Medical Essays
by
Oliver Wendell Holmes, Sr. (The Physician and Poet)
Part 5 out of 7
some discontented practitioner, who, tired of seeing patients die
with their skins full of whiskey and their brains muddy with opium,
returns to a bold antiphlogistic treatment, and has the luck to see a
few patients of note get well under it. So of the remedies which
have gone out of fashion and been superseded by others. It can
hardly be doubted that they will come into vogue again, more or less
extensively, under the influence of that irresistible demand for
change just referred to.
Then will come the usual talk about a change in the character of
disease, which has about as much meaning as that concerning
"old-fashioned snow-storms." "Epidemic constitutions" of disease
mean something, no doubt; a great deal as applied to malarious
affections; but that the whole type of diseases undergoes such
changes that the practice must be reversed from depleting to
stimulating, and vice versa, is much less likely than that methods of
treatment go out of fashion and come in again. If there is any
disease which claims its percentage with reasonable uniformity, it is
phthisis. Yet I remember that the reverend and venerable Dr. Prince
of Salem told me one Commencement day, as I was jogging along towards
Cambridge with him, that he recollected the time when that disease
was hardly hardly known; and in confirmation of his statement
mentioned a case in which it was told as a great event, that somebody
down on "the Cape" had died of "a consumption." This story does not
sound probable to myself, as I repeat it, yet I assure you it is
true, and it shows how cautiously we must receive all popular stories
of great changes in the habits of disease.
Is there no progress, then, but do we return to the same beliefs and
practices which our forefathers wore out and threw away? I trust and
believe that there is a real progress. We may, for instance, return
in a measure to the Brunonian stimulating system, but it must be in a
modified way, for we cannot go back to the simple Brunonian
pathology, since we have learned too much of diseased action to
accept its convenient dualism. So of other doctrines, each new
Avatar strips them of some of their old pretensions, until they take
their fitting place at last, if they have any truth in them, or
disappear, if they were mere phantasms of the imagination.
In the mean time, while medical theories are coming in and going out,
there is a set of sensible men who are never run away with by them,
but practise their art sagaciously and faithfully in much the same
way from generation to generation. From the time of Hippocrates to
that of our own medical patriarch, there has been an apostolic
succession of wise and good practitioners. If you will look at the
first aphorism of the ancient Master you will see that before all
remedies he places the proper conduct of the patient and his
attendants, and the fit ordering of all the conditions surrounding
him. The class of practitioners I have referred to have always been
the most faithful in attending to these points. No doubt they have
sometimes prescribed unwisely, in compliance with the prejudices of
their time, but they have grown wiser as they have grown older, and
learned to trust more in nature and less in their plans of
interference. I believe common opinion confirms Sir James Clark's
observation to this effect.
The experience of the profession must, I think, run parallel with
that of the wisest of its individual members. Each time a plan of
treatment or a particular remedy comes up for trial, it is submitted
to a sharper scrutiny. When Cullen wrote his Materia Medica, he had
seriously to assail the practice of giving burnt toad, which was
still countenanced by at least one medical authority of note. I have
read recently in some medical journal, that an American practitioner,
whose name is known to the country, is prescribing the hoof of a
horse for epilepsy. It was doubtless suggested by that old fancy of
wearing a portion of elk's hoof hung round the neck or in a ring, for
this disease. But it is hard to persuade reasonable people to
swallow the abominations of a former period. The evidence which
satisfied Fernelius will not serve one of our hospital physicians.
In this way those articles of the Materia Medica which had nothing
but loathsomeness to recommend them have been gradually dropped, and
are not like to obtain any general favor again with civilized
communities. The next culprits to be tried are the poisons. I have
never been in the least sceptical as to the utility of some of them,
when properly employed. Though I believe that at present, taking the
world at large, and leaving out a few powerful agents of such immense
value that they rank next to food in importance, the poisons
prescribed for disease do more hurt than good, I have no doubt, and
never professed to have any, that they do much good in prudent and
instructed hands. But I am very willing to confess a great jealousy
of many agents, and I could almost wish to see the Materia Medica so
classed as to call suspicion upon certain ones among them.
Thus the alien elements, those which do not properly enter into the
composition of any living tissue, are the most to be suspected,--
mercury, lead, antimony, silver, and the rest, for the reasons I have
before mentioned. Even iodine, which, as it is found in certain
plants, seems less remote from the animal tissues, gives unequivocal
proofs from time to time that it is hostile to some portions of the
glandular system.
There is, of course, less prima facie objection to those agents which
consist of assimilable elements, such as are found making a part of
healthy tissues. These are divisible into three classes,--foods,
poisons, and inert, mostly because insoluble, substances. The food
of one animal or of one human being is sometimes poison to another,
and vice versa; inert substances may act mechanically, so as to
produce the effect of poisons; but this division holds exactly enough
for our purpose.
Strictly speaking, every poison consisting of assimilable elements
may be considered as unwholesome food. It is rejected by the
stomach, or it produces diarrhoea, or it causes vertigo or
disturbance of the heart's action, or some other symptom for which
the subject of it would consult the physician, if it came on from any
other cause than taking it under the name of medicine. Yet portions
of this unwholesome food which we call medicine, we have reason to
believe, are assimilated; thus, castor-oil appears to be partially
digested by infants, so that they require large doses to affect them
medicinally. Even that deadliest of poisons, hydrocyanic acid, is
probably assimilated, and helps to make living tissue, if it do not
kill the patient, for the assimilable elements which it contains,
given in the separate forms of amygdalin and emulsin, produce no
disturbance, unless, as in Bernard's experiments, they are suffered
to meet in the digestive organs. A medicine consisting of
assimilable substances being then simply unwholesome food, we
understand what is meant by those cumulative effects of such remedies
often observed, as in the case of digitalis and strychnia. They are
precisely similar to the cumulative effects of a salt diet in
producing scurvy, or of spurred rye in producing dry gangrene. As
the effects of such substances are a violence to the organs, we
should exercise the same caution with regard to their use that we
would exercise about any other kind of poisonous food,--partridges at
certain seasons, for instance. Even where these poisonous kinds of
food seem to be useful, we should still regard them with great
jealousy. Digitalis lowers the pulse in febrile conditions.
Veratrum viride does the same thing. How do we know that a rapid
pulse is not a normal adjustment of nature to the condition it
accompanies? Digitalis has gone out of favor; how sure are we that
Veratrum viride will not be found to do more harm than good in a case
of internal inflammation, taking the whole course of the disease into
consideration? Think of the change of opinion with regard to the use
of opium in delirium tremens (which you remember is sometimes called
delirium vigilans), where it seemed so obviously indicated, since the
publication of Dr. Ware's admirable essay. I respect the evidence of
my contemporaries, but I cannot forget the sayings of the Father of
medicine,--Ars longa, judicium diffcile.
I am not presuming to express an opinion concerning Veratrum viride,
which was little heard of when I was still practising medicine. I am
only appealing to that higher court of experience which sits in
judgment on all decisions of the lower medical tribunals, and which
requires more than one generation for its final verdict.
Once change the habit of mind so long prevalent among practitioners
of medicine; once let it be everywhere understood that the
presumption is in favor of food, and not of alien substances, of
innocuous, and not of unwholesome food, for the sick; that this
presumption requires very strong evidence in each particular case to
overcome it; but that, when such evidence is afforded, the alien
substance or the unwholesome food should be given boldly, in
sufficient quantities, in the same spirit as that with which the
surgeon lifts his knife against a patient,--that is, with the same
reluctance and the same determination,--and I think we shall have and
hear much less of charlatanism in and out of the profession. The
disgrace of medicine has been that colossal system of self-deception,
in obedience to which mines have been emptied of their cankering
minerals, the vegetable kingdom robbed of all its noxious growths,
the entrails of animals taxed for their impurities, the poison-bags
of reptiles drained of their venom, and all the inconceivable
abominations thus obtained thrust down the throats of human beings
suffering from some fault of organization, nourishment, or vital
stimulation.
Much as we have gained, we have not yet thoroughly shaken off the
notion that poison is the natural food of disease, as wholesome
aliment is the support of health. Cowper's lines, in "The Task,"
show the matter-of-course practice of his time:
"He does not scorn it, who has long endured
A fever's agonies, and fed on drugs."
Dr. Kimball of Lowell, who has been in the habit of seeing a great
deal more of typhoid fever than most practitioners, and whose
surgical exploits show him not to be wanting in boldness or
enterprise, can tell you whether he finds it necessary to feed his
patients on drugs or not. His experience is, I believe, that of the
most enlightened and advanced portion of the profession; yet I think
that even in typhoid fever, and certainly in many other complaints,
the effects of ancient habits and prejudices may still be seen in the
practice of some educated physicians.
To you, young men, it belongs to judge all that has gone before you.
You come nearer to the great fathers of modern medicine than some of
you imagine. Three of my own instructors attended Dr. Rush's
Lectures. The illustrious Haller mentions Rush's inaugural thesis in
his "Bibliotheca Anatomica;" and this same Haller, brought so close
to us, tells us he remembers Ruysch, then an old man, and used to
carry letters between him and Boerhaave. Look through the history of
medicine from Boerhaave to this present day. You will see at once
that medical doctrine and practice have undergone a long series of
changes. You will see that the doctrine and practice of our own time
must probably change in their turn, and that, if we can trust at all
to the indications of their course, it will be in the direction of an
improved hygiene and a simplified treatment. Especially will the old
habit of violating the instincts of the sick give place to a
judicious study of these same instincts. It will be found that
bodily, like mental insanity, is best managed, for the most part, by
natural soothing agencies. Two centuries ago there was a
prescription for scurvy containing "stercoris taurini et anserini
par, quantitas trium magnarum nucum," of the hell-broth containing
which "guoties-cumque sitit oeger, large bibit." When I have
recalled the humane common-sense of Captain Cook in the matter of
preventing this disease; when I have heard my friend, Mr. Dana,
describing the avidity with which the scurvy-stricken sailors snuffed
up the earthy fragrance of fresh raw potatoes, the food which was to
supply the elements wanting to their spongy tissues, I have
recognized that the perfection of art is often a return to nature,
and seen in this single instance the germ of innumerable beneficent
future medical reforms.
I cannot help believing that medical curative treatment will by and
by resolve itself in great measure into modifications of the food,
swallowed and breathed, and of the natural stimuli, and that less
will be expected from specifics and noxious disturbing agents, either
alien or assimilable. The noted mineral-waters containing iron,
sulphur, carbonic acid, supply nutritious or stimulating materials to
the body as much as phosphate of lime and ammoniacal compounds do to
the cereal plants. The effects of a milk and vegetable diet, of
gluten bread in diabetes, of cod-liver oil in phthisis, even of such
audacious innovations as the water-cure and the grape-cure, are only
hints of what will be accomplished when we have learned to discover
what organic elements are deficient or in excess in a case of chronic
disease, and the best way of correcting the abnormal condition, just
as an agriculturist ascertains the wants of his crops and modifies
the composition of his soil. In acute febrile diseases we have long
ago discovered that far above all drug-medication is the use of mild
liquid diet in the period of excitement, and of stimulant and
nutritious food in that of exhaustion. Hippocrates himself was as
particular about his barley-ptisan as any Florence Nightingale of our
time could be.
The generation to which you, who are just entering the profession,
belong, will make a vast stride forward, as I believe, in the
direction of treatment by natural rather than violent agencies. What
is it that makes the reputation of Sydenham, as the chief of English
physicians? His prescriptions consisted principally of simples. An
aperient or an opiate, a "cardiac" or a tonic, may be commonly found
in the midst of a somewhat fantastic miscellany of garden herbs. It
was not by his pharmaceutic prescriptions that he gained his great
name. It was by daring to order fresh air for small-pox patients,
and riding on horseback for consumptives, in place of the smothering
system, and the noxious and often loathsome rubbish of the
established schools. Of course Sydenham was much abused by his
contemporaries, as he frequently takes occasion to remind his reader.
"I must needs conclude," he says, "either that I am void of merit, or
that the candid and ingenuous part of mankind, who are formed with so
excellent a temper of mind as to be no strangers to gratitude, make a
very small part of the whole." If in the fearless pursuit of truth
you should find the world as ungracious in the nineteenth century as
he found it in the seventeenth, you may learn a lesson of self-
reliance from another utterance of the same illustrious physician:
"'T is none of my business to inquire what other persons think, but
to establish my own observations; in order to which, I ask no favor
of the reader but to peruse my writings with temper."
The physician has learned a great deal from the surgeon, who is
naturally in advance of him, because he has a better opportunity of
seeing the effects of his remedies. Let me shorten one of Ambroise
Pare's stories for you. There had been a great victory at the pass
of Susa, and they were riding into the city. The wounded cried out
as the horses trampled them under their hoofs, which caused good
Ambroise great pity, and made him wish himself back in Paris. Going
into a stable he saw four dead soldiers, and three desperately
wounded, placed with their backs against the wall. An old campaigner
came up.--"Can these fellows get well?" he said. "No!" answered the
surgeon. Thereupon, the old soldier walked up to them and cut all
their throats, sweetly, and without wrath (doulcement et sans
cholere). Ambroise told him he was a bad man to do such a thing.
"I hope to God;" he said, "somebody will do as much for me if I ever
get into such a scrape" (accoustre de telle facon). "I was not much
salted in those days" (bien doux de sel), says Ambroise, "and little
acquainted with the treatment of wounds." However, as he tells us,
he proceeded to apply boiling oil of Sambuc (elder) after the
approved fashion of the time,--with what torture to the patient may
be guessed. At last his precious oil gave out, and he used instead
an insignificant mixture of his own contrivance. He could not sleep
that night for fear his patients who had not been scalded with the
boiling oil would be poisoned by the gunpowder conveyed into their
wounds by the balls. To his surprise, he found them much better than
the others the next morning, and resolved never again to burn his
patients with hot oil for gun-shot wounds.
This was the beginning, as nearly as we can fix it, of that reform
which has introduced plain water-dressings in the place of the
farrago of external applications which had been a source of profit to
apothecaries and disgrace to art from, and before, the time when
Pliny complained of them. A young surgeon who was at Sudley Church,
laboring among the wounded of Bull Run, tells me they had nothing but
water for dressing, and he (being also doux de sel) was astonished to
see how well the wounds did under that simple treatment.
Let me here mention a fact or two which may be of use to some of you
who mean to enter the public service. You will, as it seems, have
gun-shot wounds almost exclusively to deal with. Three different
surgeons, the one just mentioned and two who saw the wounded of Big
Bethel, assured me that they found no sabre-cuts or bayonet wounds.
It is the rifle-bullet from a safe distance which pierces the breasts
of our soldiers, and not the gallant charge of broad platoons and
sweeping squadrons, such as we have been in the habit of considering
the chosen mode of warfare of ancient and modern chivalry. [Sir
Charles James Napier had the same experience in Virginia in 1813.
"Potomac. We have nasty sort of fighting here, amongst creeks and
bushes, and lose men without show." "Yankee never shows himself, he
keeps in the thickest wood, fires and runs off."--These five
thousand in the open field might be attacked, but behind works it
would be throwing away lives." He calls it "an inglorious warfare,"
--says one of the leaders is "a little deficient in gumption,"--but
--still my opinion is, that if we tuck up our sleeves and lay our
ears back we might thrash them; that is, if we caught them out of
their trees, so as to slap at them with the bayonet."--Life, etc.
vol. i. p. 218 et seq.]
Another fact parallels the story of the old campaigner, and may teach
some of you caution in selecting your assistants. A chaplain told it
to two of our officers personally known to myself. He overheard the
examination of a man who wished to drive one of the "avalanche"
wagons, as they call them. The man was asked if he knew how to deal
with wounded men. "Oh yes," he answered; "if they're hit here,"
pointing to the abdomen, "knock 'em on the head,--they can't get
well."
In art and outside of it you will meet the same barbarisms that
Ambroise Pare met with,--for men differ less from century to century
than we are apt to suppose; you will encounter the same opposition,
if you attack any prevailing opinion, that Sydenham complained of.
So far as possible, let not such experiences breed in you a contempt
for those who are the subjects of folly or prejudice, or foster any
love of dispute for its own sake. Should you become authors, express
your opinions freely; defend them rarely. It is not often that an
opinion is worth expressing, which cannot take care of itself.
Opposition is the best mordant to fix the color of your thought in
the general belief.
It is time to bring these crowded remarks to a close. The day has
been when at the beginning of a course of Lectures I should have
thought it fitting to exhort you to diligence and entire devotion to
your tasks as students. It is not so now. The young man who has not
heard the clarion-voices of honor and of duty now sounding throughout
the land, will heed no word of mine. In the camp or the city, in the
field or the hospital, under sheltering roof, or half-protecting
canvas, or open sky, shedding our own blood or stanching that of our
wounded defenders, students or teachers, whatever our calling and our
ability, we belong, not to ourselves, but to our imperilled country,
whose danger is our calamity, whose ruin would be our enslavement,
whose rescue shall be our earthly salvation!
SCHOLASTIC AND BEDSIDE TEACHING.
An Introductory Lecture delivered before the Medical Class of Harvard
University, November 6, 1867.
The idea is entertained by some of our most sincere professional
brethren, that to lengthen and multiply our Winter Lectures will be
of necessity to advance the cause of medical education. It is a fair
subject for consideration whether they do not overrate the relative
importance of that particular mode of instruction which forms the
larger part of these courses.
As this School could only lengthen its lecture term at the expense of
its "Summer Session," in which more direct, personal, and familiar
teaching takes the place of our academic discourses, and in which
more time can be given to hospitals, infirmaries, and practical
instruction in various important specialties, whatever might be
gained, a good deal would certainly be lost in our case by the
exchange.
The most essential part of a student's instruction is obtained, as I
believe, not in the lecture-room, but at the bedside. Nothing seen
there is lost; the rhythms of disease are learned by frequent
repetition; its unforeseen occurrences stamp themselves indelibly in
the memory. Before the student is aware of what he has acquired, he
has learned the aspects and course and probable issue of the diseases
he has seen with his teacher, and the proper mode of dealing with
them, so far as his master knows it. On the other hand, our ex
cathedra prelections have a strong tendency to run into details
which, however interesting they may be to ourselves and a few of our
more curious listeners, have nothing in them which will ever be of
use to the student as a practitioner. It is a perfectly fair
question whether I and some other American Professors do not teach
quite enough that is useless already. Is it not well to remind the
student from time to time that a physician's business is to avert
disease, to heal the sick, to prolong life, and to diminish
suffering? Is it not true that the young man of average ability will
find it as much as he can do to fit himself for these simple duties?
Is it not best to begin, at any rate, by making sure of such
knowledge as he will require in his daily walk, by no means
discouraging him from any study for which his genius fits him when he
once feels that he has become master of his chosen art.
I know that many branches of science are of the greatest value as
feeders of our medical reservoirs. But the practising physician's
office is to draw the healing waters, and while he gives his time to
this labor he can hardly be expected to explore all the sources that
spread themselves over the wide domain of science. The traveller who
would not drink of the Nile until he had tracked it to its parent
lakes, would be like to die of thirst; and the medical practitioner
who would not use the results of many laborers in other departments
without sharing their special toils, would find life far too short
and art immeasurably too long.
We owe much to Chemistry, one of the most captivating as well as
important of studies; but the medical man must as a general rule
content himself with a clear view of its principles and a limited
acquaintance with its facts; such especially as are pertinent to his
pursuits. I am in little danger of underrating Anatomy or
Physiology; but as each of these branches splits up into specialties,
any one of which may take up a scientific life-time, I would have
them taught with a certain judgment and reserve, so that they shall
not crowd the more immediately practical branches. So of all the
other ancillary and auxiliary kinds of knowledge, I would have them
strictly subordinated to that particular kind of knowledge for which
the community looks to its medical advisers.
A medical school is not a scientific school, except just so far as
medicine itself is a science. On the natural history side, medicine
is a science; on the curative side, chiefly an art. This is implied
in Hufeland's aphorism: "The physician must generalize the disease
and individualize the patient."
The coordinated and classified results of empirical observation, in
distinction from scientific experiment, have furnished almost all we
know about food, the medicine of health, and medicine, the food of
sickness. We eat the root of the Solanum tuberosum and throw away
its fruit; we eat the fruit of the Solanum Lycopersicum and throw
away its root. Nothing but vulgar experience has taught us to reject
the potato ball and cook the tomato. So of most of our remedies.
The subchloride of mercury, calomel, is the great British specific;
the protochloride of mercury, corrosive sublimate, kills like
arsenic, but no chemist could have told us it would be so.
From observations like these we can obtain certain principles from
which we can argue deductively to facts of a like nature, but the
process is limited, and we are suspicious of all reasoning in that
direction applied to the processes of healthy and diseased life. We
are continually appealing to special facts. We are willing to give
Liebig's artificial milk when we cannot do better, but we watch the
child anxiously whose wet-nurse is a chemist's pipkin. A pair of
substantial mammary glands has the advantage over the two hemispheres
of the most learned Professor's brain, in the art of compounding a
nutritious fluid for infants.
The bedside is always the true centre of medical teaching. Certain
branches must be taught in the lecture-room, and will necessarily
involve a good deal that is not directly useful to the future
practitioner. But the over ambitious and active student must not be
led away by the seduction of knowledge for its own sake from his
principal pursuit. The humble beginner, who is alarmed at the vast
fields of knowledge opened to him, may be encouraged by the assurance
that with a very slender provision of science, in distinction from
practical skill, he may be a useful and acceptable member of the
profession to which the health of the community is intrusted.
To those who are not to engage in practice, the various pursuits of
science hardly require to be commended. Only they must not be
disappointed if they find many subjects treated in our courses as a
medical class requires, rather than as a scientific class would
expect, that is, with special limitations and constant reference to
practical ends. Fortunately they are within easy reach of the
highest scientific instruction. The business of a school like this
is to make useful working physicians, and to succeed in this it is
almost as important not to overcrowd the mind of the pupil with
merely curious knowledge as it is to store it with useful
information.
In this direction I have written my lecture, not to undervalue any
form of scientific labor in its place, an unworthy thought from which
I hope I need not defend myself,--but to discourage any undue
inflation of the scholastic programme, which even now asks more of
the student than the teacher is able to obtain from the great
majority of those who present themselves for examination. I wish to
take a hint in education from the Secretary of the Massachusetts
Board of Agriculture, who regards the cultivation of too much land as
a great defect in our New England farming. I hope that our Medical
Institutions may never lay themselves open to the kind of accusation
Mr. Lowe brings against the English Universities, when he says that
their education is made up "of words that few understand and most
will shortly forget; of arts that can never be used, if indeed they
can even be learnt; of histories inapplicable to our times; of
languages dead and even mouldy; of grammatical rules that never had
living use and are only post mortem examinations; and of statements
fagoted with utter disregard of their comparative value."
This general thought will be kept in view throughout my somewhat
discursive address, which will begin with an imaginary clinical
lesson from the lips of an historical personage, and close with the
portrait from real life of one who, both as teacher and practitioner,
was long loved and honored among us. If I somewhat overrun my hour,
you must pardon me, for I can say with Pascal that I have not had the
time to make my lecture shorter.
In the year 1647, that good man John Eliot, commonly called the
Apostle Eliot, writing to Mr. Thomas Shepherd, the pious minister of
Cambridge, referring to the great need of medical instruction for the
Indians, used these words:
"I have thought in my heart that it were a singular good work, if the
Lord would stirre up the hearts of some or other of his people in
England to give some maintenance toward some Schoole or Collegiate
exercise this way, wherein there should be Anatomies and other
instructions that way, and where there might be some recompence given
to any that should bring in any vegetable or other thing that is
vertuous in the way of Physick.
"There is another reason which moves my thought and desires this way,
namely that our young students in Physick may be trained up better
then they yet bee, who have onely theoreticall knowledge, and are
forced to fall to practise before ever they saw an Anatomy made, or
duely trained up in making experiments, for we never had but one
Anatomy in the countrey, which Mr. Giles Firman [Firmin] now in
England, did make and read upon very well, but no more of that now."
Since the time of the Apostle Eliot the Lord has stirred up the
hearts of our people to the building of many Schools and Colleges
where medicine is taught in all its branches. Mr. Giles Firmin's
"Anatomy" may be considered the first ancestor of a long line of
skeletons which have been dangling and rattling in our lecture-rooms
for more than a century.
Teaching in New England in 1647 was a grave but simple matter. A
single person, combining in many cases, as in that of Mr. Giles
Firmin, the offices of physician and preacher, taught what he knew to
a few disciples whom he gathered about him. Of the making of that
"Anatomy" on which my first predecessor in the branch I teach" did
read very well" we can know nothing. The body of some poor wretch
who had swung upon the gallows, was probably conveyed by night to
some lonely dwelling at the outskirts of the village, and there by
the light of flaring torches hastily dissected by hands that trembled
over the unwonted task. And ever and anon the master turned to his
book, as he laid bare the mysteries of the hidden organs; to his
precious Vesalius, it might be, or his figures repeated in the
multifarious volume of Ambroise Pare; to the Aldine octavo in which
Fallopius recorded his fresh observations; or that giant folio of
Spigelius just issued from the press of Amsterdam, in which lovely
ladies display their viscera with a coquettish grace implying that it
is rather a pleasure than otherwise to show the lace-like omentum,
and hold up their appendices epiploicae as if they were saying "these
are our jewels."
His teaching of medicine was no doubt chiefly clinical, and received
with the same kind of faith as that which accepted his words from the
pulpit. His notions of disease were based on what he had observed,
seen always in the light of the traditional doctrines in which he was
bred. His discourse savored of the weighty doctrines of Hippocrates,
diluted by the subtle speculations of Galen, reinforced by the
curious comments of the Arabian schoolmen as they were conveyed in
the mellifluous language of Fernelius, blended, it may be, with
something of the lofty mysticism of Van Helmont, and perhaps stealing
a flavor of that earlier form of Homoeopathy which had lately come to
light in Sir Kenelm Digby's "Discourse concerning the Cure of Wounds
by the Sympathetic Powder."
His Pathology was mythology. A malformed foetus, as the readers of
Winthrop's Journal may remember, was enough to scare the colonists
from their propriety, and suggest the gravest fears of portended
disaster. The student of the seventeenth century opened his Licetus
and saw figures of a lion with the head of a woman, and a man with
the head of an elephant. He had offered to his gaze, as born of a
human mother, the effigy of a winged cherub, a pterocephalous
specimen, which our Professor of Pathological Anatomy would hardly
know whether to treat with the reverence due to its celestial aspect,
or to imprison in one of his immortalizing jars of alcohol.
His pharmacopoeia consisted mainly of simples, such as the venerable
"Herball" of Gerard describes and figures in abounding affluence.
St. John's wort and Clown's All-heal, with Spurge and Fennel, Saffron
and Parsley, Elder and Snake-root, with opium in some form, and
roasted rhubarb and the Four Great Cold Seeds, and the two Resins, of
which it used to be said that whatever the Tacamahaca has not cured,
the Caranna will, with the more familiar Scammony and Jalap and Black
Hellebore, made up a good part of his probable list of remedies. He
would have ordered Iron now and then, and possibly an occasional dose
of Antimony. He would perhaps have had a rheumatic patient wrapped
in the skin of a wolf or a wild cat, and in case of a malignant fever
with "purples" or petechiae, or of an obstinate king's evil, he might
have prescribed a certain black powder, which had been made by
calcining toads in an earthen pot; a choice remedy, taken internally,
or applied to any outward grief.
Except for the toad-powder and the peremptory drastics, one might
have borne up against this herb doctoring as well as against some
more modern styles of medication. Barbeyrac and his scholar Sydenham
had not yet cleansed the Pharmacopoeia of its perilous stuff, but
there is no doubt that the more sensible physicians of that day knew
well enough that a good honest herb-tea which amused the patient and
his nurses was all that was required to carry him through all common
disorders.
The student soon learned the physiognomy of disease by going about
with his master; fevers, pleurisies, asthmas, dropsies, fluxes,
small-pox, sore-throats, measles, consumptions. He saw what was done
for them. He put up the medicines, gathered the herbs, and so
learned something of materia medico and botany. He learned these few
things easily and well, for he could give his whole attention to
them. Chirurgery was a separate specialty. Women in child-birth
were cared for by midwives. There was no chemistry deserving the
name to require his study. He did not learn a great deal, perhaps,
but what he did learn was his business, namely, how to take care of
sick people.
Let me give you a picture of the old=fashioned way of instruction, by
carrying you with me in imagination in the company of worthy Master
Giles Firmin as he makes his round of visits among the good folk of
Ipswich, followed by his one student, who shall answer to the
scriptural name of Luke. It will not be for entertainment chiefly,
but to illustrate the one mode of teaching which can never be
superseded, and which, I venture to say, is more important than all
the rest put together. The student is a green hand, as you will
perceive.
In the first dwelling they come to, a stout fellow is bellowing with
colic.
"He will die, Master, of a surety, methinks," says the timid youth in
a whisper.
"Nay, Luke," the Master answers, "'t is but a dry belly-ache. Didst
thou not mark that he stayed his roaring when I did press hard over
the lesser bowels? Note that he hath not the pulse of them with
fevers, and by what Dorcas telleth me there hath been no long
shutting up of the vice naturales. We will steep certain comforting
herbs which I will shew thee, and put them in a bag and lay them on
his belly. Likewise he shall have my cordial julep with a portion of
this confection which we do call Theriaca Andromachi, which hath
juice of poppy in it, and is a great stayer of anguish. This fellow
is at his prayers to-day, but I warrant thee he shall be swearing
with the best of them to-morrow."
They jog along the bridle-path on their horses until they come to
another lowly dwelling. They sit a while with a delicate looking
girl in whom the ingenuous youth naturally takes a special interest.
The good physician talks cheerfully with her, asks her a few
questions. Then to her mother: "Good-wife, Margaret hath somewhat
profited, as she telleth, by the goat's milk she hath taken night and
morning. Do thou pluck a maniple--that is an handful--of the plant
called Maidenhair, and make a syrup therewith as I have shewed thee.
Let her take a cup full of the same, fasting, before she sleepeth,
also before she riseth from her bed." And so they leave the house.
"What thinkest thou, Luke, of the maid we have been visiting?" "She
seemeth not much ailing, Master, according to my poor judgment. For
she did say she was better. And she had a red cheek and a bright
eye, and she spake of being soon able to walk unto the meeting, and
did seem greatly hopeful, but spare of flesh, methought, and her
voice something hoarse, as of one that hath a defluxion, with some
small coughing from a cold, as she did say. Speak I not truly,
Master, that she will be well speedily?"
"Yea, Luke, I do think she shall be well, and mayhap speedily. But
it is not here with us she shall be well. For that redness of the
cheek is but the sign of the fever which, after the Grecians, we do
call the hectical; and that shining of the eyes is but a sickly
glazing, and they which do every day get better and likewise thinner
and weaker shall find that way leadeth to the church-yard gate. This
is the malady which the ancients did call tubes, or the wasting
disease, and some do name the consumption. A disease whereof most
that fall ailing do perish. This Margaret is not long for earth--but
she knoweth it not, and still hopeth."
"Why, then, Master, didst thou give her of thy medicine, seeing that
her ail is unto death?"
"Thou shalt learn, boy, that they which are sick must have somewhat
wherewith to busy their thoughts. There be some who do give these
tabid or consumptives a certain posset made with lime-water and anise
and liquorice and raisins of the sun, and there be other some who do
give the juice of craw-fishes boiled in barley-water with chicken-
broth, but these be toys, as I do think, and ye shall find as good
virtue, nay better, in this syrup of the simple called Maidenhair."
Something after this manner might Master Giles Firmin have delivered
his clinical instructions. Somewhat in this way, a century and a
half later, another New England physician, Dr. Edward Augustus
Holyoke, taught a young man who came to study with him, a very
diligent and intelligent youth, James Jackson by name, the same whose
portrait in his advanced years hangs upon this wall, long the honored
Professor of Theory and Practice in this Institution, of whom I shall
say something in this Lecture. Our venerated Teacher studied
assiduously afterwards in the great London Hospitals, but I think he
used to quote his "old Master" ten times where he quoted Mr. Cline or
Dr. Woodville once.
When I compare this direct transfer of the practical experience of a
wise man into the mind of a student,--every fact one that he can use
in the battle of life and death,--with the far off, unserviceable
"scientific" truths that I and some others are in the habit of
teaching, I cannot help asking myself whether, if we concede that our
forefathers taught too little, there is not--a possibility that we
may sometimes attempt to teach too much. I almost blush when I think
of myself as describing the eight several facets on two slender
processes of the palate bone, or the seven little twigs that branch
off from the minute tympanic nerve, and I wonder whether my excellent
colleague feels in the same way when he pictures himself as giving
the constitution of neurin, which as he and I know very well is that
of the hydrate of trimethyle-oxethyle-ammonium, or the formula for
the production of alloxan, which, though none but the Professors and
older students can be expected to remember it, is C10 H4 N4 O6+ 2HO,
NO5}=C8 H4 N2 O10+2CO2+N2+NH4 O, NO5.
I can bear the voice of some rough iconoclast addressing the
Anatomist and the Chemist in tones of contemptuous indignation: "What
is this stuff with which you are cramming the brains of young men who
are to hold the lives of the community in their hands? Here is a man
fallen in a fit; you can tell me all about the eight surfaces of the
two processes of the palate bone, but you have not had the sense to
loosen that man's neck-cloth, and the old women are all calling you a
fool? Here is a fellow that has just swallowed poison. I want
something to turn his stomach inside out at the shortest notice. Oh,
you have forgotten the dose of the sulphate of zinc, but you remember
the formula for the production of alloxan!"
"Look you, Master Doctor,--if I go to a carpenter to come and stop a
leak in my roof that is flooding the house, do you suppose I care
whether he is a botanist or not? Cannot a man work in wood without
knowing all about endogens and exogens, or must he attend Professor
Gray's Lectures before he can be trusted to make a box-trap? If my
horse casts a shoe, do you think I will not trust a blacksmith to
shoe him until I have made sure that he is sound on the distinction
between the sesquioxide and the protosesquioxide of iron?"
--But my scientific labor is to lead to useful results by and by, in
the next generation, or in some possible remote future.--
"Diavolo!" as your Dr. Rabelais has it,--answers the iconoclast,--
"what is that to me and my colic, to me and my strangury? I pay the
Captain of the Cunard steamship to carry me quickly and safely to
Liverpool, not to make a chart of the Atlantic for after voyagers!
If Professor Peirce undertakes to pilot me into Boston Harbor and
runs me on Cohasset rocks, what answer is it to tell me that he is
Superintendent of the Coast Survey? No, Sir! I want a plain man in
a pea-jacket and a sou'wester, who knows the channel of Boston
Harbor, and the rocks of Boston Harbor, and the distinguished
Professor is quite of my mind as to the matter, for I took the pains
to ask him before I ventured to use his name in the way of
illustration."
I do not know how the remarks of the image-breaker may strike others,
but I feel that they put me on my defence with regard to much of my
teaching. Some years ago I ventured to show in an introductory
Lecture how very small a proportion of the anatomical facts taught in
a regular course, as delivered by myself and others, had any
practical bearing whatever on the treatment of disease. How can I,
how can any medical teacher justify himself in teaching anything that
is not like to be of practical use to a class of young men who are to
hold in their hands the balance in which life and death, ease and
anguish, happiness and wretchedness are to be daily weighed?
I hope we are not all wrong. Oftentimes in finding how sadly
ignorant of really essential and vital facts and rules were some of
those whom we had been larding with the choicest scraps of science, I
have doubted whether the old one-man system of teaching, when the one
man was of the right sort, did not turn out better working physicians
than our more elaborate method. The best practitioner I ever knew
was mainly shaped to excellence in that way. I can understand
perfectly the regrets of my friend Dr. John Brown of Edinburgh, for
the good that was lost with the old apprenticeship system. I
understand as well Dr. Latham's fear "that many men of the best
abilities and good education will be deterred from prosecuting physic
as a profession, in consequence of the necessity indiscriminately
laid upon all for impossible attainments."
I feel therefore impelled to say a very few words in defence of that
system of teaching adopted in our Colleges, by which we wish to
supplement and complete the instruction given by private individuals
or by what are often called Summer Schools.
The reason why we teach so much that is not practical and in itself
useful, is because we find that the easiest way of teaching what is
practical and useful. If we could in any way eliminate all that
would help a man to deal successfully with disease, and teach it by
itself so that it should be as tenaciously rooted in the memory, as
easily summoned when wanted, as fertile in suggestion of related
facts, as satisfactory to the peremptory demands of the intelligence
as if taught in its scientific connections, I think it would be our
duty so to teach the momentous truths of medicine, and to regard all
useless additions as an intrusion on the time which should be
otherwise occupied.
But we cannot successfully eliminate and teach by itself that which
is purely practical. The easiest and surest why of acquiring facts
is to learn them in groups, in systems, and systematized knowledge is
science. You can very often carry two facts fastened together more
easily than one by itself, as a housemaid can carry two pails of
water with a hoop more easily than one without it. You can remember
a man's face, made up of many features, better than you can his nose
or his mouth or his eye-brow. Scores of proverbs show you that you
can remember two lines that rhyme better than one without the jingle.
The ancients, who knew the laws of memory, grouped the seven cities
that contended for the honor of being Homer's birthplace in a line
thus given by Aulus Gellius:
Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai.
I remember, in the earlier political days of Martin Van Buren, that
Colonel Stone, of the "New York Commercial," or one of his
correspondents, said that six towns of New York would claim in the
same way to have been the birth-place of the "Little Magician," as he
was then called; and thus he gave their names, any one of which I
should long ago have forgotten, but which as a group have stuck tight
in my memory from that day to this;
Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac.
If the memory gains so much by mere rhythmical association, how much
more will it gain when isolated facts are brought together under laws
and principles, when organs are examined in their natural
connections, when structure is coupled with function, and healthy and
diseased action are studied as they pass one into the other!
Systematic, or scientific study is invaluable as supplying a natural
kind of mnemonics, if for nothing else. You cannot properly learn
the facts you want from Anatomy and Chemistry in any way so easily as
by taking them in their regular order, with other allied facts, only
there must be common sense exercised in leaving out a great deal
which belongs to each of the two branches as pure science. The
dullest of teachers is the one who does not know what to omit.
The larger aim of scientific training is to furnish you with
principles to which you will be able to refer isolated facts, and so
bring these within the range of recorded experience. See what the
"London Times" said about the three Germans who cracked open John
Bull Chatwood's strong-box at the Fair the other day, while the three
Englishmen hammered away in vain at Brother Jonathan Herring's. The
Englishmen represented brute force. The Germans had been trained to
appreciate principle. The Englishman "knows his business by rote and
rule of thumb"--science, which would "teach him to do in an hour what
has hitherto occupied him two hours," "is in a manner forbidden to
him." To this cause the "Times" attributes the falling off of
English workmen in comparison with those of the Continent.
Granting all this, we must not expect too much from "science" as
distinguished from common experience. There are ten thousand
experimenters without special apparatus for every one in the
laboratory. Accident is the great chemist and toxicologist. Battle
is the great vivisector. Hunger has instituted researches on food
such as no Liebig, no Academic Commission has ever recorded.
Medicine, sometimes impertinently, often ignorantly, often carelessly
called "allopathy," appropriates everything from every source that
can be of the slightest use to anybody who is ailing in any way, or
like to be ailing from any cause. It learned from a monk how to use
antimony, from a Jesuit how to cure agues, from a friar how to cut
for stone, from a soldier how to treat gout, from a sailor how to
keep off scurvy, from a postmaster how to sound the Eustachian tube,
from a dairy-maid how to prevent small-pox, and from an old market-
woman how to catch the itch-insect. It borrowed acupuncture and the
moxa from the Japanese heathen, and was taught the use of lobelia by
the American savage. It stands ready to-day to accept anything from
any theorist, from any empiric who can make out a good case for his
discovery or his remedy. "Science" is one of its benefactors, but
only one, out of many. Ask the wisest practising physician you know,
what branches of science help him habitually, and what amount of
knowledge relating to each branch he requires for his professional
duties. He will tell you that scientific training has a value
independent of all the special knowledge acquired. He will tell you
that many facts are explained by studying them in the wider range of
related facts to which they belong. He will gratefully recognize
that the anatomist has furnished him with indispensable data, that
the physiologist has sometimes put him on the track of new modes of
treatment, that the chemist has isolated the active principles of his
medicines, has taught him how to combine them, has from time to time
offered him new remedial agencies, and so of others of his allies.
But he will also tell you, if I am not mistaken, that his own branch
of knowledge is so extensive and so perplexing that he must accept
most of his facts ready made at their hands. He will own to you that
in the struggle for life which goes on day and night in our thoughts
as in the outside world of nature, much that he learned under the
name of science has died out, and that simple homely experience has
largely taken the place of that scholastic knowledge to which he and
perhaps some of his instructors once attached a paremount importance.
This, then, is my view of scientific training as conducted in courses
such as you are entering on. Up to a certain point I believe in set
Lectures as excellent adjuncts to what is far more important,
practical instruction at the bedside, in the operating room, and
under the eye of the Demonstrator. But I am so far from wishing
these courses extended, that I think some of them--suppose I say my
own--would almost bear curtailing. Do you want me to describe more
branches of the sciatic and crural nerves? I can take Fischer's
plates, and lecturing on that scale fill up my whole course and not
finish the nerves alone. We must stop somewhere, and for my own part
I think the scholastic exercises of our colleges have already claimed
their full share of the student's time without our seeking to extend
them.
I trust I have vindicated the apparent inconsequence of teaching
young students a good deal that seems at first sight profitless, but
which helps them to learn and retain what is profitable. But this is
an inquisitive age, and if we insist on piling up beyond a certain
height knowledge which is in itself mere trash and lumber to a man
whose life is to be one long fight with death and disease, there will
be some sharp questions asked by and by, and our quick-witted people
will perhaps find they can get along as well without the professor's
cap as without the bishop's mitre and the monarch's crown.
I myself have nothing to do with clinical teaching. Yet I do not
hesitate to say it is more essential than all the rest put together,
so far as the ordinary practice of medicine is concerned; and this is
by far the most important thing to be learned, because it deals with
so many more lives than any other branch of the profession. So of
personal instruction, such as we give and others give in the interval
of lectures, much of it at the bedside, some of it in the laboratory,
some in the microscope-room, some in the recitation-room, I think it
has many advantages of its own over the winter course, and I do not
wish to see it shortened for the sake of prolonging what seems to me
long enough already.
If I am jealous of the tendency to expand the time given to the
acquisition of curious knowledge, at the expense of the plain old-
fashioned bedside teachings, I only share the feeling which Sydenham
expressed two hundred years ago, using an image I have already
borrowed. "He would be no honest and successful pilot who was to
apply himself with less industry to avoid rocks and sands and bring
his vessel safely home, than to search into the causes of the ebbing
and flowing of the sea, which, though very well for a philosopher, is
foreign to him whose business it is to secure the ship. So neither
will a physician, whose province it is to cure diseases, be able to
do so, though he be a person of great genius, who bestows less time
on the hidden and intricate method of nature, and adapting his means
thereto, than on curious and subtle speculation."
"Medicine is my wife and Science is my mistress," said Dr. Rush. I
do not think that the breach of the seventh commandment can be shown
to have been of advantage to the legitimate owner of his affections.
Read what Dr. Elisha Bartlett says of him as a practitioner, or ask
one of our own honored ex-professors, who studied under him, whether
Dr. Rush had ever learned the meaning of that saying of Lord Bacon,
that man is the minister and interpreter of Nature, or whether he did
not speak habitually of Nature as an intruder in the sick room, from
which his art was to expel her as an incompetent and a meddler.
All a man's powers are not too much for such a profession as
Medicine. "He is a learned man," said old Parson Emmons of Franklin,
"who understands one subject, and he is a very learned man who
understands two subjects." Schonbein says he has been studying
oxygen for thirty years. Mitscherlich said it took fourteen years to
establish a new fact in chemistry. Aubrey says of Harvey, the
discoverer of the circulation, that "though all his profession would
allow him to be an excellent anatomist, I have never heard of any who
admired his therapeutic way." My learned and excellent friend before
referred to, Dr. Brown of Edinburgh, from whose very lively and
sensible Essay, "Locke and Sydenham," I have borrowed several of my
citations, contrasts Sir Charles Bell, the discoverer, the man of
science, with Dr. Abercrombie, the master in the diagnosis and
treatment of disease. It is through one of the rarest of
combinations that we have in our Faculty a teacher on whom the
scientific mantle of Bell has fallen, and who yet stands preeminent
in the practical treatment of the class of diseases which his
inventive and ardent experimental genius has illustrated. M. Brown-
Sequard's example is as, eloquent as his teaching in proof of the
advantages of well directed scientific investigation. But those who
emulate his success at once as a discoverer and a practitioner must
be content like him to limit their field of practice. The highest
genius cannot afford in our time to forget the ancient precept,
Divide et impera.
"I suppose I must go and earn this guinea," said a medical man who
was sent for while he was dissecting an animal. I should not have
cared to be his patient. His dissection would do me no good, and his
thoughts would be too much upon it. I want a whole man for my
doctor, not a half one. I would have sent for a humbler
practitioner, who would have given himself entirely to me, and told
the other--who was no less a man than John Hunter--to go on and
finish the dissection of his tiger.
Sydenham's "Read Don Quixote" should be addressed not to the student,
but to the Professor of today. Aimed at him it means, "Do not be too
learned."
Do not think you are going to lecture to picked young men who are
training themselves to be scientific discoverers. They are of fair
average capacity, and they are going to be working doctors.
These young men are to have some very serious vital facts to deal
with. I will mention a few of them.
Every other resident adult you meet in these streets is or will be
more or less tuberculous. This is not an extravagant estimate, as
very nearly one third of the deaths of adults in Boston last year
were from phthisis. If the relative number is less in our other
northern cities, it is probably in a great measure because they are
more unhealthy; that is, they have as much, or nearly as much,
consumption, but they have more fevers or other fatal diseases.
These heavy-eyed men with the alcoholized brains, these pallid youths
with the nicotized optic ganglia and thinking-marrows brown as their
own meerschaums, of whom you meet too many,--will ask all your wisdom
to deal with their poisoned nerves and their enfeebled wills.
Nearly seventeen hundred children under five years of age died last
year in this city. A poor human article, no doubt, in many cases,
still, worth an attempt to save them, especially when we remember the
effect of Dr. Clarke's suggestion at the Dublin Hospital, by which
some twenty-five or thirty thousand children's lives have probably
been saved in a single city.
Again, the complaint is often heard that the native population is not
increasing so rapidly as in former generations. The breeding and
nursing period of American women is one of peculiar delicacy and
frequent infirmity. Many of them must require a considerable
interval between the reproductive efforts, to repair damages arid
regain strength. This matter is not to be decided by an appeal to
unschooled nature. It is the same question as that of the deformed
pelvis,--one of degree. The facts of mal-vitalization are as much to
be attended to as those of mal-formation. If the woman with a
twisted pelvis is to be considered an exempt, the woman with a
defective organization should be recognized as belonging to the
invalid corps. We shudder to hear what is alleged as to the
prevalence of criminal practices; if back of these there can be shown
organic incapacity or overtaxing of too limited powers, the facts
belong to the province of the practical physician, as well as of the
moralist and the legislator, and require his gravest consideration.
Take the important question of bleeding. Is venesection done with
forever? Six years ago it was said here in an introductory Lecture
that it would doubtless come back again sooner or later. A fortnight
ago I found myself in the cars with one of the most sensible and
esteemed practitioners in New England. He took out his wallet and
showed me two lancets, which he carried with him; he had never given
up their use. This is a point you will have to consider.
Or, to mention one out of many questionable remedies, shall you give
Veratrum Viride in fevers and inflammations? It makes the pulse
slower in these affections. Then the presumption would naturally be
that it does harm. The caution with reference to it on this ground
was long ago recorded in the Lecture above referred to. See what Dr.
John Hughes Bennett says of it in the recent edition of his work on
Medicine. Nothing but the most careful clinical experience can
settle this and such points of treatment.
These are all practical questions--questions of life and death, and
every day will be full of just such questions. Take the problem of
climate. A patient comes to you with asthma and wants to know where
he can breathe; another comes to you with phthisis and wants to know
where he can live. What boy's play is nine tenths of all that is
taught in many a pretentious course of lectures, compared with what
an accurate and extensive knowledge of the advantages and
disadvantages of different residences in these and other complaints
would be to a practising physician
I saw the other day a gentleman living in Canada, who had spent seven
successive winters in Egypt, with the entire relief of certain
obscure thoracic symptoms which troubled him while at home. I saw,
two months ago, another gentleman from Minnesota, an observer and a
man of sense, who considered that State as the great sanatorium for
all pulmonary complaints. If half our grown population are or will
be more or less tuberculous, the question of colonizing Florida
assumes a new aspect. Even within the borders of our own State, the
very interesting researches of Dr. Bowditch show that there is a
great variation in the amount of tuberculous disease in different
towns, apparently connected with local conditions. The hygienic map
of a State is quite as valuable as its geological map, and it is the
business of every practising physician to know it thoroughly. They
understand this in England, and send a patient with a dry irritating
cough to Torquay or Penzance, while they send another with relaxed
bronchial membranes to Clifton or Brighton. Here is another great
field for practical study.
So as to the all-important question of diet. "Of all the means of
cure at our command," says Dr. Bennett, "a regulation of the quantity
and quality of the diet is by far the most powerful." Dr. MacCormac
would perhaps except the air we breathe, for he thinks that impure
air, especially in sleeping rooms, is the great cause of tubercle.
It is sufficiently proved that the American,--the New Englander,--the
Bostonian, can breed strong and sound children, generation after
generation,--nay, I have shown by the record of a particular family
that vital losses may be retrieved, and a feeble race grow to lusty
vigor in this very climate and locality. Is not the question why our
young men and women so often break down, and how they can be kept
from breaking down, far more important for physicians to settle than
whether there is one cranial vertebra, or whether there are four, or
none?
--But I have a taste for the homologies, I want to go deeply into the
subject of embryology, I want to analyze the protonihilates
precipitated from pigeon's milk by the action of the lunar spectrum,-
shall I not follow my star,--shall I not obey my instinct,--shall I
not give myself to the lofty pursuits of science for its own sake?
Certainly you may, if you like. But take down your sign, or never
put it up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and
Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the
difficulty. We all admire the achievements of this band of
distinguished doctors who do not practise. But we say of their work
and of all pure science, as the French officer said of the charge of
the six hundred at Balaclava, "C'est magnifique, mais ce n'est pas la
guerre,"--it is very splendid, but it is not a practising doctor's
business. His patient has a right to the cream of his life and not
merely to the thin milk that is left after "science" has skimmed it
off. The best a physician can give is never too good for the
patient.
It is often a disadvantage to a young practitioner to be known for
any accomplishment outside of his profession. Haller lost his
election as Physician to the Hospital in his native city of Berne,
principally on the ground that he was a poet. In his later years the
physician may venture more boldly. Astruc was sixty-nine years old
when he published his "Conjectures," the first attempt, we are told,
to decide the authorship of the Pentateuch showing anything like a
discerning criticism. Sir Benjamin Brodie was seventy years old
before he left his physiological and surgical studies to indulge in
psychological speculations. The period of pupilage will be busy
enough in acquiring the knowledge needed, and the season of active
practice will leave little leisure for any but professional studies.
Dr. Graves of Dublin, one of the first clinical teachers of our time,
always insisted on his students' beginning at once to visit the
hospital. At the bedside the student must learn to treat disease,
and just as certainly as we spin out and multiply our academic
prelections we shall work in more and more stuffing, more and more
rubbish, more and more irrelevant, useless detail which the student
will get rid of just as soon as he leaves us. Then the next thing
will be a new organization, with an examining board of first-rate
practical men, who will ask the candidate questions that mean
business,--who will make him operate if he is to be a surgeon, and
try him at the bedside if he is to be a physician,--and not puzzle
him with scientific conundrums which not more than one of the
questioners could answer himself or ever heard of since he graduated.
Or these women who are hammering at the gates on which is written "No
admittance for the mothers of mankind," will by and by organize an
institution, which starting from that skilful kind of nursing which
Florence Nightingale taught so well, will work backwards through
anodynes, palliatives, curatives, preventives, until with little show
of science it imparts most of what is most valuable in those branches
of the healing art it professes to teach. When that time comes, the
fitness of women for certain medical duties, which Hecquet advocated
in 1708, which Douglas maintained in 1736, which Dr. John Ware, long
the honored Professor of Theory and Practice in this Institution,
upheld within our own recollection in the face of his own recorded
opinion to the contrary, will very possibly be recognized.
My advice to every teacher less experienced than myself would be,
therefore: Do not fret over the details you have to omit; you
probably teach altogether too many as it is. Individuals may learn a
thing with once hearing it, but the only way of teaching a whole
class is by enormous repetition, representation, and illustration in
all possible forms. Now and then you will have a young man on your
benches like the late Waldo Burnett,--not very often, if you lecture
half a century. You cannot pretend to lecture chiefly for men like
that,--a Mississippi raft might as well take an ocean-steamer in tow.
To meet his wants you would have to leave the rest of your class
behind and that you must not do. President Allen of Jefferson
College says that his instruction has been successful in proportion
as it has been elementary. It may be a humiliating statement, but it
is one which I have found true in my own experience.
To the student I would say, that however plain and simple may be our
teaching, he must expect to forget much which he follows
intelligently in the lecture-room. But it is not the same as if he
had never learned it. A man must get a thing before he can forget
it. There is a great world of ideas we cannot voluntarily recall,--
they are outside the limits of the will. But they sway our conscious
thought as the unseen planets influence the movements of those within
the sphere of vision. No man knows how much he knows,--how many
ideas he has,--any more than he knows how many blood-globules roll in
his veins. Sometimes accident brings back here and there one, but
the mind is full of irrevocable remembrances and unthinkable
thoughts, which take a part in all its judgments as indestructible
forces. Some of you must feel your scientific deficiencies painfully
after your best efforts. But every one can acquire what is most
essential. A man of very moderate ability may be a good physician,
if he devotes himself faithfully to the work. More than this, a
positively dull man, in the ordinary acceptation of the term,
sometimes makes a safer practitioner than one who has, we will say,
five per cent. more brains than his average neighbor, but who thinks
it is fifty per cent. more. Skulls belonging to this last variety of
the human race are more common, I may remark, than specimens like the
Neanderthal cranium, a cast of which you will find on the table in
the Museum.
Whether the average talent be high or low, the Colleges of the land
must make the best commodity they can out of such material as the
country and the cities furnish them. The community must have Doctors
as it must have bread. It uses up its Doctors just as it wears out
its shoes, and requires new ones. All the bread need not be French
rolls, all the shoes need not be patent leather ones; but the bread
must be something that can be eaten, and the shoes must be something
that can be worn. Life must somehow find food for the two forces
that rub everything to pieces, or burn it to ashes,--friction and
oxygen. Doctors are oxydable products, and the schools must keep
furnishing new ones as the old ones turn into oxyds; some of first-
rate quality that burn with a great light, some of a lower grade of
brilliancy, some honestly, unmistakably, by the grace of God, of
moderate gifts, or in simpler phrase, dull.
The public will give every honest and reasonably competent worker in
the healing art a hearty welcome. It is on the whole very loyal to
the Medical Profession. Three successive years have borne witness to
the feeling with which this Institution, representing it in its
educational aspect, is regarded by those who are themselves most
honored and esteemed. The great Master of Natural Science bade the
last year's class farewell in our behalf, in those accents which
delight every audience. The Head of our ancient University honored
us in the same way in the preceding season. And how can we forget
that other occasion when the Chief Magistrate of the Commonwealth,
that noble citizen whom we have just lost, large-souled, sweet-
natured, always ready for every kind office, came among us at our
bidding, and talked to us of our duties in words as full of wisdom as
his heart was of goodness?
You have not much to fear, I think, from the fancy practitioners.
The vulgar quackeries drop off, atrophied, one after another.
Homoeopathy has long been encysted, and is carried on the body
medical as quietly as an old wen. Every year gives you a more
reasoning and reasonable people to deal with. See how it is in
Literature. The dynasty of British dogmatists, after lasting a
hundred years and more, is on its last legs. Thomas Carlyle, third
in the line of descent, finds an audience very different from those
which listened to the silver speech of Samuel Taylor Coleridge and
the sonorous phrases of Samuel Johnson. We read him, we smile at his
clotted English, his "swarmery" and other picturesque expressions,
but we lay down his tirade as we do one of Dr. Cumming's
interpretations of prophecy, which tells us that the world is coming
to an end next week or next month, if the weather permits,--not
otherwise,--feeling very sure that the weather will be unfavorable.
It is the same common-sense public you will appeal to. The less
pretension you make, the better they will like you in the long run.
I hope we shall make everything as plain and as simple to you as we
can. I would never use a long word, even, where a short one would
answer the purpose. I know there are professors in this country who
"ligate" arteries. Other surgeons only tie them, and it stops the
bleeding just as well. It is the familiarity and simplicity of
bedside instruction which makes it so pleasant as well as so
profitable. A good clinical teacher is himself a Medical School. We
need not wonder that our young men are beginning to announce
themselves not only as graduates of this or that College, but also as
pupils of some one distinguished master.
I wish to close this Lecture, if you will allow me a few moments
longer, with a brief sketch of an instructor and practitioner whose
character was as nearly a model one in both capacities as I can find
anywhere recorded.
Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine
in this University from 1812 to 1846, and whose name has been since
retained on our rolls as Professor Emeritus, died on the 27th of
August last, in the ninetieth year of his age. He studied his
profession, as I have already mentioned, with Dr. Holyoke of Salem,
one of the few physicians who have borne witness to their knowledge
of the laws of life by living to complete their hundredth year. I
think the student took his Old Master, as he always loved to call
him, as his model; each was worthy of the other, and both were bright
examples to all who come after them.
I remember that in the sermon preached by Dr. Grazer after Dr.
Holyoke's death, one of the points most insisted upon as
characteristic of that wise and good old man was the perfect balance
of all his faculties. The same harmonious adjustment of powers, the
same symmetrical arrangement of life, the same complete fulfilment of
every day's duties, without haste and without needless delay, which
characterized the master, equally distinguished the scholar. A
glance at the life of our own Old Master, if I can do any justice at
all to his excellences, will give you something to carry away from
this hour's meeting not unworthy to be remembered.
From December, 1797, to October, 1799, he remained with Dr. Holyoke
as a student, a period which he has spoken of as a most interesting
and most gratifying part of his life. After this he passed eight
months in London, and on his return, in October, 1800, he began
business in Boston.
He had followed Mr. Cline, as I have mentioned, and was competent to
practise Surgery. But he found Dr. John Collins Warren had already
occupied the ground which at that day hardly called for more than one
leading practitioner, and wisely chose the Medical branch of the
profession. He had only himself to rely upon, but he had confidence
in his prospects, conscious, doubtless, of his own powers, knowing
his own industry and determination, and being of an eminently
cheerful and hopeful disposition. No better proof of his spirit can
be given than that, just a year from the time when he began to
practise as a physician, he took that eventful step which in such a
man implies that he sees his way clear to a position; he married a
lady blessed with many gifts, but not bringing him a fortune to
paralyze his industry.
He had not miscalculated his chances in life. He very soon rose into
a good practice, and began the founding of that reputation which grew
with his years, until he stood by general consent at the head of his
chosen branch of the profession, to say the least, in this city and
in all this region of country. His skill and wisdom were the last
tribunal to which the sick and suffering could appeal. The community
trusted and loved him, the profession recognized him as the noblest
type of the physician. The young men whom he had taught wandered
through foreign hospitals; where they learned many things that were
valuable, and many that were curious; but as they grew older and
began to think more of their ability to help the sick than their
power of talking about phenomena, they began to look back to the
teaching of Dr. Jackson, as he, after his London experience, looked
back to that of Dr. Holyoke. And so it came to be at last that the
bare mention of his name in any of our medical assemblies would call
forth such a tribute of affectionate regard as is only yielded to age
when it brings with it the record of a life spent in well doing.
No accident ever carries a man to eminence such as his in the medical
profession. He who looks for it must want it earnestly and work for
it vigorously; Nature must have qualified him in many ways, and
education must have equipped him with various knowledge, or his
reputation will evaporate before it reaches the noon-day blaze of
fame. How did Dr. Jackson gain the position which all conceded to
him? In the answer to this question some among you may find a key
that shall unlock the gate opening on that fair field of the future
of which all dream but which not all will ever reach.
First of all, he truly loved his profession. He had no intellectual
ambitions outside of it, literary, scientific or political. To him
it was occupation enough to apply at the bedside the best of all that
he knew for the good of his patient; to protect the community against
the inroads of pestilence; to teach the young all that he himself had
been taught, with all that his own experience had added; to leave on
record some of the most important results of his long observation.
With his patients he was so perfect at all points that it is hard to
overpraise him. I have seen many noted British and French and
American practitioners, but I never saw the man so altogether
admirable at the bedside of the sick as Dr. James Jackson. His smile
was itself a remedy better than the potable gold and the dissolved
pearls that comforted the praecordia of mediaeval monarchs. Did a
patient, alarmed without cause, need encouragement, it carried the
sunshine of hope into his heart and put all his whims to flight, as
David's harp cleared the haunted chamber of the sullen king. Had the
hour come, not for encouragement, but for sympathy, his face, his
voice, his manner all showed it, because his heart felt it. So
gentle was he, so thoughtful, so calm, so absorbed in the case before
him, not to turn round and look for a tribute to his sagacity, not to
bolster himself in a favorite theory, but to find out all he could,
and to weigh gravely and cautiously all that he found, that to follow
him in his morning visit was not only to take a lesson in the healing
art, it was learning how to learn, how to move, how to look, how to
feel, if that can be learned. To visit with Dr. Jackson was a
medical education.
He was very firm, with all his kindness. He would have the truth
about his patients. The nurses found it out; and the shrewder ones
never ventured to tell him anything but a straight story. A clinical
dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse
in the Massachusetts General Hospital, a mistress in her calling, was
as good questioning and answering as one would be like to hear
outside of the court-room.
Of his practice you can form an opinion from his book called "Letters
to a Young Physician." Like all sensible men from the days of
Hippocrates to the present, he knew that diet and regimen were more
important than any drug or than all drugs put together. Witness his
treatment of phthisis and of epilepsy. He retained, however, more
confidence in some remedial agents than most of the younger
generation would concede to them. Yet his materia medica was a
simple one.
"When I first went to live with Dr. Holyoke," he says, "in 1797,
showing me his shop, he said, 'There seems to you to be a great
variety of medicines here, and that it will take you long to get
acquainted with them, but most of them are unimportant. There are
four which are equal to all the rest, namely, Mercury, Antimony, Bark
and Opium.'" And Dr. Jackson adds, "I can only say of his practice,
the longer I have lived, I have thought better and better of it."
When he thought it necessary to give medicine, he gave it in earnest.
He hated half-practice--giving a little of this or that, so as to be
able to say that one had done something, in case a consultation was
held, or a still more ominous event occurred. He would give opium,
for instance, as boldly as the late Dr. Fisher of Beverly, but he
followed the aphorism of the Father of Medicine, and kept extreme
remedies for extreme cases.
When it came to the "non-naturals," as he would sometimes call them,
after the old physicians,--namely, air, meat and drink, sleep and
watching, motion and rest, the retentions and excretions, and the
affections of the mind,--he was, as I have said, of the school of
sensible practitioners, in distinction from that vast community of
quacks, with or without the diploma, who think the chief end of man
is to support apothecaries, and are never easy until they can get
every patient upon a regular course of something nasty or noxious.
Nobody was so precise in his directions about diet, air, and
exercise, as Dr. Jackson. He had the same dislike to the a peu pres,
the about so much, about so often, about so long, which I afterwards
found among the punctilious adherents of the numerical system at La
Pitie.
He used to insist on one small point with a certain philological
precision, namely, the true meaning of the word "cure." He would
have it that to cure a patient was simply to care for him. I refer
to it as showing what his idea was of the relation of the physician
to the patient. It was indeed to care for him, as if his life were
bound up in him, to watch his incomings and outgoings, to stand guard
at every avenue that disease might enter, to leave nothing to chance;
not merely to throw a few pills and powders into one pan of the
scales of Fate, while Death the skeleton was seated in the other, but
to lean with his whole weight on the side of life, and shift the
balance in its favor if it lay in human power to do it. Such
devotion as this is only to be looked for in the man who gives
himself wholly up to the business of healing, who considers Medicine
itself a Science, or if not a science, is willing to follow it as an
art,--the noblest of arts, which the gods and demigods of ancient
religions did not disdain to practise and to teach.
The same zeal made him always ready to listen to any new suggestion
which promised to be useful, at a period of life when many men find
it hard to learn new methods and accept new doctrines. Few of his
generation became so accomplished as he in the arts of direct
exploration; coming straight from the Parisian experts, I have
examined many patients with him, and have had frequent opportunities
of observing his skill in percussion and auscultation.
One element in his success, a trivial one compared with others, but
not to be despised, was his punctuality. He always carried two
watches,--I doubt if he told why, any more than Dr. Johnson told what
he did with the orange-peel,--but probably with reference to this
virtue. He was as much to be depended upon at the appointed time as
the solstice or the equinox. There was another point I have heard
him speak of as an important rule with him; to come at the hour when
he was expected; if he had made his visit for several days
successively at ten o'clock, for instance, not to put it off, if be
could possibly help it, until eleven, and so keep a nervous patient
and an anxious family waiting for him through a long, weary hour.
If I should attempt to characterize his teaching, I should say that
while it conveyed the best results of his sagacious and extended
observation, it was singularly modest, cautious, simple, sincere.
Nothing was for show, for self-love; there was no rhetoric, no
declamation, no triumphant "I told you so," but the plain statement
of a clear-headed honest man, who knows that he is handling one of
the gravest subjects that interest humanity. His positive
instructions were full of value, but the spirit in which he taught
inspired that loyal love of truth which lies at the bottom of all
real excellence.
I will not say that, during his long career, Dr. Jackson never made
an enemy. I have heard him tell how, in his very early days, old Dr.
Danforth got into a towering passion with him about some professional
consultation, and exploded a monosyllable or two of the more
energetic kind on the occasion. I remember that that somewhat
peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson
succeeded to his place as Professor of Theory and Practice. A young
man of Dr. Jackson's talent and energy could hardly take the position
that belonged to him without crowding somebody in a profession where
three in a bed is the common rule of the household. But he was a
peaceful man and a peace-maker all his days. No man ever did more,
if so much, to produce and maintain the spirit of harmony for which
we consider our medical community as somewhat exceptionally
distinguished.
If this harmony should ever be threatened, I could wish that every
impatient and irritable member of the profession would read that
beautiful, that noble Preface to the "Letters," addressed to John
Collins Warren. I know nothing finer in the medical literature of
all time than this Prefatory Introduction. It is a golden prelude,
fit to go with the three great Prefaces which challenge the
admiration of scholars,--Calvin's to his Institutes, De Thou's to his
History, and Casaubon's to his Polybius,--not because of any learning
or rhetoric, though it is charmingly written, but for a spirit
flowing through it to which learning and rhetoric are but as the
breath that is wasted on the air to the Mood that warms the heart.
Of a similar character is this short extract which I am permitted to
make from a private letter of his to a dear young friend. He was
eighty-three years old at the time of writing it.
"I have not loved everybody whom I have known, but I have striven to
see the good points in the characters of all men and women. At first
I must have done this from something in my own nature, for I was not
aware of it, and yet was doing it without any plan, when one day,
sixty years ago, a friend whom I loved and respected said this to me,
'Ah, James, I see that you are destined to succeed in the world, and
to make friends, because you are so ready to see the good point in
the characters of those you meet.'"
I close this imperfect notice of some features in the character of
this most honored and beloved of physicians by applying to him the
words which were written of William Heberden, whose career was not
unlike his own, and who lived to the same patriarchal age.
"From his early youth he had always entertained a deep sense of
religion, a consummate love of virtue, an ardent thirst after
knowledge, and an earnest desire to promote the welfare and happiness
of all mankind. By these qualities, accompanied with great sweetness
of manners, he acquired the love and esteem of all good men, in a
degree which perhaps very few have experienced; and after passing an
active life with the uniform testimony of a good conscience, he
became an eminent example of its influence, in the cheerfulness and
serenity of his latest age."
Such was the man whom I offer to you as a model, young gentlemen, at
the outset of your medical career. I hope that many of you will
recognize some traits of your own special teachers scattered through
various parts of the land in the picture I have drawn. Let me assure
you that whatever you may learn in this or any other course of public
lectures,--and I trust you will learn a great deal,--the daily
guidance, counsel, example, of your medical father, for such the Oath
of Hippocrates tells you to consider your preceptor, will, if he is
in any degree like him of whom I have spoken, be the foundation on
which all that we teach is reared, and perhaps outlive most of our
teachings, as in Dr. Jackson's memory the last lessons that remained
with him were those of his Old Master.
THE MEDICAL PROFESSION IN MASSACHUSETTS.
A Lecture of a Course by members of the Massachusetts Historical
Society, delivered before the Lowell Institute, January 29, 1869.
The medical history of eight generations, told in an hour, must be in
many parts a mere outline. The details I shall give will relate
chiefly to the first century. I shall only indicate the leading
occurrences, with the more prominent names of the two centuries which
follow, and add some considerations suggested by the facts which have
been passed in review.
A geographer who was asked to describe the tides of Massachusetts
Bay, would have to recognize the circumstance that they are a limited
manifestation of a great oceanic movement. To consider them apart
from this, would be to localize a planetary phenomenon, and to
provincialize a law of the universe. The art of healing in
Massachusetts has shared more or less fully and readily the movement
which, with its periods of ebb and flow, has been raising its level
from age to age throughout the better part of Christendom. Its
practitioners brought with them much of the knowledge and many of the
errors of the Old World; they have always been in communication with
its wisdom and its folly; it is not without interest to see how far
the new conditions in which they found themselves have been favorable
or unfavorable to the growth of sound medical knowledge and practice.
The state of medicine is an index of the civilization of an age and
country,--one of the best, perhaps, by which it can be judged.
Surgery invokes the aid of all the mechanical arts. From the rude
violences of the age of stone,--a relic of which we may find in the
practice of Zipporah, the wife of Moses,--to the delicate operations
of to-day upon patients lulled into temporary insensibility, is a
progress which presupposes a skill in metallurgy and in the labors of
the workshop and the laboratory it has taken uncounted generations to
accumulate. Before the morphia which deadens the pain of neuralgia,
or the quinine which arrests the fit of an ague, can find their place
in our pharmacies, commerce must have perfected its machinery, and
science must have refined its processes, through periods only to be
counted by the life of nations. Before the means which nature and
art have put in the hands of the medical practitioner can be fairly
brought into use, the prejudices of the vulgar must be overcome, the
intrusions of false philosophy must be fenced out, and the
partnership with the priesthood dissolved. All this implies that
freedom and activity of thought which belong only to the most
advanced conditions of society; and the progress towards this is by
gradations as significant of wide-spread changes, as are the varying
states of the barometer of far-extended conditions of the atmosphere.
Apart, then, from its special and technical interest, my subject has
a meaning which gives a certain importance, and even dignity, to
details in themselves trivial and almost unworthy of record. A
medical entry in Governor Winthrop's journal may seem at first sight
a mere curiosity; but, rightly interpreted, it is a key to his whole
system of belief as to the order of the universe and the relations
between man and his Maker. Nothing sheds such light on the
superstitions of an age as the prevailing interpretation and
treatment of disease. When the touch of a profligate monarch was a
cure for one of the most inveterate of maladies, when the common
symptoms of hysteria were prayed over as marks of demoniacal
possession, we might well expect the spiritual realms of thought to
be peopled with still stranger delusions.
Let us go before the Pilgrims of the Mayflower, and look at the
shores on which they were soon to land. A wasting pestilence had so
thinned the savage tribes that it was sometimes piously interpreted
as having providentially prepared the way for the feeble band of
exiles. Cotton Mather, who, next to the witches, hated the
"tawnies," "wild beasts," "blood-hounds," "rattlesnakes,"
"infidels," as in different places he calls the unhappy Aborigines,
describes the condition of things in his lively way, thus:
"The Indians in these Parts had newly, even about a Year or Two
before, been visited with such a prodigious Pestilence; as carried
away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of
Twenty) among them so that the Woods were almost cleared of those
pernicious Creatures to make Room for a better Growth."
What this pestilence was has been much discussed. It is variously
mentioned by different early writers as "the plague," "a great and
grievous plague," "a sore consumption," as attended with spots which
left unhealed places on those who recovered, as making the "whole
surface yellow as with a garment." Perhaps no disease answers all
these conditions so well as smallpox. We know from different sources
what frightful havoc it made among the Indians in after years,--in
1631, for instance, when it swept away the aboriginal inhabitants of
"whole towns," and in 1633. We have seen a whole tribe, the Mandans,
extirpated by it in our own day. The word "plague" was used very
vaguely, as in the description of the "great sickness" found among
the Indians by the expedition of 1622. This same great sickness
could hardly have been yellow fever, as it occurred in the month of
November. I cannot think, therefore, that either the scourge of the
East or our Southern malarial pestilence was the disease that wasted
the Indians. As for the yellowness like a garment, that is too
familiar to the eyes of all who have ever looked on the hideous mask
of confluent variola.
Without the presence or the fear of these exotic maladies, the
forlorn voyagers of the Mayflower had sickness enough to contend
with. At their first landing at Cape Cod, gaunt and hungry and
longing for fresh food, they found upon the sandy shore "great
mussel's, and very fat and full of sea-pearl." Sailors and
passengers indulged in the treacherous delicacy; which seems to have
been the sea-clam; and found that these mollusks, like the shell the
poet tells of, remembered their august abode, and treated the way-
worn adventurers to a gastric reminiscence of the heaving billows.
In the mean time it blew and snowed and froze. The water turned to
ice on their clothes, and made them many times like coats of iron.
Edward Tilley had like to have "sounded" with cold. The gunner, too,
was sick unto death, but "hope of trucking" kept him on his feet,--a
Yankee, it should seem, when he first touched the shore of New
England. Most, if not all, got colds and coughs, which afterwards
turned to scurvy, whereof many died.
How can we wonder that the crowded and tempest-tossed voyagers, many
of them already suffering, should have fallen before the trials of
the first winter in Plymouth? Their imperfect shelter, their
insufficient supply of bread, their salted food, now in unwholesome
condition, account too well for the diseases and the mortality that
marked this first dreadful season; weakness, swelling of the limbs,
and other signs of scurvy, betrayed the want of proper nourishment
and protection from the elements. In December six of their number
died, in January eight, in February, seventeen, in March thirteen.
With the advance of spring the mortality diminished, the sick and
lame began to recover, and the colonists, saddened but not
disheartened, applied themselves to the labors of the opening year.
One of the most pressing needs of the early colonists must have been
that of physicians and surgeons. In Mr. Savage's remarkable
Genealogical Dictionary of the first settlers who came over before
1692 and their descendants to the third generation, I find scattered
through the four crowded volumes the names of one hundred and thirty-
four medical practitioners. Of these, twelve, and probably many
more, practised surgery; three were barber-surgeons. A little
incident throws a glimmer from the dark lantern of memory upon
William Direly, one of these practitioners with the razor and the
lancet. He was lost between Boston and Roxbury in a violent tempest
of wind and snow; ten days afterwards a son was born to his widow,
and with a touch of homely sentiment, I had almost said poetry, they
called the little creature "Fathergone" Direly. Six or seven,
probably a larger number, were ministers as well as physicians, one
of whom, I am sorry to say, took to drink and tumbled into the
Connecticut River, and so ended. One was not only doctor, but also
schoolmaster and poet. One practised medicine and kept a tavern.
One was a butcher, but calls himself a surgeon in his will, a union
of callings which suggests an obvious pleasantry. One female
practitioner, employed by her own sex,--Ann Moore,--was the precursor
of that intrepid sisterhood whose cause it has long been my pleasure
and privilege to advocate on all fitting occasions.
Outside of this list I must place the name of Thomas Wilkinson, who
was complained of, is 1676, for practising contrary to law.
Many names in the catalogue of these early physicians have been
associated, in later periods, with the practice of the profession,--
among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge,
Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams,
Woodward. Touton was a Huguenot, Burchsted a German from Silesia,
Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the
honor of the profession, was only Peacock disguised under this alias,
which would not, I fear, prove very attractive to patients.
What doctrines and practice were these colonists likely to bring,
with them?
Two principal schools of medical practice prevailed in the Old World
during the greater part of the seventeenth century. The first held
to the old methods of Galen: its theory was that the body, the
microcosm, like the macrocosm, was made up of the four elements--
fire, air, water, earth; having respectively the qualities hot, dry,
moist, cold. The body was to be preserved in health by keeping each
of these qualities in its natural proportion; heat, by the proper
temperature; moisture, by the due amount of fluid; and so as to the
rest. Diseases which arose from excess of heat were to be attacked
by cooling remedies; those from excess of cold, by heating ones; and
so of the other derangements of balance. This was truly the
principle of contraries contrariis, which ill-informed persons have
attempted to make out to be the general doctrine of medicine, whereas
there is no general dogma other than this: disease is to be treated
by anything that is proved to cure it. The means the Galenist
employed were chiefly diet and vegetable remedies, with the use of
the lancet and other depleting agents. He attributed the four
fundamental qualities to different vegetables, in four different
degrees; thus chicory was cold in the fourth degree, pepper was hot
in the fourth, endive was cold and dry in the second, and bitter
almonds were hot in the first and dry in the second degree. When we
say "cool as a cucumber," we are talking Galenism. The seeds of that
vegetable ranked as one of "the four greater cold seeds" of this
system.
Galenism prevailed mostly in the south of Europe and France. The
readers of Moliere will have no difficulty in recalling some of its
favorite modes of treatment, and the abundant mirth he extracted from
them.
These Galenists were what we should call "herb-doctors" to-day.
Their insignificant infusions lost credit after a time; their
absurdly complicated mixtures excited contempt, and their nauseous
prescriptions provoked loathing and disgust. A simpler and bolder
practice found welcome in Germany, depending chiefly on mineral
remedies, mercury, antimony, sulphur, arsenic, and the use, sometimes
the secret use, of opium. Whatever we think of Paracelsus, the chief
agent in the introduction of these remedies, and whatever limits we
may assign to the use of these long-trusted mineral drugs, there can
be no doubt that the chemical school, as it was called, did a great
deal towards the expurgation of the old, overloaded, and repulsive
pharmacopoeia. We shall find evidence in the practice of our New-
England physicians of the first century, that they often employed
chemical remedies, and that, by the early part of the following
century, their chief trust was in the few simple, potent drugs of
Paracelsus.
We have seen that many of the practitioners of medicine, during the
first century of New England, were clergymen. This relation between
medicine and theology has existed from a very early period; from the
Egyptian priest to the Indian medicine-man, the alliance has been
maintained in one form or another. The partnership was very common
among our British ancestors. Mr. Ward, the Vicar of Stratford-on-
Avon, himself a notable example of the union of the two characters,
writing about 1660, says,
"The Saxons had their blood-letters, but under the Normans physicke,
begunne in England; 300 years agoe itt was not a distinct profession
by itself, but practised by men in orders, witness Nicholas de
Ternham, the chief English physician and Bishop of Durham; Hugh of
Evesham, a physician and cardinal; Grysant, physician and pope; John
Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul
Bush, a bachelor of divinitie in Oxford, was a man well read in
physick as well as divinitie, he was the first bishop of Bristol."
"Again in King Richard the Second's time physicians and divines were
not distinct professions; for one Tydeman, Bishop of Landaph and
Worcester, was physician to King Richard the Second."
This alliance may have had its share in creating and keeping up the
many superstitions which have figured so largely in the history of
medicine. It is curious to see that a medical work left in
manuscript by the Rev. Cotton Mather and hereafter to be referred to,
is running over with follies and superstitious fancies; while his
contemporary and fellow-townsman, William Douglass, relied on the
same few simple remedies which, through Dr. Edward Holyoke and Dr.
James Jackson, have come down to our own time, as the most important
articles of the materia medica.
Let us now take a general glance at some of the conditions of the
early settlers; and first, as to the healthfulness of the climate.
The mortality of the season that followed the landing of the Pilgrims
at Plymouth has been sufficiently accounted for. After this, the
colonists seem to have found the new country agreeing very well with
their English constitutions. Its clear air is the subject of eulogy.
Its dainty springs of sweet water are praised not only by Higginson
and Wood, but even the mischievous Morton says, that for its delicate
waters Canaan came not near this country." There is a tendency to
dilate on these simple blessings, which reminds one a little of the
Marchioness in Dickens's story, with her orange-peel-and-water
beverage. Still more does one feel the warmth of coloring,--such as
we expect from converts to a new faith, and settlers who want to
entice others over to their clearings, when Winslow speaks, in 1621,
of "abundance of roses, white, red, and damask; single, but very
sweet indeed;" a most of all, however, when, in the same connection,
he says, "Here are grapes white and red, and very sweet and strong
also." This of our wild grape, a little vegetable Indian, which
scalps a civilized man's mouth, as his animal representative scalps
his cranium. But there is something quite charming in Winslow's
picture of the luxury in which they are living. Lobsters, oysters,
eels, mussels, fish and fowl, delicious fruit, including the grapes
aforesaid,--if they only had "kine, horses, and sheep," he makes no
question but men would live as contented here as in any part of the
world. We cannot help admiring the way in which they took their
trials, and made the most of their blessings.
"And how Content they were," says Cotton Mather, "when an Honest Man,
as I have heard, inviting his Friends to a Dish of Clams, at the
Table gave Thanks to Heaven, who had given them to suck the abundance
of the Seas, and of the Treasures Aid in the Sands!"
Strangely enough, as it would seem, except for this buoyant
determination to make the best of everything, they hardly appear to
recognize the difference of the climate from that which they had
left. After almost three years' experience, Winslow says, he can
scarce distinguish New England from Old England, in respect of heat
and cold, frost, snow, rain, winds, etc. The winter, he thinks (if
there is a difference), is sharper and longer; but yet he may be
deceived by the want of the comforts he enjoyed at home. He cannot
conceive any climate to agree better with the constitution of the
English, not being oppressed with extremity of heats, nor nipped by
biting cold:
"By which means, blessed be God, we enjoy our health, notwithstanding
those difficulties we have undergone, in such a measure as would have
been admired, if we had lived in England with the like means."
Edward Johnson, after mentioning the shifts to which they were put
for food, says,--
"And yet, methinks, our children are as cheerful, fat, and lusty,
with feeding upon those mussels, clams, and other fish, as they were
in England with their fill of bread."
Higginson, himself a dyspeptic, "continually in physic," as he says,
and accustomed to dress in thick clothing, and to comfort his stomach
with drink that was "both strong and stale,"--the "jolly good ale and
old," I suppose, of free and easy Bishop Still's song,--found that he
both could and did oftentimes drink New England water very well,
--which he seems to look upon as a remarkable feat. He could go as
lightclad as any, too, with only a light stuff cassock upon his
shirt, and stuff breeches without linings. Two of his children were
sickly: one,--little misshapen Mary,--died on the passage, and, in
her father's words, "was the first in our ship that was buried in the
bowels of the great Atlantic sea;" the other, who had been "most
lamentably handled" by disease, recovered almost entirely "by the
very wholesomeness of the air, altering, digesting, and drying up the
cold and crude humors of the body." Wherefore, he thinks it a wise
course for all cold complexions to come to take physic in New
England, and ends with those often quoted words, that "a sup of New
England's air is better than a whole draught of Old England's ale."
Mr. Higginson died, however, "of a hectic fever," a little more than
a year after his arrival.
The medical records which I shall cite show that the colonists were
not exempt from the complaints of the Old World. Besides the common
diseases to which their descendants are subject, there were two
others, to say nothing of the dreaded small-pox, which later medical
science has disarmed,--little known among us at the present day, but
frequent among the first settlers. The first of these was the
scurvy, already mentioned, of which Winthrop speaks in 1630, saying,
that it proved fatal to those who fell into discontent, and lingered
after their former conditions in England; the poor homesick creatures
in fact, whom we so forget in our florid pictures of the early times
of the little band in the wilderness. Many who were suffering from
scurvy got well when the Lyon arrived from England, bringing store of
juice of lemons. The Governor speaks of another case in 1644; and it
seems probable that the disease was not of rare occurrence.
The other complaint from which they suffered, but which has nearly
disappeared from among us, was intermittent fever, or fever and ague.
I investigated the question as to the prevalence of this disease in
New England, in a dissertation, which was published in a volume with
other papers, in the year 1838. I can add little to the facts there
recorded. One which escaped me was, that Joshua Scottow, in "Old
Men's Tears," dated 1691, speaks of "shaking agues," as among the
trials to which they had been subjected. The outline map of New
England, accompanying the dissertation above referred to, indicates
all the places where I had evidence that the disease had originated.
It was plain enough that it used to be known in many localities where
it has long ceased to be feared. Still it was and is remarkable to
see what a clean bill of health in this particular respect our barren
soil inherited with its sterility. There are some malarious spots on
the edge of Lake Champlain, arid there have been some temporary
centres of malaria, within the memory of man, on one or more of our
Massachusetts rivers, but these are harmless enough, for the most
part, unless the millers dam them, when they are apt to retaliate
with a whiff from their meadows, that sets the whole neighborhood
shaking with fever and ague.
The Pilgrims of the Mayflower had with them a good physician, a man
of standing, a deacon of their church, one whom they loved and
trusted, Dr. Samuel Fuller. But no medical skill could keep cold and
hunger and bad food, and, probably enough, desperate homesickness in
some of the feebler sort, from doing their work. No detailed record
remains of what they suffered or what was attempted for their relief
during the first sad winter. The graves of those who died were
levelled and sowed with grain that the losses of the little band
might not be suspected by the savage tenants of the wilderness, and
their story remains untold.
Of Dr. Fuller's practice, at a later period, we have an account in a
letter of his to Governor Bradford, dated June, 1630. "I have been
to Matapan" (now Dorchester), he says, "and let some twenty of those
people blood." Such wholesale depletion as this, except with avowed
homicidal intent, is quite unknown in these days; though I once saw
the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy,
order some ten or fifteen patients, taken almost indiscriminately, to
be bled in a single morning.
Dr. Fuller's two visits to Salem, at the request of Governor
Endicott, seem to have been very satisfactory to that gentleman.
Morton, the wild fellow of Merry Mount, gives a rather questionable
reason for the Governor's being so well pleased with the physician's
doings. The names under which he mentions the two personages, it
will be seen, are not intended to be complimentary. "Dr. Noddy did a
great cure for Captain Littleworth. He cured him of a disease called
a wife." William Gager, who came out with Winthrop, is spoken of as
"a right godly man and skilful chyrurgeon, but died of a malignant
fever not very long after his arrival."
Two practitioners of the ancient town of Newbury are entitled to
special notice, for different reasons. The first is Dr. John Clark,
who is said by tradition to have been the first regularly educated
physician who resided in New England. His portrait, in close-fitting
skull-cap, with long locks and venerable flowing beard, is familiar
to our eyes on the wall of our Society's antechamber. His left hand
rests upon a skull, his right hand holds an instrument which deserves
a passing comment. It is a trephine, a surgical implement for
cutting round pieces out of broken skulls, so as to get at the
fragments which have been driven in, and lift them up. It has a
handle like that of a gimlet, with a claw like a hammer, to lift
with, I suppose, which last contrivance I do not see figured in my
books. But the point I refer to is this: the old instrument, the
trepan, had a handle like a wimble, what we call a brace or bit-
stock. The trephine is not mentioned at all in Peter Lowe's book,
London, 1634; nor in Wiseman's great work on Surgery, London, 1676;
nor in the translation of Dionis, published by Jacob Tonson, in 1710.
In fact it was only brought into more general use by Cheselden and
Sharpe so late as the beginning of the last century. As John Clark
died in 1661, it is remarkable to see the last fashion in the way of
skull-sawing contrivances in his hands,--to say nothing of the claw
on the handle, and a Hey's saw, so called in England, lying on the
table by him, and painted there more than a hundred years before Hey
was born. This saw is an old invention, perhaps as old as
Hippocrates, and may be seen figured in the "Armamentarium
Chirurgicum" of Scultetus, or in the Works of Ambroise Pare.
Dr. Clark is said to have received a diploma before be came, for
skill in lithotomy. He loved horses, as a good many doctors do, and
left a good property, as they all ought to do. His grave and noble
presence, with the few facts concerning him, told with more or less
traditional authority, give us the feeling that the people of
Newbury, and afterwards of Boston, had a wise and skilful medical
adviser and surgeon in Dr. John Clark.
The venerable town of Newbury had another physician who was less
fortunate. The following is a court record of 1652:
"This is to certify whom it may concern, that we the subscribers,
being called upon to testify against doctor William Snelling for
words by him uttered, affirm that being in way of merry discourse, a
health being drank to all friends, he answered,
"I'll pledge my friends,
And for my foes
A plague for their heels
And,'---
[a similar malediction on the other extremity of their feet.]
"Since when he hath affirmed that he only intended the proverb used
in the west country, nor do we believe he intended otherwise.
"[Signed]
"WILLIAM THOMAS.
"THOMAS MILWARD.
"March 12th 1651, All which I acknowledge, and am sorry I did not
expresse my intent, or that I was so weak as to use so foolish a
proverb.
"[Signed]
"GULIELMUS SNELLING."
Notwithstanding this confession and apology, the record tells us that
"William Snelling in his presentment for cursing is fined ten
shillings and the fees of court."
I will mention one other name among those of the Fathers of the
medical profession in New England. The "apostle" Eliot says, writing
in 1647, "We never had but one anatomy in the country, which Mr.
Giles Firman, now in England, did make and read upon very well."
Giles Firmin, as the name is commonly spelled, practised physic in
this country for a time. He seems to have found it a poor business;
for, in a letter to Governor Winthrop, he says, "I am strongly sett
upon to studye divinitie: my studyes else must be lost, for physick
is but a meene helpe."
Giles Firmin's Lectures on Anatomy were the first scientific
teachings of the New World. While the Fathers were enlightened
enough to permit such instructions, they were severe in dealing with
quackery; for, in 1631, our court records show that one Nicholas
Knopp, or Knapp, was sentenced to be fined or whipped "for taking
upon him to cure the scurvey by a water of noe worth nor value, which
he solde att a very deare rate." Empty purses or sore backs would be
common with us to-day if such a rule were enforced.
Besides the few worthies spoken of, and others whose names I have not
space to record, we must remember that there were many clergymen who
took charge of the bodies as well as the souls of their patients,
among them two Presidents of Harvard College, Charles Chauncy and
Leonard Hoar,--and Thomas Thacher, first minister of the "Old South,"
author of the earliest medical treatises printed in the country,[A
Brief Rule to Guide the Common People in Small pox and
Measles. 1674.] whose epitaph in Latin and Greek, said to have been
written by Eleazer, an "Indian Youth" and a member of the Senior
Class of Harvard College, may be found in the "Magnalia." I miss
this noble savage's name in our triennial catalogue; and as there is
many a slip between the cup and lip, one is tempted to guess that he
may have lost his degree by some display of his native instinct,--
possibly a flourish of the tomahawk or scalping-knife. However this
may have been, the good man he celebrated was a notable instance of
the Angelical Conjunction, as the author of the "Magnalia" calls it,
of the offices of clergyman and medical practitioner.
Michael Wigglesworth, author of the "Day of Doom," attended the sick,
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