionalmost without hindrance. Its ignorance and prejudices react uponthe profession to the great injury of both. The jealous feeling, forinstance, with regard to such provisions for the study of anatomy as aresanctioned by the laws in this State and carried out with strictregard to those laws, threatens the welfare, if not the existence ofinstitutions for medical instruction wherever it is not held in check byenlightened intelligence. And on the other hand the profession hasjust been startled by a verdict against a physician, ruinous in itsamount, --enough to drive many a hard-working young practitioner outof house and home, --a verdict which leads to the fear that suits formalpractice may take the place of the panel game and child-stealing as ameans of extorting money. If the profession in this State, which claimsa high standard of civilization, is to be crushed and ground beneath theupper millstone of the dearth of educational advantages and the lowermillstone of ruinous penalties for what the ignorant ignorantly shalldecide to be ignorance, all I can say is

 God save the Commonhealth of Massachusetts!

Once more, we cannot fail to see that just as astrology has given placeto astronomy, so theology, the science of Him whom by searching no mancan find out, is fast being replaced by what we may not improperly calltheonomy, or the science of the laws according to which the Creatoracts. And since these laws find their fullest manifestations for us, atleast, in rational human natures, the study of anthropology is largelyreplacing that of scholastic divinity. We must contemplate our Makerindirectly in human attributes as we talk of Him in human parts ofspeech. And this gives a sacredness to the study of man in his physical, mental, moral, social, and religious nature which elevates the faithfulstudents of anthropology to the dignity of a priesthood, and sheds aholy light on the recorded results of their labors, brought together asthey are in such a collection as this which is now spread out before us. 

Thus, then, our library is a temple as truly as the dome-crownedcathedral hallowed by the breath of prayer and praise, where the deadrepose and the living worship. May it, with all its treasures, beconsecrated like that to the glory of God, through the contributions itshall make to the advancement of sound knowledge, to the relief of humansuffering, to the promotion of harmonious relations between the membersof the two noble professions which deal with the diseases of the souland with those of the body, and to the common cause in which allgood men are working, the furtherance of the well-being of theirfellow-creatures!

NOTE. --As an illustration of the statement in the last paragraph butone, I take the following notice from the "Boston Daily Advertiser, " ofDecember 4th, the day after the delivery of the address: "Prince LucienBonaparte is now living in London, and is devoting himself to the workof collecting the creeds of all religions and sects, with a viewto their classification, --his object being simply scientific oranthropological. "

Since delivering the address, also, I find a leading article in the"Cincinnati Lancet and Clinic" of November 30th, headed "TheDecadence of Homoeopathy, " abundantly illustrated by extracts from the"Homoeopathic Times, " the leading American organ of that sect. 

In the New York "Medical Record" of the same date, which I had not seenbefore the delivery of my address, is an account of the action of theHomoeopathic Medical Society of Northern New York, in which Hahnemann'stheory of "dynamization" is characterized in a formal resolve as"unworthy the confidence of the Homoeopathic profession. "

It will be a disappointment to the German Homoeopathists to read in the"Homoeopathic Times" such a statement as the following: "Whatever theinfluences have been which have checked the outward development ofHomoeopathy, it is plainly evident that the Homoeopathic school, asregards the number of its openly avowed representatives, has attainedits majority, and has begun to decline both in this country and inEngland. "

All which is an additional reason for making a collection of theincredibly curious literature of Homoeopathy before that pseudologicalinanity has faded out like so many other delusions. 

SOME OF MY EARLY TEACHERS

[A Farewell Address to the Medical School of Harvard University, November 28, 1882. ]

I had intended that the recitation of Friday last should be followed bya few parting words to my class and any friends who might happen to bein the lecture-room. But I learned on the preceding evening that therewas an expectation, a desire, that my farewell should take a somewhatdifferent form; and not to disappoint the wishes of those whom I wasanxious to gratify, I made up my mind to appear before you with suchhasty preparation as the scanty time admitted. 

There are three occasions upon which a human being has a right toconsider himself as a centre of interest to those about him: when he ischristened, when he is married, and when he is buried. Every one is thechief personage, the hero, of his own baptism, his own wedding, and hisown funeral. 

There are other occasions, less momentous, in which one may make moreof himself than under ordinary circumstances he would think it properto do; when he may talk about himself, and tell his own experiences, in fact, indulge in a more or less egotistic monologue without fear orreproach. 

I think I may claim that this is one of those occasions. I havedelivered my last anatomical lecture and heard my class recite for thelast time. They wish to hear from me again in a less scholastic moodthan that in which they have known me. Will you not indulge me intelling you something of my own story?

This is the thirty-sixth Course of Lectures in which I have taken myplace and performed my duties as Professor of Anatomy. For more thanhalf of my term of office I gave instruction in Physiology, after thefashion of my predecessors and in the manner then generally prevalent inour schools, where the physiological laboratory was not a necessary partof the apparatus of instruction. It was with my hearty approval that theteaching of Physiology was constituted a separate department and madean independent Professorship. Before my time, Dr. Warren had taughtAnatomy, Physiology, and Surgery in the same course of Lectures, lastingonly three or four months. As the boundaries of science are enlarged, new divisions and subdivisions of its territories become necessary. Inthe place of six Professors in 1847, when I first became a member ofthe Faculty, I count twelve upon the Catalogue before me, and I find thewhole number engaged in the work of instruction in the Medical Schoolamounts to no less than fifty. 

Since I began teaching in this school, the aspect of many branches ofscience has undergone a very remarkable transformation. Chemistry andPhysiology are no longer what they were, as taught by the instructorsof that time. We are looking forward to the synthesis of new organiccompounds; our artificial madder is already in the market, and theindigo-raisers are now fearing that their crop will be supplanted by themanufactured article. In the living body we talk of fuel supplied andwork done, in movement, in heat, just as if we were dealing with amachine of our own contrivance. 

A physiological laboratory of to-day is equipped with instruments ofresearch of such ingenious contrivance, such elaborate construction, that one might suppose himself in a workshop where some exquisite fabricwas to be wrought, such as Queens love to wear, and Kings do not alwayslove to pay for. They are, indeed, weaving a charmed web, for these arethe looms from which comes the knowledge that clothes the nakedness ofthe intellect. Here are the mills that grind food for its hunger, and"is not the life more than meat, and the body than raiment?"

But while many of the sciences have so changed that the teachers of thepast would hardly know them, it has not been so with the branch I teach, or, rather, with that division of it which is chiefly taught in thisamphitheatre. General anatomy, or histology, on the other hand, isalmost all new; it has grown up, mainly, since I began my medicalstudies. I never saw a compound microscope during my years of study inParis. Individuals had begun to use the instrument, but I never heardit alluded to by either Professors or students. In descriptive anatomy Ihave found little to unlearn, and not a great deal that was both new andimportant to learn. Trifling additions are made from year to year, notto be despised and not to be overvalued. Some of the older anatomicalworks are still admirable, some of the newer ones very much thecontrary. I have had recent anatomical plates brought me for inspection, and I have actually button-holed the book-agent, a being commonly ashard to get rid of as the tar-baby in the negro legend, that I might puthim to shame with the imperial illustrations of the bones and musclesin the great folio of Albinus, published in 1747, and the unapproachedfigures of the lymphatic system of Mascagni, now within a very few yearsof a century old, and still copied, or, rather, pretended to be copied, in the most recent works on anatomy. 

I am afraid that it is a good plan to get rid of old Professors, and Iam thankful to hear that there is a movement for making provisionfor those who are left in need when they lose their offices and theirsalaries. I remember one of our ancient Cambridge Doctors once asked meto get into his rickety chaise, and said to me, half humorously, halfsadly, that he was like an old horse, --they had taken off his saddle andturned him out to pasture. I fear the grass was pretty short where thatold servant of the public found himself grazing. If I myself needed anapology for holding my office so long, I should find it in the fact thathuman anatomy is much the same study that it was in the days of Vesaliusand Fallopius, and that the greater part of my teaching was of such anature that it could never become antiquated. 

Let me begin with my first experience as a medical student. I had comefrom the lessons of Judge Story and Mr. Ashmun in the Law School atCambridge. I had been busy, more or less, with the pages of Blackstoneand Chitty, and other text-books of the first year of legal study. Moreor less, I say, but I am afraid it was less rather than more. For duringthat year I first tasted the intoxicating pleasure of authorship. Acollege periodical, conducted by friends of mine, still undergraduates, tempted me into print, and there is no form of lead-poisoning which morerapidly and thoroughly pervades the blood and bones and marrow than thatwhich reaches the young author through mental contact with type-metal. Qui a bu, boira, --he who has once been a drinker will drink again, saysthe French proverb. So the man or woman who has tasted type is sure toreturn to his old indulgence sooner or later. In that fatal year I hadmy first attack of authors' lead-poisoning, and I have never got quiterid of it from that day to this. But for that I might have appliedmyself more diligently to my legal studies, and carried a green bag inplace of a stethoscope and a thermometer up to the present day. 

What determined me to give up Law and apply myself to Medicine I canhardly say, but I had from the first looked upon that year's study asan experiment. At any rate, I made the change, and soon found myselfintroduced to new scenes and new companionships. 

I can scarcely credit my memory when I recall the first impressionsproduced upon me by sights afterwards become so familiar that theycould no more disturb a pulse-beat than the commonest of every-dayexperiences. The skeleton, hung aloft like a gibbeted criminal, lookedgrimly at me as I entered the room devoted to the students of the schoolI had joined, just as the fleshless figure of Time, with the hour-glassand scythe, used to glare upon me in my childhood from the "New EnglandPrimer. " The white faces in the beds at the Hospital found theirreflection in my own cheeks, which lost their color as I looked uponthem. All this had to pass away in a little time; I had chosen myprofession, and must meet its painful and repulsive aspects until theylost their power over my sensibilities. 

The private medical school which I had joined was one established by Dr. James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow Lewis, and Dr. George W. Otis. Of the first three gentlemen I have eitherspoken elsewhere or may find occasion to speak hereafter. The twoyounger members of this association of teachers were both graduates ofour University, one of the year 1819, the other of 1818. 

Dr. Lewis was a great favorite with students. He was a man of verylively temperament, fond of old books and young people, open-hearted, free-spoken, an enthusiast in teaching, and especially at home in thatapartment of the temple of science where nature is seen in undress, theanthropotomic laboratory, known to common speech as the dissecting-room. He had that quality which is the special gift of the man born for ateacher, --the power of exciting an interest in that which he taught. While he was present the apartment I speak of was the sunniest ofstudios in spite of its mortuary spectacles. Of the students I met thereI best remember James Jackson, Junior, full of zeal and playful as aboy, a young man whose early death was a calamity to the profession ofwhich he promised to be a chief ornament; the late Reverend J. S. C. Greene, who, as the prefix to his name signifies, afterwards changed hisprofession, but one of whose dissections I remember looking upon withadmiration; and my friend Mr. Charles Amory, as we call him, Dr. CharlesAmory, as he is entitled to be called, then, as now and always, afavorite with all about him. He had come to us from the schoolsof Germany, and brought with him recollections of the teachings ofBlumenbach and the elder Langenbeck, father of him whose portrait hangsin our Museum. Dr. Lewis was our companion as well as our teacher. Agood demonstrator is, --I will not say as important as a good Professorin the teaching of Anatomy, because I am not sure that he is notmore important. He comes into direct personal relations with thestudents, --he is one of them, in fact, as the Professor cannot be fromthe nature of his duties. The Professor's chair is an insulating stool, so to speak; his age, his knowledge, real or supposed, his officialstation, are like the glass legs which support the electrician's pieceof furniture, and cut it off from the common currents of the floor uponwhich it stands. Dr. Lewis enjoyed teaching and made his students enjoybeing taught. He delighted in those anatomical conundrums to answerwhich keeps the student's eyes open and his wits awake. He was happy ashe dexterously performed the tour de maitre of the old barber-surgeons, or applied the spica bandage and taught his scholars to do it, so neatlyand symmetrically that the aesthetic missionary from the older centre ofcivilization would bend over it in blissful contemplation, as if it werea sunflower. Dr. Lewis had many other tastes, and was a favorite, notonly with students, but in a wide circle, professional, antiquarian, masonic, and social. 

Dr. Otis was less widely known, but was a fluent and agreeable lecturer, and esteemed as a good surgeon. 

I must content myself with this glimpse at myself and a few of myfellow-students in Boston. After attending two courses of Lectures inthe school of the University, I went to Europe to continue my studies. 

You may like to hear something of the famous Professors of Paris in thedays when I was a student in the Ecole de Medicine, and following thegreat Hospital teachers. 

I can hardly believe my own memory when I recall the old practitionersand Professors who were still going round the hospitals when I mingledwith the train of students that attended the morning visits. See thatbent old man who is groping his way through the wards of La Charity. That is the famous Baron Boyer, author of the great work on surgery innine volumes, a writer whose clearness of style commends his treatise togeneral admiration, and makes it a kind of classic. He slashes away at aterrible rate, they say, when he gets hold of the subject of fistula inits most frequent habitat, --but I never saw him do more than look as ifhe wanted to cut a good dollop out of a patient he was examining. Theshort, square, substantial man with iron-gray hair, ruddy face, andwhite apron is Baron Larrey, Napoleon's favorite surgeon, the mosthonest man he ever saw, --it is reputed that he called him. To go roundthe Hotel des Invalides with Larrey was to live over the campaignsof Napoleon, to look on the sun of Austerlitz, to hear the cannons ofMarengo, to struggle through the icy waters of the Beresina, to shiverin the snows of the Russian retreat, and to gaze through the battlesmoke upon the last charge of the red lancers on the redder field ofWaterloo. Larrey was still strong and sturdy as I saw him, and fewportraits remain printed in livelier colors on the tablet of my memory. 

Leave the little group of students which gathers about Larrey beneaththe gilded dome of the Invalides and follow me to the Hotel Dieu, whererules and reigns the master-surgeon of his day, at least so far asParis and France are concerned, --the illustrious Baron Dupuytren. Noman disputed his reign, some envied his supremacy. Lisfranc shrugged hisshoulders as he spoke of "ce grand homme de l'autre cots de la riviere, "that great man on the other side of the river, but the great man heremained, until he bowed before the mandate which none may disobey. "Three times, " said Bouillaud, "did the apoplectic thunderbolt fall onthat robust brain, "--it yielded at last as the old bald cliff thatis riven and crashes down into the valley. I saw him before thefirst thunderbolt had descended: a square, solid man, with a high andfull-domed head, oracular in his utterances, indifferent to those aroundhim, sometimes, it was said, very rough with them. He spoke in low, eventones, with quiet fluency, and was listened to with that hush of raptattention which I have hardly seen in any circle of listeners unlesswhen such men as ex-President John Quincy Adams or Daniel Webster werethe speakers. I do not think that Dupuytren has left a record whichexplains his influence, but in point of fact he dominated those aroundhim in a remarkable manner. You must have all witnessed something of thesame kind. The personal presence of some men carries command with it, and their accents silence the crowd around them, when the same wordsfrom other lips might fall comparatively unheeded. 

As for Lisfranc, I can say little more of him than that he was agreat drawer of blood and hewer of members. I remember his ordering awholesale bleeding of his patients, right and left, whatever might bethe matter with them, one morning when a phlebotomizing fit was onhim. I recollect his regretting the splendid guardsmen of the oldEmpire, --for what? because they had such magnificent thighs to amputate. I got along about as far as that with him, when I ceased to be afollower of M. Lisfranc. 

The name of Velpeau must have reached many of you, for he died in 1867, and his many works made his name widely known. Coming to Paris in woodenshoes, starving, almost, at first, he raised himself to great eminenceas a surgeon and as an author, and at last obtained the Professorshipto which his talents and learning entitled him. His example may be anencouragement to some of my younger hearers who are born, not with thesilver spoon in their mouths, but with the two-tined iron fork in theirhands. It is a poor thing to take up their milk porridge with intheir young days, but in after years it will often transfix the soliddumplings that roll out of the silver spoon. So Velpeau found it. Hehad not what is called genius, he was far from prepossessing in aspect, looking as if he might have wielded the sledge-hammer (as I think hehad done in early life) rather than the lancet, but he had industry, determination, intelligence, character, and he made his way todistinction and prosperity, as some of you sitting on these benches andwondering anxiously what is to become of you in the struggle for lifewill have done before the twentieth century has got halfway through itsfirst quarter. A good sound head over a pair of wooden shoes is a greatdeal better than a wooden head belonging to an owner who cases his feetin calf-skin, but a good brain is not enough without a stout heart tofill the four great conduits which carry at once fuel and fire to thatmightiest of engines. 

How many of you who are before me are familiarly acquainted with thename of Broussais, or even with that of Andral? Both were lecturing atthe Ecole de Medicine, and I often heard them. Broussais was in thosedays like an old volcano, which has pretty nearly used up its fire andbrimstone, but is still boiling and bubbling in its interior, and nowand then sends up a spirt of lava and a volley of pebbles. His theoriesof gastro-enteritis, of irritation and inflammation as the cause ofdisease, and the practice which sprang from them, ran over the fields ofmedicine for a time like flame over the grass of the prairies. The wayin which that knotty-featured, savage old man would bring out the wordirritation--with rattling and rolling reduplication of the resonantletter r--might have taught a lesson in articulation to Salvini. ButBroussais's theory was languishing and well-nigh become obsolete, andthis, no doubt, added vehemence to his defence of his cherished dogmas. 

Old theories, and old men who cling to them, must take themselves out ofthe way as the new generation with its fresh thoughts and altered habitsof mind comes forward to take the place of that which is dying out. Thiswas a truth which the fiery old theorist found it very hard to learn, and harder to bear, as it was forced upon him. For the hour of hislecture was succeeded by that of a younger and far more popularprofessor. As his lecture drew towards its close, the benches, thinlysprinkled with students, began to fill up; the doors creaked open andbanged back oftener and oftener, until at last the sound grew almostcontinuous, and the voice of the lecturer became a leonine growl as hestrove in vain to be heard over the noise of doors and footsteps. 

Broussais was now sixty-two years old. The new generation had outgrownhis doctrines, and the Professor for whose hour the benches had filledthemselves belonged to that new generation. Gabriel Andral was littlemore than half the age of Broussais, in the full prime and vigor ofmanhood at thirty-seven years. He was a rapid, fluent, fervid, andimaginative speaker, pleasing in aspect and manner, --a strong contrastto the harsh, vituperative old man who had just preceded him. HisClinique Medicale is still valuable as a collection of cases, andhis researches on the blood, conducted in association with Gavarret, contributed new and valuable facts to science. But I remember himchiefly as one of those instructors whose natural eloquence made itdelightful to listen to him. I doubt if I or my fellow-students did fulljustice either to him or to the famous physician of Hotel Dieu, Chomel. We had addicted ourselves almost too closely to the words of anothermaster, by whom we were ready to swear as against all teachers that everwere or ever would be. 

This object of our reverence, I might almost say idolatry, was one whosename is well known to most of the young men before me, even to those whomay know comparatively little of his works and teachings. Pierre CharlesAlexandre Louis, at the age of forty-seven, as I recall him, was a tall, rather spare, dignified personage, of serene and grave aspect, but witha pleasant smile and kindly voice for the student with whom he cameinto personal relations. If I summed up the lessons of Louis in twoexpressions, they would be these; I do not hold him answerable for thewords, but I will condense them after my own fashion in French, and thengive them to you, expanded somewhat, in English:

 Formez toujours des idees nettes. Fuyez toujours les a peu pres. 

Always make sure that you form a distinct and clear idea of the matteryou are considering. 

Always avoid vague approximations where exact estimates are possible;about so many, --about so much, instead of the precise number andquantity. 

Now, if there is anything on which the biological sciences have pridedthemselves in these latter years it is the substitution of quantitativefor qualitative formulae. The "numerical system, " of which Louis wasthe great advocate, if not the absolute originator, was an attemptto substitute series of carefully recorded facts, rigidly counted andclosely compared, for those never-ending records of vague, unverifiableconclusions with which the classics of the healing art were overloaded. The history of practical medicine had been like the story of theDanaides. "Experience" had been, from time immemorial, pouring itsflowing treasures into buckets full of holes. At the existing rate ofsupply and leakage they would never be filled; nothing would ever besettled in medicine. But cases thoroughly recorded and mathematicallyanalyzed would always be available for future use, and when accumulatedin sufficient number would lead to results which would be trustworthy, and belong to science. 

You young men who are following the hospitals hardly know how much youare indebted to Louis. I say nothing of his Researches on Phthisis orhis great work on Typhoid Fever. But I consider his modest and briefEssay on Bleeding in some Inflammatory Diseases, based on casescarefully observed and numerically analyzed, one of the most importantwritten contributions to practical medicine, to the treatment ofinternal disease, of this century, if not since the days of Sydenham. The lancet was the magician's wand of the dark ages of medicine. The oldphysicians not only believed in its general efficacy as a wonder-workerin disease, but they believed that each malady could be successfullyattacked from some special part of the body, --the strategic point whichcommanded the seat of the morbid affection. On a figure given in thecurious old work of John de Ketam, no less than thirty-eight separateplaces are marked as the proper ones to bleed from, in differentdiseases. Even Louis, who had not wholly given up venesection, used nowand then to order that a patient suffering from headache should be bledin the foot, in preference to any other part. 

But what Louis did was this: he showed by a strict analysis of numerouscases that bleeding did not strangle, --jugulate was the word thenused, --acute diseases, more especially pneumonia. This was not areform, --it was a revolution. It was followed up in this country by theremarkable Discourse of Dr. Jacob Bigelow upon Self-Limited Diseases, which has, I believe, done more than any other work or essay in ourown language to rescue the practice of medicine from the slavery to thedrugging system which was a part of the inheritance of the profession. 

Yes, I say, as I look back on the long hours of the many days I spentin the wards and in the autopsy room of La Pitie, where Louis was oneof the attending physicians, --yes, Louis did a great work for practicalmedicine. Modest in the presence of nature, fearless in the face ofauthority, unwearying in the pursuit of truth, he was a man whom anystudent might be happy and proud to claim as his teacher and his friend, and yet, as I look back on the days when I followed his teachings, Ifeel that I gave myself up too exclusively to his methods of thought andstudy. 

There is one part of their business which certain medical practitionersare too apt to forget; namely, that what they should most of all try todo is to ward off disease, to alleviate suffering, to preserve life, orat least to prolong it if possible. It is not of the slightest interestto the patient to know whether three or three and a quarter cubic inchesof his lung are hepatized. His mind is not occupied with thinking ofthe curious problems which are to be solved by his own autopsy, --whetherthis or that strand of the spinal marrow is the seat of this or thatform of degeneration. He wants something to relieve his pain, tomitigate the anguish of dyspnea, to bring back motion and sensibilityto the dead limb, to still the tortures of neuralgia. What is it to himthat you can localize and name by some uncouth term the disease whichyou could not prevent and which you cannot cure? An old woman who knowshow to make a poultice and how to put it on, and does it tuto, eito, jucunde, just when and where it is wanted, is better, --a thousand timesbetter in many cases, --than a staring pathologist, who explores andthumps and doubts and guesses, and tells his patient be will be bettertomorrow, and so goes home to tumble his books over and make out adiagnosis. 

But in those days, I, like most of my fellow students, was thinking muchmore of "science" than of practical medicine, and I believe if we hadnot clung so closely to the skirts of Louis and had followed some ofthe courses of men like Trousseau, --therapeutists, who gave specialattention to curative methods, and not chiefly to diagnosis, --it wouldhave been better for me and others. One thing, at any rate, we didlearn in the wards of Louis. We learned that a very large proportion ofdiseases get well of themselves, without any special medication, --thegreat fact formulated, enforced, and popularized by Dr. Jacob Bigelowin the Discourse referred to. We unlearned the habit of drugging for itsown sake. This detestable practice, which I was almost proscribed forcondemning somewhat too epigrammatically a little more than twenty yearsago, came to us, I suspect, in a considerable measure from the English"general practitioners, " a sort of prescribing apothecaries. Youremember how, when the city was besieged, each artisan who was calledupon in council to suggest the best means of defence recommended thearticles he dealt in: the carpenter, wood; the blacksmith, iron; themason, brick; until it came to be a puzzle to know which to adopt. Thenthe shoemaker said, "Hang your walls with new boots, " and gave goodreasons why these should be the best of all possible defences. Now the"general practitioner" charged, as I understand, for his medicine, and in that way got paid for his visit. Wherever this is the practice, medicine is sure to become a trade, and the people learn to expectdrugging, and to consider it necessary, because drugs are so universallygiven to the patients of the man who gets his living by them. 

It was something to have unlearned the pernicious habit of constantlygiving poisons to a patient, as if they were good in themselves, ofdrawing off the blood which he would want in his struggle with disease, of making him sore and wretched with needless blisters, of turning hisstomach with unnecessary nauseous draught and mixtures, --only because hewas sick and something must be done. But there were positive as well asnegative facts to be learned, and some of us, I fear, came home richin the negatives of the expectant practice, poor in the resources whichmany a plain country practitioner had ready in abundance for the reliefand the cure of disease. No one instructor can be expected to do all fora student which he requires. Louis taught us who followed him the loveof truth, the habit of passionless listening to the teachings of nature, the most careful and searching methods of observation, and the suremeans of getting at the results to be obtained from them in the constantemployment of accurate tabulation. He was not a showy, or eloquent, or, I should say, a very generally popular man, though the favorite, almostthe idol, of many students, especially Genevese and Bostonians. But hewas a man of lofty and admirable scientific character, and his work willendure in its influences long after his name is lost sight of save tothe faded eyes of the student of medical literature. 

Many other names of men more or less famous in their day, and who wereteaching while I was in Paris, come up before me. They are but emptysounds for the most part in the ears of persons of not more than middleage. Who of you knows anything of Richerand, author of a very popularwork on Physiology, commonly put into the student's hands when I firstbegan to ask for medical text-books? I heard him lecture once, and havehad his image with me ever since as that of an old, worn-out man, --avenerable but dilapidated relic of an effete antiquity. To verify thisimpression I have just looked out the dates of his birth and death, and find that he was eighteen years younger than the speaker who is nowaddressing you. There is a terrible parallax between the period beforethirty and that after threescore and ten, as two men of those ages look, one with naked eyes, one through his spectacles, at the man of fifty andthereabout. Magendie, I doubt not you have all heard of. I attended butone of his lectures. I question if one here, unless some contemporaryof my own has strayed into the amphitheatre, --knows anything aboutMarjolin. I remember two things about his lectures on surgery, the deeptones of his voice as he referred to his oracle, --the earlier writer, Jean Louis Petit, --and his formidable snuffbox. What he taught me liesfar down, I doubt not, among the roots of my knowledge, but it doesnot flower out in any noticeable blossoms, or offer me any very obviousfruits. Where now is the fame of Bouillaud, Professor and Deputy, theSangrado of his time? Where is the renown of Piorry, percussionist andpoet, expert alike in the resonances of the thoracic cavity and thoseof the rhyming vocabulary?--I think life has not yet done with thevivacious Ricord, whom I remember calling the Voltaire of pelvicliterature, --a sceptic as to the morality of the race in general, whowould have submitted Diana to treatment with his mineral specifics, andordered a course of blue pills for the vestal virgins. 

Ricord was born at the beginning of the century, and Piorry some yearsearlier. Cruveilhier, who died in 1874, is still remembered by his greatwork on pathological anatomy; his work on descriptive anatomy has somethings which I look in vain for elsewhere. But where is Civiale, --whereare Orfila, Gendrin, Rostan, Biett, Alibert, --jolly old Baron Alibert, whom I remember so well in his broad-brimmed hat, worn a little jauntilyon one side, calling out to the students in the court-yard of theHospital St. Louis, "Enfans de la methode naturelle, etes-vous tousici?" "Children of the natural method [his own method of classificationof skin diseases, ] are you all here?" All here, then, perhaps; allwhere, now?

My show of ghosts is over. It is always the same story that old men tellto younger ones, some few of whom will in their turn repeat the tale, only with altered names, to their children's children. 

 Like phantoms painted on the magic slide, Forth from the darkness of the past we glide, As living shadows for a moment seen In airy pageant on the eternal screen, Traced by a ray from one unchanging flame, Then seek the dust and stillness whence we came. 

Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden, where he had written his Latin graduating thesis, talking of the learnedGaubius and the late illustrious Boerhaave and other dead Dutchmen, ofwhom you know as much, most of you, as you do of Noah's apothecary andthe family physician of Methuselah, whose prescriptions seem to havebeen lost to posterity. Dr. Lloyd came back to Boston full of theteachings of Cheselden and Sharpe, William Hunter, Smellie, and Warner;Dr. James Jackson loved to tell of Mr. Cline and to talk of Mr. JohnHunter; Dr. Reynolds would give you his recollections of Sir AstleyCooper and Mr. Abernethy; I have named the famous Frenchmen of mystudent days; Leyden, Edinburgh, London, Paris, were each in turn theMecca of medical students, just as at the present day Vienna and Berlinare the centres where our young men crowd for instruction. These alsomust sooner or later yield their precedence and pass the torch theyhold to other hands. Where shall it next flame at the head of the longprocession? Shall it find its old place on the shores of the Gulf ofSalerno, or shall it mingle its rays with the northern aurora up amongthe fiords of Norway, --or shall it be borne across the Atlantic andreach the banks of the Charles, where Agassiz and Wyman have taught, where Hagen still teaches, glowing like his own Lampyris splendidula, with enthusiasm, where the first of American botanists and the ablestof American surgeons are still counted in the roll of honor of our greatUniversity?

Let me add a few words which shall not be other than cheerful, as I bidfarewell to this edifice which I have known so long. I am grateful tothe roof which has sheltered me, to the floors which have sustained me, though I have thought it safest always to abstain from anything likeeloquence, lest a burst of too emphatic applause might land my classand myself in the cellar of the collapsing structure, and bury us in thefate of Korah, Dathan, and Abiram. I have helped to wear these stairsinto hollows, --stairs which I trod when they were smooth and level, fresh from the plane. There are just thirty-two of them, as there werefive and thirty years ago, but they are steeper and harder to climb, itseems to me, than they were then. I remember that in the early youth ofthis building, the late Dr. John K. Mitchell, father of our famous Dr. Weir Mitchell, said to me as we came out of the Demonstrator's room, that some day or other a whole class would go heels over head down thisgraded precipice, like the herd told of in Scripture story. This hasnever happened as yet; I trust it never will. I have never been proudof the apartment beneath the seats, in which my preparations for lecturewere made. But I chose it because I could have it to myself, and Iresign it, with a wish that it were more worthy of regret, into thehands of my successor, with my parting benediction. Within its twilightprecincts I have often prayed for light, like Ajax, for the daylightfound scanty entrance, and the gaslight never illuminated its darkrecesses. May it prove to him who comes after me like the cave of theSibyl, out of the gloomy depths of which came the oracles which shonewith the rays of truth and wisdom!

This temple of learning is not surrounded by the mansions of thegreat and the wealthy. No stately avenues lead up to its facadesand porticoes. I have sometimes felt, when convoying a distinguishedstranger through its precincts to its door, that he might questionwhether star-eyed Science had not missed her way when she found herselfin this not too attractive locality. I cannot regret that we--you, Ishould say--are soon to migrate to a more favored region, and carry onyour work as teachers and as learners in ampler halls and under far morefavorable conditions. 

I hope that I may have the privilege of meeting you there, possibly maybe allowed to add my words of welcome to those of my former colleagues, and in that pleasing anticipation I bid good-by to this scene of my longlabors, and, for the present at least, to the friends with whom I havebeen associated. 

APPENDUM

NOTES TO THE ADDRESS ON CURRENTS AND COUNTER CURRENTS IN MEDICAL SCIENCE. 

Some passages contained in the original manuscript of the Address, andomitted in the delivery on account of its length, are restored in thetext or incorporated with these Notes. 

NOTE A. --

There is good reason to doubt whether the nitrate of silver has any realefficacy in epilepsy. It has seemed to cure many cases, but epilepsyis a very uncertain disease, and there is hardly anything which hasnot been supposed to cure it. Dr. Copland cites many authorities in itsfavor, most especially Lombard's cases. But De la Berge and Monneret(Comp. De Med. Paris), 1839, analyze these same cases, eleven in number, and can only draw the inference of a very questionable value in thesupposed remedy. Dr. James Jackson says that relief of epilepsy is notto be attained by any medicine with which he is acquainted, but by diet. (Letters to a Young Physician, p. 67. ) Guy Patin, Dean of the Facultyof Paris, Professor at the Royal College, Author of the AntimonialMartyrology, a wit and a man of sense and learning, who died almost twohundred years ago, had come to the same conclusion, though the chemistsof his time boasted of their remedies. "Did, you ever see a case ofepilepsy cured by nitrate of silver?" I said to one of the oldest andmost experienced surgeons in this country. "Never, " was his instantreply. Dr. Twitchell's experience was very similar. How, then, didnitrate of silver come to be given for epilepsy? Because, as Dr. Martinhas so well reminded us, lunatics were considered formerly to be underthe special influence of Luna, the moon (which Esquirol, be it observed, utterly denies), and lunar caustic, or nitrate of silver, is a salt ofthat metal which was called luna from its whiteness, and of coursemust be in the closest relations with the moon. It follows beyond allreasonable question that the moon's metal, silver, and its preparations, must be the specific remedy for moonblasted maniacs and epileptics!

Yet the practitioner who prescribes the nitrate of silver supposes heis guided by the solemn experience of the past, instead of by its idlefancies. He laughs at those old physicians who placed such confidencein the right hind hoof of an elk as a remedy for the same disease, andleaves the record of his own belief in a treatment quite as fanciful andfar more objectionable, written in indelible ink upon a living tabletwhere he who runs may read it for a whole generation, if nature spareshis walking advertisement so long. 

NOTE B. --

The presumption that a man is innocent until he is proved guilty, doesnot mean that there are no rogues, but lays the onus probandi on theparty to which it properly belongs. So with this proposition. A noxiousagent should never be employed in sickness unless there is ampleevidence in the particular case to overcome the general presumptionagainst all such agents, and the evidence is very apt to be defective. 

The miserable delusion of Homoeopathy builds itself upon an axiomdirectly the opposite of this; namely, that the sick are to be cured bypoisons. Similia similibus curantur means exactly this. It is simplya theory of universal poisoning, nullified in practice by theinfinitesimal contrivance. The only way to kill it and all similarfancies, and to throw every quack nostrum into discredit, is to root outcompletely the suckers of the old rotten superstition that whatever isodious or noxious is likely to be good for disease. The current of soundpractice with ourselves is, I believe, setting fast in the directionI have indicated in the above proposition. To uphold the exhibitionof noxious agents in disease, as the rule, instead of admitting themcautiously and reluctantly as the exception, is, as I think, an eddy ofopinion in the direction of the barbarism out of which we believe ourart is escaping. It is only through the enlightened sentiment andaction of the Medical Profession that the community can be brought toacknowledge that drugs should always be regarded as evils. 

It is true that some suppose, and our scientific and thoughtfulassociate, Dr. Gould, has half countenanced the opinion, that there mayyet be discovered a specific for every disease. Let us not despair ofthe future, but let us be moderate in our expectations. When an oil isdiscovered that will make a bad watch keep good time; when a recipe isgiven which will turn an acephalous foetus into a promising child; whena man can enter the second time into his mother's womb and give her backthe infirmities which twenty generations have stirred into her blood, and infused into his own through hers, we may be prepared to enlarge theNational Pharmacopoeia with a list of specifies for everything but oldage, --and possibly for that also. 

NOTE C. --

The term specific is used here in its ordinary sense, without raisingthe question of the propriety of its application to these or otherremedies. 

The credit of introducing Cinchona rests between the Jesuits, theCountess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor, who employed it as a secret remedy. (Pereira. ) Mercury as an internalspecific remedy was brought into use by that impudent and presumptuousquack, as he was considered, Paracelsus. (Encyc. Brit. Art. "Paracelsus. ") Arsenic was introduced into England as a remedy forintermittents by Dr. Fowler, in consequence of the success of a patentmedicine, the Tasteless Ague Drops, which were supposed, "probablywith reason, " to be a preparation of that mineral. (Rees's Cyc. Art. "Arsenic. ") Colchicum came into notice in a similar way, from thesuccess of the Eau Medicinale of M. Husson, a French military officer. (Pereira. ) Iodine was discovered by a saltpetre manufacturer, butapplied by a physician in place of the old remedy, burnt sponge, whichseems to owe its efficacy to it. (Dunglison, New Remedies. ) As forSulphur, "the common people have long used it as an ointment" forscabies. (Rees's Cyc. Art. "Scabies. ") The modern cantiscorbutic regimenis credited to Captain Cook. "To his sagacity we are indebted for thefirst impulse to those regulations by which scorbutus is so successfullyprevented in our navy. " (Lond. Cyc. Prac. Med. Art. "Scorbutus. ") Ironand various salts which enter into the normal composition of the humanbody do not belong to the materia medica by our definition, but to themateria alimentaria. 

For the first introduction of iron as a remedy, see Pereira, who gives avery curious old story. 

The statement in the text concerning a portion of the materia medicastands exactly as delivered, and is meant exactly as it stands. Nodenunciation of drugs, as sparingly employed by a wise physician, wasor is intended. If, however, as Dr. Gould stated in his "valuableand practical discourse" to which the Massachusetts Medical Society"listened with profit as well as interest, " "Drugs, in themselvesconsidered, may always be regarded as evils, "--any one who chooses mayquestion whether the evils from their abuse are, on the whole, greateror less than the undoubted benefits obtained from their proper use. Thelarge exception of opium, wine, specifics, and anaesthetics, made in thetext, takes off enough from the useful side, as I fully believe, to turnthe balance; so that a vessel containing none of these, but loaded withantimony, strychnine, acetate of lead, aloes, aconite, lobelia, lapisinfernalis, stercus diaboli, tormentilla, and other approved, and, inskilful hands, really useful remedies, brings, on the whole, more harmthan good to the port it enters. 

It is a very narrow and unjust view of the practice of medicine, tosuppose it to consist altogether in the use of powerful drugs, or ofdrugs of any kind. Far from it. "The physician may do very much for thewelfare of the sick, more than others can do, although he does not, even in the major part of cases, undertake to control and overcomethe disease by art. It was with these views that I never reported anypatient cured at our hospital. Those who recovered their health werereported as well; not implying that they were made so by the activetreatment they had received there. But it was to be understood that allpatients received in that house were to be cured, that is, taken careof. " (Letters to a Young Physician, by James 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, ofSt. Bartholomew's Hospital, aptly calls the 'raw material of the blood;'and we believe that if any real improvement has taken place in medicalpractice, independently of those truly valuable contributions we havebefore described, it is in the substitution of tonics, stimulants, andgeneral management, for drastic cathartics, for bleeding, depressingagents, including mercury, tartar emetics, etc. , so much in vogue duringthe early part even of this century. " (F. P. Porcher, in Charleston Med. Journal and Review for January, 1860. )