Medical Essays
by
Oliver Wendell Holmes, Sr. (The Physician and Poet)
Part 2 out of 7
those substances called morbid poisons, of which it is a peculiar
character to multiply themselves, when introduced into the system, as
a seed does in the soil. Therefore the hundredth part 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 is a grain or
more, and can be removed in considerable drops. And what is a very
curious illustration of Homoeopathy, it does not produce its most.
characteristic effects until it is already in sufficient quantity not
merely to be visible, but to be collected for further use. The
thoughtlessness which can allow an inference to be extended from a
product of disease possessing this susceptibility of multiplication
when conveyed into the living body, to substances of inorganic
origin, such as silex or sulphur, would be capable of arguing that a
pebble may produce a mountain, because an acorn can become a forest.
As to the analogy to be found between the alleged action of the
infinitely attenuated doses, and the effects of some odorous
substances which possess the extraordinary power of diffusing their
imponderable emanations through a very wide space, however it may be
abused in argument, and rapidly as it evaporates on examination, it
is not like that just mentioned, wholly without meaning. The fact of
the vast diffusion of some odors, as that of musk or the rose, for
instance, has long been cited as the most remarkable illustration of
the divisibility of matter, and the nicety of the senses. And if
this were compared with the effects of a very minute dose of morphia
on the whole system, or the sudden and fatal impression of a single
drop of prussic acid, or, with what comes still nearer, the poisonous
influence of an atmosphere impregnated with invisible malaria, we
should find in each of these examples an evidence of the degree to
which nature, in some few instances, concentrates powerful qualities
in minute or subtile forms of matter. 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 which nobody ever thought to have any
smell at all, as, for instance, a grain of chalk or of charcoal, and
that he will, after an hour or two of rubbing and scraping, develop
in a portion of it an odor which, if the whole grain were used, would
be capable of pervading an apartment, a house, a village, a province,
an empire, nay, the entire atmosphere of this broad planet upon which
we tread; and that from each of fifty or sixty substances he can in
this way develop a distinct and hitherto unknown odor: and if he
tries to show that all this is rendered quite reasonable by the
analogy of musk and roses, I shall certainly be justified in
considering him incapable of reasoning, and beyond the reach of my
argument. What if, instead of this, he professes to develop new and
wonderful medicinal powers from the same speck of chalk or charcoal,
in such proportions as would impregnate every pond, lake, river, sea,
and ocean of our globe, and appeals to the same analogy in favor of
the probability of his assertion.
All this may be true, notwithstanding these considerations. But so
extraordinary would be the fact, that a single atom of substances
which a child might swallow without harm by the teaspoonful could, by
an easy mechanical process, be made to develop such inconceivable
powers, that nothing but the strictest agreement of the most cautious
experimenters, secured by every guaranty that they were honest and
faithful, appealing to repeated experiments in public, with every
precaution to guard against error, and with the most plain and
peremptory results, should induce us to lend any credence to such
pretensions.
The third doctrine, that Psora, the other name of which you remember,
is the cause of the great majority of chronic diseases, is a
startling one, to say the least. That an affection always recognized
as a very unpleasant personal companion, but generally regarded as a
mere temporary incommodity, readily yielding to treatment in those
unfortunate enough to suffer from it, and hardly known among the
better classes of society, should be all at once found out by a
German physician to be the great scourge of mankind, the cause of
their severest bodily and mental calamities, cancer and consumption,
idiocy and madness, must excite our unqualified surprise. And when
the originator of this singular truth ascribes, as in the page now
open before me, the declining health of a disgraced courtier, the
chronic malady of a bereaved mother, even the melancholy of the love-
sick and slighted maiden, to nothing more nor less than the
insignificant, unseemly, and almost unmentionable ITCH, does it not
seem as if the very soil upon which we stand were dissolving into
chaos, over the earthquake-heaving of discovery?
And when one man claims to have established these three independent
truths, which are about as remote from each other as the discovery of
the law of gravitation, the invention of printing, and that of the
mariner's compass, unless the facts in their favor are overwhelming
and unanimous, the question naturally arises, Is not this man
deceiving himself, or trying to deceive others?
I proceed to examine the proofs of the leading ideas of Hahnemann and
his school.
In order to show the axiom, similia similibus curantur (or like is
cured by like), to be the basis of the healing art,--"the sole law of
nature in therapeutics,"--it is necessary,
1. That the symptoms produced by drugs in healthy persons should be
faithfully studied and recorded.
2. That drugs should be shown to be always capable of curing those
diseases most like their own symptoms.
3. That remedies should be shown not to cure diseases when they do
not produce symptoms resembling those presented in these diseases.
1. The effects of drugs upon healthy persons have been studied by
Hahnemann and his associates. Their results were made known in his
Materia Medica, a work in three large volumes in the French
translation, published about eight years ago. The mode of
experimentation appears to have been, to take the substance on trial,
either in common or minute doses, and then to set down every little
sensation, every little movement of mind or body, which occurred
within many succeeding hours or days, as being produced solely by the
substance employed. When I have enumerated some of the symptoms
attributed to the power of the drugs taken, you will be able to judge
how much value is to be ascribed to the assertions of such observers.
The following list was taken literally from the Materia Medica of
Hahnemann, by my friend M. Vernois, for whose accuracy I am willing
to be responsible. He has given seven pages of these symptoms, not
selected, but taken at hazard from the French translation of the
work. I shall be very brief in my citations.
"After stooping some time, sense of painful weight about the head
upon resuming the erect posture."
"An itching, tickling sensation at the outer edge of the palm of the
left hand, which obliges the person to scratch." The medicine was
acetate of lime, and as the action of the globule taken is said to
last twenty-eight days, you may judge how many such symptoms as the
last might 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 a
little bent over, violent pain in the back and shoulder-blades, as if
from a strain,"--"dreams which are not remembered,--disposition to
mental dejection,--wakefulness before and after midnight."
I might extend this catalogue almost indefinitely. I have not cited
these specimens with any view to exciting a sense of the ridiculous,
which many others of those mentioned would not fail to do, but to
show that the common accidents of sensation, the little bodily
inconveniences to which all of us are subject, are seriously and
systematically ascribed to whatever medicine may have been exhibited,
even in the minute doses I have mentioned, whole days or weeks
previously.
To these are added all the symptoms ever said by anybody, whether
deserving confidence or not, as I shall hereafter illustrate, to be
produced by the substance in question.
The effects of sixty-four medicinal substances, ascertained by one or
both of these methods, are enumerated in the Materia Medica of
Hahnemann, which may be considered as the basis of practical
Homoeopathy. In the Manual of Jahr, which is the common guide, so
far as I know, of those who practise Homoeopathy in these regions,
two hundred remedies are enumerated, many of which, however, have
never been employed in practice. In at least one edition there were
no means of distinguishing 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 standard practical author on Materia Medica, who at
one time omits to designate the proper doses of his remedies, and at
another to let us have any means of knowing whether a remedy has ever
been tried or not, while he is recommending its employment in the
most critical and threatening diseases?
I think that, from what I have shown of the character of Hahnemann's
experiments, it would be a satisfaction to any candid inquirer to
know whether other persons, to whose assertions he could look with
confidence, confirm these pretended facts. Now there are many
individuals, long and well known to the scientific world, who have
tried these experiments upon healthy subjects, and utterly deny that
their effects have at all corresponded to Hahnemann's assertions.
I will take, for instance, the statements of Andral (and I am not
referring to his well-known public experiments in his hospital) as
to the result of his own trials. This distinguished physician is
Professor of Medicine in the School of Paris, and one of the most
widely known and valued authors upon practical and theoretical
subjects the profession can 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 experimented on the effects of
cinchona, aconite, sulphur, arnica, and the other most highly
extolled remedies. His experiments lasted a year, and he stated
publicly to the Academy of Medicine that they never produced the
slightest appearance of the symptoms attributed to them. The results
of a man like this, so extensively known as one of the most
philosophical and candid, as well as brilliant of instructors, and
whose admirable abilities and signal liberality are generally
conceded, ought to be of great weight in deciding the question.
M. Double, a well-known medical writer and a physician of high
standing in Paris, had occasion so long ago as 1801, before he had
heard of Homoeopathy, to make experiments upon Cinchona, or Peruvian
bark. He and several others took the drug in every kind of dose for
four months, and the fever it is pretended by Hahnemann to excite
never was produced.
M. Bonnet, President of the Royal Society of Medicine of Bordeaux,
had occasion to observe many soldiers during the Peninsular War, who
made use of Cinchona as a preservative against different diseases,
but he never found it to produce the pretended paroxysms.
If any objection were made to evidence of this kind, I would refer to
the express experiments on many of the Homoeopathic substances, which
were given to healthy persons with every precaution as to diet and
regimen, by M. Louis Fleury, without being followed by the slightest
of the pretended consequences. And let me mention as a curious fact,
that the same quantity of arsenic given to one animal in the common
form of the unprepared powder, and to another after having been
rubbed up into six hundred globules, offered no particular difference
of activity in the two cases.
This is a strange contradiction to the doctrine of the development of
what they call dynamic power, by means of friction and subdivision.
In 1835 a public challenge was offered to the best known Homoeopathic
physician in Paris to select any ten substances asserted to produce
the most striking effects; to prepare them himself; to choose one by
lot without knowing which of them he had taken, and try it upon
himself or any intelligent and devoted Homoeopatbist, and, waiting
his own time, to come forward and tell what substance had been
employed. The challenge was at first accepted, but the acceptance
retracted before the time of trial arrived.
From all this I think it fair to conclude that the catalogues of
symptoms attributed in Homoeopathic works to the influence of various
drugs upon healthy persons are not entitled to any confidence.
2. It is necessary to show, in the next place, that medicinal
substances are always capable of curing diseases most like their own
symptoms. For facts relating to this question we must look to two
sources; the recorded experience of the medical profession in
general, and the results of trials made according to Homoeopathic
principles, and capable of testing the truth of the doctrine.
No person, that I am aware of, has ever denied that in some cases
there exists a resemblance between the effects of a remedy and the
symptoms of diseases in which it is beneficial. This has been
recognized, as Hahnemann himself has shown, from the time of
Hippocrates. But according to the records of the medical profession,
as they have been hitherto interpreted, this is true of only a very
small proportion of useful remedies. Nor has it ever been considered
as an established truth that the efficacy of even these few remedies
was in any definite ratio to their power of producing symptoms more
or less like those they cured.
Such was the state of opinion when Hahnemann came forward with the
proposition that all the cases of successful treatment found in the
works of all preceding medical writers were to be ascribed solely to
the operation of the Homoeopathic principle, which had effected the
cure, although without the physician's knowledge that this was the
real secret. And strange as it may seem, he was enabled to give such
a degree of plausibility to this assertion, that any person not
acquainted somewhat with medical literature, not quite familiar, I
should rather say, with the relative value of medical evidence,
according to the sources whence it is derived, would be almost
frightened into the belief, at seeing the pages upon pages of Latin
names he has summoned as his witnesses.
It has hitherto been customary, when examining the writings of
authors of preceding ages, upon subjects as to which they were less
enlightened than ourselves, and which they were very liable to
misrepresent, to exercise some little discretion; to discriminate, in
some measure, between writers deserving confidence and those not
entitled to it. But there is not the least appearance of any such
delicacy on the part of Hahnemann. A large majority of the names of
old authors he cites are wholly unknown to science. With some of
them I have been long acquainted, and I know that their accounts of
diseases are no more to be trusted than their contemporary Ambroise
Pare's stories of mermen, and similar absurdities. But if my
judgment is rejected, as being a prejudiced one, I can refer to
Cullen, who mentioned three of Hahnemann's authors in one sentence,
as being "not necessarily bad authorities; but certainly such when
they delivered very improbable events;" and as this was said more
than half a century ago, it could not have had any reference to
Hahnemann. But although not the slightest sign of discrimination is
visible in his quotations,--although for him a handful of chaff from
Schenck is all the same thing as a measure of wheat from Morgagni,--
there is a formidable display of authorities, and an abundant proof
of ingenious researches to be found in each of the great works of
Hahnemann with which I am familiar. [Some painful surmises might
arise as to the erudition of Hahnemann's English Translator, who
makes two individuals of "Zacutus, Lucitanus," as well as respecting
that of the conductors of an American Homoeopathic periodical, who
suffer the name of the world-renowned Cardanus to be spelt Cardamus
in at least three places, were not this gross ignorance of course
attributable only to the printer.]
It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has
proved many of Hahnemann's quotations from old authors to be
adulterate and false. What particular instances he has pointed out I
have no means of learning. And it is probably wholly impossible on
this side of the Atlantic, and even in most of the public libraries
of Europe, to find anything more than a small fraction of the
innumerable obscure publications which the neglect of grocers and
trunkmakers has spared to be ransacked by the all-devouring genius of
Homoeopathy. I have endeavored to verify such passages as my own
library afforded me the means of doing. For some I have looked in
vain, for want, as I am willing to believe, of more exact references.
But this I am able to affirm, that, out of the very small number
which I have been able, to trace back to their original authors, I
have found two to be wrongly quoted, 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 the
following expressions,--if he is not misrepresented in the English
Translation of the 'Organon': "Asclepiades on one occasion cured an
inflammation of the brain by administering a small quantity of wine."
After correcting the erroneous reference of the Translator, I can
find no such case alluded to in the chapter. But Caelius Aurelianus
mentions two modes of treatment employed by Asclepiades, into both of
which the use of wine entered, as being "in the highest degree
irrational and dangerous." [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 Forestus
observed violent colic caused by its administration. But, as the
author tells the story, a young man took, by the counsel of a
surgeon, an acrid and virulent medicine, the name of which is not
given, which brought on a most cruel fit of the gripes and colic.
After this another surgeon was called, who gave him oil of anise-seed
and wine, "which increased his suffering." [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. But it is a much
graver question why a man who has shrewdness and learning enough to
go so far after his facts, should think it right to treat them with
such astonishing negligence or such artful unfairness.
Even if every word he had pretended to take from his old authorities
were to be found in them, even if the authority of every one of these
authors were beyond question, the looseness with which they are used
to prove whatever Hahnemann chooses is beyond the bounds of
credibility. Let me give one instance to illustrate the character of
this man's mind. Hahnemann asserts, in a note annexed to the 110th
paragraph of the "Organon," that the smell of the rose will cause
certain persons to faint. And he says in the text that substances
which produce peculiar effects of this nature on particular
constitutions cure the same symptoms in people in general. Then in
another note to the same paragraph he quotes the following fact from
one of the last sources one would have looked to for medical
information, the Byzantine Historians.
"It was by these means (i.e. Homoeopathically) that the Princess
Eudosia with rose-water restored a person who had fainted!"
Is it possible that a man who is guilty of such pedantic folly as
this,--a man who can see a confirmation of his doctrine in such a
recovery as this,--a recovery which is happening every day, from a
breath of air, a drop or two of water, untying a bonnet-string,
loosening a stay-lace, and which can hardly help happening, whatever
is done,--is it possible that a man, of whose pages, not here and
there one, but hundreds upon hundreds are loaded with such
trivialities, is the Newton, the Columbus, the Harvey of the
nineteenth century!
The whole process of demonstration he employs is this. An experiment
is instituted with some drug upon one or more healthy persons.
Everything that happens for a number of days or weeks is, as we have
seen, set down as an effect of the medicine. Old volumes are then
ransacked promiscuously, and every morbid sensation or change that
anybody ever said was produced by the drug in question is added to
the list of symptoms. By one or both of these methods, each of the
sixty-four substances enumerated by Hahnemann is shown to produce a
very large number of symptoms, the lowest in his scale being ninety-
seven, and the highest fourteen hundred and ninety-one. And having
made out this list respecting any drug, a catalogue which, as you may
observe in any Homoeopathic manual, contains various symptoms
belonging to every organ of the body, what can be easier than to find
alleged cures in every medical author which can at once be attributed
to the Homoeopathic principle; still more if the grave of
extinguished credulity is called upon to give up its dead bones as
living witnesses; and worst of all, if the monuments of the past are
to be mutilated in favor of "the sole law of Nature in therapeutics"?
There are a few familiar facts of which great use has been made as an
entering wedge for the Homoeopathic doctrine. They have been
suffered to pass current so long that it is time they should be
nailed to the counter, a little operation which I undertake, with
perfect cheerfulness, to perform for them.
The first is a supposed illustration of the Homoeopathic law found in
the precept given for the treatment of parts which have been frozen,
by friction 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 is applied. But even if it were at the same temperature when
applied, it never did and never could do the least good to a frozen
part, except as a mode of regulating the application of what? of
heat. But the heat must be applied gradually, just as food must be
given a little at a time to those perishing with hunger. If the
patient were brought into a warm room, heat would be applied very
rapidly, were not something interposed to prevent this, and allow its
gradual admission. Snow or iced water is exactly what is wanted; it
is not cold to the part; it is very possibly warm, on the contrary,
for these terms are relative, and if it does not melt and let the
heat in, or is not taken away, the part will remain frozen up until
doomsday. Now the treatment of a frozen limb by heat, in large or
small quantities, is not Homoeopathy.
The next supposed illustration of the Homoeopathic law is the alleged
successful management of burns, by holding them to the fire. This is
a popular mode of treating those burns which are of too little
consequence to require any more efficacious remedy, and would
inevitably get well of themselves, without any trouble being bestowed
upon them. It produces a most acute pain in the part, which is
followed by some loss of sensibility, as happens with the eye after
exposure to strong light, and the ear after being subjected to very
intense sounds. This is all it is capable of doing, and all further
notions of its efficacy must be attributed merely to the vulgar love
of paradox. If this example affords any comfort to the
Homoeopathist, it seems as cruel to deprive him of it as it would be
to convince the mistress of the smoke-jack or the flatiron that the
fire does not literally "draw the fire out," which is her hypothesis.
But if it were true that frost-bites were cured by cold and burns by
heat, it would be subversive, so far as it went, of the great
principle of Homoeopathy.
For you will remember that this principle is that Like cures Like,
and not that Same cures Same; that there is resemblance and not
identity between the symptoms of the disease and those produced by
the drug which cures it, and none have been readier to insist upon
this distinction than the Homoeopathists themselves. For if Same
cures Same, then every poison must be its own antidote,--which is
neither a part of their theory nor their so-called experience. They
have been asked often enough, why it was that arsenic could not cure
the mischief which arsenic had caused, and why the infectious cause
of small-pox did not remedy the disease it had produced, and then
the; were ready enough to see the distinction I have pointed out. O
no! it was not the hair of the same dog, but only of one very much
like him!
A third instance in proof of the Homoeopathic law is sought for in
the acknowledged efficacy of vaccination. And how does the law apply
to this? It is granted by the advocates of Homoeopathy that there is
a resemblance between the effects of the vaccine virus on a person in
health and the symptoms of small-pox. Therefore, according to the
rule, the vaccine virus will cure the small-pox, which, as everybody
knows, is entirely untrue. But it prevents small-pox, say the
Homoeopathists. Yes, and so does small-pox prevent itself from ever
happening again, and we know just as much of the principle involved
in the one case as in the other. For this is only one of a series of
facts which we are wholly unable to explain. Small-pox, measles,
scarlet-fever, hooping-cough, protect those who have them once from
future attacks; but nettle-rash and catarrh and lung fever, each of
which is just as Homoeopathic to itself as any one of the others,
have no such preservative power. We are obliged to accept the fact,
unexplained, and we can do no more for vaccination than for the rest.
I come now to the most directly practical point connected with the
subject, namely,--
What is the state of the evidence as to the efficacy of the proper
Homoeopathic treatment in the cure of diseases.
As the treatment adopted by the Homoeopathists has been almost
universally by means of the infinitesimal doses, the question of
their efficacy is thrown open, in common with that of the truth of
their fundamental axiom, as both are tested in practice.
We must look for facts as to the actual working of Homoeopathy to
three sources.
1. The statements of the unprofessional public.
2. The assertions of Homoeopathic practitioners.
3. The results of trials by competent and honest physicians, not
pledged to the system.
I think, after what we have seen of medical facts, as they are
represented by incompetent persons, we are disposed to attribute
little value to all statements of wonderful cures, coming from those
who have never been accustomed to watch the caprices of disease, and
have not cooled down their young enthusiasm by the habit of tranquil
observation. Those who know nothing of the natural progress of a
malady, of its ordinary duration, of its various modes of
terminating, of its liability to accidental complications, of the
signs which mark its insignificance or severity, of what is to be
expected of it when left to itself, of how much or how little is to
be anticipated from remedies, those who know nothing or next to
nothing of all these things, and who are in a great state of
excitement from benevolence, sympathy, or zeal for a new medical
discovery, can hardly be expected to be sound judges of facts which
have misled so many sagacious men, who have spent their lives in the
daily study and observation of them. I believe that, after having
drawn the portrait of defunct Perkinism, with its five thousand
printed cures, and its million and a half computed ones, its miracles
blazoned about through America, Denmark, and England; after relating
that forty years ago women carried the Tractors about in their
pockets, and workmen could not make them fast enough for the public
demand; and then showing you, as a curiosity, a single one of these
instruments, an odd one of a pair, which I obtained only by a lucky
accident, so utterly lost is the memory of all their wonderful
achievements; I believe, after all this, I need not waste time in
showing that medical accuracy is not to be looked for in the florid
reports of benevolent associations, the assertions of illustrious
patrons, the lax effusions of daily journals, or the effervescent
gossip of the tea-table.
Dr. Hering, whose name is somewhat familiar to the champions of
Homoeopathy, has said that "the new healing art is not to be judged
by its success in isolated cases only, but according to its success
in general, its innate truth, and the incontrovertible nature of its
innate principles."
We have seen something of "the incontrovertible nature of its innate
principles," and it seems probable, on the whole, that its success in
general must be made up of its success in isolated cases. Some
attempts have been made, however, to finish the whole matter by
sweeping statistical documents, which are intended to prove its
triumphant success 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 to show for itself. It is well remarked, on the twenty-
third page of this article, that "the comparison of bills of
mortality among an equal number of sick, treated by divers methods,
is a most poor and lame way to get at conclusions touching principles
of the healing art." In confirmation of which, the author proceeds
upon the twenty-fifth page to prove the superiority of the
Homoeopathic treatment of cholera, by precisely these very bills of
mortality. Now, every intelligent physician is aware that the poison
of cholera differed so much in its activity at different times and,
places, that it was next to impossible to form any opinion as to the
results of treatment, unless every precaution was taken to secure the
most perfectly corresponding conditions in the patients treated, and
hardly even then. Of course, then, a Russian Admiral, by the name of
Mordvinov, backed by a number of so-called physicians practising in
Russian villages, is singularly competent to the task of settling the
whole question of the utility of this or that kind of treatment; to
prove that, if not more than eight and a half per cent. of those
attacked with the disease perished, the rest owed their immunity to
Hahnemann. I can remember when more than a hundred patients in a
public institution were attacked with what, I doubt not, many
Homoeopathic physicians (to say nothing of Homoeopathic admirals)
would have called cholera, and not one of them died, though treated
in the common way, and it is my firm belief that, if such a result
had followed the administration of the omnipotent globules, it would
have been in the mouth of every adept in Europe, from Quin of London
to Spohr of Gandersheim. No longer ago than yesterday, in one of the
most widely circulated papers of this city, there was published an
assertion that the mortality in several Homoeopathic Hospitals was
not quite five in a hundred, whereas, in what are called by the
writer Allopathic Hospitals, it is said to be eleven in a hundred.
An honest man should be ashamed of such an argumentum ad ignorantiam.
The mortality of a hospital depends not merely on the treatment of
the patients, 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 Europe that receive few diseases of a nature to endanger
life, and, on the other hand, there are others where dangerous
diseases are accumulated out of the common proportion. Thus, in the
wards of Louis, at the Hospital of La Pitie, a vast number of
patients in the last stages of consumption were constantly entering,
to swell the mortality of that hospital. It was because he was known
to pay particular attention to the diseases of the chest that
patients laboring under those fatal affections to an incurable extent
were so constantly coming in upon him. It is always a miserable
appeal to the thoughtlessness of the vulgar, to allege the naked fact
of the less comparative mortality in the practice of one hospital or
of one physician than another, as an evidence of the superiority of
their treatment. Other things being equal, it must always be
expected that those institutions and individuals enjoying to the
highest degree the confidence of the community will lose the largest
proportion of their patients; for the simple reason that they will
naturally be looked to by those suffering from the gravest class of
diseases; that many, who know that they are affected with mortal
disease, will choose to die under their care or shelter, while the
subjects of trifling maladies, and merely troublesome symptoms, amuse
themselves to any extent among the fancy practitioners. When,
therefore, Dr. Mublenbein, as stated in the "Homoeopathic Examiner,"
and quoted in yesterday's "Daily Advertiser," asserts that the
mortality among his patients is only one per cent. since he has
practised Homoeopathy, whereas it was six per cent. when he employed
the common mode of practice, I am convinced by this, his own
statement, that the citizens of Brunswick, whenever they are
seriously sick, take good care not to send for Dr. Muhlenbein!
It is evidently impossible that I should attempt, within the compass
of a single lecture, any detailed examination of the very numerous
cases reported in the Homoeopathic Treatises and Journals. Having
been in the habit of receiving the French "Archives of Homoeopathic
Medicine" until the premature decease of that Journal, I have had the
opportunity of becoming acquainted somewhat with the style of these
documents, and experiencing whatever degree of conviction they were
calculated to produce. Although of course I do not wish any value to
be assumed for my opinion, such as it is, I consider that you are
entitled to hear it. So far, then, as I am acquainted with the
general character of the cases reported by the Homoeopathic
physicians, they would for the most part be considered as wholly
undeserving a place in any English, French, or American periodical of
high standing, if, instead of favoring the doctrine they were
intended to support, they were brought forward to prove the efficacy
of any common remedy administered by any common practitioner. There
are occasional exceptions to this remark; but the general truth of it
is rendered probable by the fact that these cases are always, or
almost always, written with the single object of showing the efficacy
of the medicine used, or the skill of the practitioner, and it is
recognized as a general rule that such cases deserve very little
confidence. Yet they may sound well enough, one at a time, to those
who are not fully aware of the fallacies of medical evidence. Let me
state a case in illustration. Nobody doubts that some patients
recover under every form of practice. Probably all are willing to
allow that a large majority, for instance, ninety in a hundred, of
such cases as a physician is called to in daily practice, would
recover, sooner or later, with more or less difficulty, provided
nothing were done to interfere seriously with the efforts of nature.
Suppose, then, a physician who has a hundred patients prescribes to
each of them pills made of some entirely inert substance, as starch,
for instance. Ninety of them get well, or if he chooses to use such
language, he cures ninety of them. It is evident, according to the
doctrine of chances, that there must be a considerable number of
coincidences between the relief of the patient and the administration
of the remedy. It is altogether probable that there will happen two
or three very striking coincidences out of the whole ninety cases, in
which it would seem evident that the medicine produced the relief,
though it had, as we assumed, nothing to do with it. Now suppose
that the physician publishes these cases, will they not have a
plausible appearance of proving that which, as we granted at the
outset, was entirely false? Suppose that instead of pills of starch
he employs microscopic sugarplums, with the five' million billion
trillionth part of a suspicion of aconite or pulsatilla, and then
publishes his successful cases, through the leaden lips of the press,
or the living ones of his female acquaintances,--does that make the
impression a less erroneous one? But so it is that in Homoeopathic
works and journals and gossip one can never, or next to never, find
anything but successful cases, which might do very well as a proof of
superior skill, did it not prove as much for the swindling
advertisers whose certificates disgrace so many of our newspapers.
How long will it take mankind to learn that while they listen to "the
speaking hundreds and units, who make the world ring "with the
pretended triumphs they have witnessed, the "dumb millions" of
deluded and injured victims are paying the daily forfeit of their
misplaced confidence!
I am sorry to see, also, that a degree of ignorance as to the natural
course of diseases is often shown in these published cases, which,
although it may not be detected by the unprofessional reader, conveys
an unpleasant impression to those who are acquainted with the
subject. Thus a young woman affected with jaundice is mentioned in
the German "Annals of Clinical Homoeopathy" as having been cured in
twenty-nine days by pulsatilla and nux vomica. Rummel, a well-known
writer of the same school, speaks of curing a case of jaundice in
thirty-four days by Homoeopathic doses of pulsatilla, aconite, and
cinchona. I happened to have a case in my own household, a few weeks
since, which lasted about ten days, and this was longer than I have
repeatedly seen it in hospital practice, so that it was nothing to
boast of.
Dr. Munneche of Lichtenburg in Saxony is called to a patient with
sprained ankle who had been a fortnight under the common treatment.
The patient gets well by the use of arnica in a little more than a
month longer, and this extraordinary fact is published in the French
"Archives of Homoeopathic Medicine."
In the same Journal is recorded the case of a patient who with
nothing more, so far as any proof goes, than inluenza, gets down to
her shop upon the sixth day.
And again, the cool way in which everything favorable in a case is
set down by these people entirely to their treatment, may be seen in
a case of croup reported in the "Homoeopathic Gazette" of Leipsic,
in which leeches, blistering, inhalation of hot vapor, and powerful
internal medicine had been employed, and yet the merit was all
attributed to one drop of some Homoeopathic fluid.
I need not multiply these quotations, which illustrate the grounds of
an 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 if more were wanted; for nothing is necessary but to look into
any of the numerous broken-down Journals of Homoeopathy, the volumes
of which may be found on the shelves of those curious in such
matters.
A number of public trials of Homoeopathy have been made in different
parts of the world. Six of these are mentioned in the Manifesto of
the "Homoeopathic Examiner." Now to suppose that any trial can
absolutely silence people, would be to forget the whole experience of
the past. Dr. Haygarth and Dr. Alderson could not stop the sale of
the five-guinea Tractors, although they proved that they could work
the same miracles with pieces of wood and tobacco-pipe. It takes
time for truth to operate as well as Homoeopathic globules. Many
persons thought the results of these trials were decisive enough of
the nullity of the treatment; those who wish to see the kind of
special pleading and evasion by which it is attempted to cover
results which, stated by the "Homoeopathic Examiner" itself, look
exceedingly like a miserable failure, may consult the opening
flourish of that Journal. I had not the intention to speak of these
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 few
words,--that instituted at Naples and that of Andral.
There have been few names in the medical profession, for the last
half century, so widely known throughout the world of science as that
of M. Esquirol, whose life was devoted to the treatment of insanity,
and who was without a rival in that department of practical medicine.
It is from an analysis communicated by him to the "Gazette Medicale
de Paris" that I derive my acquaintance with the account of the trial
at Naples by Dr. Panvini, physician to the Hospital della Pace. This
account seems to be entirely deserving of credit. Ten patients were
set apart, and not allowed to take any medicine at all,--much against
the wish of the Homoeopathic physician. All of them got well, and of
course all of them would have been claimed as triumphs if they had
been submitted to the treatment. Six other slight cases (each of
which is specified) got well under the Homoeopathic treatment, none
of its asserted specific effects being manifested.
All the rest were cases of grave disease; and so far as the trial,
which was interrupted about the fortieth day, extended, the patients
grew worse, or received no benefit. A case is reported on the page
before me of a soldier affected with acute inflammation in the chest,
who took successively aconite, bryonia, nux vomica, and pulsatilla,
and after thirty-eight days of treatment remained without any
important change in his disease. The Homoeopathic physician who
treated these patients was M. de Horatiis, who had the previous year
been announcing his wonderful cures. 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 renounced Homoeopathy. I may remark, by the
way, that this same periodical, which is so very easy in explaining
away the results of these trials, makes a mistake of only six years
or a little more as to the time when this at Naples was instituted.
M. Andral, the "eminent and very enlightened allopathist" of the
"Homoeopathic Examiner," made the following statement in March, 1835,
to the Academy of Medicine: "I have submitted this doctrine to
experiment; I can reckon at this time from one hundred and thirty to
one hundred and forty cases, recorded with perfect fairness, in a
great hospital, under the eye of numerous witnesses; to avoid every
objection--I obtained my remedies of M. Guibourt, who keeps a
Homoeopathic pharmacy, and whose strict exactness is well known; the
regimen has been scrupulously observed, and I obtained from the
sisters attached to the hospital a special regimen, such as Hahnemann
orders. I was told, however, some months since, that I had not been
faithful to all the rules of the doctrine. I therefore took the
trouble to begin again; I have studied the practice of the Parisian
Homoeopathists, as I had studied their books, and I became convinced
that they treated their patients as I had treated mine, and I affirm
that I have been as rigorously exact in the treatment as any other
person."
And he expressly asserts the entire nullity of the influence of all
the Homoeopathic remedies tried by him in modifying, so far as he
could observe, the progress or termination of diseases. It deserves
notice that he experimented with the most boasted substances,--
cinchona, aconite, mercury, bryonia, belladonna. Aconite, for
instance, he says he administered in more than forty cases of that
collection of feverish symptoms in which it exerts so much power,
according to Hahnemann, and in not one of them did it have the
slightest influence, the pulse and heat remaining as before.
These statements look pretty honest, and would seem hard to be
explained away, but it is calmly said that he "did not know enough of
the method to select the remedies with any tolerable precision."
["Homoeopathic Examiner, vol. i. p. 22.]
"Nothing is left to the caprice of the physician." (In a word,
instead of being dependent upon blind chance, that there is an
infallible law, guided by which; the physician MUST select the proper
remedies.') ['Ibid.,' in a notice of Menzel's paper.] Who are they
that practice Homoeopathy, and say this of a man with the Materia
Medica of Hahnemann lying before him? Who are they that send these
same globules, on which he experimented, accompanied by a little
book, into families, whose members are thought competent to employ
them, when they deny any such capacity 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 most renowned practical writers, not
merely of his nation, but of his age? I leave the quibbles by which
such persons would try to creep out from under the crushing weight of
these conclusions to the unfortunates who suppose 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.
One of these was Curie, now of London, whose works are on the
counters of some of our bookstores, and probably in the hands of some
of my audience. This gentleman, whom Dr. Baillie declares to be an
enlightened man, and perfectly sincere in his convictions, brought
his own medicines from the pharmacy which furnished Hahnemann
himself, and employed them for four or five months upon patients in
his ward, and with results equally unsatisfactory, as appears from
Dr. Baillie's statement at a meeting of the Academy of Medicine. And
a similar experiment was permitted by the Clinical Professor of the
Hotel Dieu of Lyons, with the same complete failure.
But these are old and prejudiced practitioners. Very well, then take
the statement of Dr. Fleury, a most intelligent young physician, who
treated homoeopathically more than fifty patients, suffering from
diseases which it was not dangerous to treat in this way, taking
every kind of precaution as to regimen, removal of disturbing
influences, and the state of the atmosphere, insisted upon by the
most vigorous partisans of the doctrine, and found not the slightest
effect produced by the medicines. And more than this, read nine of
these cases, which he has published, as I have just done, and observe
the absolute nullity of aconite, belladonna, and bryonia, against the
symptoms over which they are pretended to exert such palpable, such
obvious, such astonishing influences. In the view of these
statements, it is impossible not to realize the entire futility of
attempting to silence this asserted science by the flattest and most
peremptory results of experiment. Were all the hospital physicians
of Europe and America to devote themselves, for the requisite period,
to this sole pursuit, and were their results to be unanimous as to
the total worthlessness of the whole system in practice, this
slippery delusion would slide through their fingers without the
slightest discomposure, when, as they supposed, they had crushed
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
third place, that remedies never cure diseases when they are not
capable of producing similar symptoms! The burden of this somewhat
comprehensive demonstration lying entirely upon the advocates of this
doctrine, it may be left to their mature reflections.
It entered into my original plan to treat of the doctrine relating to
Psora, or itch,--an almost insane conception, which I am glad to get
rid of, for this is a subject one does not care to handle without
gloves. I am saved this trouble, however, by finding that many of
the disciples of Hahnemann, those disciples the very gospel of whose
faith stands upon his word, make very light of his authority on this
point, although he himself says, "It has cost me twelve years of
study and research to trace out the source of this incredible number
of chronic affections, to discover this great truth, which remained
concealed from all my predecessors and contemporaries, to establish
the basis of its demonstration, and find out, at the same time, the
curative medicines that 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
"Homoeopathic Examiner," "represent the opinions of a large majority
of Homoeopathists in Europe."
"It cannot be unknown to any one at all familiar with Homoeopathic
literature, that Hahnemann's idea of tracing the large majority of
chronic diseases to actual itch has met with the greatest opposition
from Homoeopathic physicians themselves." And again, "If the Psoric
theory has led to no proper schism, the reason is to be found in the
fact that it is almost without any influence in practice."
We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Duke
of Baden," and a "distinguished" Homoeopathist, actually asked
Hahnemann for the proof that chronic diseases, such as dropsy, for
instance, never arise from any other cause than itch; and that,
according to common report, the venerable sage was highly incensed
(fort courrouce) with Dr. Hartmann, of Leipsic, another
"distinguished" Homoeopathist, for maintaining 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 that physicians are divided on this point into diabolists and
exorcists, declares that, according to a remark of Hahnemann, the
whole civilized world is affected with Psora. I must therefore
disappoint any advocate of Hahnemann who may honor me with his
presence, by not attacking a doctrine on which some of the disciples
of his creed would be very happy to have its adversaries waste their
time and strength. I will not meddle with this excrescence, which,
though often used in time of peace, would be dropped, like the limb
of a shell-fish, the moment it was assailed; time is too precious,
and the harvest of living extravagances nods too heavily to my
sickle, that I should blunt it upon straw and stubble.
I will close the subject with a brief examination of some of the
statements made in Homoeopathic works, and more particularly in the
brilliant Manifesto of the "Examiner," before referred to. And
first, it is there stated under the head of "Homoeopathic
Literature," that "SEVEN HUNDRED volumes have been issued from the
press developing the peculiarities of the system, and many of them
possessed of a scientific character that savans know well how to
respect." If my assertion were proper evidence in the case, I should
declare, that, having seen a good many of these publications, from
the year 1834, when I bought the work of the Rev. Thomas Everest,"
[Dr. Curie speaks of this silly pamphlet as having been published in
1835.] to within a few weeks, when I received my last importation of
Homaeopathic literature, I have found that all, with a very few
exceptions, were stitched pamphlets varying from twenty or thirty
pages to somewhat less than a hundred, and generally resembling each
other as much as so many spelling-books.
But not being evidence in the case, I will give you the testimony of
Dr. Trinks, of Dresden, who flourishes on the fifteenth page of the
same Manifesto as one of the most distinguished among the
Homoeopathists of Europe. I translate the sentence literally from
the "Archives de la Medecine Homoeopathique."
"The literature of Homoeopathy, if that honorable name must be
applied to all kinds of book-making, has been degraded to the
condition of the humblest servitude. Productions without talent,
without spirit, without discrimination, flat and pitiful eulogies,
exaggerations surpassing the limits of the most robust faith,
invectives against such as dared to doubt the dogmas which had been
proclaimed, or catalogues of remedies; of such materials is it
composed! From distance to distance only, have appeared some memoirs
useful to science or practice, which appear as so many green oases in
the midst of this literary desert."
It is a very natural as well as a curious question to ask, What has
been the success of Homoeopathy in the different countries of Europe,
and what is its present condition?
The greatest reliance of the advocates of Homoeopathy is of course on
Germany. We know very little of its medical schools, its medical
doctrines, or its medical men, compared with those of England and
France. And, therefore, when an intelligent traveller gives a direct
account from personal inspection of the miserable condition of the
Homoeopathic hospital at Leipsic, the first established in Europe,
and the first on the list of the ever-memorable Manifesto, it is easy
enough answer or elude the fact by citing various hard names of
"distinguished" practitioners, which sound just as well to the
uninformed public as if they were Meckel, or Tiedemann, or
Langenbeck. Dr. Leo-Wolf, who, to be sure, is opposed to
Homoeopathy, but who is a scholar, and ought to know something
of his own countrymen, assures us that "Dr. Kopp is the only German
Homoeopathist, if we can call him so, who has been distinguished as
an author and practitioner before he examined this method." And Dr.
Lee, the same gentleman in whose travels the paragraph relating to
the Leipsic Hospital is to be found, says the same thing. And I will
cheerfully expose myself to any impertinent remark which it might
suggest, to assure my audience that I never heard or saw one
authentic Homoeopathic name of any country in Europe, which I had
ever heard mentioned before as connected with medical science by a
single word or deed sufficient to make it in any degree familiar to
my ears, unless Arnold of Heidelberg is the anatomist who discovered
a little nervous centre, called the otic ganglion. But you need ask
no better proof of who and what the German adherents of this doctrine
must be, than the testimony of a German Homoeopathist as to the
wretched character of the works they manufacture to enforce its
claims.
As for the act of this or that government tolerating or encouraging
Homoeopathy, every person of common intelligence knows that it is a
mere form granted or denied according to the general principles of
policy adopted in different states, or the degree of influence which
some few persons who have adopted it may happen to have at court.
What may be the value of certain pompous titles with which many of
the advocates of Homoeopathy are honored, it might be disrespectful
to question. But in the mean time the judicious inquirer may ponder
over an extract which I translate from a paper relating to a
personage well known to the community as Williams the Oculist, with
whom I had the honor of crossing the Atlantic some years since, and
who himself handed me two copies of the paper in question.
"To say that he was oculist of Louis XVIII. and of Charles X., and
that he now enjoys the same title with respect to His Majesty, Louis
Philippe, and the King of the Belgians, is unquestionably to say a
great deal; and yet it is one of the least of his titles to public
confidence. His reputation rests upon a basis more substantial even
than the numerous diplomas with which he is provided, than the
membership of the different medical societies which have chosen him
as their associate," etc., etc.
And as to one more point, it is time that the public should fully
understand that the common method of supporting barefaced imposture
at the present day, both in Europe and in this country, consists in
trumping up "Dispensaries," "Colleges of Health," and other
advertising charitable clap-traps, which use the poor as decoy-ducks
for the rich, and the proprietors of which have a strong predilection
for the title of "Professor." These names, therefore, have come to
be of little or no value as evidence of the good character, still
less of the high pretensions of those who invoke their authority.
Nor does it follow, even when a chair is founded in connection with a
well-known institution, that it has either a salary or an occupant;
so that it may be, and probably is, a mere harmless piece of
toleration on the part of the government if a Professorship of
Homoeopathy is really in existence at Jena or Heidelberg. And
finally, in order to correct the error of any who might suppose that
the whole Medical Profession of Germany has long since fallen into
the delusions of Hahnemann, I will quote two lines which a celebrated
anatomist and surgeon (whose name will occur again in this lecture in
connection with a very pleasing letter) addressed to the French
Academy of Medicine in 1835. "I happened to be in Germany some
months since, at a meeting of nearly six hundred physicians; one of
them wished to bring up the question of Homoeopathy; they would not
even listen to him." This may have been very impolite and bigoted,
but that is not precisely the point in reference to which I mention
the circumstance.
But if we cannot easily get at Germany, we can very easily obtain
exact information from France and England. I took the trouble to
write some months ago to two friends in Paris, in whom I could place
confidence, for information upon the subject. One of them answered
briefly to the effect that nothing was said about it. When the late
Curator of the Lowell Institute, at his request, asked about the
works upon the subject, he was told that they had remained a long
time on the shelves quite unsalable, and never spoken of.
The other gentleman, [Dr. Henry T. Bigelow, now Professor of
Surgery in Harvard University] whose name is well known to my
audience, and who needs no commendation of mine, had the kindness to
procure for me many publications upon the subject, and some
information which sets the whole matter at rest, so far as Paris is
concerned. He went directly to the Baillieres, the principal and
almost the only publishers of all the Homoeopathic books and journals
in that city. The following facts were taken by him from the
account-books of this publishing firm. Four Homoeopathic Journals
have been published in Paris; three of them by the Baillieres.
The reception they met with may be judged of by showing the number of
subscribers to each on the books of the publishing firm.
A Review published by some other house, which lasted one year, and
had about 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
Homoeopathic books was much less than formerly, and that consequently
they should undertake to publish no new books upon the subject,
except those of Jahr or Hahnemann. "This man," says my
correspondent,--referring to one of the brothers,--"the publisher and
headquarters of Homoeopathy in Paris, informs me that it is going
down in England and Germany as well as in Paris." For all the facts
he had stated he pledged himself as responsible.
Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and
since then has been going down.
Louis told my correspondent that no person of distinction in Paris
had embraced Homoeopathy, and that it was declining. If you ask who
Louis is, I refer you to the well-known Homoeopathist, Peschier of
Geneva, who says, addressing him, "I respect no one more than
yourself; the feeling which guides your researches, your labors, and
your pen, is so honorable and rare, that I could not but bow down
before it; and I own, if there were any allopathist who inspired me
with higher veneration, it would be him and not yourself whom I
should address."
Among the names of "Distinguished Homoeopathists," however, displayed
in imposing columns, in the index of the "Homoeopathic Examiner," are
those of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the
world of science, and the last of them identified with some of the
most valuable contributions which anatomical knowledge has received
since the commencement of the present century. One Dr. Chrysaora,
who stands sponsor for many facts in that Journal, makes the
following statement among the rest: "Professors, who are esteemed
among the most distinguished of the Faculty (Faculty de Medicine),
both as to knowledge and reputation, have openly confessed the power
of Homoeopathia in forms of disease where the ordinary method of
practice proved totally insufficient. It affords me the highest
pleasure to select from among these gentlemen, Marjolin, Amussat, and
Breschet."
Here is a literal translation of an original letter, now in my
possession, 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 new
American Journal, the 'New World,' has made use of my name in
support of the pretended Homoeopathic doctrines, and that I am
represented as one of the warmest partisans of Homoeopathy in France.
"I am vastly surprised at the reputation manufactured for me upon the
new continent; but I am obliged, in deference to truth, to reject it
with my whole energy. I spurn far from me everything which relates
to that charlatanism called Homoeopathy, for these pretended
doctrines cannot endure the scrutiny of wise and enlightened persons,
who are guided 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,
Surgeon of 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 by
Madame 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
surgeon of their own establishment; that is, performed as a surgeon
all the operations 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
Grecian horse, 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 foreign correspondence of the "Homoeopathic
Examiner," any further information I might obtain would seem so
superfluous as hardly to be worth the postage.
Homoeopathy may be said, then, to be in a sufficiently miserable
condition in Paris. Yet there lives, and there has lived for years,
the illustrious Samuel Hahnemann, who himself assured my
correspondent that no place offered the advantages of Paris in its
investigation, by reason of 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
there were eighteen Homoeopathic physicians in the United Kingdom, of
whom only three were to be found out of London, and that many of
these practised Homoeopathy in secret.
It will be seen, therefore, that, according to the recent statement
of one of its leading English advocates, Homoeopathy had obtained not
quite half as many practical disciples in England as Perkinism could
show for itself in a somewhat less period from the time of its first
promulgation in that country.
Dr. Curie's letter, dated London, October 30, 1839, says there is
"one in Dublin, Dr. Luther; at Glasgow, Dr. Scott." The
"distinguished" Chrysaora writes from Paris, dating October 20, 1839,
"On the other hand, Homoeopathy is commencing to make an inroad into
England by the way of Ireland. At Dublin, distinguished physicians
have already embraced the new system, and a great part of the
nobility and gentry of that city have emancipated themselves from the
English fashion and professional authority."
But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize
Homoeopathy; the Queen Dowager Adelaide has been treated by a
Homoeopathic physician. "Jarley is the delight of the nobility and
gentry." "The Royal Family are the patrons of Jarley."
Let me ask if a Marquis and a Knight are better than two Lords, and
if the Dowager of Royalty is better than Royalty itself, all of which
illustrious dignities were claimed in behalf of Benjamin Douglass
Perkins?
But if the balance is thought too evenly suspended in this case,
another instance can be given in which the evidence of British
noblemen and their ladies is shown to be as valuable in establishing
the character of a medical man or doctrine, as would be the testimony
of the Marquis of Waterford concerning the present condition and
prospects of missionary enterprise. I have before me an octavo
volume of more than four hundred pages, in which, among much similar
matter, I find highly commendatory letters from the Marchioness of
Ormond, Lady Harriet Kavanagh, the Countess of Buckinghamshire, the
Right Hon. Viscount Ingestre, M. P., and the Most Noble, the Marquis
of Sligo,--all addressed to "John St. John Long, Esq," a wretched
charlatan, twice tried for, and once convicted of, manslaughter at
the Old Bailey.
This poor creature, too, like all of his tribe, speaks of the medical
profession as a great confederation of bigoted monopolists. He, too,
says that "If an innovator should appear, holding out hope to those
in despair, and curing disorders which the faculty have recorded as
irremediable, he is at once, and without inquiry, denounced as an
empiric and an impostor." He, too, cites the inevitable names of
Galileo and Harvey, and refers to the feelings excited by the great
discovery of Jenner. From the treatment of the great astronomer who
was visited with the punishment of other heretics by the
ecclesiastical authorities of a Catholic country some centuries
since, there is no very direct inference to be drawn to the medical
profession of the present time. His name should be babbled no
longer, after having been placarded for the hundredth time in the
pages of St. John Long. But if we are doomed to see constant
reference to the names of Harvey and Jenner in every worthless
pamphlet containing the prospectus of some new trick upon the public,
let us, once for all, stare the facts in the face, and see how the
discoveries of these great men were actually received by the medical
profession.
In 1628, Harvey published his first work upon the circulation. His
doctrines were a complete revolution of the prevailing opinions of
all antiquity. They immediately found both champions and opponents;
of which last, one only, Riolanus, seemed to Harvey worthy of an
answer, on account of his "rank, fame, and learning." Controversy in
science, as in religion, was not, in those days, carried on with all
the courtesy which our present habits demand, and it is possible that
some hard words may have been applied to Harvey, as it is very
certain that he used the most contemptuous expressions towards
others.
Harvey declares in his second letter to Riolanus, "Since the first
discovery of the circulation, hardly a day, or a moment, has passed
without my hearing it both well and ill spoken of; some attack it
with great hostility, others defend it with high encomiums; one party
believe that I have abundantly proved the truth of the doctrine
against all the weight of opposing arguments, by experiments,
observations, and dissections; others think it not yet sufficiently
cleared up, and free from 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
of Hippocrates and Galen, dissolved away, gradually, but certainly,
before the demonstrations of Harvey. Twenty-four years after the
publication of his first work, and six years before his death, his
bust in marble was placed in the Hall of the College of Physicians,
with a suitable inscription recording his discoveries.
Two years after this he was unanimously invited to accept the
Presidency of that body; and he lived to see his doctrine
established, and all reputable opposition withdrawn.
There were many circumstances connected with the discovery of Dr.
Jenner which were of a nature to excite repugnance and opposition.
The practice of inoculation for the small-pox had already disarmed
that disease of many of its terrors. The introduction of a
contagious disease from a brute creature into the human system
naturally struck the public mind with a sensation of disgust and
apprehension, and a part of the medical public may have shared these
feelings. I find that Jenner's discovery of vaccination was made
public in June, 1798. In July of the same year the celebrated
surgeon, Mr. Cline, vaccinated a child with virus received from Dr.
Jenner, and in communicating the success of this experiment, he
mentions that Dr. Lister, formerly of the Small-Pox Hospital, and
himself, are convinced of the efficacy of the cow-pox. In November
of the same year, Dr. Pearson published his "Inquiry," containing the
testimony of numerous practitioners in different parts of the
kingdom, to the efficacy of the practice. Dr. HAYGARTH, who was so
conspicuous in exposing the follies of Perkinism, was among the very
earliest to express his opinion in favor of vaccination. In 1801,
Dr. Lettsom mentions the circumstance "as being to the honor of the
medical professors, that they have very generally encouraged this
salutary practice, although it is certainly calculated to lessen
their pecuniary advantages by its tendency to extirpate a fertile
source of professional practice."
In the same year the Medical Committee of Paris spoke of vaccination
in a public letter, as "the most brilliant and most important
discovery of the eighteenth century." The Directors of a Society for
the Extermination of the Small-Pox, in a Report dated October 1st,
1807, "congratulate the public on the very favorable opinion which
the Royal College of Physicians of London, after a most minute and
laborious investigation made by the command of his Majesty, have a
second time expressed on the subject of vaccination, in their Report
laid before the House of Commons, in the last session of Parliament;
in consequence of which the sum of twenty thousand pounds was voted
to Dr. Jenner, as a remuneration for his discovery, in addition to
ten thousand pounds before granted." (In June, 1802.)
These and similar accusations, so often brought up against the
Medical Profession, are only one mode in which is manifested a spirit
of opposition not merely to medical science, but to all science, and
to all sound knowledge. It is a spirit which neither understands
itself nor the object at which it is aiming. It gropes among the
loose records of the past, and the floating fables of the moment, to
glean a few truths or falsehoods tending to prove, if they prove
anything, that the persons who have passed their lives in the study
of a branch of knowledge the very essence of which must always
consist in long and accurate observation, are less competent to judge
of new doctrines in their own department than the rest of the
community. It belongs to the clown in society, the destructive in
politics, and the rogue in practice.
The name of Harvey, whose great discovery was the legitimate result
of his severe training and patient study, should be mentioned only to
check the pretensions of presumptuous ignorance. The example of
Jenner, who gave his inestimable secret, the result of twenty-two
years of experiment and researches, unpurchased, to the public,--
when, as was said in Parliament, he might have made a hundred
thousand pounds by it as well as any smaller sum,--should be referred
to only to rebuke the selfish venders of secret remedies, among whom
his early history obliges us reluctantly to record Samuel Hahnemann.
Those who speak of the great body of physicians as if they were
united in a league to support the superannuated notions of the past
against the progress of improvement, have read the history of
medicine to little purpose. The prevalent failing of this profession
has been, on the contrary, to lend a too credulous ear to ambitious
and plausible innovators. If at the present time ten years of public
notoriety have passed over any doctrine professing to be of
importance in medical science, and if it has not succeeded in raising
up a powerful body of able, learned, and ingenious advocates for its
claims, the fault must be in the doctrine and not in the 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
few conjectures as to the particular manner in which it is to break
up and disappear.
1. The confidence of the few believers in this delusion will never
survive the loss of friends who may die of any acute disease, under a
treatment such as that prescribed by Homoeopathy. It is doubtful how
far cases of this kind will be trusted to its tender mercies, but
wherever it acquires any considerable foothold, such cases must come,
and with them the ruin of those who practise it, should any highly
valued life be thus sacrificed.
2. After its novelty has worn out, the ardent and capricious
individuals who constitute the most prominent class of its patrons
will return to visible doses, were it only for the sake of a change.
3. The Semi-Homoeopathic practitioner will gradually withdraw from
the rotten half of his business and try to make the public forget his
connection with it.
4. The ultra Homoeopathist will either recant and try to rejoin the
medical profession; or he will embrace some newer and if possible
equally extravagant doctrine; or he will stick to his colors and go
down with his sinking doctrine. Very few will pursue the course last
mentioned.
A single fact may serve to point out in what direction there will
probably be a movement of the dissolving atoms of Homoeopathy. On
the 13th page of the too frequently cited Manifesto of the "Examiner"
I read the following stately paragraph:
"Bigelius, M. D., physician to the Emperor of Russia, whose elevated
reputation is well known in Europe, has been an acknowledged advocate
of Hahnemann's doctrines for several years. He abandoned Allopathia
for Homoeopathia." The date of this statement is January, 1840. I
find on looking at the booksellers' catalogues that one Bigel, or
Bigelius, to speak more classically, has been at various times
publishing Homoeopathic books for some years.
Again, on looking into the "Encyclographie des Sciences Medicales"
for April, 1840, I find a work entitled "Manual of HYDROSUDOPATHY,
or the Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel,
Physician of the School of Strasburg, Member of the Medico-
Chirurgical Institute of Naples, of the Academy of St. Petersburg,--
Assessor of the College of the Empire of Russia, Physician of his
late Imperial Highness the Grand Duke Constantine, Chevalier of the
Legion of Honor, etc." Hydrosudopathy or Hydropathy, as it is
sometimes called, is a new medical doctrine or practice which has
sprung up in Germany since Homoeopathy, which it bids fair to drive
out of the market, if, as Dr. Bigel says, fourteen physicians
afflicted with diseases which defied themselves and their colleagues
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 of the
curative method of Graefenberg a profession of medical faith, and he
will be correct in so doing." And his work closes with the following
sentence, worthy of so distinguished an individual: "We believe, with
religion, that the water of baptism purifies the soul from its
original sin; let us believe also, with experience, that it is for
our corporeal sins the redeemer of the human body." If Bigel,
Physician to the late Grand Duke Constantine, is identical with Bigel
whom the "Examiner" calls Physician to the Emperor of Russia, it
appears that he is now actively engaged in throwing cold water at
once upon his patients and the future prospects of Homoeopathy.
If, as must be admitted, no one of Hahnemann's doctrines is received
with tolerable unanimity among his disciples, except the central
axiom, Similia similibus curantur; if this axiom itself relies mainly
for its support upon the folly and trickery of Hahnemann, what can we
think of those who announce themselves ready to relinquish all the
accumulated treasures of our art, to trifle with life upon the
strength of these fantastic theories? What shall we think of
professed practitioners of medicine, if, in the words of Jahr, "from
ignorance, for their personal convenience, or through charlatanism,
they treat their patients one day Homoeopathically and the next
Allopathically;" if they parade their pretended new science before
the unguarded portion of the community; if they suffer their names to
be coupled with it wherever it may gain a credulous patient; and deny
all responsibility for its character, refuse all argument for its
doctrines, allege no palliation for the ignorance and deception
interwoven with every thread of its flimsy tissue, when they are
questioned by those competent to judge and entitled to an answer?
Such is the pretended science of Homoeopathy, to which you are asked
to trust your lives and the lives of those dearest to you. A mingled
mass of perverse ingenuity, of tinsel erudition, of imbecile
credulity, and of artful misrepresentation, too often mingled in
practice, if we may trust the authority of its founder, with
heartless and shameless imposition. Because it is suffered so often
to appeal unanswered to the public, because it has its journals, its
patrons, its apostles, some are weak enough to suppose it can escape
the inevitable doom of utter disgrace and oblivion. Not many years
can pass away before the same curiosity excited by one of Perkins's
Tractors will be awakened at the sight of one of the Infinitesimal
Globules. If it should claim a longer existence, it can only be by
falling into the hands of the sordid wretches who wring their bread
from the cold grasp of disease and death in the hovels of ignorant
poverty.
As one humble member of a profession which for more than two thousand
years has devoted itself to the pursuit of the best earthly interests
of mankind, always assailed and insulted from without by such as are
ignorant of its infinite perplexities and labors, always striving in
unequal contest with the hundred-armed giant who walks in the
noonday, and sleeps not in the midnight, yet still toiling, not
merely for itself and the present moment, but for the race and the
future, I have lifted my voice against this lifeless delusion,
rolling its shapeless bulk into the 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 be
frequently 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 to
exalt your views of the value and dignity of our profession, but to
divest your minds of the overpowering dread that you can ever become,
especially to woman, under the extremely interesting circumstances of
gestation and parturition, the minister of evil; that you can ever
convey, in any possible manner, a horrible virus, so destructive in
its effects, and so mysterious in its operations as that attributed
to puerperal fever."--Professor Hodge,
1852.
"I prefer to attribute them to accident, or Providence, of which I
can form a conception, rather than to a contagion of which I cannot
form any clear idea, at least as to this particular malady."--
Professor Meigs, 1852.
" . . . in the propagation of which they have no more to do, than
with the propagation of cholera from Jessore to San Francisco, and
from Mauritius to St. Petersburg."--Professor Meigs, 1854.
---------------------
"I arrived at that certainty in the matter, that I could venture to
foretell what women would be affected with the disease, upon hearing
by what midwife they were to be delivered, or by what nurse they were
to be attended, during their lying-in; and, almost in every instance,
my prediction was verified."--Gordon, 1795.
"A certain number of deaths is caused every year by the contagion of
puerperal 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
medical institutions of a country, should have the power of coercing,
or of inflicting some kind of punishment on those who recklessly go
from cases of puerperal fevers to parturient or puerperal females,
without using due precaution; and who, having been shown the risk,
criminally encounter it, and convey pestilence and death to the
persons they are employed to aid in the most interesting and
suffering period of female existence."--Copland's Medical
Dictionary, Art. Puerperal States and Diseases, 1852.
"We conceive it unnecessary to go into detail to prove the contagious
nature of this disease, as there are few, if any, American
practitioners who do not believe in this doctrine."--Dr. Lee, in
Additions to Article last cited.
-----------------------
[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion
arose in a Medical Society of which I was a member, involving the
subject of a certain supposed cause of disease, about which something
was known, a good deal suspected, and not a little feared. The
discussion was suggested by a case, reported at the preceding
meeting, of a physician who made an examination of the body of a
patient who had died with puerperal fever, and who himself died in
less than a week, apparently in consequence of a wound received at
the examination, having attended several women in confinement in the
mean time, all of whom, as it was alleged, were attacked with
puerperal fever.
Whatever apprehensions and beliefs were entertained, it was plain
that a fuller knowledge of the facts relating to the subject would be
acceptable to all present. I therefore felt that it would be doing a
good service to look into the best records I could find, and inquire
of the most trustworthy practitioners I knew, to learn what
experience had to teach in the matter, and arrived at the results
contained in the following pages.
The Essay was read before the Boston Society for Medical Improvement,
and, at the request of the Society, printed in the "New England
Quarterly Journal of Medicine and Surgery" for April, 1843. As this
Journal never obtained a large circulation, and ceased to be
published after a year's existence, and as the few copies I had
struck off separately were soon lost sight of among the friends to
whom they were sent, the Essay can hardly be said to have been fully
brought before the Profession.
The subject of this Paper has the same profound interest for me at
the present moment as it had when I was first collecting the terrible
evidence out of which, as it seems to me, the commonest exercise of
reason could not help shaping the truth it involved. It is not
merely on account of the bearing of the question,--if there is a
question,--on all that is most sacred in human life and happiness,
that the subject cannot lose its interest. It is because it seems
evident that a fair statement of the facts must produce its proper
influence on a very large proportion of well-constituted and
unprejudiced minds. Individuals may, here and there, resist the
practical bearing of the evidence on their own feelings or interests;
some may fail to see its meaning, as some persons may be found who
cannot tell red from green; but I cannot doubt that most readers will
be satisfied and convinced, to loathing, long before they have
finished the dark obituary calendar laid before them.
I do not know that I shall ever again have so good an opportunity of
being useful as was granted me by the raising of the question which
produced this Essay. For I have abundant evidence that it has made
many practitioners more cautious in their relations with puerperal
females, and I have no doubt it will do so still, if it has a chance
of being read, though it should call out a hundred counterblasts,
proving to the satisfaction of their authors that it proved nothing.
And for my part, I had rather rescue one mother from being poisoned
by her attendant, than claim to have saved forty out of fifty
patients to whom I had carried the disease. Thus, I am willing to
avail myself of any hint coming from without to offer this paper once
more to the press. The occasion has presented itself, as will be
seen, in a convenient if not in a flattering form.
I send this Essay again to the MEDICAL PROFESSION, without the change
of a word or syllable. I find, on reviewing it, that it anticipates
and eliminates those secondary questions which cannot be entertained
for a moment until the one great point of fact is peremptorily
settled. In its very statement of the doctrine maintained it avoids
all discussion of the nature of the disease "known as puerperal
fever," and all the somewhat stale philology of the word contagion.
It mentions, fairly enough, the names of sceptics, or unbelievers as
to the reality of personal transmission; of Dewees, of Tonnelle, of
Duges, of Baudelocque, and others; of course, not including those
whose works were then unwritten or unpublished; nor enumerating all
the Continental writers who, in ignorance of the great mass of
evidence accumulated by British practitioners, could hardly be called
well informed on this subject. It meets all the array of negative
cases,--those in which disease did not follow exposure,--by the
striking example of small-pox, which, although one of the most
contagious of diseases, is subject to the most remarkable
irregularities and seeming caprices in its transmission. It makes
full allowance for other causes besides personal transmission,
especially for epidemic influences. It allows for the possibility of
different modes of conveyance of the destructive principle. It
recognizes and supports the belief that a series of cases may
originate from a single primitive source which affects each new
patient in turn; and especially from cases of Erysipelas. It does
not undertake to discuss the theoretical aspect of the subject; that
is a secondary matter of consideration. Where facts are numerous,
and unquestionable, and unequivocal in their significance, theory
must follow them as it best may, keeping time with their step, and
not go before them, marching to the sound of its own drum and
trumpet. Having thus narrowed its area to a limited practical
platform of discussion, a matter of life and death, and not of
phrases or theories, it covers every inch of it with a mass of
evidence which I conceive a Committee of Husbands, who can count
coincidences and draw conclusions as well as a Synod of Accoucheurs,
would justly consider as affording ample reasons for an unceremonious
dismissal of a practitioner (if it is conceivable that such a step
could be waited for), after five or six funerals had marked the path
of his daily visits, while other practitioners were not thus
escorted. To the Profession, therefore, I submit the paper in its
original form, and leave it to take care of itself.
To the MEDICAL STUDENTS, into whose hands this Essay may fall, some
words of introduction may be appropriate, and perhaps, to a small
number of them, necessary. There are some among them who, from
youth, or want of training, are easily bewildered and confused in any
conflict of opinions into which their studies lead them. They are
liable to lose sight of the main question in collateral issues, and
to be run away with by suggestive speculations. They confound belief
with evidence, often trusting the first because it is expressed with
energy, and slighting the latter because it is calm and
unimpassioned. They are not satisfied with proof; they cannot
believe a point is settled so long as everybody is not silenced.
They have not learned that error is got out of the minds that cherish
it, as the taenia is removed from the body, one joint, or a few
joints at a time, for the most part, rarely the whole evil at once.
They naturally have faith in their instructors, turning to them for
truth, and taking what they may choose to give them; babes in
knowledge, not yet able to tell the breast from the bottle, pumping
away for the milk of truth at all that offers, were it nothing better
than a Professor's shrivelled forefinger.
In the earliest and embryonic stage of professional development, any
violent impression on the instructor's mind is apt to be followed by
some lasting effect on that of the pupil. No mother's mark is more
permanent than the mental naevi and moles, and excrescences, and
mutilations, that students carry with them out of the lecture-room,
if once the teeming intellect which nourishes theirs has been scared
from its propriety by any misshapen fantasy. Even an impatient or
petulant expression, which to a philosopher would be a mere index of
the low state of amiability of the speaker at the moment of its
utterance, may pass into the young mind as an element of its future
constitution, to injure its temper or corrupt its judgment. It is a
duty, therefore, which we owe to this younger class of students, to
clear any important truth which may have been rendered questionable
in their minds by such language, or any truth-teller against whom
they may have been prejudiced by hasty epithets, from the impressions
such words have left. Until this is 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 the prejudice, there seems to be no
impropriety in showing that this prejudice is local or personal, and
not an acknowledged conviction with the public at large. It may be
necessary to break through our usual habits of reserve to do this,
but this is the fault of the position in which others have placed us.
Two widely-known and highly-esteemed practitioners, Professors in two
of the largest Medical Schools of the Union, teaching the branch of
art which includes the Diseases of Women, and therefore speaking with
authority; addressing in their lectures and printed publications
large numbers of young men, many of them in the tenderest immaturity
of knowledge, have recently taken ground in a formal way against the
doctrine maintained in this paper:
On the Non-Contagious Character of Puerperal Fever: An Introductory
Lecture. By Hugh L. Hodge, M. D., Professor of Obstetrics in the
University of Pennsylvania. Delivered Monday, October 11, 1852.
Philadelphia, 1852.
On the Nature, Signs, and Treatment of Childbed Fevers : in a Series
of Letters addressed to the Students of his Class. By Charles D.
Meigs, M. D., Professor of Midwifery and the Diseases of Women and
Children in Jefferson Medical College, Philadelphia, etc., etc.
Philadelphia, 1854. Letter VI.
The first of the two publications, Dr. Hodge's Lecture, while its
theoretical considerations and negative experiences do not seem to me
to require any further notice than such as lay ready for them in my
Essay written long before, is, I am pleased to say, unobjectionable
in tone and language, and may be read without offence.
This can hardly be said of the chapter of Dr. Meigs's volume which
treats of Contagion in Childbed Fever. There are expressions used in
it which might well put a stop to all scientific discussions, were
they to form the current coin in our exchange of opinions. I leave
the "very young gentlemen," whose careful expositions of the results
of practice in more than six thousand cases are characterized as "the
jejune and fizenless dreamings of sophomore writers," to the
sympathies of those "dear young friends," and "dear young gentlemen,"
who will judge how much 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 oblige
me to appropriate to myself, as my reward for a certain amount of
labor bestowed on the investigation of a very important question of
evidence, and a statement of my own practical conclusions. I take no
offence, and attempt no retort. No man makes a quarrel with me over
the counterpane that covers a mother, with her new-born infant at her
breast. There is no epithet in the vocabulary of slight and sarcasm
that can reach my personal sensibilities in such a controversy. Only
just so far as a disrespectful phrase may turn the student aside from
the examination of the evidence, by discrediting or dishonoring the
witness, does it call for any word of notice.
I appeal from the disparaging language by which the Professor in the
Jefferson School of Philadelphia world dispose of my claims to be
listened to. I appeal, not to the vote of the Society for Medical
Improvement, although this was an unusual evidence of interest in the
paper in question, for it was a vote passed among my own townsmen;
nor to the opinion of any American, for none know better than the
Professors in the great Schools of Philadelphia how cheaply the
praise of native contemporary criticism is obtained. I appeal to the
recorded opinions of those whom I do not know, and who do not know
me, nor care for me, except for the truth that I may have uttered; to
Copland, in his "Medical Dictionary," who has spoken of my Essay in
phrases to which the pamphlets of American "scribblers" are seldom
used from European authorities; to Ramsbotham, whose compendious
eulogy is all that self-love could ask; to the "Fifth Annual Report"
of the Registrar-General of England, in which the second-hand
abstract of my Essay figures largely, and not without favorable
comment, in an important appended paper. These testimonies, half
forgotten until this circumstance recalled them, are dragged into the
light, not in a paroxysm of vanity, but to show that there may be
food for thought in the small pamphlet which the Philadelphia Teacher
treats so lightly. They were at least unsought for, and would never
have been proclaimed but for the sake of securing the privilege of a
decent and unprejudiced hearing.
I will take it for granted that they have so far counterpoised the
depreciating language of my fellow-countryman and fellow-teacher as
to gain me a reader here and there among the youthful class of
students I am now addressing. It is only for their sake that I think
it necessary to analyze, or explain, or illustrate, or corroborate
any portion of the following Essay. But I know that nothing can be
made too plain for beginners; and as I do not expect the
practitioner, or even the more mature student, to take the trouble to
follow me through an Introduction which I consider wholly unnecessary
and superfluous for them, I shall not hesitate to stoop to the most
elementary simplicity for the benefit of the younger student. I do
this more willingly because it affords a good opportunity, as it
seems to me, of exercising the untrained mind in that medical logic
which does not seem to have been either taught or practised in our
schools of late, to the extent that might be desired.
I will now exhibit, in a series of propositions reduced to their
simplest expression, the same essential statements and conclusions as
are contained in the Essay, with such commentaries and explanations
as may be profitable to the inexperienced class of readers addressed.
I. It has been long believed, by many competent observers, that
Puerperal Fever (so called) is sometimes carried from patient to
patient by 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 consult
any medical theorist as to whether or not it is consistent with his
preconceived notions that such a mode of transfer should exist.
IV. If the medical theorist insists on being consulted, and we see
fit to indulge him, he cannot be allowed to assume that the alleged
laws of contagion, deduced from observation in other diseases, shall
be cited to disprove the alleged laws deduced from observation in
this. Science would never make progress under such conditions.
Neither the long incubation of hydrophobia, nor the protecting power
of vaccination, would ever have been admitted, if the results of
observation in these affections had been rejected as contradictory to
the previously ascertained laws of contagion.
V. The disease in question is not a common one; producing, on the
average, about three deaths in a thousand births, according to the
English Registration returns which I have examined.
VI. When an unusually large number of cases of this disease occur
about the same time, it is inferred, therefore, that there exists
some special cause for this increased frequency. If the disease
prevails extensively over a wide region of country, it is attributed
without dispute to an epidemic influence. If it prevails in a single
locality, as in a hospital, and not elsewhere, this is considered
proof that some local cause is there active in its production.
VII. When a large number of cases of this disease occur in rapid
succession, in one individual's ordinary practice, and few or none
elsewhere, these cases appearing in scattered localities, in patients
of the same average condition as those who escape under the care of
others, there is the same reason for connecting the cause of the
disease with the person in this instance, as with the place in that
last mentioned.
VIII. Many series of cases, answering to these conditions, are given
in this Essay, and many others will be referred to which have
occurred since it was written.
IX. The alleged results of observation may be set aside; first,
because the so-called facts are in their own nature equivocal;
secondly, because they stand on insufficient authority; thirdly,
because they are not sufficiently numerous. But, in this case, the
disease is one of striking and well-marked character; the witnesses
are experts, interested in denying and disbelieving the facts; the
number of consecutive cases in many instances frightful, and the
number of series of cases such that I have 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 be considered the effect of chance. I have had the chances
calculated by a competent person, that a given practitioner, A.,
shall have sixteen fatal cases in a month, on the following data:
A. to average attendance upon two hundred and fifty births in a year;
three deaths in one thousand births to be assumed as the average from
puerperal fever; no epidemic to be at the time prevailing. It
follows, from the answer given me, that if we suppose every one of
the five hundred thousand annual births of England to have been
recorded during the last half-century, there would not be one chance
in a million million million millions that one such series should be
noted. No possible fractional error in this calculation can render
the chance a working probability. Applied to dozens of series of
various lengths, it is obviously an absurdity. Chance, therefore, is
out of the question as an explanation of the admitted coincidences.
XI. There is, therefore, some relation of cause and effect between
the physician's presence and the patient's disease.
XII. Until it is proved to what removable condition attaching to the
attendant the disease is owing, he is bound to stay away from his
patients so soon as he finds himself singled out to be tracked by the
disease. How long, and with what other precautions, I have
suggested, without dictating, at the close of my Essay. If the
physician does not at once act on any reasonable suspicion of his
being the medium of transfer, the families where he is engaged, if
they are allowed to know the facts, should decline his services for
the time. His feelings on the occasion, however interesting to
himself, should not be even named in this connection. A physician
who talks about ceremony and gratitude, and services rendered, and
the treatment he got, surely forgets himself; it is impossible that
he should seriously think of these small matters where there is even
a question whether he may not carry disease, and death, and
bereavement into any one of "his families," as they are sometimes
called.
I will now point out to the young student the mode in which he may
relieve his mind of any confusion, or possibly, if very young, any
doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised
in his mind.
The most prominent ideas of the Letter are, first, that the
transmissible 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 in
London, found it improbable, and exceedingly inconvenient to himself,
that cow pox should prevent small-pox; but Dr. Jenner took the
liberty to prove the fact, notwithstanding.
I will first call the young student's attention to the show of
negative facts (exposure without subsequent disease), of which much
seems to be thought. 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 now take up Watson's Lectures, the good sense and
spirit of which have made his book a universal favorite, and open to
the chapter on Continued Fever. He will find a paragraph containing
the following sentence: "A man might say, 'I was in the battle of
Waterloo, and saw many men around me fall down and die, and it was
said that they were struck down by musket-balls; but I know better
than that, for I was there all the time, and so were many of my
friends, and we were never hit by any musket-balls. Musket-balls,
therefore, could not have been the cause of the deaths we witnessed.'
And if, like contagion, they were not palpable to the senses, such a
person might go on to affirm that no proof existed of there being any
such thing as musket-balls." Now let the student turn back to the
chapter on Hydrophobia in the same volume. He will find that John
Hunter knew a case in which, of twenty-one persons bitten, only one
died of the disease. He will find that one dog at Charenton was
bitten at different times by thirty different mad dogs, and outlived
it all. Is there no such thing, then, as hydrophobia? Would one
take no especial precautions if his wife, about to become a mother,
had been bitten by a rabid animal, because so many escape? Or let
him look at "Underwood on Diseases of Children,"[Philadelphia, 1842,
p. 244, note.] and he will find the case of a young woman who was
inoculated eight times in thirty days, at the same time attending
several children with smallpox, and yet was not infected. But seven
weeks afterwards she took the disease and died.
It would seem as if the force of this argument could hardly fail to
be seen, if it were granted that every one of these series of cases
were so reported 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, as to 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, but from the character of the very imperfect evidence
the question can never be settled without further disclosures.
Although the Letter is, as I have implied, principally taken up with
secondary and collateral questions, and might therefore be set aside
as in the main irrelevant, I am willing, for the student's sake, to
touch some of these questions briefly, as an illustration of its
logical character.
The first thing to be done, as I thought when I wrote my Essay, was
to throw out all discussions of the word contagion, and this I did
effectually by the careful wording of my statement of the subject to
be discussed. My object was not to settle the etymology or
definition of a word, but to show that women had often died in
childbed, poisoned in some way by their medical attendants. On the
other point, I, at least, have no controversy with anybody, and I
think the student will do well to avoid it in this connection. If I
must define my position, however, as well as the term in question, I
am contented with Worcester's definition; provided always this avowal
do not open another side controversy on the merits of his Dictionary,
which Dr. Meigs has not cited, as compared with Webster's, which he
has.
I cannot see the propriety of insisting that all the laws of the
eruptive fevers must necessarily hold true of this peculiar disease
of puerperal women. If there were any such propriety, the laws of
the eruptive fevers must at least be stated correctly. It is not
true, for instance, as Dr. Meigs states, that contagion is "no
respecter of persons;" that "it attacks all individuals alike." To
give one example: Dr. Gregory, of the Small-Pox Hospital, who ought
to know, says that persons pass through life apparently insensible to
or unsusceptible of the small-pox virus, and that the same persons do
not take the vaccine disease.
As to the short time of incubation, of which so much is made, we have
no right to decide beforehand whether it shall be long or short, in
the cases we are considering. A dissection wound may produce
symptoms of poisoning in six hours; the bite of a rabid animal may
take as many months.
After the student has read the case in Dr. Meigs's 136th paragraph,
and the following one, in which he exclaims against the idea of
contagion, because the patient, delivered on the 26th of December,
was attacked in twenty-four hours, and died on the third day, let him
read what happened at the "Black Assizes" of 1577 and 1750. In the
first case, six hundred persons sickened the same night of the
exposure, and three hundred more in three days. [Elliotson's
Practice, p. 298.] Of those attacked in the latter year, the
exposure being on the 11th of May, Alderman Lambert died on the 13th,
Under-Sheriff Cox on the 14th, and many of note before the
20th. But these are old stories. Let the student listen then to Dr.
Gerhard, whose reputation as a cautious observer he may be supposed
to know. "The nurse was shaving a man, who died in a few hours after
his entrance; he inhaled his breath, which had a nauseous taste, and
in an hour afterwards was taken with nausea, cephalalgia, and singing
of the ears. 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 with the symptoms of typhus."[Am. Jour. Med.
Sciences, Feb. 1837, p. 299.] It is by notes of cases, rather
than notes of admiration, that we must be guided, when we study the
Revised Statutes of Nature, as laid down from the curule chairs of
Medicine.
Let the student read Dr. Meigs's 140th paragraph soberly, and then
remember, that not only does he infer, suspect, and surmise, but he
actually asserts (page 154), "there was poison in the house," because
three out of five patients admitted into a ward had puerperal fever
and died. 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 of the Dublin Hospital? All practical medicine, and all action
in common affairs, is founded on inferences. How does Dr. Meigs know
that the patients he bled in puerperal fever would not have all got
well if he had not bled them?
"You see a man discharge a gun at another; you see the flash, you
hear the report, you see the person fall a lifeless corpse; and you
infer, from all these circumstances, that there was a ball discharged
from the gun, which entered his body and caused his death, because
such is the usual and natural cause of such an effect. But you did
not see the ball leave the gun, pass through the air, and enter the
body of the slain; and your testimony to the fact of killing is,
therefore, only inferential,--in other words, circumstantial. It is
possible that no ball was in the gun; and we infer that there was,
only because we cannot account for death on any other supposition."
[Chief Justice Gibson, in Am. Law Journal, vol. vi. p. 123.]
"The question always comes to this: Is the circumstance of
intercourse with the sick followed by the appearance of the disease
in a proportion of cases so much greater than any other circumstance
common to any portion of the inhabitants of the place under
observation, as to make it inconceivable that the succession of cases
occurring in persons having that intercourse should have been the
result of chance? If so, the inference is unavoidable, that that
intercourse must have acted as a cause of the disease. All
observations which do not bear strictly on that point are irrelevant,
and, in the case of an epidemic first appearing in a town or
district, a succession of two cases is sometimes sufficient to
furnish evidence which, on the principle I have stated, is nearly
irresistible."
Possibly an inexperienced youth may be awe-struck by the quotation
from Cuvier. These words, or their equivalent, are certainly to be
found in his Introduction. So are the words "top not come down"!
to be found in the Bible, and they were as much meant for the ladies'
head-dresses as the words of Cuvier were meant to make clinical
observation wait for a permit from anybody to look with its eyes and
count on its fingers. Let the inquiring youth read the whole
Introduction, and he will see what they mean.
I intend no breach of courtesy, but this is a proper place to warn
the student against skimming the prefaces and introductions of works
for mottoes and embellishments to his thesis. He cannot learn
anatomy by thrusting an exploring needle into the body. He will be
very liable to misquote his author's meaning while he is picking off
his outside sentences. He may make as great a blunder as that simple
prince who praised the conductor of his orchestra for the piece just
before the overture; the musician was too good a courtier to tell him
that it was only 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 which act 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; and that poison may produce its symptoms in a few
hours after the system has received it, as any may see in Druitt's
"Surgery," if they care to look. Puerperal peritonitis may produce
such a poison, and puerperal women may be very sensible to its
influences, conveyed by contact or exhalation. Whether this is so or
not, facts alone can determine, and to facts we have had recourse to
settle it.
The following statement is made by Dr. Meigs in his 142d paragraph,
and developed more at length, with rhetorical amplifications, in the
134th. "No human being, save a pregnant or parturient woman, is
susceptible to the poison." This statement is wholly incorrect, as I
am sorry to have to point out to a Teacher in Dr. Meigs's position.
I do not object to the erudition which quotes Willis and Fernelius,
the last of whom was pleasantly said to have "preserved the dregs of
the Arabs in the honey of his Latinity." But I could wish that more
modern authorities had not been overlooked. On this point, for
instance, among the numerous facts disproving the statement, the
"American Journal of Medical Sciences," published not far from his
lecture-room, would have presented him with a respectable catalog of
such cases. Thus he might refer to Mr. Storrs's paper "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 dying of
peritonitis in an epidemic of puerperal fever at the Philadelphia
Hospital (Oct. 1842), or to various instances cited in Dr.
Kneeland's article (April, 186). Or, if he would have referred to
the "New York Journal," he might have seen Prof. Austin Flint's
cases. Or, if he had honored my Essay so far, he might have found
striking instances of the same kind in the first of the new series of
cases there reported and elsewhere. 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 slight examination of the facts; and I
confess my surprise, that a professor who 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
I would not be "understood to imply that there exists a doubt in the
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