Chapter 33
It was something to have unlearned the pernicious habit of constantly giving poisons to a patient, as if they were good in themselves, of drawing off the blood which he would want in his struggle with disease, of making him sore and wretched with needless blisters, of turning his stomach with unnecessary nauseous draught and mixtures,--only because he was sick and something must be done. But there were positive as well as negative facts to be learned, and some of us, I fear, came home rich in the negatives of the expectant practice, poor in the resources which many a plain country practitioner had ready in abundance for the relief and the cure of disease. No one instructor can be expected to do all for a student which he requires. Louis taught us who followed him the love of truth, the habit of passionless listening to the teachings of nature, the most careful and searching methods of observation, and the sure means of getting at the results to be obtained from them in the constant employment of accurate tabulation. He was not a showy, or eloquent, or, I should say, a very generally popular man, though the favorite, almost the idol, of many students, especially Genevese and Bostonians. But he was a man of lofty and admirable scientific character, and his work will endure in its influences long after his name is lost sight of save to the faded eyes of the student of medical literature.
Many other names of men more or less famous in their day, and who were teaching while I was in Paris, come up before me. They are but empty sounds for the most part in the ears of persons of not more than middle age. Who of you knows anything of Richerand, author of a very popular work on Physiology, commonly put into the student's hands when I first began to ask for medical text-books? I heard him lecture once, and have had his image with me ever since as that of an old, worn-out man,--a venerable but dilapidated relic of an effete antiquity. To verify this impression I have just looked out the dates of his birth and death, and find that he was eighteen years younger than the speaker who is now addressing you. There is a terrible parallax between the period before thirty and that after threescore and ten, as two men of those ages look, one with naked eyes, one through his spectacles, at the man of fifty and thereabout. Magendie, I doubt not you have all heard of. I attended but one of his lectures. I question if one here, unless some contemporary of my own has strayed into the amphitheatre,--knows anything about Marjolin. I remember two things about his lectures on surgery, the deep tones of his voice as he referred to his oracle,--the earlier writer, Jean Louis Petit,--and his formidable snuffbox. What he taught me lies far down, I doubt not, among the roots of my knowledge, but it does not flower out in any noticeable blossoms, or offer me any very obvious fruits. Where now is the fame of Bouillaud, Professor and Deputy, the Sangrado of his time? Where is the renown of Piorry, percussionist and poet, expert alike in the resonances of the thoracic cavity and those of the rhyming vocabulary?--I think life has not yet done with the vivacious Ricord, whom I remember calling the Voltaire of pelvic literature,--a sceptic as to the morality of the race in general, who would have submitted Diana to treatment with his mineral specifics, and ordered a course of blue pills for the vestal virgins.
Ricord was born at the beginning of the century, and Piorry some years earlier. Cruveilhier, who died in 1874, is still remembered by his great work on pathological anatomy; his work on descriptive anatomy has some things which I look in vain for elsewhere. But where is Civiale,--where are Orfila, Gendrin, Rostan, Biett, Alibert,--jolly old Baron Alibert, whom I remember so well in his broad-brimmed hat, worn a little jauntily on one side, calling out to the students in the court-yard of the Hospital St. Louis, “Enfans de la methode naturelle, etes-vous tous ici?” “Children of the natural method [his own method of classification of skin diseases,] are you all here?” All here, then, perhaps; all where, now?
My show of ghosts is over. It is always the same story that old men tell to younger ones, some few of whom will in their turn repeat the tale, only with altered names, to their children's children.
Like phantoms painted on the magic slide, Forth from the darkness of the past we glide, As living shadows for a moment seen In airy pageant on the eternal screen, Traced by a ray from one unchanging flame, Then seek the dust and stillness whence we came.
Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden, where he had written his Latin graduating thesis, talking of the learned Gaubius and the late illustrious Boerhaave and other dead Dutchmen, of whom you know as much, most of you, as you do of Noah's apothecary and the family physician of Methuselah, whose prescriptions seem to have been lost to posterity. Dr. Lloyd came back to Boston full of the teachings of Cheselden and Sharpe, William Hunter, Smellie, and Warner; Dr. James Jackson loved to tell of Mr. Cline and to talk of Mr. John Hunter; Dr. Reynolds would give you his recollections of Sir Astley Cooper and Mr. Abernethy; I have named the famous Frenchmen of my student days; Leyden, Edinburgh, London, Paris, were each in turn the Mecca of medical students, just as at the present day Vienna and Berlin are the centres where our young men crowd for instruction. These also must sooner or later yield their precedence and pass the torch they hold to other hands. Where shall it next flame at the head of the long procession? Shall it find its old place on the shores of the Gulf of Salerno, or shall it mingle its rays with the northern aurora up among the fiords of Norway,--or shall it be borne across the Atlantic and reach the banks of the Charles, where Agassiz and Wyman have taught, where Hagen still teaches, glowing like his own Lampyris splendidula, with enthusiasm, where the first of American botanists and the ablest of American surgeons are still counted in the roll of honor of our great University?
Let me add a few words which shall not be other than cheerful, as I bid farewell to this edifice which I have known so long. I am grateful to the roof which has sheltered me, to the floors which have sustained me, though I have thought it safest always to abstain from anything like eloquence, lest a burst of too emphatic applause might land my class and myself in the cellar of the collapsing structure, and bury us in the fate of Korah, Dathan, and Abiram. I have helped to wear these stairs into hollows,--stairs which I trod when they were smooth and level, fresh from the plane. There are just thirty-two of them, as there were five and thirty years ago, but they are steeper and harder to climb, it seems to me, than they were then. I remember that in the early youth of this building, the late Dr. John K. Mitchell, father of our famous Dr. Weir Mitchell, said to me as we came out of the Demonstrator's room, that some day or other a whole class would go heels over head down this graded precipice, like the herd told of in Scripture story. This has never happened as yet; I trust it never will. I have never been proud of the apartment beneath the seats, in which my preparations for lecture were made. But I chose it because I could have it to myself, and I resign it, with a wish that it were more worthy of regret, into the hands of my successor, with my parting benediction. Within its twilight precincts I have often prayed for light, like Ajax, for the daylight found scanty entrance, and the gaslight never illuminated its dark recesses. May it prove to him who comes after me like the cave of the Sibyl, out of the gloomy depths of which came the oracles which shone with the rays of truth and wisdom!
This temple of learning is not surrounded by the mansions of the great and the wealthy. No stately avenues lead up to its facades and porticoes. I have sometimes felt, when convoying a distinguished stranger through its precincts to its door, that he might question whether star-eyed Science had not missed her way when she found herself in this not too attractive locality. I cannot regret that we--you, I should say--are soon to migrate to a more favored region, and carry on your work as teachers and as learners in ampler halls and under far more favorable conditions.
I hope that I may have the privilege of meeting you there, possibly may be allowed to add my words of welcome to those of my former colleagues, and in that pleasing anticipation I bid good-by to this scene of my long labors, and, for the present at least, to the friends with whom I have been associated.
APPENDUM
NOTES TO THE ADDRESS ON CURRENTS AND COUNTER CURRENTS IN MEDICAL SCIENCE.
Some passages contained in the original manuscript of the Address, and omitted in the delivery on account of its length, are restored in the text or incorporated with these Notes.
NOTE A.--
There is good reason to doubt whether the nitrate of silver has any real efficacy in epilepsy. It has seemed to cure many cases, but epilepsy is a very uncertain disease, and there is hardly anything which has not been supposed to cure it. Dr. Copland cites many authorities in its favor, most especially Lombard's cases. But De la Berge and Monneret (Comp. de Med. Paris), 1839, analyze these same cases, eleven in number, and can only draw the inference of a very questionable value in the supposed remedy. Dr. James Jackson says that relief of epilepsy is not to be attained by any medicine with which he is acquainted, but by diet. (Letters to a Young Physician, p. 67.) Guy Patin, Dean of the Faculty of Paris, Professor at the Royal College, Author of the Antimonial Martyrology, a wit and a man of sense and learning, who died almost two hundred years ago, had come to the same conclusion, though the chemists of his time boasted of their remedies. “Did, you ever see a case of epilepsy cured by nitrate of silver?” I said to one of the oldest and most experienced surgeons in this country. “Never,” was his instant reply. Dr. Twitchell's experience was very similar. How, then, did nitrate of silver come to be given for epilepsy? Because, as Dr. Martin has so well reminded us, lunatics were considered formerly to be under the special influence of Luna, the moon (which Esquirol, be it observed, utterly denies), and lunar caustic, or nitrate of silver, is a salt of that metal which was called luna from its whiteness, and of course must be in the closest relations with the moon. It follows beyond all reasonable question that the moon's metal, silver, and its preparations, must be the specific remedy for moonblasted maniacs and epileptics!
Yet the practitioner who prescribes the nitrate of silver supposes he is guided by the solemn experience of the past, instead of by its idle fancies. He laughs at those old physicians who placed such confidence in the right hind hoof of an elk as a remedy for the same disease, and leaves the record of his own belief in a treatment quite as fanciful and far more objectionable, written in indelible ink upon a living tablet where he who runs may read it for a whole generation, if nature spares his walking advertisement so long.
NOTE B.--
The presumption that a man is innocent until he is proved guilty, does not mean that there are no rogues, but lays the onus probandi on the party to which it properly belongs. So with this proposition. A noxious agent should never be employed in sickness unless there is ample evidence in the particular case to overcome the general presumption against all such agents, and the evidence is very apt to be defective.
The miserable delusion of Homoeopathy builds itself upon an axiom directly the opposite of this; namely, that the sick are to be cured by poisons. Similia similibus curantur means exactly this. It is simply a theory of universal poisoning, nullified in practice by the infinitesimal contrivance. The only way to kill it and all similar fancies, and to throw every quack nostrum into discredit, is to root out completely the suckers of the old rotten superstition that whatever is odious or noxious is likely to be good for disease. The current of sound practice with ourselves is, I believe, setting fast in the direction I have indicated in the above proposition. To uphold the exhibition of noxious agents in disease, as the rule, instead of admitting them cautiously and reluctantly as the exception, is, as I think, an eddy of opinion in the direction of the barbarism out of which we believe our art is escaping. It is only through the enlightened sentiment and action of the Medical Profession that the community can be brought to acknowledge that drugs should always be regarded as evils.
It is true that some suppose, and our scientific and thoughtful associate, Dr. Gould, has half countenanced the opinion, that there may yet be discovered a specific for every disease. Let us not despair of the future, but let us be moderate in our expectations. When an oil is discovered that will make a bad watch keep good time; when a recipe is given which will turn an acephalous foetus into a promising child; when a man can enter the second time into his mother's womb and give her back the infirmities which twenty generations have stirred into her blood, and infused into his own through hers, we may be prepared to enlarge the National Pharmacopoeia with a list of specifies for everything but old age,--and possibly for that also.
NOTE C.--
The term specific is used here in its ordinary sense, without raising the question of the propriety of its application to these or other remedies.
The credit of introducing Cinchona rests between the Jesuits, the Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor, who employed it as a secret remedy. (Pereira.) Mercury as an internal specific remedy was brought into use by that impudent and presumptuous quack, as he was considered, Paracelsus. (Encyc. Brit. art. “Paracelsus.”) Arsenic was introduced into England as a remedy for intermittents by Dr. Fowler, in consequence of the success of a patent medicine, the Tasteless Ague Drops, which were supposed, “probably with reason,” to be a preparation of that mineral. (Rees's Cyc. art. “Arsenic.”) Colchicum came into notice in a similar way, from the success of the Eau Medicinale of M. Husson, a French military officer. (Pereira.) Iodine was discovered by a saltpetre manufacturer, but applied by a physician in place of the old remedy, burnt sponge, which seems to owe its efficacy to it. (Dunglison, New Remedies.) As for Sulphur, “the common people have long used it as an ointment” for scabies. (Rees's Cyc. art. “Scabies.”) The modern cantiscorbutic regimen is credited to Captain Cook. “To his sagacity we are indebted for the first impulse to those regulations by which scorbutus is so successfully prevented in our navy.” (Lond. Cyc. Prac. Med. art. “Scorbutus.”) Iron and various salts which enter into the normal composition of the human body do not belong to the materia medica by our definition, but to the materia alimentaria.
For the first introduction of iron as a remedy, see Pereira, who gives a very curious old story.
The statement in the text concerning a portion of the materia medica stands exactly as delivered, and is meant exactly as it stands. No denunciation of drugs, as sparingly employed by a wise physician, was or is intended. If, however, as Dr. Gould stated in his “valuable and practical discourse” to which the Massachusetts Medical Society “listened with profit as well as interest,” “Drugs, in themselves considered, may always be regarded as evils,”--any one who chooses may question whether the evils from their abuse are, on the whole, greater or less than the undoubted benefits obtained from their proper use. The large exception of opium, wine, specifics, and anaesthetics, made in the text, takes off enough from the useful side, as I fully believe, to turn the balance; so that a vessel containing none of these, but loaded with antimony, strychnine, acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus diaboli, tormentilla, and other approved, and, in skilful hands, really useful remedies, brings, on the whole, more harm than good to the port it enters.
It is a very narrow and unjust view of the practice of medicine, to suppose it to consist altogether in the use of powerful drugs, or of drugs of any kind. Far from it. “The physician may do very much for the welfare of the sick, more than others can do, although he does not, even in the major part of cases, undertake to control and overcome the disease by art. It was with these views that I never reported any patient cured at our hospital. Those who recovered their health were reported as well; not implying that they were made so by the active treatment they had received there. But it was to be understood that all patients received in that house were to be cured, that is, taken care of.” (Letters to a Young Physician, by James Jackson, M. D., Boston, 1855.)
“Hygienic rules, properly enforced, fresh air, change of air, travel, attention to diet, good and appropriate food judiciously regulated, together with the administration of our tonics, porter, ale, wine, iron, etc., supply the diseased or impoverished system with what Mr. Gull, of St. Bartholomew's Hospital, aptly calls the 'raw material of the blood;' and we believe that if any real improvement has taken place in medical practice, independently of those truly valuable contributions we have before described, it is in the substitution of tonics, stimulants, and general management, for drastic cathartics, for bleeding, depressing agents, including mercury, tartar emetics, etc., so much in vogue during the early part even of this century.” (F. P. Porcher, in Charleston Med. Journal and Review for January, 1860.)
End of Project Gutenberg's Medical Essays, by Oliver Wendell Holmes, Sr.