Part 15

Look at Vesalius, the contemporary of Luther. Who can fail to see one common spirit in the radical ecclesiastic and the reforming court-physician? Both still to some extent under the dominion of the letter: Luther holding to the real presence; Vesalius actually causing to be drawn and engraved two muscles which he knew were not found in the human subject, because they had been described by Galen, from dissections of the lower animals. Both breaking through old traditions in the search of truth; one, knife in hand, at the risk of life and reputation, the other at the risk of fire and fagot, with that mightier weapon which all the devils could not silence, though they had been thicker than the tiles on the house-tops. How much the physician of the Catholic Charles V. had in common with the great religious destructive, may be guessed by the relish with which he tells the story how certain Pavian students exhumed the body of an “elegans scortum,” or lovely dame of ill repute, the favorite of a monk of the order of St. Anthony, who does not seem to have resisted temptation so well as the founder of his order. We have always ranked the physician Rabelais among the early reformers, but I do not know that Vesalius has ever been thanked for his hit at the morals of the religious orders, or for turning to the good of science what was intended for the “benefit of clergy.”

Our unfortunate medical brother, Michael Servetus, the spiritual patient to whom the theological moxa was applied over the entire surface for the cure of his heresy, came very near anticipating Harvey. The same quickened thought of the time which led him to dispute the dogma of the Church, opened his mind to the facts which contradicted the dogmas of the Faculty.

Harvey himself was but the posthumous child of the great Elizabethan period. Bacon was at once his teacher and his patient. The founder of the new inductive philosophy had only been dead two years when the treatise on the Circulation, the first-fruit of the Restoration of Science, was given to the world.

And is it to be looked at as a mere accidental coincidence, that while Napoleon was modernizing the political world, Bichat was revolutionizing the science of life and the art that is based upon it; that while the young general was scaling the Alps, the young surgeon was climbing the steeper summits of unexplored nature; that the same year read the announcement of those admirable “Researches on Life and Death,” and the bulletins of the battle of Marengo?

If we come to our own country, who can fail to recognize that Benjamin Rush, the most conspicuous of American physicians, was the intellectual offspring of the movement which produced the Revolution? “The same hand,” says one of his biographers, “which subscribed the declaration of the political independence of these States, accomplished their emancipation from medical systems formed in foreign countries, and wholly unsuitable to the state of diseases in America.”

Following this general course of remark, I propose to indicate in a few words the direction of the main intellectual current of the time, and to point out more particularly some of the eddies which tend to keep the science and art of medicine from moving with it, or even to carry them backwards.

The two dominant words of our time are law and average, both pointing to the uniformity of the order of being in which we live. Statistics have tabulated everything,--population, growth, wealth, crime, disease. We have shaded maps showing the geographical distribution of larceny and suicide. Analysis and classification have been at work upon all tangible and visible objects. The Positive Philosophy of Comte has only given expression to the observing and computing mind of the nineteenth century.

In the mean time, the great stronghold of intellectual conservatism, traditional belief, has been assailed by facts which would have been indicted as blasphemy but a few generations ago. Those new tables of the law, placed in the hands of the geologist by the same living God who spoke from Sinai to the Israelites of old, have remodelled the beliefs of half the civilized world. The solemn scepticism of science has replaced the sneering doubts of witty philosophers. The more positive knowledge we gain, the more we incline to question all that has been received without absolute proof.

As a matter of course, this movement has its partial reactions. The province of faith is claimed as a port free of entry to unsupported individual convictions. The tendency to question is met by the unanalyzing instinct of reverence. The old church calls back its frightened truants. Some who have lost their hereditary religious belief find a resource in the revelations of Spiritualism. By a parallel movement, some of those who have become medical infidels pass over to the mystic band of believers in the fancied miracles of Homoeopathy.

Under these influences transmitted to, or at least shared by, the medical profession, the old question between “Nature,” so called, and “Art,” or professional tradition, has reappeared with new interest. I say the old question, for Hippocrates stated the case on the side of “Nature” more than two thousand years ago. Miss Florence Nightingale,--and if I name her next to the august Father of the Healing Art, its noblest daughter well deserves that place of honor,--Miss Florence Nightingale begins her late volume with a paraphrase of his statement. But from a very early time to this there has always been a strong party against “Nature.” Themison called the practice of Hippocrates “a meditation upon death.” Dr. Rush says: “It is impossible to calculate the mischief which Hippocrates has done, by first marking Nature with his name and afterwards letting her loose upon sick people. Millions have perished by her hands in all ages and countries.” Sir John Forbes, whose defence of “Nature” in disease you all know, and to the testimonial in whose honor four of your Presidents have contributed, has been recently greeted, on retiring from the profession, with a wish that his retirement had been twenty years sooner, and the opinion that no man had done so much to destroy the confidence of the public in the medical profession.

In this Society we have had the Hippocratic and the Themisonic side fairly represented. The treatise of one of your early Presidents on the Mercurial Treatment is familiar to my older listeners. Others who have held the same office have been noted for the boldness of their practice, and even for partiality to the use of complex medication.

On the side of “Nature” we have had, first of all, that remarkable discourse on Self-Limited Diseases, [On Self-Limited Diseases. A Discourse delivered before the Massachusetts Medical Society, at their Annual Meeting, May 27, 1835. By Jacob Bigelow, M. D.] which has given the key-note to the prevailing medical tendency of this neighborhood, at least, for the quarter of a century since it was delivered. Nor have we forgotten the address delivered at Springfield twenty years later, [Search out the Secrets, of Nature. By Augustus A. Gould, M. D. Read at the Annual Meeting, June 27, 1855.] full of good sense and useful suggestions, to one of which suggestions we owe the learned, impartial, judicious, well-written Prize Essay of Dr. Worthington Hooker. [Rational Therapeutics. A Prize Essay. By Worthington Hooker, M. D., of New Haven. Boston. 1857.] We should not omit from the list the important address of another of our colleagues, [On the Treatment of Compound and Complicated Fractures. By William J. Walker, M. D. Read at the Annual Meeting, May 29, 1845.] showing by numerous cases the power of Nature in healing compound fractures to be much greater than is frequently supposed,--affording, indeed, more striking illustrations than can be obtained from the history of visceral disease, of the supreme wisdom, forethought, and adaptive dexterity of that divine Architect, as shown in repairing the shattered columns which support the living temple of the body.

We who are on the side of “Nature” please ourselves with the idea that we are in the great current in which the true intelligence of the time is moving. We believe that some who oppose, or fear, or denounce our movement are themselves caught in various eddies that set back against the truth. And we do most earnestly desire and most actively strive, that Medicine, which, it is painful to remember, has been spoken of as “the withered branch of science” at a meeting of the British Association, shall be at length brought fully to share, if not to lead, the great wave of knowledge which rolls with the tides that circle the globe.

If there is any State or city which might claim to be the American headquarters of the nature-trusting heresy, provided it be one, that State is Massachusetts, and that city is its capital. The effect which these doctrines have upon the confidence reposed in the profession is a matter of opinion. For myself, I do not believe this confidence can be impaired by any investigations which tend to limit the application of troublesome, painful, uncertain, or dangerous remedies. Nay, I will venture to say this, that if every specific were to fail utterly, if the cinchona trees all died out, and the arsenic mines were exhausted, and the sulphur regions were burned up, if every drug from the vegetable, animal, and mineral kingdom were to disappear from the market, a body of enlightened men, organized as a distinct profession, would be required just as much as now, and respected and trusted as now, whose province should be to guard against the causes of disease, to eliminate them if possible when still present, to order all the conditions of the patient so as to favor the efforts of the system to right itself, and to give those predictions of the course of disease which only experience can warrant, and which in so many cases relieve the exaggerated fears of sufferers and their friends, or warn them in season of impending danger. Great as the loss would be if certain active remedies could no longer be obtained, it would leave the medical profession the most essential part of its duties, and all, and more than all, its present share of honors; for it would be the death-blow to charlatanism, which depends for its success almost entirely on drugs, or at least on a nomenclature that suggests them.

There is no offence, then, or danger in expressing the opinion, that, after all which has been said, the community is still overdosed: The best proof of it is, that “no families take so little medicine as those of doctors, except those of apothecaries, and that old practitioners are more sparing of active medicines than younger ones.” [Dr. James Jackson has kindly permitted me to make the following extract from a letter just received by him from Sir James Clark, and dated May 26, 1860: “As a physician advances in age, he generally, I think, places less confidence in the ordinary medical treatment than he did, not only during his early, but even his middle period of life.”] The conclusion from these facts is one which the least promising of Dr. Howe's pupils in the mental department could hardly help drawing.

Part of the blame of over-medication must, I fear, rest with the profession, for yielding to the tendency to self-delusion, which seems inseparable from the practice of the art of healing. I need only touch on the common modes of misunderstanding or misapplying the evidence of nature.

First, there is the natural incapacity for sound observation, which is like a faulty ear in music. We see this in many persons who know a good deal about books, but who are not sharp-sighted enough to buy a horse or deal with human diseases.

Secondly, there is in some persons a singular inability to weigh the value of testimony; of which, I think, from a pretty careful examination of his books, Hahnemann affords the best specimen outside the walls of Bedlam.

The inveterate logical errors to which physicians have always been subject are chiefly these:

The mode of inference per enumerationem simplicem, in scholastic phrase; that is, counting only their favorable cases. This is the old trick illustrated in Lord Bacon's story of the gifts of the shipwrecked people, hung up in the temple.--Behold! they vowed these gifts to the altar, and the gods saved them. Ay, said a doubting bystander, but how many made vows of gifts and were shipwrecked notwithstanding? The numerical system is the best corrective of this and similar errors. The arguments commonly brought against its application to all matters of medical observation, treatment included, seem to apply rather to the tabulation of facts ill observed, or improperly classified, than to the method itself.

The post hoc ergo propter hoc error: he got well after taking my medicine; therefore in consequence of taking it.

The false induction from genuine facts of observation, leading to the construction of theories which are then deductively applied in the face of the results of direct observation. The school of Broussais has furnished us with a good example of this error.

And lastly, the error which Sir Thomas Browne calls giving “a reason of the golden tooth;” that is, assuming a falsehood as a fact, and giving reasons for it, commonly fanciful ones, as is constantly done by that class of incompetent observers who find their “golden tooth” in the fabulous effects of the homoeopathie materia medica,--which consists of sugar of milk and a nomenclature.

Another portion of the blame rests with the public itself, which insists on being poisoned. Somebody buys all the quack medicines that build palaces for the mushroom, say rather, the toadstool millionaires. Who is it? These people have a constituency of millions. The popular belief is all but universal that sick persons should feed on noxious substances. One of our members was called not long since to a man with a terribly sore mouth. On inquiry he found that the man had picked up a box of unknown pills, in Howard Street, and had proceeded to take them, on general principles, pills being good for people. They happened to contain mercury, and hence the trouble for which he consulted our associate.

The outside pressure, therefore, is immense upon the physician, tending to force him to active treatment of some kind. Certain old superstitions, still lingering in the mind of the public, and not yet utterly expelled from that of the profession, are at the bottom of this, or contribute to it largely. One of the most ancient is, that disease is a malignant agency, or entity, to be driven out of the body by offensive substances, as the smoke of the fish's heart and liver drove the devil out of Tobit's bridal chamber, according to the Apochrypha. Epileptics used to suck the blood from the wounds of dying gladiators. [Plinii Hist. Mundi. lib. xxviii. c. 4.] The Hon. Robert Boyle's little book was published some twenty or thirty years before our late President, Dr. Holyoke, was born. [A Collection of Choice and Safe Remedies. The Fifth Edition, corrected. London, 1712. Dr. Holyoke was born in 1728.] In it he recommends, as internal medicines, most of the substances commonly used as fertilizers of the soil. His “Album Graecum” is best left untranslated, and his “Zebethum Occidentale” is still more transcendentally unmentionable except in a strange dialect. It sounds odiously to us to hear him recommend for dysentery a powder made from “the sole of an old shoe worn by some man that walks much.” Perhaps nobody here ever heard of tying a stocking, which had been worn during the day, round the neck at night for a sore throat. The same idea of virtue in unlovely secretions! [The idea is very ancient. “Sordes hominis” “Sudore et oleo medicinam facientibus.”--Plin. xxviii. 4.]

Even now the Homoeopathists have been introducing the venom of serpents, under the learned title of Lachesis, and outraging human nature with infusions of the pediculus capitis; that is, of course, as we understand their dilutions, the names of these things; for if a fine-tooth-comb insect were drowned in Lake Superior, we cannot agree with them in thinking that every drop of its waters would be impregnated with all the pedicular virtues they so highly value. They know what they are doing. They are appealing to the detestable old superstitious presumption in favor of whatever is nauseous and noxious as being good for the sick.

Again, we all occasionally meet persons stained with nitrate of silver, given for epilepsy. Read what Dr. Martin says, about the way in which it came to be used, in his excellent address before the Norfolk County Medical Society, and the evidence I can show, but have not time for now, and then say what you think of the practice which on such presumptions turns a white man as blue as the double-tattooed King of the Cannibal Islands! [Note A.]

If medical superstitions have fought their way down through all the rationalism and scepticism of the nineteenth century, of course the theories of the schools, supported by great names, adopted into the popular belief and incorporated with the general mass of misapprehension with reference to disease, must be expected to meet us at every turn in the shape of bad practice founded on false doctrine. A French patient complains that his blood heats him, and expects his doctor to bleed him. An English or American one says he is bilious, and will not be easy without a dose of calomel. A doctor looks at a patient's tongue, sees it coated, and says the stomach is foul; his head full of the old saburral notion which the extreme inflammation-doctrine of Broussais did so much to root out, but which still leads, probably, to much needless and injurious wrong of the stomach and bowels by evacuants, when all they want is to be let alone. It is so hard to get anything out of the dead hand of medical tradition! The mortmain of theorists extinct in science clings as close as that of ecclesiastics defunct in law.

One practical hint may not be out of place here. It seems to be sometimes forgotten, by those who must know the fact, that the tongue is very different, anatomically and physiologically, from the stomach. Its condition does not in the least imply a similar one of the stomach, which is a very different structure, covered with a different kind of epithelium, and furnished with entirely different secretions. A silversmith will, for a dollar, make a small hoe, of solid silver, which will last for centuries, and will give a patient more comfort, used for the removal of the accumulated epithelium and fungous growths which constitute the “fur,” than many a prescription with a split-footed Rx before it, addressed to the parts out of reach.

I think more of this little implement on account of its agency in saving the Colony at Plymouth in the year 1623. Edward Winslow heard that Massasoit was sick and like to die. He found him with a houseful of people about him, women rubbing his arms and legs, and friends “making such a hellish noise” as they probably thought would scare away the devil of sickness. Winslow gave him some conserve, washed his mouth, scraped his tongue, which was in a horrid state, got down some drink, made him some broth, dosed him with an infusion of strawberry leaves and sassafras root, and had the satisfaction of seeing him rapidly recover. Massasoit, full of gratitude, revealed the plot which had been formed to destroy the colonists, whereupon the Governor ordered Captain Miles Standish to see to them; who thereupon, as everybody remembers, stabbed Pecksuot with his own knife, broke up the plot, saved the colony, and thus rendered Massachusetts and the Massachusetts Medical Society a possibility, as they now are a fact before us. So much for this parenthesis of the tongue-scraper, which helped to save the young colony from a much more serious scrape, and may save the Union yet, if a Presidential candidate should happen to be taken sick as Massasoit was, and his tongue wanted cleaning,--which process would not hurt a good many politicians, with or without a typhoid fever.

Again, see how the “bilious” theory works in every-day life here and now, illustrated by a case from actual life. A youthful practitioner, whose last molars have not been a great while cut, meets an experienced and noted physician in consultation. This is the case. A slender, lymphatic young woman is suckling two lusty twins, the intervals of suction being occupied on her part with palpitations, headaches, giddiness, throbbing in the head, and various nervous symptoms, her cheeks meantime getting bloodless, and her strength running away in company with her milk. The old experienced physician, seeing the yellowish waxy look which is common in anaemic patients, considers it a “bilious” case, and is for giving a rousing emetic. Of course, he has to be wheedled out of this, a recipe is written for beefsteaks and porter, the twins are ignominiously expelled from the anaemic bosom, and forced to take prematurely to the bottle, and this prolific mother is saved for future usefulness in the line of maternity.

The practice of making a profit on the medicine ordered has been held up to reprobation by one at least of the orators who have preceded me. That the effect of this has been ruinous in English practice I cannot doubt, and that in this country the standard of practice was in former generations lowered through the same agency is not unlikely. I have seen an old account-book in which the physician charged an extra price for gilding his rich patients' pills. If all medicine were very costly, and the expense of it always came out of the physician's fee, it would really be a less objectionable arrangement than this other most pernicious one. He would naturally think twice before he gave an emetic or cathartic which evacuated his own pocket, and be sparing of the cholagogues that emptied the biliary ducts of his own wallet, unless he were sure they were needed. If there is any temptation, it should not be in favor of giving noxious agents, as it clearly must be in the case of English druggists and “General Practitioners.” The complaint against the other course is a very old one. Pliny, inspired with as truly Roman horror of quackery as the elder Cato,--who declared that the Greek doctors had sworn to exterminate all barbarians, including the Romans, with their drugs, but is said to have physicked his own wife to death, notwithstanding,--Pliny says, in so many words, that the cerates and cataplasms, plasters, collyria, and antidotes, so abundant in his time, as in more recent days, were mere tricks to make money.

A pretty strong eddy, then, or rather many eddies, setting constantly back from the current of sober observation of nature, in the direction of old superstitions and fancies, of exploded theories, of old ways of making money, which are very slow to pass out of fashion.