Medical Essays
by
Oliver Wendell Holmes, Sr. (The Physician and Poet)
Part 7 out of 7
We must not forget the various medical libraries which preceded this:
that of an earlier period, when Boston contained about seventy
regular practitioners, the collection afterwards transferred to the
Boston Athenaeum; the two collections belonging to the University;
the Treadwell Library at the Massachusetts General Hospital; the
collections of the two societies, that for Medical Improvement and
that for Medical Observation; and more especially the ten thousand
volumes relating to medicine belonging to our noble public city
library,--too many blossoms on the tree of knowledge, perhaps, for
the best fruit to ripen. But the Massachusetts Medical Society now
numbers nearly four hundred members in the city of Boston. The time
had arrived for a new and larger movement. There was needed a place
to which every respectable member of the medical profession could
obtain easy access; where, under one roof, all might find the special
information they were seeking; where the latest medical intelligence
should be spread out daily as the shipping news is posted on the
bulletins of the exchange; where men engaged in a common pursuit
could meet, surrounded by the mute oracles of science and art; where
the whole atmosphere should be as full of professional knowledge as
the apothecary's shop is of the odor of his medicaments. This was
what the old men longed for,--the prophets and kings of the
profession, who
"Desired it long,
But died without the sight."
This is what the young men and those who worked under their guidance
undertook to give us. And now such a library, such a reading-room,
such an exchange, such an intellectual and social meeting place, we
be hold a fact, plain before us. The medical profession of our city,
and, let us add, of all those neighboring places which it can reach
with its iron arms, is united as never before by the commune
vinculum, the common bond of a large, enduring, ennobling, unselfish
interest. It breathes a new air of awakened intelligence. It
marches abreast of the other learned professions, which have long had
their extensive and valuable centralized libraries; abreast of them,
but not promising to be content with that position. What glorifies a
town like a cathedral? What dignifies a province like a university?
What illuminates a country like its scholarship, and what is the nest
that hatches scholars but a library?
The physician, some may say, is a practical man and has little use
for all this book-learning. Every student has heard Sydenham's reply
to Sir Richard Blackmore's question as to what books he should read,
--meaning medical books. "Read Don Quixote," was his famous answer.
But Sydenham himself made medical books and may be presumed to have
thought those at least worth reading. Descartes was asked where was
his library, and in reply held up the dissected body of an animal.
But Descartes made books, great books, and a great many of them. A
physician of common sense without erudition is better than a learned
one without common sense, but the thorough master of his profession
must have learning added to his natural gifts.
It is not necessary to maintain the direct practical utility of all
kinds of learning. Our shelves contain many books which only a
certain class of medical scholars will be likely to consult. There
is a dead medical literature, and there is a live one. The dead is
not all ancient, the live is not all modern. There is none, modern
or ancient, which, if it has no living value for the student, will
not teach him something by its autopsy. But it is with the live
literature of his profession that the medical practitioner is first
of all concerned.
Now there has come a great change in our time over the form in which
living thought presents itself. The first printed books,--the
incunabula,--were inclosed in boards of solid oak, with brazen clasps
and corners; the boards by and by were replaced by pasteboard covered
with calf or sheepskin; then cloth came in and took the place of
leather; then the pasteboard was covered with paper instead of cloth;
and at this day the quarterly, the monthly, the weekly periodical in
its flimsy unsupported dress of paper, and the daily journal, naked
as it came from the womb of the press, hold the larger part of the
fresh reading we live upon. We must have the latest thought in its
latest expression; the page must be newly turned like the morning
bannock; the pamphlet must be newly opened like the ante-prandial
oyster.
Thus a library, to meet the need of our time, must take, and must
spread out in a convenient form, a great array of periodicals. Our
active practitioners read these by preference over almost everything
else. Our specialists, more particularly, depend on the month's
product, on the yearly crop of new facts, new suggestions, new
contrivances, as much as the farmer on the annual yield of his acres.
One of the first wants, then, of the profession is supplied by our
library in its great array of periodicals from many lands, in many
languages. Such a number of medical periodicals no private library
would have room for, no private person would pay for, or flood his
tables with if they were sent him for nothing. These, I think, with
the reports of medical societies and the papers contributed to them,
will form the most attractive part of our accumulated medical
treasures. They will be also one of our chief expenses, for these
journals must be bound in volumes and they require a great amount of
shelf-room; all this, in addition to the cost of subscription for
those which are not furnished us gratuitously.
It is true that the value of old scientific periodicals is, other
things being equal, in the inverse ratio of their age, for the
obvious reason that what is most valuable in the earlier volumes of a
series is drained off into the standard works with which the
intelligent practitioner is supposed to be familiar. But no extended
record of facts grows too old to be useful, provided only that we
have a ready and sure way of getting at the particular fact or facts
we are in search of.
And this leads me to speak of what I conceive to be one of the
principal tasks to be performed by the present and the coming
generation of scholars, not only in the medical, but in every
department of knowledge. I mean the formation of indexes, and more
especially of indexes to periodical literature.
This idea has long been working in the minds of scholars, and all who
have had occasion to follow out any special subject. I have a right
to speak of it, for I long ago attempted to supply the want of
indexes in some small measure for my own need. I had a very complete
set of the "American Journal of the Medical Sciences;" an entire set
of the "North American Review," and many volumes of the reprints of
the three leading British quarterlies. Of what use were they to me
without general indexes? I looked them all through carefully and
made classified lists of all the articles I thought I should most
care to read. But they soon outgrew my lists. The "North American
Review" kept filling up shelf after shelf, rich in articles which I
often wanted to consult, but what a labor to find them, until the
index of Mr. Gushing, published a few months since, made the contents
of these hundred and twenty volumes as easily accessible as the words
in a dictionary! I had a, copy of good Dr. Abraham Rees's
Cyclopaedia, a treasure-house to my boyhood which has not lost its
value for me in later years. But where to look for what I wanted? I
wished to know, for instance, what Dr. Burney had to say about
singing. Who would have looked for it under the Italian word
cantare? I was curious to learn something of the etchings of
Rembrandt, and where should I find it but under the head "Low
Countries, Engravers of the,"--an elaborate and most valuable article
of a hundred double-columned close-printed quarto pages, to which no
reference, even, is made under the title Rembrandt.
There was nothing to be done, if I wanted to know where that which I
specially cared for was to be found in my Rees's Cyclopaedia, but to
look over every page of its forty-one quarto volumes and make out a
brief list of matters of interest which I could not find by their
titles, and this I did, at no small expense of time and trouble.
Nothing, therefore, could be more pleasing to me than to see the
attention which has been given of late years to the great work of
indexing. It is a quarter of a century since Mr. Poole published his
"Index to Periodical Literature," which it is much to be hoped is
soon to appear in a new edition, grown as it must be to formidable
dimensions by the additions of so long a period. The "British and
Foreign Medical Review," edited by the late Sir John Forties,
contributed to by Huxley, Carpenter, Laycock, and others of the most
distinguished scientific men of Great Britain, has an index to its
twenty-four volumes, and by its aid I find this valuable series as
manageable as a lexicon. The last edition of the "Encyclopaedia
Britannica" had a complete index in a separate volume, and the
publishers of Appletons' "American Cyclopaedia" have recently issued
an index to their useful work, which must greatly add to its value.
I have already referred to the index to the "North American Review,"
which to an American, and especially to a New Englander, is the most
interesting and most valuable addition of its kind to our literary
apparatus since the publication of Mr. Allibone's "Dictionary of
Authors." I might almost dare to parody Mr. Webster's words in
speaking of Hamilton, to describe what Mr. Gushing did for the solemn
rows of back volumes of our honored old Review which had been long
fossilizing on our shelves: "He touched the dead corpse of the 'North
American,' and it sprang to its feet." A library of the best
thought of the best American scholars during the greater portion of
the century was brought to light by the work of the indexmaker as
truly as were the Assyrian tablets by the labors of Layard.
A great portion of the best writing and reading literary, scientific,
professional, miscellaneous--comes to us now, at stated intervals, in
paper covers. The writer appears, as it were, in his shirt-sleeves.
As soon as he has delivered his message the book-binder puts a coat
on his back, and he joins the forlorn brotherhood of "back volumes,"
than which, so long as they are unindexed, nothing can be more
exasperating. Who wants a lock without a key, a ship without a
rudder, a binnacle without a compass, a check without a signature, a
greenback without a goldback behind it?
I have referred chiefly to the medical journals, but I would include
with these the reports of medical associations, and those separate
publications which, coming in the form of pamphlets, heap themselves
into chaotic piles and bundles which are worse than useless, taking
up a great deal of room, and frightening everything away but mice and
mousing antiquarians, or possibly at long intervals some terebrating
specialist.
Arranged, bound, indexed, all these at once become accessible and
valuable. I will take the first instance which happens to suggest
itself. How many who know all about osteoblasts and the experiments
of Ollier, and all that has grown out of them, know where to go for a
paper by the late Dr. A. L. Peirson of Salem, published in the year
1840, under the modest title, Remarks on Fractures? And if any
practitioner who has to deal with broken bones does not know that
most excellent and practical essay, it is a great pity, for it
answers very numerous questions which will be sure to suggest
themselves to the surgeon and the patient as no one of the recent
treatises, on my own shelves, at least, can do.
But if indexing is the special need of our time in medical
literature, as in every department of knowledge, it must be
remembered that it is not only an immense labor, but one that never
ends. It requires, therefore, the cooperation of a large number of
individuals to do the work, and a large amount of money to pay for
making its results public through the press. When it is remembered
that the catalogue of the library of the British Museum is contained
in nearly three thousand large folios of manuscript, and not all its
books are yet included, the task of indexing any considerable branch
of science or literature looks as if it were well nigh impossible.
But many hands make light work. An "Index Society" has been formed
in England, already numbering about one hundred and seventy members.
It aims at "supplying thorough indexes to valuable works and
collections which have hitherto lacked them; at issuing indexes to
the literature of special subjects; and at gathering materials for a
general reference index." This society has published a little
treatise setting forth the history and the art of indexing, which I
trust is in the hands of some of our members, if not upon our
shelves.
Something has been done in the same direction by individuals in our
own country, as we have already seen. The need of it in the
department of medicine is beginning to be clearly felt. Our library
has already an admirable catalogue with cross references, the work of
a number of its younger members cooperating in the task. A very
intelligent medical student, Mr. William D. Chapin, whose excellent
project is indorsed by well-known New York physicians and professors,
proposes to publish a yearly index to original communications in the
medical journals of the United States, classified by authors and
subjects. But it is from the National Medical Library at Washington
that we have the best promise and the largest expectations. That
great and growing collection of fifty thousand volumes is under the
eye and hand of a librarian who knows books and how to manage them.
For libraries are the standing armies of civilization, and an army is
but a mob without a general who can organize and marshal it so as to
make it effective. The "Specimen Fasciculus of a Catalogue of the
National Medical Library," prepared under the direction of Dr.
Billings, the librarian, would have excited the admiration of Haller,
the master scholar in medical science of the last century, or rather
of the profession in all centuries, and if carried out as it is begun
will be to the nineteenth all and more than all that the three
Bibliothecae--Anatomica, Chirurgica, and Medicinae-Practicae--were to
the eighteenth century. I cannot forget the story that Agassiz was
so fond of telling of the king of Prussia and Fichte. It was after
the humiliation and spoliation of the kingdom by Napoleon that the
monarch asked the philosopher what could be done to regain the lost
position of the nation. "Found a great university, Sire," was the
answer, and so it was that in the year 1810 the world-renowned
University of Berlin came into being. I believe that we in this
country can do better than found a national university, whose
professors shall be nominated in caucuses, go in and out, perhaps,
like postmasters, with every change of administration, and deal with
science in the face of their constituency as the courtier did with
time when his sovereign asked him what o'clock it was: "Whatever hour
your majesty pleases." But when we have a noble library like that at
Washington, and a librarian of exceptional qualifications like the
gentleman who now holds that office, I believe that a liberal
appropriation by Congress to carry out a conscientious work for the
advancement of sound knowledge and the bettering of human conditions,
like this which Dr. Billings has so well begun, would redound greatly
to the honor of the nation. It ought to be willing to be at some
charge to make its treasures useful to its citizens, and, for its own
sake, especially to that class which has charge of health, public and
private. This country abounds in what are called "self-made men,"
and is justly proud of many whom it thus designates. In one sense no
man is self-made who breathes the air of a civilized community. In
another sense every man who is anything other than a phonograph on
legs is self-made. But if we award his just praise to the man who
has attained any kind of excellence without having had the same
advantages as others whom, nevertheless, he has equalled or
surpassed, let us not be betrayed into undervaluing the mechanic's
careful training to his business, the thorough and laborious
education of the scholar and the professional man.
Our American atmosphere is vocal with the flippant loquacity of half
knowledge. We must accept whatever good can be got out of it, and
keep it under as we do sorrel and mullein and witchgrass, by
enriching the soil, and sowing good seed in plenty; by good teaching
and good books, rather than by wasting our time in talking against
it. Half knowledge dreads nothing but whole knowledge.
I have spoken of the importance and the predominance of periodical
literature, and have attempted to do justice to its value. But the
almost exclusive reading of it is not without its dangers. The
journals contain much that is crude and unsound; the presumption; it
might be maintained, is against their novelties, unless they come
from observers of established credit. Yet I have known a
practitioner,--perhaps more than one,--who was as much under the
dominant influence of the last article he had read in his favorite
medical journal as a milliner under the sway of the last fashion-
plate. The difference between green and seasoned knowledge is very
great, and such practitioners never hold long enough to any of their
knowledge to have it get seasoned.
It is needless to say, then, that all the substantial and permanent
literature of the profession should be represented upon our shelves.
Much of it is there already, and as one private library after another
falls into this by the natural law of gravitation, it will gradually
acquire all that is most valuable almost without effort. A scholar
should not be in a hurry to part with his books. They are probably
more valuable to him than they can be to any other individual. What
Swedenborg called "correspondence" has established itself between his
intelligence and the volumes which wall him within their sacred
inclosure. Napoleon said that his mind was as if furnished with
drawers,--he drew out each as he wanted its contents, and closed it
at will when done with them. The scholar's mind, to use a similar
comparison, is furnished with shelves, like his library. Each book
knows its place in the brain as well as against the wall or in the
alcove. His consciousness is doubled by the books which encircle
him, as the trees that surround a lake repeat themselves in its
unruffled waters. Men talk of the nerve that runs to the pocket, but
one who loves his books, and has lived long with them, has a nervous
filament which runs from his sensorium to every one of them. Or, if
I may still let my fancy draw its pictures, a scholar's library is to
him what a temple is to the worshipper who frequents it. There is
the altar sacred to his holiest experiences. There is the font where
his new-born thought was baptized and first had a name in his
consciousness. There is the monumental tablet of a dead belief,
sacred still in the memory of what it was while yet alive. No
visitor can read all this on the lettered backs of the books that
have gathered around the scholar, but for him, from the Aldus on the
lowest shelf to the Elzevir on the highest, every volume has a
language which none but be can interpret. Be patient with the book-
collector who loves his companions too well to let them go. Books
are not buried with their owners, and the veriest book-miser that
ever lived was probably doing far more for his successors than his
more liberal neighbor who despised his learned or unlearned avarice.
Let the fruit fall with the leaves still clinging round it. Who
would have stripped Southey's walls of the books that filled them,
when, his mind no longer capable of taking in their meaning, he would
still pat and fondle them with the vague loving sense of what they
had once been to him,--to him, the great scholar, now like a little
child among his playthings?
We need in this country not only the scholar, but the virtuoso, who
hoards the treasures which he loves, it may be chiefly for their
rarity and because others who know more than he does of their value
set a high price upon them. As the wine of old vintages is gently
decanted out of its cobwebbed bottles with their rotten corks into
clean new receptacles, so the wealth of the New World is quietly
emptying many of the libraries and galleries of the Old World into
its newly formed collections and newly raised edifices. And this
process must go on in an accelerating ratio. No Englishman will be
offended if I say that before the New Zealander takes his stand on a
broken arch of London Bridge to sketch the ruins of St. Paul's in the
midst of a vast solitude, the treasures of the British Museum will
have found a new shelter in the halls of New York or Boston. No
Catholic will think hardly of my saying that before the Coliseum
falls, and with it the imperial city, whose doom prophecy has linked
with that of the almost eternal amphitheatre, the marbles, the
bronzes, the paintings, the manuscripts of the Vatican will have left
the shores of the Tiber for those of the Potomac, the Hudson, the
Mississippi, or the Sacramento. And what a delight in the pursuit of
the rarities which the eager book-hunter follows with the scent of a
beagle!
Shall I ever forget that rainy day in Lyons, that dingy bookshop,
where I found the Aetius, long missing from my Artis bledicae
Principes, and where I bought for a small pecuniary consideration,
though it was marked rare, and was really tres rare, the Aphorisms of
Hippocrates, edited by and with a preface from the hand of Francis
Rabelais? And the vellum-bound Tulpius, which I came upon in Venice,
afterwards my only reading when imprisoned in quarantine at
Marseilles, so that the two hundred and twenty-eight cases he has
recorded are, many of them, to this day still fresh in my memory.
And the Schenckius,--the folio filled with casus rariores, which had
strayed in among the rubbish of the bookstall on the boulevard,--and
the noble old Vesalius with its grand frontispiece not unworthy of
Titian, and the fine old Ambroise Pare, long waited for even in Paris
and long ago, and the colossal Spigelius with his eviscerated
beauties, and Dutch Bidloo with its miracles of fine engraving and
bad dissection, and Italian Mascagni, the despair of all would-be
imitators, and pre-Adamite John de Ketam, and antediluvian
Berengarius Carpensis,--but why multiply names, every one of which
brings back the accession of a book which was an event almost like
the birth of an infant?
A library like ours must exercise the largest hospitality. A great
many books may be found in every large collection which remind us of
those apostolic looking old men who figure on the platform at our
political and other assemblages. Some of them have spoken words of
wisdom in their day, but they have ceased to be oracles; some of them
never had any particularly important message for humanity, but they
add dignity to the meeting by their presence; they look wise, whether
they are so or not, and no one grudges them their places of honor.
Venerable figure-heads, what would our platforms be without you?
Just so with our libraries. Without their rows of folios in creamy
vellum, or showing their black backs with antique lettering of
tarnished gold, our shelves would look as insufficient and unbalanced
as a column without its base, as a statue without its pedestal. And
do not think they are kept only to be spanked and dusted during that
dreadful period when their owner is but too thankful to become an
exile and a wanderer from the scene of single combats between dead
authors and living housemaids. Men were not all cowards before
Agamemnon or all fools before the days of Virchow and Billroth. And
apart from any practical use to be derived from the older medical
authors, is there not a true pleasure in reading the accounts of
great discoverers in their own words? I do not pretend to hoist up
the Bibliotheca Anatomica of Mangetus and spread it on my table every
day. I do not get out my great Albinus before every lecture on the
muscles, nor disturb the majestic repose of Vesalius every time I
speak of the bones he has so admirably described and figured. But it
does please me to read the first descriptions of parts to which the
names of their discoverers or those who have first described them
have become so joined that not even modern science can part them; to
listen to the talk of my old volume as Willis describes his circle
and Fallopius his aqueduct and Varolius his bridge and Eustachius his
tube and Monro his foramen,--all so well known to us in the human
body; it does please me to know the very words in which Winslow
described the opening which bears his name, and Glisson his capsule
and De Graaf his vesicle; I am not content until I know in what
language Harvey announced his discovery of the circulation, and how
Spigelius made the liver his perpetual memorial, and Malpighi found a
monument more enduring than brass in the corpuscles of the spleen and
the kidney.
But after all, the readers who care most for the early records of
medical science and art are the specialists who are dividing up the
practice of medicine and surgery as they were parcelled out,
according to Herodotus, by the Egyptians. For them nothing is too
old, nothing is too new, for to their books of ail others is
applicable the saying of D'Alembert that the author kills himself in
lengthening out what the reader kills himself in trying to shorten.
There are practical books among these ancient volumes which can never
grow old. Would you know how to recognize "male hysteria" and to
treat it, take down your Sydenham; would you read the experience of a
physician who was himself the subject of asthma, and who,
notwithstanding that, in the words of Dr. Johnson, "panted on till
ninety," you will find it in the venerable treatise of Sir John
Floyer; would you listen to the story of the King's Evil cured by the
royal touch, as told by a famous chirurgeon who fully believed in it,
go to Wiseman; would you get at first hand the description of the
spinal disease which long bore his name, do not be startled if I tell
you to go to Pott,--to Percival Pott, the great surgeon of the last
century.
There comes a time for every book in a library when it is wanted by
somebody. It is but a few weeks since one of the most celebrated
physicians in the country wrote to me from a great centre of medical
education to know if I had the works of Sanctorius, which he had
tried in vain to find. I could have lent him the "Medicina Statica,"
with its frontispiece showing Sanctorius with his dinner on the table
before him, in his balanced chair which sunk with him below the level
of his banquet-board when he had swallowed a certain number of
ounces,--an early foreshadowing of Pettenkofer's chamber and
quantitative physiology,--but the "Opera Omnia" of Sanctorius I had
never met with, and I fear he had to do without it.
I would extend the hospitality of these shelves to a class of works
which we are in the habit of considering as being outside of the pale
of medical science, properly so called, and sometimes of coupling
with a disrespectful name. Such has always been my own practice. I
have welcomed Culpeper and Salmon to my bookcase as willingly as
Dioscorides or Quincy, or Paris or Wood and Bache. I have found a
place for St. John Long, and read the story of his trial for
manslaughter with as much interest as the laurel-water case in which
John Hunter figured as a witness. I would give Samuel Hahnemann a
place by the side of Samuel Thomson. Am I not afraid that some
student of imaginative turn and not provided with the needful
cerebral strainers without which all the refuse of gimcrack
intelligences gets into the mental drains and chokes them up,--am I
not afraid that some such student will get hold of the "Organon" or
the "Maladies Chroniques" and be won over by their delusions, and so
be lost to those that love him as a man of common sense and a brother
in their high calling? Not in the least. If he showed any symptoms
of infection I would for once have recourse to the principle of
similia similibus. To cure him of Hahnemann I would prescribe my
favorite homoeopathic antidote, Okie's Bonninghausen. If that
failed, I would order Grauvogl as a heroic remedy, and if he survived
that uncured, I would give him my blessing, if I thought him honest,
and bid him depart in peace. For me he is no longer an individual.
He belongs to a class of minds which we are bound to be patient with
if their Maker sees fit to indulge them with existence. We must
accept the conjuring ultra-ritualist, the dreamy second adventist,
the erratic spiritualist, the fantastic homoeopathist, as not
unworthy of philosophic study; not more unworthy of it than the
squarers of the circle and the inventors of perpetual motion, and the
other whimsical visionaries to whom De Morgan has devoted his most
instructive and entertaining "Budget of Paradoxes." I hope,
therefore, that our library will admit the works of the so-called
Eclectics, of the Thomsonians, if any are in existence, of the
Clairvoyants, if they have a literature, and especially of the
Homoeopathists. This country seems to be the place for such a
collection, which will by and by be curious and of more value than at
present, for Homoeopathy seems to be following the pathological law
of erysipelas, fading out where it originated as it spreads to new
regions. At least I judge so by the following translated extract
from a criticism of an American work in the "Homoeopatische
Rundschau" of Leipzig for October, 1878, which I find in the
"Homoeopathic Bulletin" for the month of November just passed:
"While we feel proud of the spread and rise of Homoeopathy across the
ocean, and while the Homoeopathic works reaching us from there, and
published in a style such as is unknown in Germany, bear eloquent
testimony to the eminent activity of our transatlantic colleagues, we
are overcome by sorrowful regrets at the position Homoeopathy
occupies in Germany. Such a work [as the American one referred to]
with us would be impossible; it would lack the necessary support."
By all means let our library secure a good representation of the
literature of Homoeopathy before it leaves us its "sorrowful regrets"
and migrates with its sugar of milk pellets, which have taken the
place of the old pilulae micae panis, to Alaska, to "Nova Zembla, or
the Lord knows where."
What shall I say in this presence of the duties of a Librarian?
Where have they ever been better performed than in our own public
city library, where the late Mr. Jewett and the living Mr. Winsor
have shown us what a librarian ought to be,--the organizing head, the
vigilant guardian, the seeker's index, the scholar's counsellor? His
work is not merely that of administration, manifold and laborious as
its duties are. He must have a quick intelligence and a retentive
memory. He is a public carrier of knowledge in its germs. His
office is like that which naturalists attribute to the bumble-bee,--
he lays up little honey for himself, but he conveys the fertilizing
pollen from flower to flower.
Our undertaking, just completed,--and just begun--has come at the
right time, not a day too soon. Our practitioners need a library
like this, for with all their skill and devotion there is too little
genuine erudition, such as a liberal profession ought to be able to
claim for many of its members. In reading the recent obituary
notices of the late Dr. Geddings of South Carolina, I recalled what
our lamented friend Dr. Coale used to tell me of his learning and
accomplishments, and I could not help reflecting how few such medical
scholars we had to show in Boston or New England. We must clear up
this unilluminated atmosphere, and here,--here is the true electric
light which will irradiate its darkness.
The public will catch the rays reflected from the same source of
light, and it needs instruction on the great subjects of health and
disease,--needs it sadly. It is preyed upon by every kind of
imposition almost without hindrance. Its ignorance and prejudices
react upon the profession to the great injury of both. The jealous
feeling, for instance, with regard to such provisions for the study
of anatomy as are sanctioned by the laws in this State and carried
out with strict regard to those laws, threatens the welfare, if not
the existence of institutions for medical instruction wherever it is
not held in check by enlightened intelligence. And on the other hand
the profession has just been startled by a verdict against a
physician, ruinous in its amount,--enough to drive many a hard-
working young practitioner out of house and home,--a verdict which
leads to the fear that suits for malpractice may take the place of
the panel game and child-stealing as a means of extorting money. If
the profession in this State, which claims a high standard of
civilization, is to be crushed and ground beneath the upper millstone
of the dearth of educational advantages and the lower millstone of
ruinous penalties for what the ignorant ignorantly shall decide to be
ignorance, all I can say is
God save the Commonhealth of Massachusetts!
Once more, we cannot fail to see that just as astrology has given
place to astronomy, so theology, the science of Him whom by searching
no man can find out, is fast being replaced by what we may not
improperly call theonomy, or the science of the laws according to
which the Creator acts. And since these laws find their fullest
manifestations for us, at least, in rational human natures, the study
of anthropology is largely replacing that of scholastic divinity. We
must contemplate our Maker indirectly in human attributes as we talk
of Him in human parts of speech. And this gives a sacredness to the
study of man in his physical, mental, moral, social, and religious
nature which elevates the faithful students of anthropology to the
dignity of a priesthood, and sheds a holy light on the recorded
results of their labors, brought together as they are in such a
collection as this which is now spread out before us.
Thus, then, our library is a temple as truly as the dome-crowned
cathedral hallowed by the breath of prayer and praise, where the dead
repose and the living worship. May it, with all its treasures, be
consecrated like that to the glory of God, through the contributions
it shall make to the advancement of sound knowledge, to the relief of
human suffering, to the promotion of harmonious relations between the
members of the two noble professions which deal with the diseases of
the soul and with those of the body, and to the common cause in which
all good men are working, the furtherance of the well-being of their
fellow-creatures!
NOTE.--As an illustration of the statement in the last paragraph but
one, I take the following notice from the "Boston Daily Advertiser,"
of December 4th, the day after the delivery of the address:
"Prince Lucien Bonaparte is now living in London, and is devoting
himself to the work of collecting the creeds of all religions and
sects, with a view to their classification,--his object being simply
scientific or anthropological."
Since delivering the address, also, I find a leading article in the
"Cincinnati Lancet and Clinic" of November 30th, headed "The
Decadence of Homoeopathy," abundantly illustrated by extracts from
the "Homoeopathic Times," the leading American organ of that sect.
In the New York "Medical Record" of the same date, which I had not
seen before the delivery of my address, is an account of the action
of the Homoeopathic Medical Society of Northern New York, in which
Hahnemann's theory of "dynamization" is characterized in a formal
resolve as "unworthy the confidence of the Homoeopathic profession."
It will be a disappointment to the German Homoeopathists to read in
the "Homoeopathic Times" such a statement as the following:
"Whatever the influences have been which have checked the outward
development of Homoeopathy, it is plainly evident that the
Homoeopathic school, as regards the number of its openly avowed
representatives, has attained its majority, and has begun to decline
both in this country and in England."
All which is an additional reason for making a collection of the
incredibly curious literature of Homoeopathy before that
pseudological inanity has faded out like so many other delusions.
SOME OF MY EARLY TEACHERS
[A Farewell Address to the Medical School of Harvard University,
November 28, 1882.]
I had intended that the recitation of Friday last should be followed
by a few parting words to my class and any friends who might happen
to be in the lecture-room. But I learned on the preceding evening
that there was an expectation, a desire, that my farewell should take
a somewhat different form; and not to disappoint the wishes of those
whom I was anxious to gratify, I made up my mind to appear before you
with such hasty preparation as the scanty time admitted.
There are three occasions upon which a human being has a right to
consider himself as a centre of interest to those about him: when he
is christened, when he is married, and when he is buried. Every one
is the chief personage, the hero, of his own baptism, his own
wedding, and his own funeral.
There are other occasions, less momentous, in which one may make more
of himself than under ordinary circumstances he would think it proper
to do; when he may talk about himself, and tell his own experiences,
in fact, indulge in a more or less egotistic monologue without fear
or reproach.
I think I may claim that this is one of those occasions. I have
delivered my last anatomical lecture and heard my class recite for
the last time. They wish to hear from me again in a less scholastic
mood than that in which they have known me. Will you not indulge me
in telling you something of my own story?
This is the thirty-sixth Course of Lectures in which I have taken my
place and performed my duties as Professor of Anatomy. For more than
half of my term of office I gave instruction in Physiology, after the
fashion of my predecessors and in the manner then generally prevalent
in our schools, where the physiological laboratory was not a
necessary part of the apparatus of instruction. It was with my
hearty approval that the teaching of Physiology was constituted a
separate department and made an independent Professorship. Before my
time, Dr. Warren had taught Anatomy, Physiology, and Surgery in the
same course of Lectures, lasting only three or four months. As the
boundaries of science are enlarged, new divisions and subdivisions of
its territories become necessary. In the place of six Professors in
1847, when I first became a member of the Faculty, I count twelve
upon the Catalogue before me, and I find the whole number engaged in
the work of instruction in the Medical School amounts to no less than
fifty.
Since I began teaching in this school, the aspect of many branches of
science has undergone a very remarkable transformation. Chemistry
and Physiology are no longer what they were, as taught by the
instructors of that time. We are looking forward to the synthesis of
new organic compounds; our artificial madder is already in the
market, and the indigo-raisers are now fearing that their crop will
be supplanted by the manufactured article. In the living body we
talk of fuel supplied and work done, in movement, in heat, just as if
we were dealing with a machine of our own contrivance.
A physiological laboratory of to-day is equipped with instruments of
research of such ingenious contrivance, such elaborate construction,
that one might suppose himself in a workshop where some exquisite
fabric was to be wrought, such as Queens love to wear, and Kings do
not always love to pay for. They are, indeed, weaving a charmed web,
for these are the looms from which comes the knowledge that clothes
the nakedness of the intellect. Here are the mills that grind food
for its hunger, and "is not the life more than meat, and the body
than raiment?"
But while many of the sciences have so changed that the teachers of
the past would hardly know them, it has not been so with the branch I
teach, or, rather, with that division of it which is chiefly taught
in this amphitheatre. General anatomy, or histology, on the other
hand, is almost all new; it has grown up, mainly, since I began my
medical studies. I never saw a compound microscope during my years
of study in Paris. Individuals had begun to use the instrument, but
I never heard it alluded to by either Professors or students. In
descriptive anatomy I have found little to unlearn, and not a great
deal that was both new and important to learn. Trifling additions
are made from year to year, not to be despised and not to be
overvalued. Some of the older anatomical works are still admirable,
some of the newer ones very much the contrary. I have had recent
anatomical plates brought me for inspection, and I have actually
button-holed the book-agent, a being commonly as hard to get rid of
as the tar-baby in the negro legend, that I might put him to shame
with the imperial illustrations of the bones and muscles in the great
folio of Albinus, published in 1747, and the unapproached figures of
the lymphatic system of Mascagni, now within a very few years of a
century old, and still copied, or, rather, pretended to be copied, in
the most recent works on anatomy.
I am afraid that it is a good plan to get rid of old Professors, and
I am thankful to hear that there is a movement for making provision
for those who are left in need when they lose their offices and their
salaries. I remember one of our ancient Cambridge Doctors once asked
me to get into his rickety chaise, and said to me, half humorously,
half sadly, that he was like an old horse,--they had taken off his
saddle and turned him out to pasture. I fear the grass was pretty
short where that old servant of the public found himself grazing. If
I myself needed an apology for holding my office so long, I should
find it in the fact that human anatomy is much the same study that it
was in the days of Vesalius and Fallopius, and that the greater part
of my teaching was of such a nature that it could never become
antiquated.
Let me begin with my first experience as a medical student. I had
come from the lessons of Judge Story and Mr. Ashmun in the Law School
at Cambridge. I had been busy, more or less, with the pages of
Blackstone and Chitty, and other text-books of the first year of
legal study. More or less, I say, but I am afraid it was less rather
than more. For during that year I first tasted the intoxicating
pleasure of authorship. A college periodical, conducted by friends
of mine, still undergraduates, tempted me into print, and there is no
form of lead-poisoning which more rapidly and thoroughly pervades the
blood and bones and marrow than that which reaches the young author
through mental contact with type-metal. Qui a bu, boira,--he who has
once been a drinker will drink again, says the French proverb. So
the man or woman who has tasted type is sure to return to his old
indulgence sooner or later. In that fatal year I had my first attack
of authors' lead-poisoning, and I have never got quite rid of it from
that day to this. But for that I might have applied myself more
diligently to my legal studies, and carried a green bag in place of a
stethoscope and a thermometer up to the present day.
What determined me to give up Law and apply myself to Medicine I can
hardly say, but I had from the first looked upon that year's study as
an experiment. At any rate, I made the change, and soon found myself
introduced to new scenes and new companionships.
I can scarcely credit my memory when I recall the first impressions
produced upon me by sights afterwards become so familiar that they
could no more disturb a pulse-beat than the commonest of every-day
experiences. The skeleton, hung aloft like a gibbeted criminal,
looked grimly at me as I entered the room devoted to the students of
the school I had joined, just as the fleshless figure of Time, with
the hour-glass and scythe, used to glare upon me in my childhood from
the "New England Primer." The white faces in the beds at the
Hospital found their reflection in my own cheeks, which lost their
color as I looked upon them. All this had to pass away in a little
time; I had chosen my profession, and must meet its painful and
repulsive aspects until they lost their power over my sensibilities.
The private medical school which I had joined was one established by
Dr. James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow
Lewis, and Dr. George W. Otis. Of the first three gentlemen I have
either spoken elsewhere or may find occasion to speak hereafter. The
two younger members of this association of teachers were both
graduates of our University, one of the year 1819, the other of 1818.
Dr. Lewis was a great favorite with students. He was a man of very
lively temperament, fond of old books and young people, open-hearted,
free-spoken, an enthusiast in teaching, and especially at home in
that apartment of the temple of science where nature is seen in
undress, the anthropotomic laboratory, known to common speech as the
dissecting-room. He had that quality which is the special gift of
the man born for a teacher,--the power of exciting an interest in
that which he taught. While he was present the apartment I speak of
was the sunniest of studios in spite of its mortuary spectacles. Of
the students I met there I best remember James Jackson, Junior, full
of zeal and playful as a boy, a young man whose early death was a
calamity to the profession of which he promised to be a chief
ornament; the late Reverend J. S. C. Greene, who, as the prefix to
his name signifies, afterwards changed his profession, but one of
whose dissections I remember looking upon with admiration; and my
friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is
entitled to be called, then, as now and always, a favorite with all
about him. He had come to us from the schools of Germany, and
brought with him recollections of the teachings of Blumenbach and the
elder Langenbeck, father of him whose portrait hangs in our Museum.
Dr. Lewis was our companion as well as our teacher. A good
demonstrator is,--I will not say as important as a good Professor in
the teaching of Anatomy, because I am not sure that he is not more
important. He comes into direct personal relations with the
students,--he is one of them, in fact, as the Professor cannot be
from the nature of his duties. The Professor's chair is an
insulating stool, so to speak; his age, his knowledge, real or
supposed, his official station, are like the glass legs which support
the electrician's piece of furniture, and cut it off from the common
currents of the floor upon which it stands. Dr. Lewis enjoyed
teaching and made his students enjoy being taught. He delighted in
those anatomical conundrums to answer which keeps the student's eyes
open and his wits awake. He was happy as he dexterously performed
the tour de maitre of the old barber-surgeons, or applied the spica
bandage and taught his scholars to do it, so neatly and symmetrically
that the aesthetic missionary from the older centre of civilization
would bend over it in blissful contemplation, as if it were a
sunflower. Dr. Lewis had many other tastes, and was a favorite, not
only with students, but in a wide circle, professional, antiquarian,
masonic, and social.
Dr. Otis was less widely known, but was a fluent and agreeable
lecturer, and esteemed as a good surgeon.
I must content myself with this glimpse at myself and a few of my
fellow-students in Boston. After attending two courses of Lectures
in the school of the University, I went to Europe to continue my
studies.
You may like to hear something of the famous Professors of Paris in
the days when I was a student in the Ecole de Medicine, and following
the great Hospital teachers.
I can hardly believe my own memory when I recall the old
practitioners and Professors who were still going round the hospitals
when I mingled with the train of students that attended the morning
visits. See that bent old man who is groping his way through the
wards of La Charity. That is the famous Baron Boyer, author of the
great work on surgery in nine volumes, a writer whose clearness of
style commends his treatise to general admiration, and makes it a
kind of classic. He slashes away at a terrible rate, they say, when
he gets hold of the subject of fistula in its most frequent habitat,
--but I never saw him do more than look as if he wanted to cut a good
dollop out of a patient he was examining. The short, square,
substantial man with iron-gray hair, ruddy face, and white apron is
Baron Larrey, Napoleon's favorite surgeon, the most honest man he
ever saw,--it is reputed that he called him. To go round the Hotel
des Invalides with Larrey was to live over the campaigns of Napoleon,
to look on the sun of Austerlitz, to hear the cannons of Marengo, to
struggle through the icy waters of the Beresina, to shiver in the
snows of the Russian retreat, and to gaze through the battle smoke
upon the last charge of the red lancers on the redder field of
Waterloo. Larrey was still strong and sturdy as I saw him, and few
portraits remain printed in livelier colors on the tablet of my
memory.
Leave the little group of students which gathers about Larrey beneath
the gilded dome of the Invalides and follow me to the Hotel Dieu,
where rules and reigns the master-surgeon of his day, at least so far
as Paris and France are concerned,--the illustrious Baron Dupuytren.
No man disputed his reign, some envied his supremacy. Lisfranc
shrugged his shoulders as he spoke of "ce grand homme de l'autre cots
de la riviere," that great man on the other side of the river, but
the great man he remained, until he bowed before the mandate which
none may disobey. "Three times," said Bouillaud, "did the apoplectic
thunderbolt fall on that robust brain,"--it yielded at last as the
old bald cliff that is riven and crashes down into the valley. I saw
him before the first thunderbolt had descended: a square, solid man,
with a high and full-domed head, oracular in his utterances,
indifferent to those around him, sometimes, it was said, very rough
with them. He spoke in low, even tones, with quiet fluency, and was
listened to with that hush of rapt attention which I have hardly seen
in any circle of listeners unless when such men as ex-President John
Quincy Adams or Daniel Webster were the speakers. I do not think
that Dupuytren has left a record which explains his influence, but in
point of fact he dominated those around him in a remarkable manner.
You must have all witnessed something of the same kind. The personal
presence of some men carries command with it, and their accents
silence the crowd around them, when the same words from other lips
might fall comparatively unheeded.
As for Lisfranc, I can say little more of him than that he was a
great drawer of blood and hewer of members. I remember his ordering
a wholesale bleeding of his patients, right and left, whatever might
be the matter with them, one morning when a phlebotomizing fit was on
him. I recollect his regretting the splendid guardsmen of the old
Empire,--for what? because they had such magnificent thighs to
amputate. I got along about as far as that with him, when I ceased
to be a follower of M. Lisfranc.
The name of Velpeau must have reached many of you, for he died in
1867, and his many works made his name widely known. Coming to Paris
in wooden shoes, starving, almost, at first, he raised himself to
great eminence as a surgeon and as an author, and at last obtained
the Professorship to which his talents and learning entitled him.
His example may be an encouragement to some of my younger hearers who
are born, not with the silver spoon in their mouths, but with the
two-tined iron fork in their hands. It is a poor thing to take up
their milk porridge with in their young days, but in after years it
will often transfix the solid dumplings that roll out of the silver
spoon. So Velpeau found it. He had not what is called genius, he
was far from prepossessing in aspect, looking as if he might have
wielded the sledge-hammer (as I think he had done in early life)
rather than the lancet, but he had industry, determination,
intelligence, character, and he made his way to distinction and
prosperity, as some of you sitting on these benches and wondering
anxiously what is to become of you in the struggle for life will have
done before the twentieth century has got halfway through its first
quarter. A good sound head over a pair of wooden shoes is a great
deal better than a wooden head belonging to an owner who cases his
feet in calf-skin, but a good brain is not enough without a stout
heart to fill the four great conduits which carry at once fuel and
fire to that mightiest of engines.
How many of you who are before me are familiarly acquainted with the
name of Broussais, or even with that of Andral? Both were lecturing
at the Ecole de Medicine, and I often heard them. Broussais was in
those days like an old volcano, which has pretty nearly used up its
fire and brimstone, but is still boiling and bubbling in its
interior, and now and then sends up a spirt of lava and a volley of
pebbles. His theories of gastro-enteritis, of irritation and
inflammation as the cause of disease, and the practice which sprang
from them, ran over the fields of medicine for a time like flame over
the grass of the prairies. The way in which that knotty-featured,
savage old man would bring out the word irritation--with rattling and
rolling reduplication of the resonant letter r--might have taught a
lesson in articulation to Salvini. But Broussais's theory was
languishing and well-nigh become obsolete, and this, no doubt, added
vehemence to his defence of his cherished dogmas.
Old theories, and old men who cling to them, must take themselves out
of the way as the new generation with its fresh thoughts and altered
habits of mind comes forward to take the place of that which is dying
out. This was a truth which the fiery old theorist found it very hard
to learn, and harder to bear, as it was forced upon him. For the
hour of his lecture was succeeded by that of a younger and far more
popular professor. As his lecture drew towards its close, the
benches, thinly sprinkled with students, began to fill up; the doors
creaked open and banged back oftener and oftener, until at last the
sound grew almost continuous, and the voice of the lecturer became a
leonine growl as he strove in vain to be heard over the noise of
doors and footsteps.
Broussais was now sixty-two years old. The new generation had
outgrown his doctrines, and the Professor for whose hour the benches
had filled themselves belonged to that new generation. Gabriel
Andral was little more than half the age of Broussais, in the full
prime and vigor of manhood at thirty-seven years. He was a rapid,
fluent, fervid, and imaginative speaker, pleasing in aspect and
manner,--a strong contrast to the harsh, vituperative old man who had
just preceded him. His Clinique Medicale is still valuable as a
collection of cases, and his researches on the blood, conducted in
association with Gavarret, contributed new and valuable facts to
science. But I remember him chiefly as one of those instructors
whose natural eloquence made it delightful to listen to him. I doubt
if I or my fellow-students did full justice either to him or to the
famous physician of Hotel Dieu, Chomel. We had addicted ourselves
almost too closely to the words of another master, by whom we were
ready to swear as against all teachers that ever were or ever would
be.
This object of our reverence, I might almost say idolatry, was one
whose name is well known to most of the young men before me, even to
those who may know comparatively little of his works and teachings.
Pierre Charles Alexandre Louis, at the age of forty-seven, as I
recall him, was a tall, rather spare, dignified personage, of serene
and grave aspect, but with a pleasant smile and kindly voice for the
student with whom he came into personal relations. If I summed up
the lessons of Louis in two expressions, they would be these; I do
not hold him answerable for the words, but I will condense them after
my own fashion in French, and then give them to you, expanded
somewhat, in English:
Formez toujours des idees nettes.
Fuyez toujours les a peu pres.
Always make sure that you form a distinct and clear idea of the
matter you are considering.
Always avoid vague approximations where exact estimates are possible;
about so many,--about so much, instead of the precise number and
quantity.
Now, if there is anything on which the biological sciences have
prided themselves in these latter years it is the substitution of
quantitative for qualitative formulae. The "numerical system," of
which Louis was the great advocate, if not the absolute originator,
was an attempt to substitute series of carefully recorded facts,
rigidly counted and closely compared, for those never-ending records
of vague, unverifiable conclusions with which the classics of the
healing art were overloaded. The history of practical medicine had
been like the story of the Danaides. "Experience" had been, from
time immemorial, pouring its flowing treasures into buckets full of
holes. At the existing rate of supply and leakage they would never
be filled; nothing would ever be settled in medicine. But cases
thoroughly recorded and mathematically analyzed would always be
available for future use, and when accumulated in sufficient number
would lead to results which would be trustworthy, and belong to
science.
You young men who are following the hospitals hardly know how much
you are indebted to Louis. I say nothing of his Researches on
Phthisis or his great work on Typhoid Fever. But I consider his
modest and brief Essay on Bleeding in some Inflammatory Diseases,
based on cases carefully observed and numerically analyzed, one of
the most important written contributions to practical medicine, to
the treatment of internal disease, of this century, if not since the
days of Sydenham. The lancet was the magician's wand of the dark
ages of medicine. The old physicians not only believed in its
general efficacy as a wonder-worker in disease, but they believed
that each malady could be successfully attacked from some special
part of the body,--the strategic point which commanded the seat of
the morbid affection. On a figure given in the curious old work of
John de Ketam, no less than thirty-eight separate places are marked
as the proper ones to bleed from, in different diseases. Even Louis,
who had not wholly given up venesection, used now and then to order
that a patient suffering from headache should be bled in the foot, in
preference to any other part.
But what Louis did was this: he showed by a strict analysis of
numerous cases that bleeding did not strangle,--jugulate was the word
then used,--acute diseases, more especially pneumonia. This was not
a reform,--it was a revolution. It was followed up in this country
by the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited
Diseases, which has, I believe, done more than any other work or
essay in our own language to rescue the practice of medicine from the
slavery to the drugging system which was a part of the inheritance of
the profession.
Yes, I say, as I look back on the long hours of the many days I spent
in the wards and in the autopsy room of La Pitie, where Louis was one
of the attending physicians,--yes, Louis did a great work for
practical medicine. Modest in the presence of nature, fearless in
the face of authority, unwearying in the pursuit of truth, he was a
man whom any student might be happy and proud to claim as his teacher
and his friend, and yet, as I look back on the days when I followed
his teachings, I feel that I gave myself up too exclusively to his
methods of thought and study.
There is one part of their business which certain medical
practitioners are too apt to forget; namely, that what they should
most of all try to do is to ward off disease, to alleviate suffering,
to preserve life, or at least to prolong it if possible. It is not
of the slightest interest to the patient to know whether three or
three and a quarter cubic inches of his lung are hepatized. His mind
is not occupied with thinking of the curious problems which are to be
solved by his own autopsy,--whether this or that strand of the spinal
marrow is the seat of this or that form of degeneration. He wants
something to relieve his pain, to mitigate the anguish of dyspnea, to
bring back motion and sensibility to the dead limb, to still the
tortures of neuralgia. What is it to him that you can localize and
name by some uncouth term the disease which you could not prevent and
which you cannot cure? An old woman who knows how to make a poultice
and how to put it on, and does it tuto, eito, jucunde, just when and
where it is wanted, is better,--a thousand times better in many
cases,--than a staring pathologist, who explores and thumps and
doubts and guesses, and tells his patient be will be better tomorrow,
and so goes home to tumble his books over and make out a diagnosis.
But in those days, I, like most of my fellow students, was thinking
much more of "science" than of practical medicine, and I believe if
we had not clung so closely to the skirts of Louis and had followed
some of the courses of men like Trousseau,--therapeutists, who gave
special attention to curative methods, and not chiefly to diagnosis,
--it would have been better for me and others. One thing, at any
rate, we did learn in the wards of Louis. We learned that a very
large proportion of diseases get well of themselves, without any
special medication,--the great fact formulated, enforced, and
popularized by Dr. Jacob Bigelow in the Discourse referred to. We
unlearned the habit of drugging for its own sake. This detestable
practice, which I was almost proscribed for condemning somewhat too
epigrammatically a little more than twenty years ago, came to us, I
suspect, in a considerable measure from the English "general
practitioners," a sort of prescribing apothecaries. You remember
how, when the city was besieged, each artisan who was called upon in
council to suggest the best means of defence recommended the articles
he dealt in: the carpenter, wood; the blacksmith, iron; the mason,
brick; until it came to be a puzzle to know which to adopt. Then the
shoemaker said, "Hang your walls with new boots," and gave good
reasons why these should be the best of all possible defences. Now
the "general practitioner" charged, as I understand, for his
medicine, and in that way got paid for his visit. Wherever this is
the practice, medicine is sure to become a trade, and the people
learn to expect drugging, and to consider it necessary, because drugs
are so universally given to the patients of the man who gets his
living by them.
It was something to have unlearned the pernicious habit of constantly
giving poisons to a patient, as if they were good in themselves, of
drawing off the blood which he would want in his struggle with
disease, of making him sore and wretched with needless blisters, of
turning his stomach with unnecessary nauseous draught and mixtures,
--only because he was sick and something must be done. But there
were positive as well as negative facts to be learned, and some of
us, I fear, came home rich in the negatives of the expectant
practice, poor in the resources which many a plain country
practitioner had ready in abundance for the relief and the cure of
disease. No one instructor can be expected to do all for a student
which he requires. Louis taught us who followed him the love of
truth, the habit of passionless listening to the teachings of nature,
the most careful and searching methods of observation, and the sure
means of getting at the results to be obtained from them in the
constant employment of accurate tabulation. He was not a showy, or
eloquent, or, I should say, a very generally popular man, though the
favorite, almost the idol, of many students, especially Genevese and
Bostonians. But he was a man of lofty and admirable scientific
character, and his work will endure in its influences long after his
name is lost sight of save to the faded eyes of the student of
medical literature.
Many other names of men more or less famous in their day, and who
were teaching while I was in Paris, come up before me. They are but
empty sounds for the most part in the ears of persons of not more
than middle age. Who of you knows anything of Richerand, author of a
very popular work on Physiology, commonly put into the student's
hands when I first began to ask for medical text-books? I heard him
lecture once, and have had his image with me ever since as that of an
old, worn-out man,--a venerable but dilapidated relic of an effete
antiquity. To verify this impression I have just looked out the
dates of his birth and death, and find that he was eighteen years
younger than the speaker who is now addressing you. There is a
terrible parallax between the period before thirty and that after
threescore and ten, as two men of those ages look, one with naked
eyes, one through his spectacles, at the man of fifty and thereabout.
Magendie, I doubt not you have all heard of. I attended but one of
his lectures. I question if one here, unless some contemporary of my
own has strayed into the amphitheatre,--knows anything about
Marjolin. I remember two things about his lectures on surgery, the
deep tones of his voice as he referred to his oracle,--the earlier
writer, Jean Louis Petit,--and his formidable snuffbox. What he
taught me lies far down, I doubt not, among the roots of my
knowledge, but it does not flower out in any noticeable blossoms, or
offer me any very obvious fruits. Where now is the fame of
Bouillaud, Professor and Deputy, the Sangrado of his time? Where is
the renown of Piorry, percussionist and poet, expert alike in the
resonances of the thoracic cavity and those of the rhyming
vocabulary?--I think life has not yet done with the vivacious
Ricord, whom I remember calling the Voltaire of pelvic literature,--a
sceptic as to the morality of the race in general, who would have
submitted Diana to treatment with his mineral specifics, and ordered
a course of blue pills for the vestal virgins.
Ricord was born at the beginning of the century, and Piorry some
years earlier. Cruveilhier, who died in 1874, is still remembered by
his great work on pathological anatomy; his work on descriptive
anatomy has some things which I look in vain for elsewhere. But
where is Civiale,--where are Orfila, Gendrin, Rostan, Biett, Alibert,
--jolly old Baron Alibert, whom I remember so well in his broad-
brimmed hat, worn a little jauntily on one side, calling out to the
students in the court-yard of the Hospital St. Louis, "Enfans de la
methode naturelle, etes-vous tous ici?" "Children of the natural
method [his own method of classification of skin diseases,] are you
all here? "All here, then, perhaps; all where, now?
My show of ghosts is over. It is always the same story that old men
tell to younger ones, some few of whom will in their turn repeat the
tale, only with altered names, to their children's children.
Like phantoms painted on the magic slide,
Forth from the darkness of the past we glide,
As living shadows for a moment seen
In airy pageant on the eternal screen,
Traced by a ray from one unchanging flame,
Then seek the dust and stillness whence we came.
Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden,
where he had written his Latin graduating thesis, talking of the
learned Gaubius and the late illustrious Boerhaave and other dead
Dutchmen, of whom you know as much, most of you, as you do of Noah's
apothecary and the family physician of Methuselah, whose
prescriptions seem to have been lost to posterity. Dr. Lloyd came
back to Boston full of the teachings of Cheselden and Sharpe, William
Hunter, Smellie, and Warner; Dr. James Jackson loved to tell of Mr.
Cline and to talk of Mr. John Hunter; Dr. Reynolds would give you his
recollections of Sir Astley Cooper and Mr. Abernethy; I have named
the famous Frenchmen of my student days; Leyden, Edinburgh, London,
Paris, were each in turn the Mecca of medical students, just as at
the present day Vienna and Berlin are the centres where our young men
crowd for instruction. These also must sooner or later yield their
precedence and pass the torch they hold to other hands. Where shall
it next flame at the head of the long procession? Shall it find its
old place on the shores of the Gulf of Salerno, or shall it mingle
its rays with the northern aurora up among the fiords of Norway,--or
shall it be borne across the Atlantic and reach the banks of the
Charles, where Agassiz and Wyman have taught, where Hagen still
teaches, glowing like his own Lampyris splendidula, with enthusiasm,
where the first of American botanists and the ablest of American
surgeons are still counted in the roll of honor of our great
University?
Let me add a few words which shall not be other than cheerful, as I
bid farewell to this edifice which I have known so long. I am
grateful to the roof which has sheltered me, to the floors which have
sustained me, though I have thought it safest always to abstain from
anything like eloquence, lest a burst of too emphatic applause might
land my class and myself in the cellar of the collapsing structure,
and bury us in the fate of Korah, Dathan, and Abiram. I have helped
to wear these stairs into hollows,--stairs which I trod when they
were smooth and level, fresh from the plane. There are just thirty-
two of them, as there were five and thirty years ago, but they are
steeper and harder to climb, it seems to me, than they were then. I
remember that in the early youth of this building, the late Dr. John
K. Mitchell, father of our famous Dr. Weir Mitchell, said to me as
we came out of the Demonstrator's room, that some day or other a
whole class would go heels over head down this graded precipice, like
the herd told of in Scripture story. This has never happened as yet;
I trust it never will. I have never been proud of the apartment
beneath the seats, in which my preparations for lecture were made.
But I chose it because I could have it to myself, and I resign it,
with a wish that it were more worthy of regret, into the hands of my
successor, with my parting benediction. Within its twilight
precincts I have often prayed for light, like Ajax, for the daylight
found scanty entrance, and the gaslight never illuminated its dark
recesses. May it prove to him who comes after me like the cave of
the Sibyl, out of the gloomy depths of which came the oracles which
shone with the rays of truth and wisdom!
This temple of learning is not surrounded by the mansions of the
great and the wealthy. No stately avenues lead up to its facades and
porticoes. I have sometimes felt, when convoying a distinguished
stranger through its precincts to its door, that he might question
whether star-eyed Science had not missed her way when she found
herself in this not too attractive locality. I cannot regret that
we--you, I should say--are soon to migrate to a more favored region,
and carry on your work as teachers and as learners in ampler halls
and under far more favorable conditions.
I hope that I may have the privilege of meeting you there, possibly
may be allowed to add my words of welcome to those of my former
colleagues, and in that pleasing anticipation I bid good-by to this
scene of my long labors, and, for the present at least, to the
friends with whom I have been associated.
APPENDUM
NOTES TO THE ADDRESS ON CURRENTS AND COUNTER
CURRENTS IN MEDICAL SCIENCE.
Some passages contained in the original manuscript of the Address,
and omitted in the delivery on account of its length, are restored in
the text or incorporated with these Notes.
NOTE A.--
There is good reason to doubt whether the nitrate of silver has any
real efficacy in epilepsy. It has seemed to cure many cases, but
epilepsy is a very uncertain disease, and there is hardly anything
which has not been supposed to cure it. Dr. Copland cites many
authorities in its favor, most especially Lombard's cases. But De la
Berge and Monneret (Comp. de Med. Paris), 1839, analyze these same
cases, eleven in number, and can only draw the inference of a very
questionable value in the supposed remedy. Dr. James Jackson says
that relief of epilepsy is not to be attained by any medicine with
which he is acquainted, but by diet. (Letters to a Young Physician,
p. 67.) Guy Patin, Dean of the Faculty of Paris, Professor at the
Royal College, Author of the Antimonial Martyrology, a wit and a man
of sense and learning, who died almost two hundred years ago, had
come to the same conclusion, though the chemists of his time boasted
of their remedies. "Did, you ever see a case of epilepsy cured by
nitrate of silver?" I said to one of the oldest and most experienced
surgeons in this country. "Never," was his instant reply. Dr.
Twitchell's experience was very similar. How, then, did nitrate of
silver come to be given for epilepsy? Because, as Dr. Martin has so
well reminded us, lunatics were considered formerly to be under the
special influence of Luna, the moon (which Esquirol, be it observed,
utterly denies), and lunar caustic, or nitrate of silver, is a salt
of that metal which was called luna from its whiteness, and of course
must be in the closest relations with the moon. It follows beyond
all reasonable question that the moon's metal, silver, and its
preparations, must be the specific remedy for moonblasted maniacs and
epileptics!
Yet the practitioner who prescribes the nitrate of silver supposes he
is guided by the solemn experience of the past, instead of by its
idle fancies. He laughs at those old physicians who placed such
confidence in the right hind hoof of an elk as a remedy for the same
disease, and leaves the record of his own belief in a treatment quite
as fanciful and far more objectionable, written in indelible ink upon
a living tablet where he who runs may read it for a whole generation,
if nature spares his walking advertisement so long.
NOTE B.--
The presumption that a man is innocent until he is proved guilty,
does not mean that there are no rogues, but lays the onus probandi on
the party to which it properly belongs. So with this proposition.
A noxious agent should never be employed in sickness unless there is
ample evidence in the particular case to overcome the general
presumption against all such agents, and the evidence is very apt to
be defective.
The miserable delusion of Homoeopathy builds itself upon an axiom
directly the opposite of this; namely, that the sick are to be cured
by poisons. Similia similibus curantur means exactly this. It is
simply a theory of universal poisoning, nullified in practice by the
infinitesimal contrivance. The only way to kill it and all similar
fancies, and to throw every quack nostrum into discredit, is to root
out completely the suckers of the old rotten superstition that
whatever is odious or noxious is likely to be good for disease. The
current of sound practice with ourselves is, I believe, setting fast
in the direction I have indicated in the above proposition. To
uphold the exhibition of noxious agents in disease, as the rule,
instead of admitting them cautiously and reluctantly as the
exception, is, as I think, an eddy of opinion in the direction of the
barbarism out of which we believe our art is escaping. It is only
through the enlightened sentiment and action of the Medical
Profession that the community can be brought to acknowledge that
drugs should always be regarded as evils.
It is true that some suppose, and our scientific and thoughtful
associate, Dr. Gould, has half countenanced the opinion, that there
may yet be discovered a specific for every disease. Let us not
despair of the future, but let us be moderate in our expectations.
When an oil is discovered that will make a bad watch keep good time;
when a recipe is given which will turn an acephalous foetus into a
promising child; when a man can enter the second time into his
mother's womb and give her back the infirmities which twenty
generations have stirred into her blood, and infused into his own
through hers, we may be prepared to enlarge the National
Pharmacopoeia with a list of specifies for everything but old age,
--and possibly for that also.
NOTE C.--
The term specific is used here in its ordinary sense, without raising
the question of the propriety of its application to these or other
remedies.
The credit of introducing Cinchona rests between the Jesuits, the
Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor,
who employed it as a secret remedy. (Pereira.) Mercury as an
internal specific remedy was brought into use by that impudent and
presumptuous quack, as he was considered, Paracelsus. (Encyc. Brit.
art. "Paracelsus.") Arsenic was introduced into England as a remedy
for intermittents by Dr. Fowler, in consequence of the success of a
patent medicine, the Tasteless Ague Drops, which were supposed,
"probably with reason," to be a preparation of that mineral. (Rees's
Cyc. art. "Arsenic.") Colchicum came into notice in a similar way,
from the success of the Eau Medicinale of M. Husson, a French
military officer. (Pereira.) Iodine was discovered by a saltpetre
manufacturer, but applied by a physician in place of the old remedy,
burnt sponge, which seems to owe its efficacy to it. (Dunglison, New
Remedies.) As for Sulphur, "the common people have long used it as an
ointment" for scabies. (Rees's Cyc. art. "Scabies.") The modern
cantiscorbutic regimen is credited to Captain Cook. "To his sagacity
we are indebted for the first impulse to those regulations by which
scorbutus is so successfully prevented in our navy." (Lond. Cyc.
Prac. Med. art. "Scorbutus.") Iron and various salts which enter
into the normal composition of the human body do not belong to the
materia medica by our definition, but to the materia alimentaria.
For the first introduction of iron as a remedy, see Pereira, who
gives a very curious old story.
The statement in the text concerning a portion of the materia medica
stands exactly as delivered, and is meant exactly as it stands. No
denunciation of drugs, as sparingly employed by a wise physician, was
or is intended. If, however, as Dr. Gould stated in his "valuable
and practical discourse" to which the Massachusetts Medical Society
"listened with profit as well as interest," "Drugs, in themselves
considered, may always be regarded as evils,"--any one who chooses
may question whether the evils from their abuse are, on the whole,
greater or less than the undoubted benefits obtained from their
proper use. The large exception of opium, wine, specifics, and
anaesthetics, made in the text, takes off enough from the useful
side, as I fully believe, to turn the balance; so that a vessel
containing none of these, but loaded with antimony, strychnine,
acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus
diaboli, tormentilla, and other approved, and, in skilful hands,
really useful remedies, brings, on the whole, more harm than good to
the port it enters.
It is a very narrow and unjust view of the practice of medicine, to
suppose it to consist altogether in the use of powerful drugs, or of
drugs of any kind. Far from it. "The physician may do very much for
the welfare of the sick, more than others can do, although he does
not, even in the major part of cases, undertake to control and
overcome the disease by art. It was with these views that I never
reported any patient cured at our hospital. Those who recovered
their health were reported as well; not implying that they were made
so by the active treatment they had received there. But it was to be
understood that all patients received in that house were to be cured,
that is, taken care of." (Letters to a Young Physician, by James
Jackson, M. D., Boston, 1855.)
"Hygienic rules, properly enforced, fresh air, change of air, travel,
attention to diet, good and appropriate food judiciously regulated,
together with the administration of our tonics, porter, ale, wine,
iron, etc., supply the diseased or impoverished system with what Mr.
Gull, of St. Bartholomew's Hospital, aptly calls the 'raw material of
the blood;' and we believe that if any real improvement has taken
place in medical practice, independently of those truly valuable
contributions we have before described, it is in the substitution of
tonics, stimulants, and general management, for drastic cathartics,
for bleeding, depressing agents, including mercury, tartar emetics,
etc., so much in vogue during the early part even of this century."
(F. P. Porcher, in Charleston Med. Journal and Review for January,
1860.)
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