The Complete PG Works of Oliver Wendell Holmes, Sr.
Oliver Wendell Holmes, Sr. (The Physician and Poet)

Part 45 out of 51

things long known had become half-forgotten. Louis and others
confounded the solitary glands of the lower part of the small
intestine with those which "the great Brunner," as Haller calls him,
described in 1687 as being found in the duodenum. The display of the
fibrous structure of the brain seemed a novelty as shown by
Spurzheim. One is startled to find the method anticipated by Raymond
Vieussens nearly two centuries ago. I can hardly think Gordon had
ever looked at his figures, though he names their author, when he
wrote the captious and sneering article which attracted so much
attention in the pages of the "Edinburgh Review."

This is the place, if anywhere, to mention any observations I could
pretend to have made in the course of my teaching the structure of
the human body. I can make no better show than most of my
predecessors in this well-reaped field. The nucleated cells found
connected with the cancellated structure of the bones, which I first
pointed out and had figured in 1847, and have shown yearly from that
time to the present, and the fossa masseterica, a shallow concavity
on the ramus of the lower jaw, for the lodgment of the masseter
muscle, which acquires significance when examined by the side of the
deep cavity on the corresponding part in some carnivora to which it
answers, may perhaps be claimed as deserving attention. I have also
pleased myself by making a special group of the six radiating muscles
which diverge from the spine of the axis, or second cervical
vertebra, and by giving to it the name stella musculosa nuchaee. But
this scanty catalogue is only an evidence that one may teach long and
see little that has not been noted by those who have gone before him.
Of course I do not think it necessary to include rare, but already
described anomalies, such as the episternal bones, the rectus
sternalis, and other interesting exceptional formations I have
encountered, which have shown a curious tendency to present
themselves several times in the same season, perhaps because the
first specimen found calls our attention to any we may subsequently
meet with.

The anatomy of the scalpel and the amphitheatre was, then, becoming
an exhausted branch of investigation. But during the present century
the study of the human body has changed its old aspect, and become
fertile in new observations. This rejuvenescence was effected by
means of two principal agencies,--new methods and a new instrument.

Descriptive anatomy, as known from an early date, is to the body what
geography is to the planet. Now geography was pretty well known so
long ago as when Arrowsmith, who was born in 1750, published his
admirable maps. But in that same year was born Werner, who taught a
new way of studying the earth, since become familiar to us all under
the name of Geology.

What geology has done for our knowledge of the earth, has been done
for our knowledge of the body by that method of study to which is
given the name of General Anatomy. It studies, not the organs as
such, but the elements out of which the organs are constructed. It
is the geology of the body, as that is the general anatomy of the
earth. The extraordinary genius of Bichat, to whom more than any
other we owe this new method of study, does not require Mr. Buckle's
testimony to impress the practitioner with the importance of its
achievements. I have heard a very wise physician question whether
any important result had accrued to practical medicine from Harvey's
discovery of the circulation. But Anatomy, Physiology, and Pathology
have received a new light from this novel method of contemplating the
living structures, which has had a vast influence in enabling the
practitioner at least to distinguish and predict the course of
disease. We know as well what differences to expect in the habits of
a mucous and of a serous membrane, as what mineral substances to look
for in the chalk or the coal measures. You have only to read
Cullen's description of inflammation of the lungs or of the bowels,
and compare it with such as you may find in Laennec or Watson, to see
the immense gain which diagnosis and prognosis have derived from
general anatomy.

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

It is curious that the Japanese should have anticipated Europe in a
kind of rude regional anatomy. I have seen a manikin of Japanese
make traced all over with lines, and points marking their
intersection. By this their doctors are guided in the performance of
acupuncture, marking the safe places to thrust in needles, as we buoy
out our ship-channels, and doubtless indicating to learned eyes the
spots where incautious meddling had led to those little accidents of
shipwreck to which patients are unfortunately liable.

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

This instrument is the achromatic microscope. For the history of the
successive steps by which it became the effective scientific
implement we now possess, I must refer you to the work of Mr.
Quekett, to an excellent article in the "Penny Cyclopaedia," or to
that of Sir David Brewster in the "Encyclopaedia Britannica." It is
a most interesting piece of scientific history, which shows how the
problem which Biot in 1821 pronounced insolvable was in the course of
a few years practically solved, with a success equal to that which
Dollond had long before obtained with the telescope. It is enough
for our purpose that we are now in possession of an instrument freed
from all confusions and illusions, which magnifies a thousand
diameters,--a million times in surface,--without serious distortion
or discoloration of its object.

A quarter of a century ago, or a little more, an instructor would not
have hesitated to put John Bell's "Anatomy" and Bostock's
"Physiology" into a student's hands, as good authority on their
respective subjects. Let us not be unjust to either of these
authors. John Bell is the liveliest medical writer that I can
remember who has written since the days of delightful old Ambroise
Pare. His picturesque descriptions and bold figures are as good now
as they ever were, and his book can never become obsolete. But
listen to what John Bell says of the microscope:

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

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

These are only specimens of the manner in which the microscope and
its results were generally regarded by the generation just preceding
our own.

I have referred you to the proper authorities for the account of
those improvements which about the year 1830 rendered the compound
microscope an efficient and trustworthy instrument. It was now for
the first time that a true general anatomy became possible. As early
as 1816 Treviranus had attempted to resolve the tissues, of which
Bichat had admitted no less than twenty-one, into their simple
microscopic elements. How could such an attempt succeed, Henle well
asks, at a time when the most extensively diffused of all the
tissues, the areolar, was not at all understood? All that method
could do had been accomplished by Bichat and his followers. It was
for the optician to take the next step. The future of anatomy and
physiology, as an enthusiastic micrologist of the time said, was in
the hands of Messrs. Schieck and Pistor, famous opticians of Berlin.

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

Now what have we come to in our own day? In the first place, the
minute structure of all the organs has been made out in the most
satisfactory way. The special arrangements of the vessels and the
ducts of all the glands, of the air-tubes and vesicles of the lungs,
of the parts which make up the skin and other membranes, all the
details of those complex parenchymatous organs which had confounded
investigation so long, have been lifted out of the invisible into the
sight of all observers. It is fair to mention here, that we owe a
great deal to the art of minute injection, by which we are enabled to
trace the smallest vessels in the midst of the tissues where they are
distributed. This is an old artifice of anatomists. The famous
Ruysch, who died a hundred and thirty years ago, showed that each of
the viscera has its terminal vessels arranged in its own peculiar
way; the same fact which you may see illustrated in Gerber's figures
after the minute injections of Berres. I hope to show you many
specimens of this kind in the microscope, the work of English and
American hands. Professor Agassiz allows me also to make use of a
very rich collection of injected preparations sent him by Professor
Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition
of which I had a number of microscopes made expressly, by Mr. Grunow,
during the past season. All this illustrates what has been done for
the elucidation of the intimate details of formation of the organs.

But the great triumph of the microscope as applied to anatomy has
been in the resolution of the organs and the tissues into their
simple constituent anatomical elements. It has taken up general
anatomy where Bichat left it. He had succeeded in reducing the
structural language of nature to syllables, if you will permit me to
use so bold an image. The microscopic observers who have come after
him have analyzed these into letters, as we may call them,--the
simple elements by the combination of which Nature spells out
successively tissues, which are her syllables, organs which are her
words, systems which are her chapters, and so goes on from the simple
to the complex, until she binds up in one living whole that wondrous
volume of power and wisdom which we call the human body.

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

A. Cells, either floating, as in the blood, or fixed, like those in
the cancellated structure of bone, already referred to. Very
commonly they have undergone a change of figure, most frequently a
flattening which reduces them to scales, as in the epidermis and the

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

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

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

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

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

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

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

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

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

But just as in language certain diphthongs and syllables are
frequently recurring, so we have in the body certain secondary and
tertiary combinations, which we meet more frequently than the
solitary elements of which they are composed.

Thus A B, or a collection of cells united by simple structureless
solid, is seen to be extensively employed in the body under the name
of cartilage. Out of this the surfaces of the articulations and the
springs of the breathing apparatus are formed. But when Nature came
to the buffers of the spinal column (intervertebral disks) and the
washers of the joints (semilunar fibrocartilages of the knee, etc.),
she required more tenacity than common cartilage possessed. What did
she do? What does man do in a similar case of need? I need hardly
tell you. The mason lays his bricks in simple mortar. But the
plasterer works some hair into the mortar which he is going to lay in
large sheets on the walls. The children of Israel complained that
they had no straw to make their bricks with, though portions of it
may still be seen in the crumbling pyramid of Darshour, which they
are said to have built. I visited the old house on Witch Hill in
Salem a year or two ago, and there I found the walls coated with clay
in which straw was abundantly mingled;--the old Judaizing witch-
hangers copied the Israelites in a good many things. The Chinese and
the Corsicans blend the fibres of amianthus in their pottery to give
it tenacity. Now to return to Nature. To make her buffers and
washers hold together in the shocks to which they would be subjected,
she took common cartilage and mingled the white fibrous tissue with
it, to serve the same purpose as the hair in the mortar, the straw in
the bricks and in the plaster of the old wall, and the amianthus in
the earthen vessels. Thus we have the combination A B C, or fibro-
cartilage. Again, the bones were once only gristle or cartilage, A
B. To give them solidity they were infiltrated with stone, in the
form of salts of lime, an inorganic element, so that bone would be
spelt out by the letters A, B, and Y.

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

Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find
the same elements in morbid growths that we have met with in normal
structures. The pus-corpuscle and the white blood-corpuscle can only
be distinguished by tracing them to their origin. A frequent form of
so-called malignant disease proves to be only a collection of altered
epithelium-cells. Even cancer itself has no specific anatomical
element, and the diagnosis of a cancerous tumor by the microscope,
though tolerably sure under the eye of an expert, is based upon
accidental, and not essential points,--the crowding together of the
elements, the size of the cell-nuclei, and similar variable

Let us turn to PHYSIOLOGY. The microscope, which has made a new
science of the intimate structure of the organs, has at the same time
cleared up many uncertainties concerning the mechanism of the special
functions. Up to the time of the living generation of observers,
Nature had kept over all her inner workshops the forbidding
inscription, No Admittance! If any prying observer ventured to spy
through his magnifying tubes into the mysteries of her glands and
canals and fluids, she covered up her work in blinding mists and
bewildering halos, as the deities of old concealed their favored
heroes in the moment of danger.

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

Anatomy studies the organism in space. Physiology studies it also in
time. After the study of form and composition follows close that of
action, and this leads us along back to the first moment of the germ,
and forward to the resolution of the living frame into its lifeless
elements. In this way Anatomy, or rather that branch of it which we
call Histology, has become inseparably blended with the study of
function. The connection between the science of life and that of
intimate structure on the one hand, and composition on the other, is
illustrated in the titles of two recent works of remarkable
excellence,--"the Physiological Anatomy" of Todd and Bowman, and the
"Physiological Chemistry" of Lehmann.

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

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

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

This differentiation having been effected, each several part assumes
its special office, having a life of its own adjusted to that of
other parts and the whole. "Just as a tree constitutes a mass
arranged in a definite manner, in which, in every single part, in the
leaves as in the root, in the trunk as in the blossom, cells are
discovered to be the ultimate elements, so is it also with the forms
of animal life. Every animal presents itself as a sum of vital
unities, every one of which manifests all the characteristics of

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

The mechanism, and that is all. We see the workman and the tools,
but the skill that guides the work and the power that performs it are
as invisible as ever. I fear that not every listener took the
significance of those pregnant words in the passage I quoted from
John Bell,--"thinking to discover its properties in its form." We
have discovered the working bee in this great hive of organization.
We have detected the cell in the very act of forming itself from a
nucleus, of transforming itself into various tissues, of selecting
the elements of various secretions. But why one cell becomes nerve
and another muscle, why one selects bile and another fat, we can no
more pretend to tell, than why one grape sucks out of the soil the
generous juice which princes hoard in their cellars, and another the
wine which it takes three men to drink,--one to pour it down, another
to swallow it, and a third to hold him while it is going down.
Certain analogies between this selecting power and the phenomena of
endosmosis in the elective affinities of chemistry we can find, but
the problem of force remains here, as everywhere, unsolved and

Do we gain anything by attempting to get rid of the idea of a special
vital force because we find certain mutually convertible relations
between forces in the body and out of it? I think not, any more than
we should gain by getting rid of the idea and expression Magnetism
because of its correlation with electricity. We may concede the
unity of all forms of force, but we cannot overlook the fixed
differences of its manifestations according to the conditions under
which it acts. It is a mistake, however, to think the mystery is
greater in an organized body than in any other. We see a stone fall
or a crystal form, and there is nothing stranger left to wonder at,
for we have seen the Infinite in action.

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

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

It would have been reward enough to learn the method Nature pursues
for its own sake. If the sovereign Artificer lets us into his own
laboratories and workshops, we need not ask more than the privilege
of looking on at his work. We do not know where we now stand in the
hierarchy of created intelligences. We were made a little lower than
the angels. I speak it not irreverently; as the lower animals
surpass man in some of their attributes, so it may be that not every
angel's eye can see as broadly and as deeply into the material works
of God as man himself, looking at the firmament through an equatorial
of fifteen inches' aperture, and searching into the tissues with a
twelfth of an inch objective.

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

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

If we should begin with the digestive function, we should find that
the long-agitated question of the nature of the acid of the gastric
juice is becoming settled in favor of the lactic. But the whole
solvent agency of the digestive fluid enters into the category of
that exceptional mode of action already familiar to us in chemistry
as catalysis. It is therefore doubly difficult of explanation;
first, as being, like all reactions, a fact not to be accounted for
except by the imaginative appeal to "affinity," and secondly, as
being one of those peculiar reactions provoked by an element which
stands outside and looks on without compromising itself.

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

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

Quia est in eo
Virtus saccharitiva.

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

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

No one has shown satisfactorily the process by which the blood-
corpuscles are formed out of the lymph-corpuscles, nor what becomes
of them. These two questions are like those famous household
puzzles,--Where do the flies come from? and, Where do the pins go

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

The theories of the production of animal heat, from the times of
Black, Lavoisier, and Crawford to those of Liebig, are familiar to
all who have paid any attention to physiological studies. The
simplicity of Liebig's views, and the popular form in which they have
been presented, have given them wide currency, and incorporated them
in the common belief and language of our text-books. Direct
oxidation or combustion of the carbon and hydrogen contained in the
food, or in the tissues themselves; the division of alimentary
substances into respiratory, or non-azotized, and azotized,--these
doctrines are familiar even to the classes in our high-schools. But
this simple statement is boldly questioned. Nothing proves that
oxygen combines (in the system) with hydrogen and carbon in
particular, rather than with sulphur and azote. Such is the well-
grounded statement of Robin and Verdeil. "It is very probable that
animal heat is entirely produced by the chemical actions which take
place in the organism, but the phenomenon is too complex to admit of
our calculating it according to the quality of oxygen consumed."
These last are the words of Regnault, as cited by Mr. Lewes, whose
intelligent discussion of this and many of the most interesting
physiological problems I strongly recommend to your attention.

This single illustration covers a wider ground than the special
function to which it belongs. We are learning that the chemistry of
the body must be studied, not simply by its ingesta and egesta, but
that there is a long intermediate series of changes which must be
investigated in their own light, under their own special conditions.
The expression "sum of vital unities" applies to the chemical
actions, as well as to other actions localized in special parts; and
when the distinguished chemists whom I have just cited entitle their
work a treatise on the immediate principles of the body, they only
indicate the nature of that profound and subtile analysis which must
take the place of all hasty generalizations founded on a comparison
of the food with residual products.

I will only call your attention to the fact, that the exceptional
phenomenon of the laboratory is the prevailing law of the organism.
Nutrition itself is but one great catalytic process. As the blood
travels its rounds, each part selects its appropriate element and
transforms it to its own likeness. Whether the appropriating agent
be cell or nucleus, or a structureless solid like the intercellular
substance of cartilage, the fact of its presence determines the
separation of its proper constituents from the circulating fluid, so
that even when we are wounded bone is replaced by bone, skin by skin,
and nerve by nerve.

It is hardly without a smile that we resuscitate the old question of
the 'vis insita' of the muscular fibre, so famous in the discussions of
Haller and his contemporaries. Speaking generally, I think we may
say that Haller's doctrine is the one now commonly received; namely,
that the muscles contract in virtue of their own inherent endowments.
It is true that Kolliker says no perfectly decisive fact has been
brought forward to prove that the striated muscles contract with.
out having been acted on by nerves. Yet Mr. Bowman's observations on
the contraction of isolated fibres appear decisive enough (unless we
consider them invalidated by Dr. Lionel Beale's recent researches),
tending to show that each elementary fibre is supplied with nerves;
and as to the smooth muscular fibres, we have Virchow's statement
respecting the contractility of those of the umbilical cord, where
there is not a trace of any nerves.

In the investigation of the nervous system, anatomy and physiology
have gone hand in hand. It is very singular that so important, and
seemingly simple, a fact as the connection of the nerve-tubes, at
their origin or in their course, with the nerve-cells, should have so
long remained open to doubt, as you may see that it did by referring
to the very complete work of Sharpey and Quain (edition of 1849), the
histological portion of which is cordially approved by Kolliker

Several most interesting points of the minute anatomy of the nervous
centres have been laboriously and skilfully worked out by a recent
graduate of this Medical School, in a monograph worthy to stand in
line with those of Lockhart Clarke, Stilling, and Schroder van der
Kolk. I have had the privilege of examining and of showing some of
you a number of Dr. Dean's skilful preparations. I have no space to
give even an abstract of his conclusions. I can only refer to his
proof of the fact, that a single cell may send its processes into
several different bundles of nerve-roots, and to his demonstration of
the curved ascending and descending fibres from the posterior
nerveroots, to reach what he has called the longitudinal columns of
the cornea. I must also mention Dr. Dean's exquisite microscopic
photographs from sections of the medulla oblongata, which appear to
me to promise a new development, if not a new epoch, in anatomical

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

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

While these studies of the structure of the cord have been going on,
the ingenious and indefatigable Brown-Sequard has been investigating
the functions of its different parts with equal diligence. The
microscopic anatomists had shown that the ganglionic corpuscles of
the gray matter of the cord are connected with each other by their
processes, as well as with the nerve-roots. M. Brown-Sequard has
proved by numerous experiments that the gray substance transmits
sensitive impressions and muscular stimulation. The oblique
ascending and descending fibres from the posterior nerve-roots,
joining the "longitudinal columns of the cornua," account for the
results of Brown-Sequard's sections of the posterior columns. The
physiological experimenter has also made it evident that the
decussation of the conductors of sensitive impressions has its seat
in the spinal core, and not in the encephalon, as had been supposed.
Not less remarkable than these results are the facts, which I with
others of my audience have had the opportunity of observing, as shown
by M. Brown-Sequard, of the artificial production of epilepsy in
animals by injuring the spinal cord, and the induction of the
paroxysm by pinching a certain portion of the skin. I would also
call the student's attention to his account of the relations of the
nervous centres to nutrition and secretion, the last of which
relations has been made the subject of an extended essay by our
fellow countryman, Dr. H. F. Campbell of Georgia.

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

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

"All that disgraced my betters met in me."

I loved of old to see square-headed, heavy-jawed Spurzheim make a
brain flower out into a corolla of marrowy filaments, as Vieussens
had done before him, and to hear the dry-fibred but human-hearted
George Combe teach good sense under the disguise of his equivocal
system. But the pseudo-sciences, phrenology and the rest, seem to me
only appeals to weak minds and the weak points of strong ones. There
is a pica or false appetite in many intelligences; they take to odd
fancies in place of wholesome truth, as girls gnaw at chalk and
charcoal. Phrenology juggles with nature. It is so adjusted as to
soak up all evidence that helps it, and shed all that harms it. It
crawls forward in all weathers, like Richard Edgeworth's hygrometer.
It does not stand at the boundary of our ignorance, it seems to me,
but is one of the will-o'-the-wisps of its undisputed central domain
of bog and quicksand. Yet I should not have devoted so many words to
it, did I not recognize the light it has thrown on human actions by
its study of congenital organic tendencies. Its maps of the.
surface of the head are, I feel sure, founded on a delusion, but its
studies of individual character are always interesting and

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

"Castor gaudet equis, ovo proanatus eodem

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

The whole physiology of the nervous system, from the simplest
manifestation of its power in an insect up to the supreme act of the
human intelligence working through the brain, is full of the most
difficult yet profoundly interesting questions. The singular
relations between electricity and nerve-force, relations which it has
been attempted to interpret as meaning identity, in the face of
palpable differences, require still more extended studies. You may
be interested by Professor Faraday's statement of his opinion on the
matter. "Though I am not satisfied that the nervous fluid is only
electricity, still I think that the agent in the nervous system maybe
an inorganic force; and if there be reason for supposing that
magnetism is a higher relation of force than electricity, so it may
well be imagined that the nervous power may be of a still more
exalted character, and yet within the reach of experiment."

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

Reflex action, the mechanical sympathy, if I may so call it, of
distant parts; Instinct, which is crystallized intelligence,--an
absolute law with its invariable planes and angles introduced into
the sphere of consciousness, as raphides are inclosed in the living
cells of plants; Intellect,--the operation of the thinking principle
through material organs, with an appreciable waste of tissue in every
act of thought, so that our clergymen's blood has more phosphates to
get rid of on Monday than on any other day of the week; Will,--
theoretically the absolute determining power, practically limited in
different degrees by the varying organization of races and
individuals, annulled or perverted by different ill-understood
organic changes; on all these subjects our knowledge is in its
infancy, and from the study of some of them the interdict of the
Vatican is hardly yet removed.

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

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

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

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

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

It were to be wished that the elaborate and very interesting
researches of the Marquis Corti, which have revealed such singular
complexity of structure in the cochlea of the ear, had done more to
clear up its doubtful physiology; but I am afraid we have nothing but
hypotheses for the special part it plays in the act of hearing, and
that we must say the same respecting the office of the semicircular

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

To the chemist and the microscopist the living body presents the same
difficulties, arising from the fact that everything is in perpetual
change in the organism. The fibrine of the blood puzzles the one as
much as its globules puzzle the other. The difference between the
branches of science which deal with space only, and those which deal
with space and time, is this: we have no glasses that can magnify
time. The figure I here show you a was photographed from an object
(pleurosigma angulatum) magnified a thousand diameters, or presenting
a million times its natural surface. This other figure of the same
object, enlarged from the one just shown, is magnified seven thousand
diameters, or forty-nine million times in surface. When we can make
the forty-nine millionth of a second as long as its integer,
physiology and chemistry will approach nearer the completeness of

Our reverence becomes more worthy, or, if you will, less unworthy of
its Infinite Object in proportion as our intelligence is lifted and
expanded to a higher and broader understanding of the Divine methods
of action. If Galen called his heathen readers to admire, the power,
the wisdom, the providence, the goodness of the "Framer of the animal
body,"--if Mr. Boyle, the student of nature, as Addison and that
friend of his who had known him for forty years tell us, never
uttered the name of the Supreme Being without making a distinct pause
in his speech, in token of his devout recognition of its awful
meaning,--surely we, who inherit the accumulated wisdom of nearly two
hundred years since the time of the British philosopher, and of
almost two thousand since the Greek physician, may well lift our
thoughts from the works we study to their great Artificer. These
wonderful discoveries which we owe to that mighty little instrument,
the telescope of the inner firmament with all its included worlds;
these simple formulae by which we condense the observations of a
generation in a single axiom; these logical analyses by which we
fence out the ignorance we cannot reclaim, and fix the limits of our
knowledge,--all lead us up to the inspiration of the Almighty, which
gives understanding to the world's great teachers. To fear science
or knowledge, lest it disturb our old beliefs, is to fear the influx
of the Divine wisdom into the souls of our fellow-men; for what is
science but the piecemeal revelation,--uncovering,--of the plan of
creation, by the agency of those chosen prophets of nature whom God
has illuminated from the central light of truth for that single

The studies which we have glanced at are preliminary in your
education to the practical arts which make use of them,--the arts of
healing,--surgery and medicine. The more you examine the structure
of the organs and the laws of life, the more you will find how
resolutely each of the cell-republics which make up the E pluribus
unum of the body maintains its independence. Guard it, feed it, air
it, warm it, exercise or rest it properly, and the working elements
will do their best to keep well or to get well. What do we do with
ailing vegetables? Dr. Warren, my honored predecessor in this chair,
bought a country-place, including half of an old orchard. A few
years afterwards I saw the trees on his side of the fence looking in
good health, while those on the other side were scraggy and
miserable. How do you suppose this change was brought about? By
watering them with Fowler's solution? By digging in calomel freely
about their roots? Not at all; but by loosening the soil round them,
and supplying them with the right kind of food in fitting quantities.

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

I do not know that we ever apply to a plant any element which is not
a natural constituent of the vegetable structure, except perhaps
externally, for the accidental purpose of killing parasites. The
whole art of cultivation consists in learning the proper food and
conditions of plants, and supplying them. We give them water,
earths, salts of various kinds such as they are made of, with a
chance to help themselves to air and light. The farmer would be
laughed at who undertook to manure his fields or his trees with a
salt of lead or of arsenic. These elements are not constituents of
healthy plants. The gardener uses the waste of the arsenic furnaces
to kill the weeds in his walks.

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

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

But when it comes to substances alien to the healthy system, which
never belong to it as normal constituents, the case is very
different. There is a presumption against putting lead or arsenic
into the human body, as against putting them into plants, because
they do not belong there, any more than pounded glass, which, it is
said, used to be given as a poison. The same thing is true of
mercury and silver. What becomes of these alien substances after
they get into the system we cannot always tell. But in the case of
silver, from the accident of its changing color under the influence
of light, we do know what happens. It is thrown out, in part at
least, under the epidermis, and there it remains to the patient's
dying day. This is a striking illustration of the difficulty which
the system finds in dealing with non-assimilable elements, and
justifies in some measure the vulgar prejudice against mineral

I trust the youngest student on these benches will not commit the
childish error of confounding a presumption against a particular
class of agents with a condemnation of them. Mercury, for instance,
is alien to the system, and eminently disturbing in its influence.
Yet its efficacy in certain forms of specific disease is acknowledged
by all but the most sceptical theorists. Even the esprit moqueur of
Ricord, the Voltaire of pelvic literature, submits to the time-
honored constitutional authority of this great panacea in the class
of cases to which he has devoted his brilliant intelligence. Still,
there is no telling what evils have arisen from the abuse of this
mineral. Dr. Armstrong long ago pointed out some of them, and they
have become matters of common notoriety. I am pleased, therefore,
when I find so able and experienced a practitioner as Dr. Williams of
this city proving that iritis is best treated without mercury, and
Dr. Vanderpoel showing the same thing to be true for pericarditis.

Whatever elements nature does not introduce into vegetables, the
natural food of all animal life,--directly of herbivorous, indirectly
of carnivorous animals,--are to be regarded with suspicion. Arsenic-
eating may seem to improve the condition of horses for a time,--and
even of human beings, if Tschudi's stories can be trusted,--but it
soon appears that its alien qualities are at war with the animal
organization. So of copper, antimony, and other non-alimentary
simple substances; everyone of them is an intruder in the living
system, as much as a constable would be, quartered in our household.
This does not mean that they may not, any of them, be called in for a
special need, as we send for the constable when we have good reason
to think we have a thief under our roof; but a man's body is his
castle, as well as his house, and the presumption is that we are to
keep our alimentary doors bolted against these perturbing agents.

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

The traditional idea of always poisoning out disease, as we smoke out
vermin, is now seeking its last refuge behind the wooden cannon and
painted port-holes of that unblushing system of false scientific
pretences which I do not care to name in a discourse addressed to an
audience devoted to the study of the laws of nature in the light of
the laws of evidence. It is extraordinary to observe that the system
which, by its reducing medicine to a name and a farce, has accustomed
all who have sense enough to see through its thin artifices to the
idea that diseases get well without being "cured," should now be the
main support of the tottering poison-cure doctrine. It has
unquestionably helped to teach wise people that nature heals most
diseases without help from pharmaceutic art, but it continues to
persuade fools that art can arrest them all with its specifics.

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

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

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

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

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

Our practitioners, or many of them, have got back to the ways of old
Dr. Samuel Danforth, who, as it is well known, had strong objections
to the use of the lancet. By and by a new reputation will be made by
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

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

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!


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

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

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

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

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

"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

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


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