Part 59

Let us hope that the mischievous distinction between surgery and medicine may soon become an obsolete prejudice, that was never founded upon reason, but simply based upon ambitious lucre. Let us hope that the graduate of an university will not conceive it beneath his dignity to save a fellow-creature's life by breathing a vein, and not esteem a vain and pompous piece of parchment an immunity from humane feelings and philanthropic duties.

As good often results from apparent evil, the converse must also be frequently admitted. That much evil has occurred from errors in medical doctrine is unfortunately but too true, yet this evil has never attained the extent which is generally supposed. I have already alluded to the curative powers of nature, ever tending, while still enjoying a portion even of their energies, to repel obnoxious agents--this power has saved the lives of many; and indeed, when we daily witness the excesses committed by the sensualist and the drunkard with apparent impunity, although exposed to destructive agencies more powerful than the generality of medicinal substances, we must come to the conclusion that the kitchen and the cellar are, at least, as formidable as the officinal preparations of the pharmacopolist.

That the physician, guided by experience and sound observation, is able, in very many cases to afford relief, must even be admitted by the most hostile depreciator of his science, who refuses to admit that he possesses the power of curing. This simple admission of daily facts, must entitle him to some degree of weight in our confidence, whatever may be our sceptical view of his doctrines.

While the real merits of a physician are so frequently overlooked, we constantly see a blind confidence reposed in a quack. The cause is obvious. A man of real merit seldom extols his own good qualities, nor does he seek the fulsome adulation and praise of others. He rests upon his own deserts; but how seldom are they rewarded: when modesty places her light "under a bushel" who will bring it into view?

Duclos has explained in some measure this apparent anomaly.--"The desire," he says "to obtain a high stand in the estimation of society, has given rise to reputation, celebrity, and renown,--the mainsprings of worldly action--arising from a similar principle, but showing different means and results. Both reputation and renown may be enjoyed at the same time and yet be widely different. The public is not unfrequently surprised at the reputations that it had itself created. It seeks to inquire into their origin, but not being able to discover a merit which never did exist, it gradually admires and respects a phantom of its own evocation. As society thus bestows a reputation in a capricious manner, quacks will usurp one by their intrigues or by a barefaced impudence, which cannot claim the comparatively honourable denomination of proper pride and dignity. They themselves proclaim their merit to the world--at first their impertinence becomes a subject of derision, but they repeat the assertion of their superior skill so frequently and confidently, that they end by imposing themselves upon society. People forget where, whence, and from whom they heard these flattering eulogies, to which at last they yield their credence, and an adventurer who thus resolves to establish a reputation, with perseverance and impudence seldom fails."

It must also be remembered, that most medical men owe their success to woman's all-powerful aid. They are in general as blind and as pertinacious in their partialities as in their dislikes; seldom bestowing much judgment in either, but acting according to the impulses of their warm passions and flexibility. Females, from their situation in the world, stand in constant need of a friendly adviser, although they are rarely disposed to follow any advice, if their pleasures are marred by the suggestion, but when art and opportunity enable a man to turn their flexibility, their _impressionability_ to a good account, with the combined aid of vanity and weak nerves, he will in all probability succeed in obtaining a high estimation in the mind of a loquacious dame, who will blazon his fame far and near like the trumpeter of a mountebank. If this lady moves in an elevated and influencial sphere of life, to question her recommendation is to question her sense and power, both of which would be bold attempts; and thus have we seen an intriguing noble dame forcing a physician even upon royalty. Moreover, when we recollect that the wealthy send for a physician for every trifling real or supposed indisposition, which fashion or expediency may aggravate at will, to excite interest or carry a desirable point, it is manifest that the _cures_ of such a practitioner must be most numerous, since the attainment of any desire constitutes a _panacea_; and frequently we have seen a box at the opera, a check on a banker, a new carriage, or a diamond necklace, more efficacious than the most renowned nostrum, while the expulsion of an unpleasant plain-spoken acquaintance, or the kind reception of a dangerous and treacherous inmate, may produce more sudden recoveries than the most approved specific. The great science of such practitioners is to practise with equal success upon every branch of the family, to whom in return for their confidence, they can ensure peace and pleasure if they cannot bestow health. I cannot better conclude this article than by quoting the following passage of the sceptic Voltaire:

It is true that regimen is preferable to physic. It is also true that for a long period of time, out of one hundred physicians were twenty-eight quacks, and it is also true, that Molière had very good reason to turn them into ridicule. It is also certain that nothing can be more absurd than to behold a crowd of silly women, and men, not less feminine in their habits, whenever they are satiated with eating, drinking, gambling, and late hours, calling in a physician for every trifling headache; consulting him as though he were a divinity, and praying for the miraculous gift of combined health and intemperance. It is nevertheless true, that a good physician in a hundred cases may preserve life and limb. A man falls down in an apoplectic fit, it will neither be a captain of infantry or a privy councillor that will relieve him. A cataract obscures my vision; my neighbouring gossips will not restore my sight; for here I make no distinction between the physician and the surgeon. For a long time the two professions have been inseparable. Men who would make it their study to restore health to their fellow-creatures on the sole grounds of humanity and benevolence, should be considered greater than the greatest man upon earth, and bordering upon divine attributes, for preservation and restoration stand next in rank to creation. The Romans were for upwards of five hundred years without physicians. Their people, continually employed in killing, thought but little of the preservation of life; what did they do when they were attacked with a putrid fever, a fistula, a hernia, or a pleurisy?--_They died._

MEDICINE OF THE CHINESE.

This singular people possess works on medical science which they trace as far back as three thousand years, and chiefly written by two of their emperors, _Chin-nong_ and _Hoang-ti_. It has been asserted that they received the early elements of the science from the Egyptians, but it is more probable that they derived their information from their constant intercourse with the Bactrians, whose arts and sciences were flourishing at the period of Alexander's conquests, and the Chinese historians in support of this probability, state that several learned physicians came from Samarcand to establish themselves amongst them. Moreover, the doctrines of Erasistratus bear much resemblance to those of the Chinese.

The superstitious regard shown to the bodies of the departed, must naturally have materially retarded the progress of anatomical pursuits, although this people assure us that 2706 years before our era they possessed a work on this subject, entitled _Nim Kin_. Howbeit it seems probable, from their extreme ignorance of the structure of the human body, that this important branch of the science of medicine has remained stationary ever since the publication of the aforesaid treatise.

The Chinese physicians divide the body into a right and left portion, and three regions. The upper one, comprising the head and the chest, a middle one, extending from the lower part of the thorax to the umbilicus, and an inferior region, comprising the hypogaster and lower extremities. They admit twelve viscera as the sources of life, but they do not appear to have any distinct notion of the division, uses and conformation of the muscles, nerves, vessels, and the various tissues of the human economy. Their ignorance equally extends to the construction of animals.

They consider that man is influenced by two principles, heat and humidity, the harmony of which constitutes life, which ceases when their equilibrious state is destroyed. Vital moisture resides in the heart, lungs, liver, spleen, and kidneys, while vital heat pervades the intestines, the stomach, the pericardium, the gall-bladder and the ureters. These two principles are transmitted through the medium of the vital spirits and the blood by twelve canals, one of which carries a fecundating moisture from the head to the hands; another from the liver to the feet; a third from the kidneys to the left side of the body; and a fourth from the lungs to the right division.

In addition to these channels of vital transmission, they imagine that the state of our internal organs can be ascertained by the appearance of various parts of the head, which they consider as indicative sympathies of the action of the internal viscera. For instance, the head corresponds with the tongue, the lungs with the nostrils, the spleen with the mouth, the kidneys influence the ear, the liver acts upon the eyes, and thus they consider that they can form a correct idea of the nature of internal maladies by the complexion, the state of the eyes, the sound of the voice, the taste, and the smell of the patient.

The Chinese physiologists also consider the human body as a harmonic instrument, of which the muscles, tendons, nerves, arteries, &c. are vibrating chords, producing various sounds and modulations, and the pulse their chief guide in ascertaining the nature of disease, is but the result of a modification of these sounds as the chords are more or less extended or relaxed.

In addition to these singular views of the human economy, they imagine that the body is influenced by five elementary agents, earth, minerals, water, air, and fire.

Fire prevails in the heart and the thoracic viscera, which bear an astronomic relation with the south.

The liver and the gall-bladder are under the influence of air, which is in relation with the east, whence the winds arise, and it is towards spring that these organs are generally affected.

The kidneys and ureters are ruled by water, astronomically associated with the north--hence winter is the usual season of the maladies in these parts.

The stomach and spleen are regulated by earth, and are placed in connexion with the centre of the firmament, between the five cardinal points, and affections of these parts are observed in the third month of each quarter.

Diseases are distinguished by their vicinity to or their distance from the central part of the body, the heart and lungs, and are usually occasioned by vicissitudes in the atmospheric constitution--varying with cold, heat, and moisture.

The minuteness of their division of maladies is as great as the mechanical precision which all their labours exhibit: for instance, they admit no less than forty-two varieties of the smallpox; according to the shape, colour, situation of the pustules, which they compare to the cocoons of the silkworm--to strings of beads--chaplets of pearls--and lay equal stress on their being flat or round--black, red, or violet. This disease has, indeed, been described by them with much accuracy and judgment, as regards its benign or its confluent character; and there is no doubt that inoculation was practised among them from time immemorial, as I have already shown in the article on that head. Equally accurate have they been in detailing the various symptoms of gout, scurvy, elephantiasis, and syphilis, which also scourges the "Celestial empire."

The chief guide, however, in their diagnosis and prognosis, is the state of the pulse, and a very curious work, called "The Secrets of the Pulse," and said to have been written two centuries before our era, by _Ouang-chou-hó_ or _Vam-xo-ho_. The pulse is divided into the external, the middle, and the deep--producing _nine_ different pulsations called _Heon_, and the arterial beats were formerly sought for in the joint of the big toe; this custom is now abandoned, but they still follow the strange practice of taking up the right wrist in women and the left in men.

The external pulse, called _Piao_, is subdivided into several varieties.

1. The superficial P. in _Féou_, which yields to the slightest pressure.

2. The hollow P. _Kong_, which announces that the artery is empty when pressed upon.

3. The slippery P. _Hang_, which slides under the fingers, like the beads of a necklace.

4. The full P. _Ché_, striking against the fingers with a full caliber of blood.

5. The tremulous P. _Hien_, vibrating like the chord of a musical instrument.

6. The intermittent P. _Kin_, vibrating by starts, like the instrument called _Kin_.

7. The regurgitating P. _Hong_, the strong pulsation of a full and distended vessel.

These seven characters are considered much more favourable than the eight which follow, and which, arising from a deeper action, require a more forcible pressure.

1. The deep P. _Tehin_, only discovered by a firm pressure.

2. The filiform P. _Ouei_, a threadlike pulsation.

3. The moderate P. _Ouan_, slow and languid.

4. The sharp P. _Soe_, producing the sensation of a cutting or sawing instrument.

5. The slow P. _Tehis_, when the pulsations follow each other with languid intervals.

6. The sinking P. _Fou_, when the pulse, although pressed hard, sinks under the finger.

7. The soft P. _Sin_, which feels like a drop of water one might press upon.

8. The weak P. _Yo_, which yields the sensation of feeling like a worn-out texture, and ceases to be observed when pressed upon for any time.

To these are added nine other varieties, called _Tao_.

1. The long P. _Tehang_, full, smooth--feeling like a full tube.

2. The short P. _Toan_, presenting a pointed surface, that seems indivisible.

3. The empty P. _Hin_, insensible under moderate pressure.

4. The tight P. _Tsou_, which the finger feels with difficulty.

5. The embarrassed P. _Kié_, languid and occasionally stopping.

6. The intermittent P. _Tai_, when several pulsations appear to be missing.

7. The slender P. _Sié_, so slow and weak, that it feels like a hair.

8. The moving P. _Tong_, that one might compare to stones under water.

9. The tense P. _Ké_, feeling like a distended drum-head.

But as many Chinese doctors were not satisfied with this confusion in the classification of pulses, and, like practitioners in other countries, sought to render darkness still more visible--they sought to strike out a new career by increasing the multiplication, and introduced the following _addenda_:

1. The strong pulse, _Ta_, filling the vessel, yet yielding to pressure.

2. The precipitate P. _Son_, in which the pulsation was rapid in succession.

3. The scattered P. _San_, soft, slow, and non-resisting.

4. The stray P. _Li-king_, strong--not pulsating three times in each inspiration.

5. The firm P. _Tun_, consistent and resisting.

6. The lively P. _Ki_, pulsation rapid in succession.

7. The skipping P. _Teng_, pulsation unequal, sudden, and frequent.

In this minute attention to the many variations of the pulses, the Chinese aided their study, by attending to age, sex, stature, constitution, the seasons, the passions, and the comparative state of health and disease.

In a person of high stature, the pulse was full--concentrated in diminished individuals--deep and embarrassed in fat subjects--long and superficial in the meager--soft in the phlegmatic temperament--tremulous in the lively and the active--slower in man than in woman, excepting when threatened with disease--full and firm in the adult--slow and feeble in old age--soft and vivacious in infancy.

The rhythm of the pulse was affected by the passions, though chiefly in a transient manner:--moderately slow, in joy--short, in grief--deep, under the impression of fear--precipitate and regurgitating, in anger. In the spring, they maintained that the pulsation was tremulous--replete, in summer--spare and superficial, in autumn--dry and deep, in winter. Much mysterious ceremony was observed by the Chinese physicians in this investigation; they felt the pulse with four fingers, which they alternately raised or dropped on the vessel, as if playing on a musical instrument.

In this profound study, they attributed to every disease a peculiar state of the pulse by which it could be recognised and ascertained, and at the same time it enabled them to form a favourable or unfavourable prognostic. Some of these rules are curious. If the pulses stop before fifty pulsations have been counted, disease is at hand; when an interruption in the course of the circulation takes place after forty pulsations, the patient has not more than four years to live; when an interruption takes place after the third pulsation, three or four days are the probable term of existence; but the patient may linger on for six or seven days more, when the interruption only succeeds the fourth pulsation.

Idle as these speculations may appear, it is to be feared that while the Chinese paid such minute attention to the state of the circulation, more distinguished and learned schools do not consider this powerful indication of the strength or weakness of the vital functions with sufficient care and discrimination, and perhaps a translation of the works of _Ouang-chou-ho_, might not be altogether useless in the present enlightened age. I have no hesitation in saying that this important investigation is sadly neglected in medical education--so much so indeed, that the different appellations given to the varied state of the pulse, are neither well defined nor generally understood. The French physician Bordeu has given much valuable information on this subject, which occupied the ancients as much as it seems to have fixed the attention of the Chinese. We find that the Indians, in the time of Alexander, accurately studied this important point.

Notwithstanding the assertion of Sprengel, Hippocrates was a most attentive observer of the state of the pulse. Thus we find him giving the name of [Greek: sphygmos] to that violent and spasmodic beating of the artery, which was not only sensible to the touch, but evident to the bystander's eye--in more than forty passages of his immortal works do we find important references to the pulse, which he also declared could enable us to detect the secret workings of the passions. Many were the ancient physicians who have minutely entered into these investigations, amongst them we may name Herophilus, Erasistratus, Zeno, Alexander Philalethes, Heraclides of Erythræ, Heraclides of Tarentum, Aristoxenes. Several of the doctrines founded on these observations were most absurd, attributing the various conditions of the circulation to the _Pneuma_ of the heart and arteries; such were the doctrines of Asclepiades, Agathinus, Galen, and many others; and amongst the Arabians we find _Thabeth Ebn Ibrahim_ asserting that by the state of the pulse he could ascertain what articles of food had been taken--in more modern times Baillou, Wierns, Boerhaave, Hoffmann, have sedulously applied themselves to this most essential study, and Schelhammenn asserts that the pulse never once deceived him.

The effect of our passions on the circulation is much more powerful than is generally believed, and they are a more fertile source of our maladies than is commonly apprehended. We can readily conceive why the Spartan Chilo died through excess of joy whilst embracing his victorious son.[53]

In the treatment of disease, the Chinese, so fond of classification, divide the medicinal substances they employ into heating, cooling, refreshing, and temperate; their _materia medica_ is contained in the work called the _Pen-tsaocang-mou_ in fifty-two large volumes, with an atlas of plates; most of our medicines are known to them and prescribed; the mineral waters, with which their country abounds, are also much resorted to; and their emperor, _Kang-Hi_, has given an accurate account of several thermal springs. Fire is a great agent, and the _moxa_ recommended in almost every ailment, while acupuncture is in general use both in China and Japan; bathing and _champooing_ are also frequently recommended, but blood-letting is seldom resorted to.

China has also her animal magnetizers, practising the _Coug fou_, a mysterious manipulation taught by the bonzes, in which the adepts produce violent convulsions.

The Chinese divide their prescriptions into seven categories.

1. The great prescription.

2. The little prescription.

3. The slow prescription.

4. The prompt prescription.

5. The odd prescription.

6. The even prescription.

7. The double prescription.

Each of these receipts being applied to particular cases, and the ingredients that compose them being weighed with the most scrupulous accuracy.

Medicine was taught in the imperial colleges of Pekin; but in every district, a physician, who had studied six years, is appointed to instruct the candidate for the profession, who was afterwards allowed to practise, without any further studies or examination; and it is said, that, in general, the physician only receives his fee when the patient is cured. This assertion, however, is very doubtful, as the country abounds in quacks, who, under such restrictions as to remuneration, would scarcely earn a livelihood. Another singular, but economical practice prevails amongst them--a physician never pays a second visit to a patient unless he is sent for. Whatever may be the merits of Chinese practitioners both in medicine and surgery, or their mode of receiving remuneration, it appears that they are as much subject to animadversion as in other countries:--a missionary having observed to a Chinese, that their medical men had constantly recourse to fire in the shape of moxa, redhot iron, and burning needles; he replied, "Alas! you Europeans are carved with steel, while we are martyrized with hot iron; and I fear that in neither country will the fashion subside, since the operators do not feel the anguish they inflict, and are equally paid to torment us or to cure us!"

EXPERIMENTS ON LIVING ANIMALS.

However ungrateful the discussion of this subject may be, since, in truth and justice, it must be considered with an unbiassed and unprejudiced mind, and elicit observations which may prove offensive to many, and absurd to some, it is one of such moment on the score of humanity, that I undertake the task without hesitation or reluctance.