The Complete PG Works of Oliver Wendell Holmes, Sr.
by
Oliver Wendell Holmes, Sr. (The Physician and Poet)
Part 46 out of 51
that many facts are explained by studying them in the wider range of
related facts to which they belong. He will gratefully recognize
that the anatomist has furnished him with indispensable data, that
the physiologist has sometimes put him on the track of new modes of
treatment, that the chemist has isolated the active principles of his
medicines, has taught him how to combine them, has from time to time
offered him new remedial agencies, and so of others of his allies.
But he will also tell you, if I am not mistaken, that his own branch
of knowledge is so extensive and so perplexing that he must accept
most of his facts ready made at their hands. He will own to you that
in the struggle for life which goes on day and night in our thoughts
as in the outside world of nature, much that he learned under the
name of science has died out, and that simple homely experience has
largely taken the place of that scholastic knowledge to which he and
perhaps some of his instructors once attached a paremount importance.
This, then, is my view of scientific training as conducted in courses
such as you are entering on. Up to a certain point I believe in set
Lectures as excellent adjuncts to what is far more important,
practical instruction at the bedside, in the operating room, and
under the eye of the Demonstrator. But I am so far from wishing
these courses extended, that I think some of them--suppose I say my
own--would almost bear curtailing. Do you want me to describe more
branches of the sciatic and crural nerves? I can take Fischer's
plates, and lecturing on that scale fill up my whole course and not
finish the nerves alone. We must stop somewhere, and for my own part
I think the scholastic exercises of our colleges have already claimed
their full share of the student's time without our seeking to extend
them.
I trust I have vindicated the apparent inconsequence of teaching
young students a good deal that seems at first sight profitless, but
which helps them to learn and retain what is profitable. But this is
an inquisitive age, and if we insist on piling up beyond a certain
height knowledge which is in itself mere trash and lumber to a man
whose life is to be one long fight with death and disease, there will
be some sharp questions asked by and by, and our quick-witted people
will perhaps find they can get along as well without the professor's
cap as without the bishop's mitre and the monarch's crown.
I myself have nothing to do with clinical teaching. Yet I do not
hesitate to say it is more essential than all the rest put together,
so far as the ordinary practice of medicine is concerned; and this is
by far the most important thing to be learned, because it deals with
so many more lives than any other branch of the profession. So of
personal instruction, such as we give and others give in the interval
of lectures, much of it at the bedside, some of it in the laboratory,
some in the microscope-room, some in the recitation-room, I think it
has many advantages of its own over the winter course, and I do not
wish to see it shortened for the sake of prolonging what seems to me
long enough already.
If I am jealous of the tendency to expand the time given to the
acquisition of curious knowledge, at the expense of the plain old-
fashioned bedside teachings, I only share the feeling which Sydenham
expressed two hundred years ago, using an image I have already
borrowed. "He would be no honest and successful pilot who was to
apply himself with less industry to avoid rocks and sands and bring
his vessel safely home, than to search into the causes of the ebbing
and flowing of the sea, which, though very well for a philosopher, is
foreign to him whose business it is to secure the ship. So neither
will a physician, whose province it is to cure diseases, be able to
do so, though he be a person of great genius, who bestows less time
on the hidden and intricate method of nature, and adapting his means
thereto, than on curious and subtle speculation."
"Medicine is my wife and Science is my mistress," said Dr. Rush. I
do not think that the breach of the seventh commandment can be shown
to have been of advantage to the legitimate owner of his affections.
Read what Dr. Elisha Bartlett says of him as a practitioner, or ask
one of our own honored ex-professors, who studied under him, whether
Dr. Rush had ever learned the meaning of that saying of Lord Bacon,
that man is the minister and interpreter of Nature, or whether he did
not speak habitually of Nature as an intruder in the sick room, from
which his art was to expel her as an incompetent and a meddler.
All a man's powers are not too much for such a profession as
Medicine. "He is a learned man," said old Parson Emmons of Franklin,
"who understands one subject, and he is a very learned man who
understands two subjects." Schonbein says he has been studying
oxygen for thirty years. Mitscherlich said it took fourteen years to
establish a new fact in chemistry. Aubrey says of Harvey, the
discoverer of the circulation, that "though all his profession would
allow him to be an excellent anatomist, I have never heard of any who
admired his therapeutic way." My learned and excellent friend before
referred to, Dr. Brown of Edinburgh, from whose very lively and
sensible Essay, "Locke and Sydenham," I have borrowed several of my
citations, contrasts Sir Charles Bell, the discoverer, the man of
science, with Dr. Abercrombie, the master in the diagnosis and
treatment of disease. It is through one of the rarest of
combinations that we have in our Faculty a teacher on whom the
scientific mantle of Bell has fallen, and who yet stands preeminent
in the practical treatment of the class of diseases which his
inventive and ardent experimental genius has illustrated. M. Brown-
Sequard's example is as, eloquent as his teaching in proof of the
advantages of well directed scientific investigation. But those who
emulate his success at once as a discoverer and a practitioner must
be content like him to limit their field of practice. The highest
genius cannot afford in our time to forget the ancient precept,
Divide et impera.
"I suppose I must go and earn this guinea," said a medical man who
was sent for while he was dissecting an animal. I should not have
cared to be his patient. His dissection would do me no good, and his
thoughts would be too much upon it. I want a whole man for my
doctor, not a half one. I would have sent for a humbler
practitioner, who would have given himself entirely to me, and told
the other--who was no less a man than John Hunter--to go on and
finish the dissection of his tiger.
Sydenham's "Read Don Quixote" should be addressed not to the student,
but to the Professor of today. Aimed at him it means, "Do not be too
learned."
Do not think you are going to lecture to picked young men who are
training themselves to be scientific discoverers. They are of fair
average capacity, and they are going to be working doctors.
These young men are to have some very serious vital facts to deal
with. I will mention a few of them.
Every other resident adult you meet in these streets is or will be
more or less tuberculous. This is not an extravagant estimate, as
very nearly one third of the deaths of adults in Boston last year
were from phthisis. If the relative number is less in our other
northern cities, it is probably in a great measure because they are
more unhealthy; that is, they have as much, or nearly as much,
consumption, but they have more fevers or other fatal diseases.
These heavy-eyed men with the alcoholized brains, these pallid youths
with the nicotized optic ganglia and thinking-marrows brown as their
own meerschaums, of whom you meet too many,--will ask all your wisdom
to deal with their poisoned nerves and their enfeebled wills.
Nearly seventeen hundred children under five years of age died last
year in this city. A poor human article, no doubt, in many cases,
still, worth an attempt to save them, especially when we remember the
effect of Dr. Clarke's suggestion at the Dublin Hospital, by which
some twenty-five or thirty thousand children's lives have probably
been saved in a single city.
Again, the complaint is often heard that the native population is not
increasing so rapidly as in former generations. The breeding and
nursing period of American women is one of peculiar delicacy and
frequent infirmity. Many of them must require a considerable
interval between the reproductive efforts, to repair damages arid
regain strength. This matter is not to be decided by an appeal to
unschooled nature. It is the same question as that of the deformed
pelvis,--one of degree. The facts of mal-vitalization are as much to
be attended to as those of mal-formation. If the woman with a
twisted pelvis is to be considered an exempt, the woman with a
defective organization should be recognized as belonging to the
invalid corps. We shudder to hear what is alleged as to the
prevalence of criminal practices; if back of these there can be shown
organic incapacity or overtaxing of too limited powers, the facts
belong to the province of the practical physician, as well as of the
moralist and the legislator, and require his gravest consideration.
Take the important question of bleeding. Is venesection done with
forever? Six years ago it was said here in an introductory Lecture
that it would doubtless come back again sooner or later. A fortnight
ago I found myself in the cars with one of the most sensible and
esteemed practitioners in New England. He took out his wallet and
showed me two lancets, which he carried with him; he had never given
up their use. This is a point you will have to consider.
Or, to mention one out of many questionable remedies, shall you give
Veratrum Viride in fevers and inflammations? It makes the pulse
slower in these affections. Then the presumption would naturally be
that it does harm. The caution with reference to it on this ground
was long ago recorded in the Lecture above referred to. See what Dr.
John Hughes Bennett says of it in the recent edition of his work on
Medicine. Nothing but the most careful clinical experience can
settle this and such points of treatment.
These are all practical questions--questions of life and death, and
every day will be full of just such questions. Take the problem of
climate. A patient comes to you with asthma and wants to know where
he can breathe; another comes to you with phthisis and wants to know
where he can live. What boy's play is nine tenths of all that is
taught in many a pretentious course of lectures, compared with what
an accurate and extensive knowledge of the advantages and
disadvantages of different residences in these and other complaints
would be to a practising physician
I saw the other day a gentleman living in Canada, who had spent seven
successive winters in Egypt, with the entire relief of certain
obscure thoracic symptoms which troubled him while at home. I saw,
two months ago, another gentleman from Minnesota, an observer and a
man of sense, who considered that State as the great sanatorium for
all pulmonary complaints. If half our grown population are or will
be more or less tuberculous, the question of colonizing Florida
assumes a new aspect. Even within the borders of our own State, the
very interesting researches of Dr. Bowditch show that there is a
great variation in the amount of tuberculous disease in different
towns, apparently connected with local conditions. The hygienic map
of a State is quite as valuable as its geological map, and it is the
business of every practising physician to know it thoroughly. They
understand this in England, and send a patient with a dry irritating
cough to Torquay or Penzance, while they send another with relaxed
bronchial membranes to Clifton or Brighton. Here is another great
field for practical study.
So as to the all-important question of diet. "Of all the means of
cure at our command," says Dr. Bennett, "a regulation of the quantity
and quality of the diet is by far the most powerful." Dr. MacCormac
would perhaps except the air we breathe, for he thinks that impure
air, especially in sleeping rooms, is the great cause of tubercle.
It is sufficiently proved that the American,--the New Englander,--the
Bostonian, can breed strong and sound children, generation after
generation,--nay, I have shown by the record of a particular family
that vital losses may be retrieved, and a feeble race grow to lusty
vigor in this very climate and locality. Is not the question why our
young men and women so often break down, and how they can be kept
from breaking down, far more important for physicians to settle than
whether there is one cranial vertebra, or whether there are four, or
none?
--But I have a taste for the homologies, I want to go deeply into the
subject of embryology, I want to analyze the protonihilates
precipitated from pigeon's milk by the action of the lunar spectrum,-
shall I not follow my star,--shall I not obey my instinct,--shall I
not give myself to the lofty pursuits of science for its own sake?
Certainly you may, if you like. But take down your sign, or never
put it up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and
Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the
difficulty. We all admire the achievements of this band of
distinguished doctors who do not practise. But we say of their work
and of all pure science, as the French officer said of the charge of
the six hundred at Balaclava, "C'est magnifique, mais ce n'est pas la
guerre,"--it is very splendid, but it is not a practising doctor's
business. His patient has a right to the cream of his life and not
merely to the thin milk that is left after "science" has skimmed it
off. The best a physician can give is never too good for the
patient.
It is often a disadvantage to a young practitioner to be known for
any accomplishment outside of his profession. Haller lost his
election as Physician to the Hospital in his native city of Berne,
principally on the ground that he was a poet. In his later years the
physician may venture more boldly. Astruc was sixty-nine years old
when he published his "Conjectures," the first attempt, we are told,
to decide the authorship of the Pentateuch showing anything like a
discerning criticism. Sir Benjamin Brodie was seventy years old
before he left his physiological and surgical studies to indulge in
psychological speculations. The period of pupilage will be busy
enough in acquiring the knowledge needed, and the season of active
practice will leave little leisure for any but professional studies.
Dr. Graves of Dublin, one of the first clinical teachers of our time,
always insisted on his students' beginning at once to visit the
hospital. At the bedside the student must learn to treat disease,
and just as certainly as we spin out and multiply our academic
prelections we shall work in more and more stuffing, more and more
rubbish, more and more irrelevant, useless detail which the student
will get rid of just as soon as he leaves us. Then the next thing
will be a new organization, with an examining board of first-rate
practical men, who will ask the candidate questions that mean
business,--who will make him operate if he is to be a surgeon, and
try him at the bedside if he is to be a physician,--and not puzzle
him with scientific conundrums which not more than one of the
questioners could answer himself or ever heard of since he graduated.
Or these women who are hammering at the gates on which is written "No
admittance for the mothers of mankind," will by and by organize an
institution, which starting from that skilful kind of nursing which
Florence Nightingale taught so well, will work backwards through
anodynes, palliatives, curatives, preventives, until with little show
of science it imparts most of what is most valuable in those branches
of the healing art it professes to teach. When that time comes, the
fitness of women for certain medical duties, which Hecquet advocated
in 1708, which Douglas maintained in 1736, which Dr. John Ware, long
the honored Professor of Theory and Practice in this Institution,
upheld within our own recollection in the face of his own recorded
opinion to the contrary, will very possibly be recognized.
My advice to every teacher less experienced than myself would be,
therefore: Do not fret over the details you have to omit; you
probably teach altogether too many as it is. Individuals may learn a
thing with once hearing it, but the only way of teaching a whole
class is by enormous repetition, representation, and illustration in
all possible forms. Now and then you will have a young man on your
benches like the late Waldo Burnett,--not very often, if you lecture
half a century. You cannot pretend to lecture chiefly for men like
that,--a Mississippi raft might as well take an ocean-steamer in tow.
To meet his wants you would have to leave the rest of your class
behind and that you must not do. President Allen of Jefferson
College says that his instruction has been successful in proportion
as it has been elementary. It may be a humiliating statement, but it
is one which I have found true in my own experience.
To the student I would say, that however plain and simple may be our
teaching, he must expect to forget much which he follows
intelligently in the lecture-room. But it is not the same as if he
had never learned it. A man must get a thing before he can forget
it. There is a great world of ideas we cannot voluntarily recall,--
they are outside the limits of the will. But they sway our conscious
thought as the unseen planets influence the movements of those within
the sphere of vision. No man knows how much he knows,--how many
ideas he has,--any more than he knows how many blood-globules roll in
his veins. Sometimes accident brings back here and there one, but
the mind is full of irrevocable remembrances and unthinkable
thoughts, which take a part in all its judgments as indestructible
forces. Some of you must feel your scientific deficiencies painfully
after your best efforts. But every one can acquire what is most
essential. A man of very moderate ability may be a good physician,
if he devotes himself faithfully to the work. More than this, a
positively dull man, in the ordinary acceptation of the term,
sometimes makes a safer practitioner than one who has, we will say,
five per cent. more brains than his average neighbor, but who thinks
it is fifty per cent. more. Skulls belonging to this last variety of
the human race are more common, I may remark, than specimens like the
Neanderthal cranium, a cast of which you will find on the table in
the Museum.
Whether the average talent be high or low, the Colleges of the land
must make the best commodity they can out of such material as the
country and the cities furnish them. The community must have Doctors
as it must have bread. It uses up its Doctors just as it wears out
its shoes, and requires new ones. All the bread need not be French
rolls, all the shoes need not be patent leather ones; but the bread
must be something that can be eaten, and the shoes must be something
that can be worn. Life must somehow find food for the two forces
that rub everything to pieces, or burn it to ashes,--friction and
oxygen. Doctors are oxydable products, and the schools must keep
furnishing new ones as the old ones turn into oxyds; some of first-
rate quality that burn with a great light, some of a lower grade of
brilliancy, some honestly, unmistakably, by the grace of God, of
moderate gifts, or in simpler phrase, dull.
The public will give every honest and reasonably competent worker in
the healing art a hearty welcome. It is on the whole very loyal to
the Medical Profession. Three successive years have borne witness to
the feeling with which this Institution, representing it in its
educational aspect, is regarded by those who are themselves most
honored and esteemed. The great Master of Natural Science bade the
last year's class farewell in our behalf, in those accents which
delight every audience. The Head of our ancient University honored
us in the same way in the preceding season. And how can we forget
that other occasion when the Chief Magistrate of the Commonwealth,
that noble citizen whom we have just lost, large-souled, sweet-
natured, always ready for every kind office, came among us at our
bidding, and talked to us of our duties in words as full of wisdom as
his heart was of goodness?
You have not much to fear, I think, from the fancy practitioners.
The vulgar quackeries drop off, atrophied, one after another.
Homoeopathy has long been encysted, and is carried on the body
medical as quietly as an old wen. Every year gives you a more
reasoning and reasonable people to deal with. See how it is in
Literature. The dynasty of British dogmatists, after lasting a
hundred years and more, is on its last legs. Thomas Carlyle, third
in the line of descent, finds an audience very different from those
which listened to the silver speech of Samuel Taylor Coleridge and
the sonorous phrases of Samuel Johnson. We read him, we smile at his
clotted English, his "swarmery" and other picturesque expressions,
but we lay down his tirade as we do one of Dr. Cumming's
interpretations of prophecy, which tells us that the world is coming
to an end next week or next month, if the weather permits,--not
otherwise,--feeling very sure that the weather will be unfavorable.
It is the same common-sense public you will appeal to. The less
pretension you make, the better they will like you in the long run.
I hope we shall make everything as plain and as simple to you as we
can. I would never use a long word, even, where a short one would
answer the purpose. I know there are professors in this country who
"ligate" arteries. Other surgeons only tie them, and it stops the
bleeding just as well. It is the familiarity and simplicity of
bedside instruction which makes it so pleasant as well as so
profitable. A good clinical teacher is himself a Medical School. We
need not wonder that our young men are beginning to announce
themselves not only as graduates of this or that College, but also as
pupils of some one distinguished master.
I wish to close this Lecture, if you will allow me a few moments
longer, with a brief sketch of an instructor and practitioner whose
character was as nearly a model one in both capacities as I can find
anywhere recorded.
Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine
in this University from 1812 to 1846, and whose name has been since
retained on our rolls as Professor Emeritus, died on the 27th of
August last, in the ninetieth year of his age. He studied his
profession, as I have already mentioned, with Dr. Holyoke of Salem,
one of the few physicians who have borne witness to their knowledge
of the laws of life by living to complete their hundredth year. I
think the student took his Old Master, as he always loved to call
him, as his model; each was worthy of the other, and both were bright
examples to all who come after them.
I remember that in the sermon preached by Dr. Grazer after Dr.
Holyoke's death, one of the points most insisted upon as
characteristic of that wise and good old man was the perfect balance
of all his faculties. The same harmonious adjustment of powers, the
same symmetrical arrangement of life, the same complete fulfilment of
every day's duties, without haste and without needless delay, which
characterized the master, equally distinguished the scholar. A
glance at the life of our own Old Master, if I can do any justice at
all to his excellences, will give you something to carry away from
this hour's meeting not unworthy to be remembered.
From December, 1797, to October, 1799, he remained with Dr. Holyoke
as a student, a period which he has spoken of as a most interesting
and most gratifying part of his life. After this he passed eight
months in London, and on his return, in October, 1800, he began
business in Boston.
He had followed Mr. Cline, as I have mentioned, and was competent to
practise Surgery. But he found Dr. John Collins Warren had already
occupied the ground which at that day hardly called for more than one
leading practitioner, and wisely chose the Medical branch of the
profession. He had only himself to rely upon, but he had confidence
in his prospects, conscious, doubtless, of his own powers, knowing
his own industry and determination, and being of an eminently
cheerful and hopeful disposition. No better proof of his spirit can
be given than that, just a year from the time when he began to
practise as a physician, he took that eventful step which in such a
man implies that he sees his way clear to a position; he married a
lady blessed with many gifts, but not bringing him a fortune to
paralyze his industry.
He had not miscalculated his chances in life. He very soon rose into
a good practice, and began the founding of that reputation which grew
with his years, until he stood by general consent at the head of his
chosen branch of the profession, to say the least, in this city and
in all this region of country. His skill and wisdom were the last
tribunal to which the sick and suffering could appeal. The community
trusted and loved him, the profession recognized him as the noblest
type of the physician. The young men whom he had taught wandered
through foreign hospitals; where they learned many things that were
valuable, and many that were curious; but as they grew older and
began to think more of their ability to help the sick than their
power of talking about phenomena, they began to look back to the
teaching of Dr. Jackson, as he, after his London experience, looked
back to that of Dr. Holyoke. And so it came to be at last that the
bare mention of his name in any of our medical assemblies would call
forth such a tribute of affectionate regard as is only yielded to age
when it brings with it the record of a life spent in well doing.
No accident ever carries a man to eminence such as his in the medical
profession. He who looks for it must want it earnestly and work for
it vigorously; Nature must have qualified him in many ways, and
education must have equipped him with various knowledge, or his
reputation will evaporate before it reaches the noon-day blaze of
fame. How did Dr. Jackson gain the position which all conceded to
him? In the answer to this question some among you may find a key
that shall unlock the gate opening on that fair field of the future
of which all dream but which not all will ever reach.
First of all, he truly loved his profession. He had no intellectual
ambitions outside of it, literary, scientific or political. To him
it was occupation enough to apply at the bedside the best of all that
he knew for the good of his patient; to protect the community against
the inroads of pestilence; to teach the young all that he himself had
been taught, with all that his own experience had added; to leave on
record some of the most important results of his long observation.
With his patients he was so perfect at all points that it is hard to
overpraise him. I have seen many noted British and French and
American practitioners, but I never saw the man so altogether
admirable at the bedside of the sick as Dr. James Jackson. His smile
was itself a remedy better than the potable gold and the dissolved
pearls that comforted the praecordia of mediaeval monarchs. Did a
patient, alarmed without cause, need encouragement, it carried the
sunshine of hope into his heart and put all his whims to flight, as
David's harp cleared the haunted chamber of the sullen king. Had the
hour come, not for encouragement, but for sympathy, his face, his
voice, his manner all showed it, because his heart felt it. So
gentle was he, so thoughtful, so calm, so absorbed in the case before
him, not to turn round and look for a tribute to his sagacity, not to
bolster himself in a favorite theory, but to find out all he could,
and to weigh gravely and cautiously all that he found, that to follow
him in his morning visit was not only to take a lesson in the healing
art, it was learning how to learn, how to move, how to look, how to
feel, if that can be learned. To visit with Dr. Jackson was a
medical education.
He was very firm, with all his kindness. He would have the truth
about his patients. The nurses found it out; and the shrewder ones
never ventured to tell him anything but a straight story. A clinical
dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse
in the Massachusetts General Hospital, a mistress in her calling, was
as good questioning and answering as one would be like to hear
outside of the court-room.
Of his practice you can form an opinion from his book called "Letters
to a Young Physician." Like all sensible men from the days of
Hippocrates to the present, he knew that diet and regimen were more
important than any drug or than all drugs put together. Witness his
treatment of phthisis and of epilepsy. He retained, however, more
confidence in some remedial agents than most of the younger
generation would concede to them. Yet his materia medica was a
simple one.
"When I first went to live with Dr. Holyoke," he says, "in 1797,
showing me his shop, he said, 'There seems to you to be a great
variety of medicines here, and that it will take you long to get
acquainted with them, but most of them are unimportant. There are
four which are equal to all the rest, namely, Mercury, Antimony, Bark
and Opium.'" And Dr. Jackson adds, "I can only say of his practice,
the longer I have lived, I have thought better and better of it."
When he thought it necessary to give medicine, he gave it in earnest.
He hated half-practice--giving a little of this or that, so as to be
able to say that one had done something, in case a consultation was
held, or a still more ominous event occurred. He would give opium,
for instance, as boldly as the late Dr. Fisher of Beverly, but he
followed the aphorism of the Father of Medicine, and kept extreme
remedies for extreme cases.
When it came to the "non-naturals," as he would sometimes call them,
after the old physicians,--namely, air, meat and drink, sleep and
watching, motion and rest, the retentions and excretions, and the
affections of the mind,--he was, as I have said, of the school of
sensible practitioners, in distinction from that vast community of
quacks, with or without the diploma, who think the chief end of man
is to support apothecaries, and are never easy until they can get
every patient upon a regular course of something nasty or noxious.
Nobody was so precise in his directions about diet, air, and
exercise, as Dr. Jackson. He had the same dislike to the a peu pres,
the about so much, about so often, about so long, which I afterwards
found among the punctilious adherents of the numerical system at La
Pitie.
He used to insist on one small point with a certain philological
precision, namely, the true meaning of the word "cure." He would
have it that to cure a patient was simply to care for him. I refer
to it as showing what his idea was of the relation of the physician
to the patient. It was indeed to care for him, as if his life were
bound up in him, to watch his incomings and outgoings, to stand guard
at every avenue that disease might enter, to leave nothing to chance;
not merely to throw a few pills and powders into one pan of the
scales of Fate, while Death the skeleton was seated in the other, but
to lean with his whole weight on the side of life, and shift the
balance in its favor if it lay in human power to do it. Such
devotion as this is only to be looked for in the man who gives
himself wholly up to the business of healing, who considers Medicine
itself a Science, or if not a science, is willing to follow it as an
art,--the noblest of arts, which the gods and demigods of ancient
religions did not disdain to practise and to teach.
The same zeal made him always ready to listen to any new suggestion
which promised to be useful, at a period of life when many men find
it hard to learn new methods and accept new doctrines. Few of his
generation became so accomplished as he in the arts of direct
exploration; coming straight from the Parisian experts, I have
examined many patients with him, and have had frequent opportunities
of observing his skill in percussion and auscultation.
One element in his success, a trivial one compared with others, but
not to be despised, was his punctuality. He always carried two
watches,--I doubt if he told why, any more than Dr. Johnson told what
he did with the orange-peel,--but probably with reference to this
virtue. He was as much to be depended upon at the appointed time as
the solstice or the equinox. There was another point I have heard
him speak of as an important rule with him; to come at the hour when
he was expected; if he had made his visit for several days
successively at ten o'clock, for instance, not to put it off, if be
could possibly help it, until eleven, and so keep a nervous patient
and an anxious family waiting for him through a long, weary hour.
If I should attempt to characterize his teaching, I should say that
while it conveyed the best results of his sagacious and extended
observation, it was singularly modest, cautious, simple, sincere.
Nothing was for show, for self-love; there was no rhetoric, no
declamation, no triumphant "I told you so," but the plain statement
of a clear-headed honest man, who knows that he is handling one of
the gravest subjects that interest humanity. His positive
instructions were full of value, but the spirit in which he taught
inspired that loyal love of truth which lies at the bottom of all
real excellence.
I will not say that, during his long career, Dr. Jackson never made
an enemy. I have heard him tell how, in his very early days, old Dr.
Danforth got into a towering passion with him about some professional
consultation, and exploded a monosyllable or two of the more
energetic kind on the occasion. I remember that that somewhat
peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson
succeeded to his place as Professor of Theory and Practice. A young
man of Dr. Jackson's talent and energy could hardly take the position
that belonged to him without crowding somebody in a profession where
three in a bed is the common rule of the household. But he was a
peaceful man and a peace-maker all his days. No man ever did more,
if so much, to produce and maintain the spirit of harmony for which
we consider our medical community as somewhat exceptionally
distinguished.
If this harmony should ever be threatened, I could wish that every
impatient and irritable member of the profession would read that
beautiful, that noble Preface to the "Letters," addressed to John
Collins Warren. I know nothing finer in the medical literature of
all time than this Prefatory Introduction. It is a golden prelude,
fit to go with the three great Prefaces which challenge the
admiration of scholars,--Calvin's to his Institutes, De Thou's to his
History, and Casaubon's to his Polybius,--not because of any learning
or rhetoric, though it is charmingly written, but for a spirit
flowing through it to which learning and rhetoric are but as the
breath that is wasted on the air to the Mood that warms the heart.
Of a similar character is this short extract which I am permitted to
make from a private letter of his to a dear young friend. He was
eighty-three years old at the time of writing it.
"I have not loved everybody whom I have known, but I have striven to
see the good points in the characters of all men and women. At first
I must have done this from something in my own nature, for I was not
aware of it, and yet was doing it without any plan, when one day,
sixty years ago, a friend whom I loved and respected said this to me,
'Ah, James, I see that you are destined to succeed in the world, and
to make friends, because you are so ready to see the good point in
the characters of those you meet.'"
I close this imperfect notice of some features in the character of
this most honored and beloved of physicians by applying to him the
words which were written of William Heberden, whose career was not
unlike his own, and who lived to the same patriarchal age.
"From his early youth he had always entertained a deep sense of
religion, a consummate love of virtue, an ardent thirst after
knowledge, and an earnest desire to promote the welfare and happiness
of all mankind. By these qualities, accompanied with great sweetness
of manners, he acquired the love and esteem of all good men, in a
degree which perhaps very few have experienced; and after passing an
active life with the uniform testimony of a good conscience, he
became an eminent example of its influence, in the cheerfulness and
serenity of his latest age."
Such was the man whom I offer to you as a model, young gentlemen, at
the outset of your medical career. I hope that many of you will
recognize some traits of your own special teachers scattered through
various parts of the land in the picture I have drawn. Let me assure
you that whatever you may learn in this or any other course of public
lectures,--and I trust you will learn a great deal,--the daily
guidance, counsel, example, of your medical father, for such the Oath
of Hippocrates tells you to consider your preceptor, will, if he is
in any degree like him of whom I have spoken, be the foundation on
which all that we teach is reared, and perhaps outlive most of our
teachings, as in Dr. Jackson's memory the last lessons that remained
with him were those of his Old Master.
THE MEDICAL PROFESSION IN MASSACHUSETTS.
A Lecture of a Course by members of the Massachusetts Historical
Society, delivered before the Lowell Institute, January 29, 1869.
The medical history of eight generations, told in an hour, must be in
many parts a mere outline. The details I shall give will relate
chiefly to the first century. I shall only indicate the leading
occurrences, with the more prominent names of the two centuries which
follow, and add some considerations suggested by the facts which have
been passed in review.
A geographer who was asked to describe the tides of Massachusetts
Bay, would have to recognize the circumstance that they are a limited
manifestation of a great oceanic movement. To consider them apart
from this, would be to localize a planetary phenomenon, and to
provincialize a law of the universe. The art of healing in
Massachusetts has shared more or less fully and readily the movement
which, with its periods of ebb and flow, has been raising its level
from age to age throughout the better part of Christendom. Its
practitioners brought with them much of the knowledge and many of the
errors of the Old World; they have always been in communication with
its wisdom and its folly; it is not without interest to see how far
the new conditions in which they found themselves have been favorable
or unfavorable to the growth of sound medical knowledge and practice.
The state of medicine is an index of the civilization of an age and
country,--one of the best, perhaps, by which it can be judged.
Surgery invokes the aid of all the mechanical arts. From the rude
violences of the age of stone,--a relic of which we may find in the
practice of Zipporah, the wife of Moses,--to the delicate operations
of to-day upon patients lulled into temporary insensibility, is a
progress which presupposes a skill in metallurgy and in the labors of
the workshop and the laboratory it has taken uncounted generations to
accumulate. Before the morphia which deadens the pain of neuralgia,
or the quinine which arrests the fit of an ague, can find their place
in our pharmacies, commerce must have perfected its machinery, and
science must have refined its processes, through periods only to be
counted by the life of nations. Before the means which nature and
art have put in the hands of the medical practitioner can be fairly
brought into use, the prejudices of the vulgar must be overcome, the
intrusions of false philosophy must be fenced out, and the
partnership with the priesthood dissolved. All this implies that
freedom and activity of thought which belong only to the most
advanced conditions of society; and the progress towards this is by
gradations as significant of wide-spread changes, as are the varying
states of the barometer of far-extended conditions of the atmosphere.
Apart, then, from its special and technical interest, my subject has
a meaning which gives a certain importance, and even dignity, to
details in themselves trivial and almost unworthy of record. A
medical entry in Governor Winthrop's journal may seem at first sight
a mere curiosity; but, rightly interpreted, it is a key to his whole
system of belief as to the order of the universe and the relations
between man and his Maker. Nothing sheds such light on the
superstitions of an age as the prevailing interpretation and
treatment of disease. When the touch of a profligate monarch was a
cure for one of the most inveterate of maladies, when the common
symptoms of hysteria were prayed over as marks of demoniacal
possession, we might well expect the spiritual realms of thought to
be peopled with still stranger delusions.
Let us go before the Pilgrims of the Mayflower, and look at the
shores on which they were soon to land. A wasting pestilence had so
thinned the savage tribes that it was sometimes piously interpreted
as having providentially prepared the way for the feeble band of
exiles. Cotton Mather, who, next to the witches, hated the
"tawnies," "wild beasts," "blood-hounds," "rattlesnakes,"
"infidels," as in different places he calls the unhappy Aborigines,
describes the condition of things in his lively way, thus:
"The Indians in these Parts had newly, even about a Year or Two
before, been visited with such a prodigious Pestilence; as carried
away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of
Twenty) among them so that the Woods were almost cleared of those
pernicious Creatures to make Room for a better Growth."
What this pestilence was has been much discussed. It is variously
mentioned by different early writers as "the plague," "a great and
grievous plague," "a sore consumption," as attended with spots which
left unhealed places on those who recovered, as making the "whole
surface yellow as with a garment." Perhaps no disease answers all
these conditions so well as smallpox. We know from different sources
what frightful havoc it made among the Indians in after years,--in
1631, for instance, when it swept away the aboriginal inhabitants of
"whole towns," and in 1633. We have seen a whole tribe, the Mandans,
extirpated by it in our own day. The word "plague" was used very
vaguely, as in the description of the "great sickness" found among
the Indians by the expedition of 1622. This same great sickness
could hardly have been yellow fever, as it occurred in the month of
November. I cannot think, therefore, that either the scourge of the
East or our Southern malarial pestilence was the disease that wasted
the Indians. As for the yellowness like a garment, that is too
familiar to the eyes of all who have ever looked on the hideous mask
of confluent variola.
Without the presence or the fear of these exotic maladies, the
forlorn voyagers of the Mayflower had sickness enough to contend
with. At their first landing at Cape Cod, gaunt and hungry and
longing for fresh food, they found upon the sandy shore "great
mussel's, and very fat and full of sea-pearl." Sailors and
passengers indulged in the treacherous delicacy; which seems to have
been the sea-clam; and found that these mollusks, like the shell the
poet tells of, remembered their august abode, and treated the way-
worn adventurers to a gastric reminiscence of the heaving billows.
In the mean time it blew and snowed and froze. The water turned to
ice on their clothes, and made them many times like coats of iron.
Edward Tilley had like to have "sounded" with cold. The gunner, too,
was sick unto death, but "hope of trucking" kept him on his feet,--a
Yankee, it should seem, when he first touched the shore of New
England. Most, if not all, got colds and coughs, which afterwards
turned to scurvy, whereof many died.
How can we wonder that the crowded and tempest-tossed voyagers, many
of them already suffering, should have fallen before the trials of
the first winter in Plymouth? Their imperfect shelter, their
insufficient supply of bread, their salted food, now in unwholesome
condition, account too well for the diseases and the mortality that
marked this first dreadful season; weakness, swelling of the limbs,
and other signs of scurvy, betrayed the want of proper nourishment
and protection from the elements. In December six of their number
died, in January eight, in February, seventeen, in March thirteen.
With the advance of spring the mortality diminished, the sick and
lame began to recover, and the colonists, saddened but not
disheartened, applied themselves to the labors of the opening year.
One of the most pressing needs of the early colonists must have been
that of physicians and surgeons. In Mr. Savage's remarkable
Genealogical Dictionary of the first settlers who came over before
1692 and their descendants to the third generation, I find scattered
through the four crowded volumes the names of one hundred and thirty-
four medical practitioners. Of these, twelve, and probably many
more, practised surgery; three were barber-surgeons. A little
incident throws a glimmer from the dark lantern of memory upon
William Direly, one of these practitioners with the razor and the
lancet. He was lost between Boston and Roxbury in a violent tempest
of wind and snow; ten days afterwards a son was born to his widow,
and with a touch of homely sentiment, I had almost said poetry, they
called the little creature "Fathergone" Direly. Six or seven,
probably a larger number, were ministers as well as physicians, one
of whom, I am sorry to say, took to drink and tumbled into the
Connecticut River, and so ended. One was not only doctor, but also
schoolmaster and poet. One practised medicine and kept a tavern.
One was a butcher, but calls himself a surgeon in his will, a union
of callings which suggests an obvious pleasantry. One female
practitioner, employed by her own sex,--Ann Moore,--was the precursor
of that intrepid sisterhood whose cause it has long been my pleasure
and privilege to advocate on all fitting occasions.
Outside of this list I must place the name of Thomas Wilkinson, who
was complained of, is 1676, for practising contrary to law.
Many names in the catalogue of these early physicians have been
associated, in later periods, with the practice of the profession,--
among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge,
Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams,
Woodward. Touton was a Huguenot, Burchsted a German from Silesia,
Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the
honor of the profession, was only Peacock disguised under this alias,
which would not, I fear, prove very attractive to patients.
What doctrines and practice were these colonists likely to bring,
with them?
Two principal schools of medical practice prevailed in the Old World
during the greater part of the seventeenth century. The first held
to the old methods of Galen: its theory was that the body, the
microcosm, like the macrocosm, was made up of the four elements--
fire, air, water, earth; having respectively the qualities hot, dry,
moist, cold. The body was to be preserved in health by keeping each
of these qualities in its natural proportion; heat, by the proper
temperature; moisture, by the due amount of fluid; and so as to the
rest. Diseases which arose from excess of heat were to be attacked
by cooling remedies; those from excess of cold, by heating ones; and
so of the other derangements of balance. This was truly the
principle of contraries contrariis, which ill-informed persons have
attempted to make out to be the general doctrine of medicine, whereas
there is no general dogma other than this: disease is to be treated
by anything that is proved to cure it. The means the Galenist
employed were chiefly diet and vegetable remedies, with the use of
the lancet and other depleting agents. He attributed the four
fundamental qualities to different vegetables, in four different
degrees; thus chicory was cold in the fourth degree, pepper was hot
in the fourth, endive was cold and dry in the second, and bitter
almonds were hot in the first and dry in the second degree. When we
say "cool as a cucumber," we are talking Galenism. The seeds of that
vegetable ranked as one of "the four greater cold seeds" of this
system.
Galenism prevailed mostly in the south of Europe and France. The
readers of Moliere will have no difficulty in recalling some of its
favorite modes of treatment, and the abundant mirth he extracted from
them.
These Galenists were what we should call "herb-doctors" to-day.
Their insignificant infusions lost credit after a time; their
absurdly complicated mixtures excited contempt, and their nauseous
prescriptions provoked loathing and disgust. A simpler and bolder
practice found welcome in Germany, depending chiefly on mineral
remedies, mercury, antimony, sulphur, arsenic, and the use, sometimes
the secret use, of opium. Whatever we think of Paracelsus, the chief
agent in the introduction of these remedies, and whatever limits we
may assign to the use of these long-trusted mineral drugs, there can
be no doubt that the chemical school, as it was called, did a great
deal towards the expurgation of the old, overloaded, and repulsive
pharmacopoeia. We shall find evidence in the practice of our New-
England physicians of the first century, that they often employed
chemical remedies, and that, by the early part of the following
century, their chief trust was in the few simple, potent drugs of
Paracelsus.
We have seen that many of the practitioners of medicine, during the
first century of New England, were clergymen. This relation between
medicine and theology has existed from a very early period; from the
Egyptian priest to the Indian medicine-man, the alliance has been
maintained in one form or another. The partnership was very common
among our British ancestors. Mr. Ward, the Vicar of Stratford-on-
Avon, himself a notable example of the union of the two characters,
writing about 1660, says,
"The Saxons had their blood-letters, but under the Normans physicke,
begunne in England; 300 years agoe itt was not a distinct profession
by itself, but practised by men in orders, witness Nicholas de
Ternham, the chief English physician and Bishop of Durham; Hugh of
Evesham, a physician and cardinal; Grysant, physician and pope; John
Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul
Bush, a bachelor of divinitie in Oxford, was a man well read in
physick as well as divinitie, he was the first bishop of Bristol."
"Again in King Richard the Second's time physicians and divines were
not distinct professions; for one Tydeman, Bishop of Landaph and
Worcester, was physician to King Richard the Second."
This alliance may have had its share in creating and keeping up the
many superstitions which have figured so largely in the history of
medicine. It is curious to see that a medical work left in
manuscript by the Rev. Cotton Mather and hereafter to be referred to,
is running over with follies and superstitious fancies; while his
contemporary and fellow-townsman, William Douglass, relied on the
same few simple remedies which, through Dr. Edward Holyoke and Dr.
James Jackson, have come down to our own time, as the most important
articles of the materia medica.
Let us now take a general glance at some of the conditions of the
early settlers; and first, as to the healthfulness of the climate.
The mortality of the season that followed the landing of the Pilgrims
at Plymouth has been sufficiently accounted for. After this, the
colonists seem to have found the new country agreeing very well with
their English constitutions. Its clear air is the subject of eulogy.
Its dainty springs of sweet water are praised not only by Higginson
and Wood, but even the mischievous Morton says, that for its delicate
waters Canaan came not near this country." There is a tendency to
dilate on these simple blessings, which reminds one a little of the
Marchioness in Dickens's story, with her orange-peel-and-water
beverage. Still more does one feel the warmth of coloring,--such as
we expect from converts to a new faith, and settlers who want to
entice others over to their clearings, when Winslow speaks, in 1621,
of "abundance of roses, white, red, and damask; single, but very
sweet indeed;" a most of all, however, when, in the same connection,
he says, "Here are grapes white and red, and very sweet and strong
also." This of our wild grape, a little vegetable Indian, which
scalps a civilized man's mouth, as his animal representative scalps
his cranium. But there is something quite charming in Winslow's
picture of the luxury in which they are living. Lobsters, oysters,
eels, mussels, fish and fowl, delicious fruit, including the grapes
aforesaid,--if they only had "kine, horses, and sheep," he makes no
question but men would live as contented here as in any part of the
world. We cannot help admiring the way in which they took their
trials, and made the most of their blessings.
"And how Content they were," says Cotton Mather, "when an Honest Man,
as I have heard, inviting his Friends to a Dish of Clams, at the
Table gave Thanks to Heaven, who had given them to suck the abundance
of the Seas, and of the Treasures Aid in the Sands!"
Strangely enough, as it would seem, except for this buoyant
determination to make the best of everything, they hardly appear to
recognize the difference of the climate from that which they had
left. After almost three years' experience, Winslow says, he can
scarce distinguish New England from Old England, in respect of heat
and cold, frost, snow, rain, winds, etc. The winter, he thinks (if
there is a difference), is sharper and longer; but yet he may be
deceived by the want of the comforts he enjoyed at home. He cannot
conceive any climate to agree better with the constitution of the
English, not being oppressed with extremity of heats, nor nipped by
biting cold:
"By which means, blessed be God, we enjoy our health, notwithstanding
those difficulties we have undergone, in such a measure as would have
been admired, if we had lived in England with the like means."
Edward Johnson, after mentioning the shifts to which they were put
for food, says,--
"And yet, methinks, our children are as cheerful, fat, and lusty,
with feeding upon those mussels, clams, and other fish, as they were
in England with their fill of bread."
Higginson, himself a dyspeptic, "continually in physic," as he says,
and accustomed to dress in thick clothing, and to comfort his stomach
with drink that was "both strong and stale,"--the "jolly good ale and
old," I suppose, of free and easy Bishop Still's song,--found that he
both could and did oftentimes drink New England water very well,
--which he seems to look upon as a remarkable feat. He could go as
lightclad as any, too, with only a light stuff cassock upon his
shirt, and stuff breeches without linings. Two of his children were
sickly: one,--little misshapen Mary,--died on the passage, and, in
her father's words, "was the first in our ship that was buried in the
bowels of the great Atlantic sea;" the other, who had been "most
lamentably handled" by disease, recovered almost entirely "by the
very wholesomeness of the air, altering, digesting, and drying up the
cold and crude humors of the body." Wherefore, he thinks it a wise
course for all cold complexions to come to take physic in New
England, and ends with those often quoted words, that "a sup of New
England's air is better than a whole draught of Old England's ale."
Mr. Higginson died, however, "of a hectic fever," a little more than
a year after his arrival.
The medical records which I shall cite show that the colonists were
not exempt from the complaints of the Old World. Besides the common
diseases to which their descendants are subject, there were two
others, to say nothing of the dreaded small-pox, which later medical
science has disarmed,--little known among us at the present day, but
frequent among the first settlers. The first of these was the
scurvy, already mentioned, of which Winthrop speaks in 1630, saying,
that it proved fatal to those who fell into discontent, and lingered
after their former conditions in England; the poor homesick creatures
in fact, whom we so forget in our florid pictures of the early times
of the little band in the wilderness. Many who were suffering from
scurvy got well when the Lyon arrived from England, bringing store of
juice of lemons. The Governor speaks of another case in 1644; and it
seems probable that the disease was not of rare occurrence.
The other complaint from which they suffered, but which has nearly
disappeared from among us, was intermittent fever, or fever and ague.
I investigated the question as to the prevalence of this disease in
New England, in a dissertation, which was published in a volume with
other papers, in the year 1838. I can add little to the facts there
recorded. One which escaped me was, that Joshua Scottow, in "Old
Men's Tears," dated 1691, speaks of "shaking agues," as among the
trials to which they had been subjected. The outline map of New
England, accompanying the dissertation above referred to, indicates
all the places where I had evidence that the disease had originated.
It was plain enough that it used to be known in many localities where
it has long ceased to be feared. Still it was and is remarkable to
see what a clean bill of health in this particular respect our barren
soil inherited with its sterility. There are some malarious spots on
the edge of Lake Champlain, arid there have been some temporary
centres of malaria, within the memory of man, on one or more of our
Massachusetts rivers, but these are harmless enough, for the most
part, unless the millers dam them, when they are apt to retaliate
with a whiff from their meadows, that sets the whole neighborhood
shaking with fever and ague.
The Pilgrims of the Mayflower had with them a good physician, a man
of standing, a deacon of their church, one whom they loved and
trusted, Dr. Samuel Fuller. But no medical skill could keep cold and
hunger and bad food, and, probably enough, desperate homesickness in
some of the feebler sort, from doing their work. No detailed record
remains of what they suffered or what was attempted for their relief
during the first sad winter. The graves of those who died were
levelled and sowed with grain that the losses of the little band
might not be suspected by the savage tenants of the wilderness, and
their story remains untold.
Of Dr. Fuller's practice, at a later period, we have an account in a
letter of his to Governor Bradford, dated June, 1630. "I have been
to Matapan" (now Dorchester), he says, "and let some twenty of those
people blood." Such wholesale depletion as this, except with avowed
homicidal intent, is quite unknown in these days; though I once saw
the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy,
order some ten or fifteen patients, taken almost indiscriminately, to
be bled in a single morning.
Dr. Fuller's two visits to Salem, at the request of Governor
Endicott, seem to have been very satisfactory to that gentleman.
Morton, the wild fellow of Merry Mount, gives a rather questionable
reason for the Governor's being so well pleased with the physician's
doings. The names under which he mentions the two personages, it
will be seen, are not intended to be complimentary. "Dr. Noddy did a
great cure for Captain Littleworth. He cured him of a disease called
a wife." William Gager, who came out with Winthrop, is spoken of as
"a right godly man and skilful chyrurgeon, but died of a malignant
fever not very long after his arrival."
Two practitioners of the ancient town of Newbury are entitled to
special notice, for different reasons. The first is Dr. John Clark,
who is said by tradition to have been the first regularly educated
physician who resided in New England. His portrait, in close-fitting
skull-cap, with long locks and venerable flowing beard, is familiar
to our eyes on the wall of our Society's antechamber. His left hand
rests upon a skull, his right hand holds an instrument which deserves
a passing comment. It is a trephine, a surgical implement for
cutting round pieces out of broken skulls, so as to get at the
fragments which have been driven in, and lift them up. It has a
handle like that of a gimlet, with a claw like a hammer, to lift
with, I suppose, which last contrivance I do not see figured in my
books. But the point I refer to is this: the old instrument, the
trepan, had a handle like a wimble, what we call a brace or bit-
stock. The trephine is not mentioned at all in Peter Lowe's book,
London, 1634; nor in Wiseman's great work on Surgery, London, 1676;
nor in the translation of Dionis, published by Jacob Tonson, in 1710.
In fact it was only brought into more general use by Cheselden and
Sharpe so late as the beginning of the last century. As John Clark
died in 1661, it is remarkable to see the last fashion in the way of
skull-sawing contrivances in his hands,--to say nothing of the claw
on the handle, and a Hey's saw, so called in England, lying on the
table by him, and painted there more than a hundred years before Hey
was born. This saw is an old invention, perhaps as old as
Hippocrates, and may be seen figured in the "Armamentarium
Chirurgicum" of Scultetus, or in the Works of Ambroise Pare.
Dr. Clark is said to have received a diploma before be came, for
skill in lithotomy. He loved horses, as a good many doctors do, and
left a good property, as they all ought to do. His grave and noble
presence, with the few facts concerning him, told with more or less
traditional authority, give us the feeling that the people of
Newbury, and afterwards of Boston, had a wise and skilful medical
adviser and surgeon in Dr. John Clark.
The venerable town of Newbury had another physician who was less
fortunate. The following is a court record of 1652:
"This is to certify whom it may concern, that we the subscribers,
being called upon to testify against doctor William Snelling for
words by him uttered, affirm that being in way of merry discourse, a
health being drank to all friends, he answered,
"I'll pledge my friends,
And for my foes
A plague for their heels
And,'---
[a similar malediction on the other extremity of their feet.]
"Since when he hath affirmed that he only intended the proverb used
in the west country, nor do we believe he intended otherwise.
"[Signed]
"WILLIAM THOMAS.
"THOMAS MILWARD.
"March 12th 1651, All which I acknowledge, and am sorry I did not
expresse my intent, or that I was so weak as to use so foolish a
proverb.
"[Signed]
"GULIELMUS SNELLING."
Notwithstanding this confession and apology, the record tells us that
"William Snelling in his presentment for cursing is fined ten
shillings and the fees of court."
I will mention one other name among those of the Fathers of the
medical profession in New England. The "apostle" Eliot says, writing
in 1647, "We never had but one anatomy in the country, which Mr.
Giles Firman, now in England, did make and read upon very well."
Giles Firmin, as the name is commonly spelled, practised physic in
this country for a time. He seems to have found it a poor business;
for, in a letter to Governor Winthrop, he says, "I am strongly sett
upon to studye divinitie: my studyes else must be lost, for physick
is but a meene helpe."
Giles Firmin's Lectures on Anatomy were the first scientific
teachings of the New World. While the Fathers were enlightened
enough to permit such instructions, they were severe in dealing with
quackery; for, in 1631, our court records show that one Nicholas
Knopp, or Knapp, was sentenced to be fined or whipped "for taking
upon him to cure the scurvey by a water of noe worth nor value, which
he solde att a very deare rate." Empty purses or sore backs would be
common with us to-day if such a rule were enforced.
Besides the few worthies spoken of, and others whose names I have not
space to record, we must remember that there were many clergymen who
took charge of the bodies as well as the souls of their patients,
among them two Presidents of Harvard College, Charles Chauncy and
Leonard Hoar,--and Thomas Thacher, first minister of the "Old South,"
author of the earliest medical treatises printed in the country,[A
Brief Rule to Guide the Common People in Small pox and
Measles. 1674.] whose epitaph in Latin and Greek, said to have been
written by Eleazer, an "Indian Youth" and a member of the Senior
Class of Harvard College, may be found in the "Magnalia." I miss
this noble savage's name in our triennial catalogue; and as there is
many a slip between the cup and lip, one is tempted to guess that he
may have lost his degree by some display of his native instinct,--
possibly a flourish of the tomahawk or scalping-knife. However this
may have been, the good man he celebrated was a notable instance of
the Angelical Conjunction, as the author of the "Magnalia" calls it,
of the offices of clergyman and medical practitioner.
Michael Wigglesworth, author of the "Day of Doom," attended the sick,
"not only as a Pastor, but as a Physician too, and this, not only in
his own town, but also in all those of the vicinity." Mather says of
the sons of Charles Chauncy, "All of these did, while they had
Opportunity, Preach the Gospel; and most, if not all of them, like
their excellent Father before them, had an eminent skill in physick
added unto their other accomplishments," etc. Roger Williams is said
to have saved many in a kind of pestilence which swept away many
Indians.
To these names must be added, as sustaining a certain relation to the
healing art, that of the first Governor Winthrop, who is said by John
Cotton to have been "Help for our Bodies by Physick [and] for our
Estates by Law," and that of his son, the Governor of Connecticut,
who, as we shall see, was as much physician as magistrate.
I had submitted to me for examination, in 1862, a manuscript found
among the Winthrop Papers, marked with the superscription, "For my
worthy friend Mr. Wintrop," dated in 1643, London, signed Edward
Stafford, and containing medical directions and prescriptions. It
may be remembered by some present that I wrote a report on this
paper, which was published in the "Proceedings" of this Society.
Whether the paper was written for Governor John Winthrop of
Massachusetts, or for his son, Governor John of Connecticut, there is
no positive evidence that I have been able to obtain. It is very
interesting, however, as giving short and simple practical
directions, such as would be most like to be wanted and most useful,
in the opinion of a physician in repute of that day.
The diseases prescribed for are plague, small-pox, fevers, king's
evil, insanity, falling-sickness, and the like; with such injuries as
broken bones, dislocations, and burning with gunpowder. The remedies
are of three kinds: simples, such as St. John's wort, Clown's all-
heal, elder, parsley, maidenhair, mineral drugs, such as lime,
saltpetre, Armenian bole, crocus metallorum, or sulphuret of
antimony; and thaumaturgic or mystical, of which the chief is, "My
black powder against the plague, small-pox; purples, all sorts of
feavers; Poyson; either, by Way of Prevention or after Infection."
This marvellous remedy was made by putting live toads into an earthen
pot so as to half fill it, and baking and burning them "in the open
ayre, not in an house,"--concerning which latter possibility I
suspect Madam Winthrop would have had something to say,--until they
could be reduced by pounding, first into a brown, and then into a
black, powder. Blood-letting in some inflammations, fasting in the
early stage of fevers, and some of those peremptory drugs with which
most of us have been well acquainted in our time, the infragrant
memories of which I will not pursue beyond this slight allusion, are
among his remedies.
The Winthrops, to one of whom Dr. Stafford's directions were
addressed, were the medical as well as the political advisers of
their fellow-citizens for three or four successive generations. One
of them, Governor John of Connecticut, practised so extensively,
that, but for his more distinguished title in the State, he would
have been remembered as the Doctor. The fact that he practised in
another colony, for the most part, makes little difference in the
value of the records we have of his medical experience, which have
fortunately been preserved, and give a very fair idea, in all
probability, of the way in which patients were treated in
Massachusetts, when they fell into intelligent and somewhat educated
hands, a little after the middle of the seventeenth century:
I have before me, while writing, a manuscript collection of the
medical cases treated by him, and recorded at the time in his own
hand, which has been intrusted to me by our President, his
descendant.
They are generally marked Hartford, and extend from the year 1657 to
1669. From these, manuscripts, and from the letters printed in the
Winthrop Papers published by our Society, I have endeavored to obtain
some idea of the practice of Governor John Winthrop, Junior. The
learned eye of Mr. Pulsifer would have helped me, no doubt, as it has
done in other cases; but I have ventured this time to attempt finding
my own way among the hieroglyphics of these old pages. By careful
comparison of many prescriptions, and by the aid of Schroder, Salmon,
Culpeper, and other old compilers, I have deciphered many of his
difficult paragraphs with their mysterious recipes.
The Governor employed a number of the simples dear to ancient women,
--elecampane and elder and wormwood and anise and the rest; but he
also employed certain mineral remedies, which he almost always
indicates by their ancient symbols, or by a name which should leave
them a mystery to the vulgar. I am now prepared to reveal the mystic
secrets of the Governor's beneficent art, which rendered so many good
and great as well as so many poor and dependent people his debtors,-
at least, in their simple belief,--for their health and their lives.
His great remedy, which he gave oftener than any other, was nitre;
which he ordered in doses of twenty or thirty grains to adults, and
of three grains to infants. Measles, colics, sciatica, headache,
giddiness, and many other ailments, all found themselves treated, and
I trust bettered, by nitre; a pretty safe medicine in moderate doses,
and one not likely to keep the good Governor awake at night, thinking
whether it might not kill, if it did not cure. We may say as much
for spermaceti, which he seems to have considered "the sovereign'st
thing on earth" for inward bruises, and often prescribes after falls
and similar injuries.
One of the next remedies, in point of frequency, which he was in the
habit of giving, was (probably diaphoretic) antimony; a mild form of
that very active metal, and which, mild as it was, left his patients
very commonly with a pretty strong conviction that they had been
taking something that did not exactly agree with them. Now and then
he gave a little iron or sulphur or calomel, but very rarely;
occasionally, a good, honest dose of rhubarb or jalap; a taste of
stinging horseradish, oftener of warming guiacum; sometimes an
anodyne, in the shape of mithridate,--the famous old farrago, which
owed its virtue to poppy juice; [This is the remedy which a Boston
divine tried to simplify. See Electuarium Novum Alexipharmacum, by
Rev. Thomas Harward, lecturer at the Royal Chappell. Boston, 1732.
This tract is in our Society's library.] very often, a harmless
powder of coral; less frequently, an inert prescription of pleasing
amber; and (let me say it softly within possible hearing of his
honored descendant), twice or oftener,--let us hope as a last
resort,--an electuary of millipedes,--sowbugs, if we must give them
their homely English name. One or two other prescriptions, of the
many unmentionable ones which disgraced the pharmacopoeia of the
seventeenth century, are to be found, but only in very rare
instances, in the faded characters of the manuscript.
The excellent Governor's accounts of diseases are so brief, that we
get only a very general notion of the complaints for which he
prescribed. Measles and their consequences are at first more
prominent than any other one affection, but the common infirmities of
both sexes and of all ages seem to have come under his healing hand.
Fever and ague appears to have been of frequent occurrence.
His published correspondence shows that many noted people were in
communication with him as his patients. Roger Williams wants a
little of his medicine for Mrs. Weekes's daughter; worshipful John
Haynes is in receipt of his powders; troublesome Captain Underhill
wants "a little white vitterall" for his wife, and something to cure
his wife's friend's neuralgia, (I think his wife's friend's husband
had a little rather have had it sent by the hands of Mrs. Underhill,
than by those of the gallant and discursive captain); and pious John
Davenport says, his wife "tooke but one halfe of one of the papers"
(which probably contained the medicine he called rubila), "but could
not beare the taste of it, and is discouraged from taking any more;"
and honored William Leete asks for more powders for his "poore little
daughter Graciana," though he found it "hard to make her take it,"
delicate, and of course sensitive, child as she was, languishing and
dying before her time, in spite of all the bitter things she
swallowed,--God help all little children in the hands of dosing
doctors and howling dervishes! Restless Samuel Gorton, now tamed by
the burden of fourscore and two years, writes so touching an account
of his infirmities, and expresses such overflowing gratitude for the
relief he has obtained from the Governor's prescriptions, wondering
how "a thing so little in quantity, so little in sent, so little in
taste, and so little to sence in operation, should beget and bring
forth such efects," that we repent our hasty exclamation, and bless
the memory of the good Governor, who gave relief to the worn-out
frame of our long-departed brother, the sturdy old heretic of Rhode
Island.
What was that medicine which so frequently occurs in the printed
letters under the name of "rubila"? It is evidently a secret remedy,
and, so far as I know, has not yet been made out. I had almost given
it up in despair, when I found what appears to be a key to the
mystery. In the vast multitude of prescriptions contained in the
manuscripts, most of them written in symbols, I find one which I thus
interpret:
"Four grains of (diaphoretic) antimony, with twenty grains of nitre,
with a little salt of tin, making rubila." Perhaps something was
added to redden the powder, as he constantly speaks of "rubifying"
or "viridating" his prescriptions; a very common practice of
prescribers, when their powders look a little too much like plain
salt or sugar.
Waitstill Winthrop, the Governor's son, "was a skilful physician,"
says Mr. Sewall, in his funeral sermon; "and generously gave, not
only his advice, but also his Medicines, for the healing of the Sick,
which, by the Blessing of God, were made successful for the recovery
of many." "His son John, a member of the Royal Society, speaks of
himself as 'Dr. Winthrop,' and mentions one of his own prescriptions
in a letter to Cotton Mather." Our President tells me that there was
an heirloom of the ancient skill in his family, within his own
remembrance, in the form of a certain precious eye-water, to which
the late President John Quincy Adams ascribed rare virtue, and which
he used to obtain from the possessor of the ancient recipe.
These inherited prescriptions are often treasured in families, I do
not doubt, for many generations. When I was yet of trivial age, and
suffering occasionally, as many children do, from what one of my
Cambridgeport schoolmates used to call the "ager,"--meaning thereby
toothache or face-ache,--I used to get relief from a certain plaster
which never went by any other name in the family than "Dr. Oliver."
Dr. James Oliver was my great-great-grandfather, graduated in 1680,
and died in 1703. This was, no doubt, one of his nostrums; for
nostrum, as is well known, means nothing more than our own or my own
particular medicine, or other possession or secret, and physicians in
old times used to keep their choice recipes to themselves a good
deal, as we have had occasion to see.
Some years ago I found among my old books a small manuscript marked
"James Oliver. This Book Begun Aug. 12, 1685." It is a rough sort
of account-book, containing among other things prescriptions for
patients, and charges for the same, with counter-charges for the
purchase of medicines and other matters. Dr. Oliver practised in
Cambridge, where may be seen his tomb with inscriptions, and with
sculptured figures that look more like Diana of the Ephesians, as
given in Calmet's Dictionary, than like any angels admitted into good
society here or elsewhere.
I do not find any particular record of what his patients suffered
from, but I have carefully copied out the remedies he mentions, and
find that they form a very respectable catalogue. Besides the usual
simples, elder, parsley, fennel, saffron, snake-root, wormwood, I
find the Elixir Proprietatis, with other elixire and cordials, as if
he rather fancied warming medicines; but he called in the aid of some
of the more energetic remedies, including iron, and probably mercury,
as he bought two pounds of it at one time.
The most interesting item is his bill against the estate of Samuel
Pason of Roxbury, for services during his last illness. He attended
this gentleman,--for such he must have been, by the amount of physic
which he took, and which his heirs paid for,--from June 4th, 1696, to
September 3d of the same year, three months. I observe he charges
for visits as well as for medicines, which is not the case in most of
his bills. He opens the attack with a carminative appeal to the
visceral conscience, and follows it up with good hard-hitting
remedies for dropsy,--as I suppose the disease would have been
called,--and finishes off with a rallying dose of hartshorn and iron.
It is a source of honest pride to his descendant that his bill, which
was honestly paid, as it seems to have been honorably earned,
amounted to the handsome total of seven pounds and two shillings.
Let me add that he repeatedly prescribes plaster, one of which was
very probably the "Dr. Oliver" that soothed my infant griefs, and for
which I blush to say that my venerated ancestor received from Goodman
Hancock the painfully exiguous sum of no pounds, no shillings, and
sixpence.
I have illustrated the practice of the first century, from the two
manuscripts I have examined, as giving an impartial idea of its
every-day methods. The Governor, Johannes Secundus, it is fair to
remember, was an amateur practitioner, while my ancestor was a
professed physician. Comparing their modes of treatment with the
many scientific follies still prevailing in the Old World, and still
more with the extraordinary theological superstitions of the
community in which they lived, we shall find reason, I think, to
consider the art of healing as in a comparatively creditable state
during the first century of New England.
In addition to the evidence as to methods of treatment furnished by
the manuscripts I have cited, I subjoin the following document, to
which my attention was called by Dr. Shurtleff, our present Mayor.
This is a letter of which the original is to be found in vol. lxix.
page 10 of the "Archives" preserved at the State House in Boston. It
will be seen that what the surgeon wanted consisted chiefly of
opiates, stimulants, cathartics, plasters, and materials for
bandages. The complex and varied formulae have given place to
simpler and often more effective forms of the same remedies; but the
list and the manner in which it is made out are proofs of the good
sense and schooling of the surgeon, who, it may be noted, was in such
haste that he neglected all his stops. He might well be in a hurry,
as on the very day upon which he wrote, a great body of Indians--
supposed to be six or seven hundred--appeared before Hatfield; and
twenty-five resolute young men of Hadley, from which town he wrote,
crossed the river and drove them away.
HADLY May 30: 76
Mr RAWSON Sr
What we have recd by Tho: Houey the past month is not the cheifest of
our wants as you have love for poor wounded I pray let us not want
for these following medicines if you have not a speedy conveyance of
them I pray send on purpose they are those things mentioned in my
former letter but to prevent future mistakes I have wrote them att
large wee have great want with the greatest halt and speed let
us be supplyed.
Sr
Yr Sert
WILL LOCHS
(Endorsed)
Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye
Council with it but could not obtaine any thing to be sent in answer
thereto 13 June 1676
I have given some idea of the chief remedies used by our earlier
physicians, which were both Galenic and chemical; that is, vegetable
and mineral. They, of course, employed the usual perturbing
medicines which Montaigne says are the chief reliance of their craft.
There were, doubtless, individual practitioners who employed special
remedies with exceptional boldness and perhaps success. Mr. Eliot is
spoken of, in a letter of William Leete to Winthrop, Junior, as being
under Mr. Greenland's mercurial administrations. The latter was
probably enough one of these specialists.
There is another class of remedies which appears to have been
employed occasionally, but, on the whole, is so little prominent as
to imply a good deal of common sense among the medical practitioners,
as compared with the superstitions prevailing around them. I have
said that I have caught the good Governor, now and then, prescribing
the electuary of millipedes; but he is entirely excused by the almost
incredible fact that they were retained in the materia medica so late
as when Rees's Cyclopaedia was published, and we there find the
directions formerly given by the College of Edinburgh for their
preparation. Once or twice we have found him admitting still more
objectionable articles into his materia medica; in doing which, I am
sorry to say that he could plead grave and learned authority. But
these instances are very rare exceptions in a medical practice of
many years, which is, on the whole, very respectable, considering the
time and circumstances.
Some remedies of questionable though not odious character appear
occasionally to have been employed by the early practitioners, but
they were such as still had the support of the medical profession.
Governor John Winthrop, the first, sends for East Indian bezoar, with
other commodities he is writing for. Governor Endicott sends him one
he had of Mr. Humfrey. I hope it was genuine, for they cheated
infamously in the matter of this concretion, which ought to come out
of an animal's stomach, but the real history of which resembles what
is sometimes told of modern sausages.
There is a famous law-case of James the First's time, in which a
goldsmith sold a hundred pounds' worth of what he called bezoar,
which was proved to be false, and the purchaser got a verdict against
him. Governor Endicott also sends Winthrop a unicorn's horn, which
was the property of a certain Mrs. Beggarly, who, in spite of her
name, seems to have been rich in medical knowledge and possessions.
The famous Thomas Bartholinus wrote a treatise on the virtues of this
fabulous-sounding remedy, which was published in 1641, and
republished in 1678.
The "antimonial cup," a drinking vessel made of that metal, which,
like our quassia-wood cups, might be filled and emptied in saecula
saeculorum without exhausting its virtues, is mentioned by Matthew
Cradock, in a letter to the elder Winthrop, but in a doubtful way, as
it was thought, he says, to have shortened the days of Sir Nathaniel
Riche; and Winthrop himself, as I think, refers to its use, calling
it simply "the cup." An antimonial cup is included in the inventory
of Samuel Seabury, who died 1680, and is valued at five shillings.
There is a treatise entitled "The Universall Remedy, or the Vertues
of the Antimoniall Cup, By John Evans, Minister and Preacher of God's
Word, London, 1634," in our own Society's library.
One other special remedy deserves notice, because of native growth.
I do not know when Culver's root, Leptandra Virginica of our National
Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to
John Winthrop of New London, speaks of it as famous for the cure of
consumptions, and wishes to get some of it, through his mediation,
for Katharine, his eldest daughter. He gets it, and gives it to the
"poor damsel," who is languishing, as he says, and who dies the next
month,--all the sooner, I have little doubt, for this uncertain and
violent drug, with which the meddlesome pedant tormented her in that
spirit of well-meant but restless quackery, which could touch nothing
without making mischief, not even a quotation, and yet proved at
length the means of bringing a great blessing to our community, as we
shall see by and by; so does Providence use our very vanities and
infirmities for its wise purposes.
Externally, I find the practitioners on whom I have chiefly relied
used the plasters of Paracelsus, of melilot, diachylon, and probably
diaphoenicon, all well known to the old pharmacopoeias, and some of
them to the modern ones,--to say nothing of "my yellow salve," of
Governor John, the second, for the composition of which we must apply
to his respected descendant.
The authors I find quoted are Barbette's Surgery, Camerarius on Gout,
and Wecherus, of all whom notices may be found in the pages of Haller
and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's
Practice of Physic and Anatomy, the last as belonging to Samuel
Seabury, chirurgeon, before mentioned. Nicholas Culpeper was a
shrewd charlatan, and as impudent a varlet as ever prescribed for a
colic; but knew very well what he was about, and badgers the College
with great vigor. A copy of Spigelius's famous Anatomy, in the
Boston Athenaeum, has the names of Increase and Samuel Mather written
in it, and was doubtless early overhauled by the youthful Cotton, who
refers to the great anatomist's singular death, among his curious
stories in the "Magnalia," and quotes him among nearly a hundred
authors whom he cites in his manuscript "The Angel of Bethesda." Dr.
John Clark's "books and instruments, with several chirurgery
materials in the closet," a were valued in his inventory at sixty
pounds; Dr. Matthew Fuller, who died in 1678, left a library valued
at ten pounds; and a surgeon's chest and drugs valued at sixteen
pounds.'
Here we leave the first century and all attempts at any further
detailed accounts of medicine and its practitioners. It is necessary
to show in a brief glance what had been going on in Europe during the
latter part of that century, the first quarter of which had been made
illustrious in the history of medical science by the discovery of the
circulation.
Charles Barbeyrac, a Protestant in his religion, was a practitioner
and teacher of medicine at Montpellier. His creed was in the way of
his obtaining office; but the young men followed his instructions
with enthusiasm. Religious and scientific freedom breed in and in,
until it becomes hard to tell the family of one from that of the
other. Barbeyrac threw overboard the old complex medical farragos of
the pharmacopoeias, as his church had disburdened itself of the
popish ceremonies.
Among the students who followed his instructions were two Englishmen:
one of them, John Locke, afterwards author of an "Essay on the Human
Understanding," three years younger than his teacher; the other,
Thomas Sydenham, five years older. Both returned to England. Locke,
whose medical knowledge is borne witness to by Sydenham, had the good
fortune to form a correct opinion on a disease from which the Earl of
Shaftesbury was suffering, which led to an operation that saved his
life. Less felicitous was his experience with a certain ancilla
culinaria virgo,--which I am afraid would in those days have been
translated kitchen-wench, instead of lady of the culinary
department,--who turned him off after she had got tired of him, and
called in another practitioner. [Locke and Sydenham, p. 124. By John
Brown, M. D. Edinburgh, 1866.] This helped, perhaps, to spoil a
promising doctor, and make an immortal metaphysician. At any rate,
Locke laid down the professional wig and cane, and took to other
studies.
The name of Thomas Sydenham is as distinguished in the history of
medicine as that of John Locke in philosophy. As Barbeyrac was found
in opposition to the established religion, as Locke took the rational
side against orthodox Bishop Stillingfleet, so Sydenham went with
Parliament against Charles, and was never admitted a Fellow by the
College of Physicians, which, after he was dead, placed his bust in
their hall by the side of that of Harvey.
What Sydenham did for medicine was briefly this he studied the course
of diseases carefully, and especially as affected by the particular
season; to patients with fever he gave air and cooling drinks,
instead of smothering and heating them, with the idea of sweating out
their disease; he ordered horseback exercise to consumptives; he,
like his teacher, used few and comparatively simple remedies; he did
not give any drug at all, if he thought none was needed, but let well
enough alone. He was a sensible man, in short, who applied his
common sense to diseases which he had studied with the best light of
science that he could obtain.
The influence of the reform he introduced must have been more or less
felt in this country, but not much before the beginning of the
eighteenth century, as his great work was not published until 1675,
and then in Latin. I very strongly suspect that there was not so
much to reform in the simple practice of the physicians of the new
community, as there was in that of the learned big-wigs of the
"College," who valued their remedies too much in proportion to their
complexity, and the extravagant and fantastic ingredients which went
to their making.
During the memorable century which bred and bore the Revolution, the
medical profession gave great names to our history. But John Brooks
belonged to the State, and Joseph Warren belongs to the country and
mankind, and to speak of them would lead me beyond my limited--
subject. There would be little pleasure in dwelling on the name of
Benjamin Church; and as for the medical politicians, like Elisha
Cooke in the early part of the century, or Charles Jarvis, the bald
eagle of Boston, in its later years, whether their practice was
heroic or not, their patients were, for he is a bold man who trusts
one that is making speeches and coaxing voters, to meddle with the
internal politics of his corporeal republic.
One great event stands out in the medical history of this eighteenth
century; namely, the introduction of the practice of inoculation for
small-pox. Six epidemics of this complaint had visited Boston in the
course of a hundred years. Prayers had been asked in the churches
for more than a hundred sick in a single day, and this many times.
About a thousand persons had died in a twelvemonth, we are told, and,
as we may infer, chiefly from this cause.
In 1721, this disease, after a respite of nineteen years, again
appeared as an epidemic. In that year it was that Cotton Mather,
browsing, as was his wont, on all the printed fodder that came within
reach of his ever-grinding mandibles, came upon an account of
inoculation as practised in Turkey, contained in the "Philosophical
Transactions." He spoke of it to several physicians, who paid little
heed to his story; for they knew his medical whims, and had probably
been bored, as we say now-a-days, many of them, with listening to his
"Angel of Bethesda," and satiated with his speculations on the
Nishmath Chajim.
The Reverend Mather,--I use a mode of expression he often employed
when speaking of his honored brethren,--the Reverend Mather was right
this time, and the irreverent doctors who laughed at him were wrong.
One only of their number disputes his claim to giving the first
impulse to the practice, in Boston. This is what that person says:
"The Small-Pox spread in Boston, New England, A.1721, and the
Reverend Dr. Cotton Mather, having had the use of these
Communications from Dr. William Douglass (that is, the writer of
these words); surreptitiously, without the knowledge of his Informer,
that he might have the honour of a New fangled notion, sets an
Undaunted Operator to work, and in this Country about 290 were
inoculated."
All this has not deprived Cotton Mather of the credit of suggesting,
and a bold and intelligent physician of the honor of carrying out,
the new practice. On the twenty-seventh day of June, 1721, Zabdiel
Boylston of Boston inoculated his only son for smallpox,--the first
person ever submitted to the operation in the New World. The story
of the fierce resistance to the introduction of the practice; of how
Boylston was mobbed, and Mather had a hand-grenade thrown in at his
window; of how William Douglass, the Scotchman, "always positive, and
sometimes accurate," as was neatly said of him, at once depreciated
the practice and tried to get the credit of suggesting it, and how
Lawrence Dalhonde, the Frenchman, testified to its destructive
consequences; of how Edmund Massey, lecturer at St. Albans, preached
against sinfully endeavoring to alter the course of nature by
presumptuous interposition, which he would leave to the atheist and
the scoffer, the heathen and unbeliever, while in the face of his
sermon, afterwards reprinted in Boston, many of our New England
clergy stood up boldly in defence of the practice,--all this has been
told so well and so often that I spare you its details. Set this
good hint of Cotton Mather against that letter of his to John
Richards, recommending the search after witch-marks, and the
application of the water-ordeal, which means throw your grandmother
into the water, if she has a mole on her arm;--if she swims, she is a
witch and must be hanged; if she sinks, the Lord have mercy on her
soul!
Thus did America receive this great discovery, destined to save
thousands of lives, via Boston, from the hands of one of our own
Massachusetts physicians.
The year 1735 was rendered sadly memorable by the epidemic of the
terrible disease known as "throat distemper," and regarded by many as
the same as our "diphtheria." Dr. Holyoke thinks the more general
use of mercurials in inflammatory complaints dates from the time of
their employment in this disease, in which they were thought to have
proved specially useful.
At some time in the course of this century medical practice had
settled down on four remedies as its chief reliance. I must repeat
an incident which I have related in another of these Essays. When
Dr. Holyoke, nearly seventy years ago, received young Mr. James
Jackson as his student, he showed him the formidable array of
bottles, jars, and drawers around his office, and then named the four
remedies referred to as being of more importance than all the rest
put together. These were "Mercury, Antimony, Opium, and Peruvian
Bark." I doubt if either of them remembered that, nearly seventy
years before, in 1730, Dr. William Douglass, the disputatious
Scotchman, mentioned those same four remedies, in the dedication of
his quarrelsome essay on inoculation, as the most important ones in
the hands of the physicians of his time.
In the "Proceedings" of this Society for the year 1863 is a very
pleasant paper by the late Dr. Ephraim Eliot, giving an account of
the leading physicians of Boston during the last quarter of the last
century. The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch,
Danforth, John Warren, Jeffries, are all famous in local history, and
are commemorated in our medical biographies. One of them, at least,
appears to have been more widely known, not only as one of the first
aerial voyagers, but as an explorer in the almost equally hazardous
realm of medical theory. Dr. John Jeffries, the first of that name,
is considered by Broussais as a leader of medical opinion in America,
and so referred to in his famous "Examen des Doctrines Medicales."
Two great movements took place in this eighteenth century, the effect
of which has been chiefly felt in our own time; namely, the
establishment of the Massachusetts Medical Society, and the founding
of the Medical School of Harvard University.
The third century of our medical history began with the introduction
of the second great medical discovery of modern times,--of all time
up to that date, I may say,--once more via Boston, if we count the
University village as its suburb, and once more by one of our
Massachusetts physicians. In the month of July, 1800, Dr. Benjamin
Waterhouse of Cambridge submitted four of his own children to the new
process of vaccination,--the first persons vaccinated, as Dr. Zabdiel
Boylston's son had been the first person inoculated in the New World.
A little before the first half of this century was completed, in the
autumn of 1846, the great discovery went forth from the Massachusetts
General Hospital, which repaid the debt of America to the science of
the Old World, and gave immortality to the place of its origin in the
memory and the heart of mankind. The production of temporary
insensibility at will--tuto, cito, jucunde, safely, quickly,
pleasantly--is one of those triumphs over the infirmities of our
mortal condition which change the aspect of life ever afterwards.
Rhetoric can add nothing to its glory; gratitude, and the pride
permitted to human weakness, that our Bethlehem should have been
chosen as the birthplace of this new embodiment of the divine mercy,
are all we can yet find room for.
The present century has seen the establishment of all those great
charitable institutions for the cure of diseases of the body and of
the mind, which our State and our city have a right to consider as
among the chief ornaments of their civilization.
The last century had very little to show, in our State, in the way of
medical literature. The worthies who took care of our grandfathers
and great-grandfathers, like the Revolutionary heroes, fought (with
disease) and bled (their patients) and died (in spite of their own
remedies); but their names, once familiar, are heard only at rare
intervals. Honored in their day, not unremembered by a few solitary
students of the past, their memories are going sweetly to sleep in
the arms of the patient old dry-nurse, whose "blackdrop" is the
never-failing anodyne of the restless generations of men. Except the
lively controversy on inoculation, and floating papers in journals,
we have not much of value for that long period, in the shape of
medical records.
But while the trouble with the last century is to find authors to
mention, the trouble of this would be to name all that we find. Of
these, a very few claim unquestioned preeminence.
Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical
School of our University, did a great work for the advancement of
medicine and surgery in New England, by his labors as teacher and
author, greater, it is claimed by some, than was ever done by any
other man. The two Warrens, of our time, each left a large and
permanent record of a most extended surgical practice. James Jackson
not only educated a whole generation by his lessons of wisdom, but
bequeathed some of the most valuable results of his experience to
those who came after him, in a series of letters singularly pleasant
and kindly as well as instructive. John Ware, keen and cautious,
earnest and deliberate, wrote the two remarkable essays which have
identified his name, for all time, with two important diseases, on
which he has shed new light by his original observations.
I must do violence to the modesty of the living by referring to the
many important contributions to medical science by Dr. Jacob Bigelow,
and especially to his discourse on "Self-limited Diseases," an
address which can be read in a single hour, but the influence of
which will be felt for a century.
Nor would the profession forgive me if I forgot to mention the
admirable museum of pathological anatomy, created almost entirely by
the hands of Dr. John Barnard Swett Jackson, and illustrated by his
own printed descriptive catalogue, justly spoken of by a
distinguished professor in the University of Pennsylvania as the most
important contribution which had ever been made in this country to
the branch to which it relates.
When we look at the literature of mental disease, as seen in hospital
reports and special treatises, we can mention the names of Wyman,
Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts
or placed at the head of her institutions for the treatment of the
insane.
We have a right to claim also one who is known all over the civilized
world as a philanthropist, to us as a townsman and a graduate of our
own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor
of a great multitude who were born to a world of inward or of outward
darkness.
I cannot pass over in silence the part taken by our own physicians in
those sanitary movements which are assuming every year greater
importance. Two diseases especially have attracted attention, above
all others, with reference to their causes and prevention; cholera,
the "black death" of the nineteenth century, and consumption, the
white plague of the North, both of which have been faithfully studied
and reported on by physicians of our own State and city. The
cultivation of medical and surgical specialties, which is fast
becoming prevalent, is beginning to show its effects in the
literature of the profession, which is every year growing richer in
original observations and investigations.
To these benefactors who have labored for us in their peaceful
vocation, we must add the noble army of surgeons, who went with the
soldiers who fought the battles of their country, sharing many of
their dangers, not rarely falling victims to fatigue, disease, or the
deadly volleys to which they often exposed themselves in the
discharge of their duties.
The pleasant biographies of the venerable Dr. Thacher, and the worthy
and kind-hearted gleaner, Dr. Stephen W. Williams, who came after
him, are filled with the names of men who served their generation
well, and rest from their labors, followed by the blessing of those
for whom they endured the toils and fatigues inseparable from their
calling. The hardworking, intelligent country physician more
especially deserves the gratitude of his own generation, for he
rarely leaves any permanent record in the literature of his
profession. Books are hard to obtain; hospitals, which are always
centres of intelligence, are remote; thoroughly educated and superior
men are separated by wide intervals; and long rides, though favorable
to reflection, take up much of the time which might otherwise be
given to the labors of the study. So it is that men of ability and
vast experience, like the late Dr. Twitchell, for instance, make a
great and deserved reputation, become the oracles of large districts,
and yet leave nothing, or next to nothing, by which their names shall
be preserved from blank oblivion.
One or two other facts deserve mention, as showing the readiness of
our medical community to receive and adopt any important idea or
discovery. The new science of Histology, as it is now called, was
first brought fully before the profession of this country by the
translation of Bichat's great work, "Anatomie Generale," by the late
Dr. George Hayward.
The first work printed in this country on Auscultation,--that
wonderful art of discovering disease, which, as it were, puts a
window in the breast, through which the vital organs can be seen, to
all intents and purposes, was the manual published anonymously by
"A Member of the Massachusetts Medical Society."
We are now in some slight measure prepared to weigh the record of the
medical profession in Massachusetts, and pass our judgment upon it.
But in-order to do justice to the first generation of practitioners,
we must compare what we know of their treatment of disease with the
state of the art in England, and the superstitions which they saw all
around them in other departments of knowledge or belief.
English medical literature must have been at a pretty low ebb when
Sydenham recommended Don Quixote to Sir Richard Blackmore for
professional reading. The College Pharmacopoeia was loaded with the
most absurd compound mixtures, one of the most complex of which (the
same which the Reverend Mr. Harward, "Lecturer at the Royal Chappel
in Boston," tried to simplify), was not dropped until the year 1801.
Sir Kenelm Digby was playing his fantastic tricks with the
Sympathetic powder, and teaching Governor Winthrop, the second, how
to cure fever and ague, which some may like to know. "Pare the
patient's nails; put the parings in a little bag, and hang the bag
round the neck of a live eel, and put him in a tub of water. The eel
will die, and the patient will recover."
Wiseman, the great surgeon, was discoursing eloquently on the
efficacy of the royal touch in scrofula. The founder of the
Ashmolean Museum at Oxford, consorting with alchemists and
astrologers, was treasuring the manuscripts of the late pious Dr.
Richard Napier, in which certain letters (Rx Ris) were understood to
mean Responsum Raphaelis,--the answer of the angel Raphael to the
good man's medical questions. The illustrious Robert Boyle was
making his collection of choice and safe remedies, including the sole
of an old shoe, the thigh bone of a hanged man, and things far worse
than these, as articles of his materia medica. Dr. Stafford, whose
paper of directions to his "friend, Mr. Wintrop," I cited, was
probably a man of standing in London; yet toad-powder was his
sovereign remedy.
See what was the state of belief in other matters among the most
intelligent persons of the colonies, magistrates and clergymen.
Jonathan Brewster, son of the church-elder, writes the wildest
letters to John Winthrop about alchemy,--"mad for making gold as the
Lynn rock-borers are for finding it."
Remember the theology and the diabology of the time. Mr. Cotton's
Theocracy was a royal government, with the King of kings as its
nominal head, but with an upper chamber of saints, and a tremendous
opposition in the lower house; the leader of which may have been
equalled, but cannot have been surpassed by any of our earth-born
politicians. The demons were prowling round the houses every night,
as the foxes were sneaking about the hen-roosts. The men of
Gloucester fired whole flasks of gunpowder at devils disguised as
Indians and Frenchmen.
How deeply the notion of miraculous interference with the course of
nature was rooted, is shown by the tenacity of the superstition about
earthquakes. We can hardly believe that our Professor Winthrop,
father of the old judge and the "squire," whom many of us Cambridge
people remember so well, had to defend himself against the learned
and excellent Dr. Prince, of the Old South Church, for discussing
their phenomena as if they belonged to the province of natural
science:
Not for the sake of degrading the aspect of the noble men who founded
our State, do I refer to their idle beliefs and painful delusions,
but to show against what influences the common sense of the medical
profession had to assert itself.
Think, then, of the blazing stars, that shook their horrid hair in
the sky; the phantom ship, that brought its message direct from the
other world; the story of the mouse and the snake at Watertown; of
the mice and the prayer-book; of the snake in church; of the calf
with two heads; and of the cabbage in the perfect form of a cutlash,
--all which innocent occurrences were accepted or feared as alarming
portents.
We can smile at these: but we cannot smile at the account of unhappy
Mary Dyer's malformed offspring; or of Mrs. Hutchinson's domestic
misfortune of similar character, in the story of which the physician,
Dr. John Clark of Rhode Island, alone appears to advantage; or as we
read the Rev. Samuel Willard's fifteen alarming pages about an
unfortunate young woman suffering with hysteria. Or go a little
deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia,
first admonished, then whipped; at last, taking her own little
daughter's life; put on trial, and standing mute, threatened to be
pressed to death, confessing, sentenced, praying to be beheaded; and
none the less pitilessly swung from the fatal ladder.
The cooper's crazy wife--crazy in the belief that she has committed
the unpardonable sin--tries to drown her child, to save it from
misery; and the poor lunatic, who would be tenderly cared for to-day
in a quiet asylum, is judged to be acting under the instigation of
Satan himself. Yet, after all, what can we say, who put Bunyan's
"Pilgrim's Progress," full of nightmare dreams of horror, into all
our children's hands; a story in which the awful image of the man in
the cage might well turn the nursery where it is read into a
madhouse?
The miserable delusion of witchcraft illustrates, in a still more
impressive way, the false ideas which governed the supposed relation
of men with the spiritual world. I have no doubt many physicians
shared in these superstitions. Mr. Upham says they--that is, some of
them--were in the habit of attributing their want of success to the
fact, that an "evil hand" was on their patient. The temptation was
strong, no doubt, when magistrates and ministers and all that
followed their lead were contented with such an explanation. But how
was it in Salem, according to Mr. Upham's own statement? Dr. John
Swinnerton was, he says, for many years the principal physician of
Salem. And he says, also, "The Swinnerton family were all along
opposed to Mr. Parris, and kept remarkably clear from the witchcraft
delusion." Dr. John Swinnerton--the same, by the way, whose memory
is illuminated by a ray from the genius of Hawthorne--died the very
year before the great witchcraft explosion took place. But who can
doubt that it was from him that the family had learned to despise and
to resist the base superstition; or that Bridget Bishop, whose house
he rented, as Mr. Upham tells me, the first person hanged in the time
of the delusion, would have found an efficient protector in her
tenant, had he been living, to head the opposition of his family to
the misguided clergymen and magistrates?
I cannot doubt that our early physicians brought with them many Old-
World medical superstitions, and I have no question that they were
more or less involved in the prevailing errors of the community in
which they lived. But, on the whole, their record is a clean one, so
far as we can get at it; and where it is questionable we must
remember that there must have been many little-educated persons among
them; and that all must have felt, to some extent, the influence of
those sincere and devoted but unsafe men, the physic-practising
clergymen, who often used spiritual means as a substitute for
temporal ones, who looked upon a hysteric patient as possessed by the
devil, and treated a fractured skull by prayers and plasters,
following the advice of a ruling elder in opposition to the "unanimous
opinion of seven surgeons."
To what results the union of the two professions was liable to lead,
may be seen by the example of a learned and famous person, who has
left on record the product of his labors in the double capacity of
clergyman and physician.
I have had the privilege of examining a manuscript of Cotton Mather's
relating to medicine, by the kindness of the librarian of the
American Antiquarian Society, to which society it belongs. A brief
notice of this curious document may prove not uninteresting.
It is entitled "The Angel of Bethesda: an Essay upon the Common
Maladies of Mankind, offering, first, the sentiments of Piety," etc.,
etc., and "a collection of plain but potent and Approved REMEDIES for
the Maladies." There are sixty-six "Capsula's," as he calls them, or
chapters, in his table of contents; of which, five--from the
fifteenth to the nineteenth, inclusive--are missing. This is a most
unfortunate loss, as the eighteenth capsula treated of agues, and we
could have learned from it something of their degree of frequency in
this part of New England. There is no date to the manuscript; which,
however, refers to a case observed Nov. 14, 1724.
The divine takes precedence of the physician in this extraordinary
production. He begins by preaching a sermon at his unfortunate
patient. Having thrown him into a cold sweat by his spiritual
sudorific, he attacks him with his material remedies, which are often
quite as unpalatable. The simple and cleanly practice of Sydenham,
with whose works he was acquainted, seems to have been thrown away
upon him. Everything he could find mentioned in the seventy or
eighty authors he cites, all that the old women of both sexes had
ever told him of, gets into his text, or squeezes itself into his
margin.
Evolving disease out of sin, he hates it, one would say, as he hates
its cause, and would drive it out of the body with all noisome
appliances. "Sickness is in Fact Flagellum Dei pro peccatis mundi."
So saying, he encourages the young mother whose babe is wasting away
upon her breast with these reflections:
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