Brief Expositions of Rational Medicine Bigelow 1858

8/13/2019 Brief Expositions of Rational Medicine Bigelow 1858

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ILIBRARY OF CONGRESSJ# -. : #f [SMITHSONIAN DEPOSIT.] i

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UNITED STATES OF AMERICA.^


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EXPOSITIONSNATIONAL MEDICIA^E


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BRIEF EXPOSITIONS

RATIONAL MEDICINETO WHICl

JACOB BIGELOW, M. D.,

BOSTON:PHILLIPS, SAMPSON AND COMPANY,

13 Winter Steeet.1858.


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Entered according to Act of Congress, in the year 1858, byPHILLIPS, SAMPSON & CO.,

In the Clerk's Office of the District Court of the District of Massachusetts

stereotyped byHOBART & ROBBINS,New England Type and Stereotype Foundery^


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CONTENTS.PAGE

Dedication, 3The Paradise of Doctors ; A Fable, . . . 7Bribe Expositions of Rational Medicike, . . 23Appendix, 61


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TO Sm JOHN FORBES, M.D., F.R.S.,FELLOW OF THE EOTAL COLLEGE OF PHYSICIANS, LONDON,

PHTSICLiN OF THE QUEEN'S HOUSEHOLD, &C. &C.

My dear Sir :The distinguished and influential position -which

you hold in regard to principles, many of which areadvocated in this little publication, renders it properthat I should present it to your notice as an humbleauxiliary in the promotion of a just, and, I hopefully trust,a growing conviction in the public mind, as to the truemission and powers of the medical art.

It is known to you that it was my intention to havepublished in this country an edition of your very ablevolume entitled Nature and Art in the Cure of Disease,in connection with some other publications of like tendencywhich have appeared on this side of the Atlantic, andto have embodied the whole under the title of RationalMedicine. Of this plan, as well as name, I had thepleasure to receive your approval and your concurrencein its execution. But after the whole was prepared, and


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IV DEDICATION,

placed in the publisher's hands here, the unforeseen ap-pearance of a New York edition of your work renderedsuperfluous the proposed undertaking.

The world will duly appreciate the labor and learningwhich, during half a century, you have brought to theaid of true medical philosophy, and, in a particular man-ner, the impartial investigations which you have latelymade in regard to the part performed by nature in thecure of diseases. Convictions in a measure similar toyour own have, at the same time, found their way intoother minds, and generally in a near proportion to thetestimony afforded by prolonged experience. Twenty-eight years ago I read before the Medical Society of thisState a Discourse on Self-limited Diseases, which, I havereason to believe, was not without some influence at thetime and since on the minds of the profession here. Thisdiscourse was afterwards incorporated, with other essays,in a volume entitled Nature in Disease. I now hopethat the crowning and convincing testimonies afforded byyour noble work on the comparison of nature and art inthe cure of disease wijl be instrumental in causing theextravagances of a so-called heroic and overactive prac-tice on the one hand, and of a nugatory and ignorantpractice on the other, to be replaced by something whichmay deserve the name of Rational Medicine.


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DEDICATION. VIf an apology is due for so far departing from the

accustomed gravity of science as to introduce at the com-mencement of this little book a fable called The Paradiseof Doctors, it must be derived from the fact that, in thisage of overproduction in all departments of literature,the public ear is sometimes attracted by exaggeration togive its attention afterwards to more chastened expositionsof the truth.

I am, dear Sir,With much respect and regard,

Yours, JACOB BIGELOW.1*


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THE PARADISE OF DOCTORS.A FABLE.

READ AT THE ANNUAL DINNER OP THE MASSACHUSETTS MEDICAL SOCIETT,MAT 26, 1858.

It happened, once, that a general awakeningtook place among the physicians, druggists andcitizens, of the quiet old State of Massachusetts,during which it was discovered that a greatand culpable neglect had long been prevalentthroughout the community in regard to the im-portant duty of taking physic. A convictionfell upon aU that it was now imperatively neces-sary that every man, woman and child, shouldproceed at once and habitually, in sickness andin health, to take three times as much medicineas they had taken before. This new revela-tion, explained and enforced by competent


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8 THE PAEADISE OF DOCTORS.

authorities, quickened into sudden activity everydepartment of industry connected with the pre-paring, prescribing and dispensing, of drugs.The repose of cities was disturbed, in a mannernot before known, by the rattling of doctors' car-riages and the braying of apothecaries' mortars.Messengers were seen rapidly traversing streetsand roads in all directions, bearing prescrip-tions and compositions. Nurses' wages weredoubled, and cooks were transformed intonurses. All things gave evidence that a greatand portentous reform had come over theland.

In all places of business and amusement, inthe street and in the drawing-room, physic wasthe paramount subject of conversation. News-papers neglected to announce the arrival ofsteamers, and the brawls of Congress, that theymight find place for the last astonishing cures,and the most newly-discovered specifics. Sympa-thetic intercommunications and experiences wereimparted, and listened to M'ith untiring avidity.Many luxuries unknown before found their wayinto society, dinners were regularly medicated,


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THE PAEADISE OP DOCTOES. 9

wines scientifically sophisticated, and dessertswere made up of conserves, electuaries and din-ner-pills. The atmosphere was redolent with theincense of aloes and myrrh.

Clergymen and moralists forgot that men weresinful ; it was quite enough that they were bil-ious. Bile was regarded as the innate and orig-inal sin, which was to be extirpate'd with fire andphysic even from the new-born child. Nobodywas aware that bile is necessary to life ; no twopersons were agreed as to what the term hiliousmeant ; it was something insidious, mysteriousand awful. Some held that it consisted in havingtoo much bile ; others in having too little. Ac-cording to some, the bile was held back in theblood; according to others, it was absorbed readyformed into the blood. Pierce schisms and sectswere generated on the question who, and whetherany, were exempt from its contaminating pres-ence. The bon vivant, after his night's carouse,furnished abundant demonstrations of its exist-ence on the following morning. A healthy la-borer, who had had the temerity to boast of hisfreedom from bilious taint or suspicion, was con-


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10 THE PARADISE OF DOCTORS.

victed and brouglit to his senses by the ordealof a dozen grains of tartar-emetic.On the exchange, brokers postponed their

stocks and bonds, that they might pubhsh dailylists of the prices of drugs. Fortunes were,made and lost in drug speculations. A mangrew rich by a patent for manufacturing Peru-vian bark out of pine saw-dust. Gilded pills, ofvarious weight and potency, passed as a circu-lating medium, and were freely taken at the shopsin payment for better goods. Finally, the physi-cians did not attempt to eat or sleep, but barelyfound time to enter their daily professionalcharges. They were worshipped and run after,by both sick and well, as the legitimate vehiclesof medicine, and were ignominiously desertedif in any case they ventured to pronounce med-icine unnecessary.The fame of these doings went abroad, and

Massachusetts acquired the enviable celebrity ofbeing the Paradise of medical men. The doctorsin New Hampshire, and the druggists in NewYork, hearing of the success of their profes-sional brethren in this quarter, began to abandon


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THE PAEADISE OF DOCTOES. 11

their establishments and remove into Massachu-setts. The example was followed in other statesnew recruits were drawn from the counter andthe plough, and in a short time the country andcity were inundated by swarms of medical prac-titioners of all denominations. Agreeably to theacknowledged law of commerce and politicaleconomy, that demand and supply necessarilyregulate each other, the business of many per-sons, which had undergone an undue exaggera-tion, was at length found rapidly to declineunder increasing competition, and the aggre-gate receipts of the year were found, to thecost of not a few disciples of Esculapius, tobe less than they had ever been before. Med-icines became drugs, and the Paradise of Doctorsbecame an excellent place for doctors to starvein. Nevertheless, although the market was asmuch glutted as the people, still a large surplusboth of zeal and physic remained to be workedoff in some way.Meanwhile, the revival went on, and its effects

began to tell upon the faces and movements ofthe people. There was a deficiency -in the will

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12 THE PAEADISE OF DOCTORS.

to undertake, and the power to execute, evencommon enterprises. Men went languidly totheir respective places of business, or stayed athome if it was their day to take a purgative or anemetic. Purses were found to be lightened, andthe contour of persons grew sensibly less. In onething only the economy of living was promotedowing to the decline of appetite, the consump-tion of food was much diminished. Under thisorder of things it was noticed that labor andexercise were little in vogue, and people betookthemselves in preference to the occupation ofdoing nothing. A small number, it is true, madea desperate effort to eifect a change by doublingtheir doses of physic ; but the result did notencourage a repetition of the experiment. Atlast a cholera came, and, although a forty-drugpower was promptly brought to bear upon it,the mortality was greater than it had ever beenknown to be before.

Nevertheless, weak-minded men and strong-minded women failed not to harangue audiencesin the streets on the astonishing powers of med-icine. Spirit-rappers were summoned to evoke


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THE PAEADISE OF DOCTOES. 13

from their rest the heroic shades of Rush andBouillaud, Sangrado, Morrison and Brandreth.These distinguished worthies exhorted their fol-lowers not to shrink or falter under the trialsto which they were subjected, but rather to.redouble their perseverance, until the truth ofthe faith which they held should be establishedby the testimony of their martyrdom in its-cause.At length a meeting accidentally topk placebetween two old shipmasters, one of whom had

lost overboard his barrel of beef, and the otherhis medicine-chest, in a gale of wind at the com-mencement of their passage. On examination,and comparison of their respective crews, thecontrast was so marked bet^veen the ruddy facesof the latter, and the lantern-jaws of the former,,that a general mutiny sprang up in both crewsagainst the further tolerance of the physic-takingpart of their duty. The contagious insurrectionspread from Fort Hill to Copp's Hill; and onthe following night several medicine-chests were,thrown overboard by men in the disguise ofSouth-sea Islanders.

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14 THE PAEADI3E OF DOCTOKS.

The spark which had struck the magazinecaused the whole po]Dulation to explode. Auniversal mass-meeting was called upon BostonCommon, and protracted through several daysand nights. Agitators, refdrmers and stump-orators, delivered their harangues, and definedtheir positions. Many speakers advocated animmediate application to the Legislature, calhngon tliem to prohibit, by an especial act, all furthertraffic in drugs. One, more violent than the rest,demanded that the meeting should resolve itselfinto a committee of vigilance, for the purpose ofmaking a descent upon the a^^othecaries' shops,and emptying the contents of their bottles intothe streets. He was wilhug to allow to offend-ers themselves the option to quit within twenty-four hours, or swallow their own medicines. Amore moderate citizen said he rose in support ofthe general sentiment, but would offer an amend-ment, that,- in the contemplated destruction, anexception should be made in favor of Bourbonwhiskey. A few of the advocates of the policylately prevalent attempted to make themselveslieard ; but their voices were so attenuated, by


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THE PAEADISE OF DOCTORS. 15

the long use ofjalap and salts, that they failed toproduce any considerable impression.An old lady, whose shrill voice drew immediate

attention, protested against violent measures ofall kinds, and moved, as a middle course, thatresort should be had to homoeopathy. It neverdid any harm, and was very comforting, espec-ially when well recommended by the physician.It cured her child of the measles in sis weeks,and herself of a broken leg in six months, duringwhich time she had two hundred and ninety-five visits, and took more than fifteen hundredglobules. She had walked to the meeting on hercrutches to exhibit to the assembly the astonish-ing powers of the Hahnemannic system. Hereshe was interrupted by a bluff marketer, whosomewhat rudely pronounced homoeopathy to bea great humbug, since, but a short time before, hischild had eaten part of a raw pumpkin, and wasseized with convulsions ; and the physician whowas sent for, instead of taking measures to dis-lodge the offending cause, took out a little book,and remarking to the by-standers that likecures like, proceeded to prescribe the hundred


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THE PARADISE OF DOCTORS. 17

a disease, or the necessities of the existing case,inflicted a daily or hourly dose of medicine,sometimes actual and sometimes nominal, butalways at the cost of the patient. Medicine, inits place, was a good thing, but proved a badthing when we got too much of it. He hadhimself had the misfortune to be several timessick, and, during the continuance of his disease,felt much more gratified on those days in whichit was announced that he was to take no medi-cine, than when tartar emetic was replaced bycalomel, and calomel by colchicum, aconite, andthe last new remedy. If patients and theirfriends were ignorant and unreasonable, it mightsometimes be necessary to deal with a fool ac-cording to his folly ; but he believed that sensiblemen and women were gratified by being regardedand treated as reasonable beings. It was a mis-take in medical, men to suppose that their influ-ence or social position could be improved by themystery which they observed, and the activitywith which they harassed their patients. In GreatBritain, an island where the people subsist largelyon blue pills and black draughts, the doctors were


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never known to attain the high aristocratic rankwhich was occasionally accorded to successfulbankers, jurists and generals. On the contrary,the country was overflowed with starved apothe-caries and physicians advertising for situationsas traveUing servants. He thought one of thegreatest misapplications of human industry wasin the production of superfluous drugs and drug-dispensers. He did not believe in the transmu-tation of metals, but was a great believer intheir transportation. In the form of calomel, thecity of New Orleans alone had swallowed u'p somehundred tons of the quicksilver of Spain and SouthAmerica. Palaces were being built in variouscities alike from poisonous arsenic and harmlesssarsaparilla. . A century hence the mines of goldwill be sought for, not in California, but in thecemeteries of the old cities, where it has beengeologically deposited under the industry ofdentists.He beheved that the experienced and intelli-

gent part of the medical profession had longsince arrived at. the conclusion that many dis-eases were self-limited, and that time and nature


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THE .PAEADISE OF DOCTORS. 19

had quite as much to do as art in the processof their cure. Skilful physicians were alwayswanted to inform the sick of the character oftheir diseases, and of the best mode of gettingthrough them ; and their skill consisted not inthe abundance of their nominal remedies, but inthe judgment with which a few remedies wereadministered or withheld, and in the general safeconduct of the patient. Some diseases are cura-ble by art, and others are not ; yet, in the treat-ment of all diseases, there is a right method anda ^rong, and too much activity is quite as injuri-ous as tao little. A good shipmaster or pilotcould often navigate his vessel in safety, thoughhe could not cure the storui by which its safetywas endangered. He believed that medicinewould have fulfilled its true mission when doc-tors should have enlightened the public on theimportant fact that there are certain things whichmedicine can do, and certain other things whichit cannot do, instead of assuming for it thepower to do impossibilities. Among the goodeffects which must ensue from this diffusion oflight would be the disappearance of quackery


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from the world ; for quackery consists almostwholly in medication. And the more physicianslend themselves to formal, superfluous and mys-terious drugging, the more nearly do they ap-proach to being quacks themselves. He con-sidered physicians an important and necessaryclass, to whose charge the sick always had been,and always would be, committed. He wouldgladly cleanse the profession from the fanaticismof heroic doctors on the one hand, and of moon-struck doctors on the other, and would replacethese forms of delusion by a discriminating,sincere, intelligent and rational, course of treat-ing diseases.The old gentleman sat down, and his speechseemed good in the eyes of his audience. Reso-

lutions were moved and adopted to the effectthat it was unbecoming a free and enlightenedpeople to be drug-ridden or globule-ridden, andrecommending recourse to temperance, exercise,regularity and rational medicine, whenever ithappened that medical treatment was necessary.The meeting quietly dissolved, and its mem-

bers returned to their respective homes, most of


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THE PARADISE OF DOCTORS. . 21

them satisfied that the revival was past, and thatmedicine was not altogether the one thing need-ful. In a short time the price of drugs fell in themarket, while that of provisions advanced. TheNew Hampshire doctors and the New Yorkdruggists, finding their oecupations gone, re-turned to the places from which thej respect-ively came. The surplus of indigenous medicalmen went off to California, or retired to culti-vate the earth in the interior counties. Facesassume'd a more vigorous and healthy aspect, andthe country once more resounded with themusic of the axe and the hammer, and the cheer-ful rattling of knives and forks. Steam-engines,which had been erected for the pulverization ofdrugs, were attached to saw-mills and spinning-jennies. Last of all, a noble and useful art,which had long been depressed under the effectsof its own exaggeration, was enabled once moreto raise its respeetable head, and to regain theconfidence of society, under the name of RationalMedicine.


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BRIEF EXPOSITIONSOF

RATIONAL MEDICINEThe tendency to ultraism, wliicli influences

public opinion in great social questions, par-ticularly of politics and theology, has beenalso prevalent in the affairs of practical medi-cine. No age has been exempt from diversity

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of opinion among phj^sicians on the speculativesubjects of their art; and the present periodappears to be more marked than preceding onesby the opposite methods of treatment pursuedby medical men in the management of disease.These methods consist, for the most part, in avehement, officious and over-drugging systemon the one hand, and an inert, evasive and nuga-tory practice on the other. Between these ex-tremes the intermediate truth meets with less


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24 EXPOSITIONS OF EATIONAL MEDICIXE.

consideration than it ought to receive from un-biased and enlightened inquirers.Extreme doctrines in practical subjects often

arise from the self-interest of those who originateand first promote them. But the vehemence andfanaticism with which they are afterwards pur-sued are as often owing to the creation of falseissues, which divert public attention from thesubstance to the shadow, and mystify the generalquestion with minor, partial* and frequently ir-relevant considerations.The introduction into the English language,

for example, of the term allopathy, and itsadoption by some medical writers, has had theeffect to mislead superficial readers in regard tothe true issue of questions connected with thetreatment of disease. This word was designed.by its zealous, but weak and incompetent, in-ventor to express the employment of remedieswhich produce phenomena different from thoseproduced by the disease treated ; whereas theterm homoeopathy indicated a mode of treatingdiseases by employing medicines which are sup-posed to produce effects similar to those wliich


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EXPOSITIONS OF EATIONAL MEDICINE. 25

it is desired to remove. This theoretical andabsurd generalization, wholly unsupported bygeneral facts on either side, so far as the cure ofdiseases is concerned, has acquired currencyamong the less enlightened part of the public, sothat, at the present day, many persons considerhomoeopathy a sort of general law, to which al-lopathy is an exception. And, strange to tell,many otherwise sensible physicians have assumedthe cloak thus offered to them, without perceiv-ing that the propriety of so doing is the same asif the whole protestant world were to style them-selves heretics, because the Church of Rome, informer ages, saw fit to apply to them that appel-lation. Allopathy is, in fact, a worthless term,which either means nothing real, or else em-bodies so many dissimilar and discordant ele-ments that it serves no purpose as a descriptiveor distinctive name. The' occasion still existsfor terms which may definitively express thedogmas of modern practice.Anatomy, physiology, and to a certain extent

pathology, may be considered, so far as our dis-coveries have advanced, to be entitled to rank

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26 EXPOSITIONS OF EATIONAL MEDICINE.

with the exact sciences. But . therapeutics, orthe art of treating diseases, hke ethics and politi-cal economy, is still a conjectural study, inca-pable of demonstration in many of its great pro-cesses, and subject to various and even oppositeo]3inions in regard to the laws and means whichgovern its results.The methods which, at the present da}^, are

most prevalent in civilized countries, in the treat-ment of disease, may be denominated the follow-ing

1. The Artificial method, which, when carriedto excess, is commonly termed heroic, and whichconsists in reliance on artificial remedies, usuallyof an active character, in the expectation thatthey will of themselves remove diseases.

2. The Expectant method. This consistssimply in non-interference, leaving the chance ofrecovery to the powers of nature, uninfluencedby interpositions of art.

3. The Homoiopatliic method. This is a coun-terfeit of the last, and consists in leaving thecase to nature, while the patient is amused withnominal and nugatory remedies.

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EXPOSITIONS OF EATIOJTAL MEDICINE. 27

4. The Exclusive method, which applies oneremedy to all diseases, or to a majority ofdiseases. This head includes hydropathy, alsothe use of various mineral waters, electricalestablishments, etc. Drugs newly introduced,and especially secret medicines, frequently boastthis universality of application.

5. The Rational method. This recognizesnature as the great agent in the cure of diseases,and employs art as an auxiliary, to be resorted towhen useful or necessary, and avoided whenprejudicial.

The foregoing methods, with the exceptionperhaps of the last, have had their trial in variousperiods and countries, and have given rise todiscussions and controversies which are not ter-minated at the present day. The subject is toocomplicated to obtain from inquirers, out of theprofession, the amount of attention requisite forunderstanding its merits ; while, among medicalmen, consistency to pledged opinions, defectsof knowledge, and considerations of interest, notTinfrequently warp the judgment of otherwise


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honest and discerning persons. It is certain,moreover, that medical opinion on the treatmentof disease changes much between the time ofone generation and another. Any person whowill take the trouble to inspect the medicaljournals published thirty or forty years ago willfind many things, then laid down as medicaltruths, which are now generally admitted to bemedical errors. The length of a common profes-sional life is sufficient to disabuse most physi-cians of many convictions which they had re-ceived on trust, and once considered unchange-able. Yet, it does not always happen that erroris replaced by truth, and it is fortunate if thedelusions of ill-balanced minds are not succeededby newer and greater delusions.

It is, nevertheless, right that intelligent andreasonable physicians should receive the con-fidence of the community, since they are, orshould be, more qualified than other persons toundertake the care and conduct of the sick.And even if it had happened that their powerwas limited to merely understanding the natureof the existing disease, and the import and prob-


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able tendency of symptoms which occur fromday to day, without any attempt at curative in-terference, still their attendance would besolicited to throw light on the grave questionsof pain, sickness, and recovery, and still more oflife and death. The public, however, expectsomething more of physicians than the power ofdistinguishing diseases, and of predicting theirissue. They look to them for the relief of theirsufferings, and the cure or removal of their comrplaints. And the vulgar estimate of the powersof medicine' is founded on the common accepta-tion of the name, that medicine is the art of cur-ing diseases. That this is a false definition, isevident from the fact that many, diseases are in-curable, and that one such disease must at lasthappen to every living man.'^ A. far more justdefinition would be, that medicine is the art ofunderstanding diseases, and of curing or reliev-ing them when possible. If this definition were-accepted, and its truth generally understood bythe profession and the public,, a weight of super-

* See the author's Nature, -in. Disease, page 64..3-^


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30 EXPOSITIONS OF RATIONAL MEDICINE.

fluous responsibility on one side, and of dissatis-faction on tlie other, would be lifted from theshoulders of both. It is because physiciansallow themselves to profess and vaunt morepower over disease than belongs to them, thattheir occasional short-comings are made a groundiof reproach with the community, and of conten-tion among themselves.

It is now generally admitted by intelligentphysicians that certain diseases, the number ofwhich is not very great, are at once curable bymedical means. Yet, there is probably no cura-tive agent, applied to such diseases, the efficacyand even safety of which has not been warmlycontested by sectarian j)i'actitioners. It is alsobeginning to be admitted in this country thatcertain diseases are self-limited^^ incurable now

* This term was first introduced by the writer in a discourse in1835, ali-eady alluded to, with the following definition : A self-'limited disease is one which receives limits from its own nature,and not from foreign influences ; one which, after it has obtainedfoothold in the system, cannot, in the present state of our knowl-edge, be eradicated or abridged by art, but to whick there is duea certain succession of processes, to be completed in je- tain timts

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EXPOSITIONS OF RATIONAL MEDICINE. 31

by artj yet susceptible of recovery under naturalprocesses, both with and without the interferenceof art. To this class belong a great portion ofthe diseases usually called acute, and likewisesome, the character of which is decidedlychronic. Lastly, a vast tribe of incurable dis-eases takes precedence in the lists of mortality,and holds, in some form, its final sentence overthe heads of all mankind. Yet, so reluctant arephysicians to acknowledge these universal truths,or to admit their own incompetency, that incu-rable and unmanageable diseases have been com-placently called opprohria inedicinoe, as if theywere exceptions to a general rule.The great objects which medical practice pro-

fesses to effect, and which there can be no doubtthat it frequently does effect, are the following :1. The cure of certain diseases. 2. The relief orpalliation of all diseases. 3. The safe conduct of

which, time and processes may vary with the constitution andcondition of the patient, and may tend to death or to recovery,but are not known to be shortened, or greatly changed, by medicaltreatment.


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the sick. In all these objects it sometimesfails; yet, instances of its success are sufficientljnumerous to establish the necessity of the ex-istence of medicine as a profession.

No one doubts that morbid affections, oc-casioned by the presence of an offending orirritating cause, are often spee'dily cured by thedischarge or removal of that cause. And heredrugs are among the principal agents which weemploy. Again, no one doubts that many of thediseases of civilized life, brought on by luxury,intemperance, sedentary and intellectual labor,unhealthy residence, occupation, etc., are oftenwholly or partially cured by change of life, in-cluding habits, and perhaps residence. And heredrugs are, for the most part, of little avail. Sothat it may happen that the chance of cure shalldepend upon the judgment with which activedrugs are administered, on the one hand, andavoided or superseded, on the other.The palliation of diseases is another great

practical end of medical science, and really occu-pies a large portion of the time and efforts ofevery medical man. When it is considered that


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most diseases last for days, and some of tliem foryears, and that a large portion of mankind event-ually die of some chronic or lingering disease,it will readily be seen that the palliation of suffer-ing is not only called for, but really constitutesone of the most important, as well as beneficentobjects of medical practice. The use of ano-dynes and ansesthetics, the obviation of variouspainful and distressing symptoms, the removalof annoyances, the just regulation of diet, of ex-ertion and repose, of indulgence and restric-tion, the direction of moral agencies, whichmake up so large a part both of suffering andrelief, may well afford employment to the mostearnest and philanthropic physician, and obtainfrom the public a just ajapreciation of the valueof his services.The safe conduct of the sick, as will be seen

from the last head, consists much more in caution-ary guidance than in active interference. In themanagement of sickness, the rein is needed todirect quite as much as the spur to excite.People sometimes suffer from neglect, but morefrequently from ill-judged and meddlesome atten-


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not agreed as to the means by which any one ofthem is to be accomphshed or attempted ; anda man who fahs sick at home or abroad is hableto get heroic treatment or nominal treatment,random treatment or no treatment at all, accord-ing to the hands into which he may happen tofall. It is, therefore, desirable that physiciansthemselves, and the public also, should obtain asatisfactory understanding of the various diver-sities of practice which have been already men-tioned as occupying the greatest share of atten-tion at the present day.

1. The Artificial Method. This mode oftreatment is founded on the assumption thatdisease can be removed by artificial means.Prom the earliest ages a belief has prevailed thatall human maladies are amenable to controlfrom some form of purely medical treatment; andalthough the precise form has not yet been found,so far as most diseases are concerned, yet, at thisday, it continues to be as laboriously and hope-fully pursued as was the elixir vitcB in the middleages. Within the present century, books of prac-tice gravely laid down '^ the indications of cure,


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as if they were things within the grasp of everypractitioner. It was only necessary to subduethe inflammation, to expel the morbific matter, toregulate the secretions, to improve the nutrition,-and to restore the strength, and the business wasat once accomplished. What nature refused, orwas inadequate to do, was expected to beachieved by the more prompt and vigorous in-terposition of art. The destructive tendenciesof disease, and the supposed proneness to dete-rioration of nature herself, were opposed bycopious and exhausting depletion, followed bythe shadowy array of alteratives, deobstruentsand tonics. Confinement by disease, which mighthave terminated in a few days, was protracted toweeks and months, because the importance ofthe case, as it was thought, required that thepatient should be artificially '' taken down, andthen artificially built up.When carried to its heroic extent, artificialmedicine undermined the strength, elicited new

morbid manifestations, and left more disease thanit took away. The question raised was not howmuch the patient had profited under his active


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treatment, but how much more of the same hecould bear. Large doses of violent and deleteri-ous drugs were given as long as the patientevinced a tolerance of them, that is, did notsink under them. The results of such cases, iffavorable, like the escapes of desperate surgery,were chronicled as professional triumphs, whilethe press was silent on the disastrous resultssubsequently incurred in like cases by deludedimitators. If diseases proved fatal, or even ifthey were not jugulated or cut short at theoutset, the misfortune was attributed to the cir-cumstance of the remedies not being sufficientlyactive, or of the physician not being called inseason. So great at one time, and that not longago, was the ascendency of heroic teachers andwriters, that few medical men had the courage toincur the responsibility of omitting the activemodes of treatment which were deemed indis-pensable to the safety of the patient. This tim-idity on the score of omission has now, in agreat measure, passed away, yet is still promotedin most cities by some heroic doctors, and stillmore by interested specialists, who inflict severe

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discipline, and levy immense contributions, oncredulous persons, who are suitably alarmed atdenunciations which involve the loss of sight, ofhearing, or even of beauty.A considerable amount of violent practice is

still maintained by routine physicians, who, with-out going deeply into the true nature or exigen-cies of the case before them, assume the generalground that nothing is dangerous but neglect.Edge-tools are brought into use as if they couldnever be anything more than harmless playthings.It is thought allowable to harass the patient withdaily and opposite prescriptions ; to try, to aban-don, to reenforce, or to reverse ; to blovv^ hot andcold on successive days ; but never to let thepatient alone, nor to intrust his case to the quietguidance of nature. Consulting physicians fre-quently and painfully witness the gratuitous suf-fering, the continued nausea, the prostration ofstrength, the prevention of appetite, the stupefac-tion of the senses, and the wearisome days andnights, which would never have occurred hadthere been no such thing as officious medication.What practitioner has not seen infants screaming


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under the pangs of hunger, or of stimulants re-morselessly applied to their tender skins, andwhose only permitted chance of relief was in thecontinued routine of unnecessary calomel andipecacuanha ?

There is one great exception in favor of arti-ficial and even heroic practice, well known andfully demonstrable in the art of surgery. Manydefects, injuries, and diseases of the body, are,unquestionably, cured by surgical processes,which never could have got well without them.And the skilful and humane surgeon has morefrequent opportunities to reflect with satisfactionon the immediate and positive results of his artthan the most able physician. Yet even this sat-isfaction can only be measured by the fidelitywith which he has performed his duty, and theconscientiousness with which he has avoideduseless and hopeless operations. Happily theexperience and statistical results of the bestmodern surgeons have had the effect to dimin-ish greatly the amount of gratuitous sufferingwhich was imposed by their predecessors on theunhappy subjects of their art. We see much less


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than was formerly seen of the cruel but unavail-ing operations of fanciful and interested surgery;the infliction of pain without corresponding good,the useless extirpation of malignant growths, themutilation of miserable bodies already doomedby tuberculous and other irrecoverable condi-tions ; deeds which have converted hospitals intoinquisitions, and left the Bastile and the HotelDieu to contend for the palm of supremacy inthe production of human suffering.

2. The Expectant Method. This method,when fully carried out, admits no medication norinterference of art, but waits on time, and com-mits the chance of recovery to the restorativepower of nature alone. The expectant practicehas not been without its advocates, and volumeshave been published in its favor, at differenttimes, chiefly on the continent of Europe. Thatthere is some basis for the doctrine of expecta-tion is made apparent by the spontaneousrecovery of animals and savages, of careless,obstinate and incredulous persons in civilizedlife, and of those who, in consequence of theirisolated or otherwise unfavorable position, are


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EXPOSITIONS OP EATIONAL MEDICINE. 41

unable to procure medical aid/' or who, if theydo procure it, obtain only that which is inopera-tive or absolutely detrimental. I sincerely be-lieve that the unbiased opinion of most medicalmen of sound judgment and long experience ismade up, that the amount of death and disasterin the world would be less, if all disease were leftto itself, than it now is under the multiform, reck-less and contradictory modes of practice, goodand bad, with which practitioners of adversedenominations carry on their differences at theexpense of their patients. But there is noprobability that expectant medicine will everprevail in its character as such. The amount ofpositive good which, in fifty centuries, art hasbrought to the assistance of medicine, althoughfar more limited than we could desire, is, never-theless, both sufficient and worthy to employthe talents of the best and most enlightenedphysicians.

3. The Homceopathic Method.Homoeopathymay be defined as a specious mode of doing noth-ing. While it waits on the natural progress ofdisease and the restorative tendency of nature

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on the one hand, or the injurious advance of dis-ease on the other, it supphes the craving foractivity, on the part of the patient and hisfriends, by the formal and regular administrationof nominal medicine. Although homosopathywill, at some future time, be classed with histor-ical delusions, yet its tendency has undoubtedlybeen to undermine the reliance on heroic prac-tice which prevailed in former times both in thiscountry and in Europe. There was, perhaps,needed a popular delusion to institute the exper-iment on a sufficiently large scale to show thatthe sick may recover without the use of trouble-some and' severe medication. There are notwanting in history similar instances of good re-sults flowing from questionable sources. TheFrench Revolution has eventually bettered thesocial condition of the French people ; and theMormons have brought the wilderness of theSalt Lake to a state of productive cultivation.Yet no judicious person vindicates the doctrinesof those who were prime movers in these inno-vations, or holds them up as worthy examples forimitation. Sir Kenelm Digby produced a bene-


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ficial reform in English surger}'', and was able tobanish the prevalent mode of dressing incisedwounds with painful applications, by speciouslygoing from the effect to the cause, and applyingthe active medicament, not to the wound, but tothe weapon that did the mischief; thus giving tothe former a chance to heal by the first intention.

There is great reason to believe that, at thepresent day, homoeopathic faith is not alwayskept up in its original purity by its professors.Traces of the occasional use of very heroic rem-edies are often detected among the most unsus-pected of its practitioners. And it must not beconcealed that there are instances in which thetemptation is very great, even for the most reso-lute convert, to come to the aid of the sick withreasonable and efficient doses of real medicine.The man must be somewhat of a stoic whocan look upon a case of severe colic, or of themultiform distresses which result from overtaskedorgans of digestion, and quiet his conscience withadministering inappreciable globules, instead ofremedies.

4. The Exclusive Method. This, hke the


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heroic system, is various in its means of treat-ment, but differs from it in the professed univer-sality of its peculiar applications. ' Hydropathyapplies one remedy, cold water, to all cases.Yet, like homoeopathy, it combines with itsspecial agent a strict course of life, includingexercise, temperance, regular hours, and a dietin the main simple and wholesome, though some-Avhat fanciful in its exclusions. The same wasdone so far as was proper in the previous prac-tice of all judicious physicians. The use of coldbathing is not new, having been employed as ahygienic process from time immemorial by thecivilized world. As a therapeutic agent, coldaffusion was resorted to more than half a cen-tury ago, and has been practiced ever since in agreater or less degree. But the peculiar modeof applying water by packing appears to beoriginal with Priessnitz, an ignorant German, towhom it owes its popularity. Like the Russianbath, in Avhich alternate approaches to scaldingand freezing are said to be followed at last byvery delightful sensations, the hydropathic dis-cipline, in those who have soundness of constitu-


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tion sufficient to insure a healthy reaction, isfollowed by agreeable and often salubrious re-sults. Yet the ineffective character of hydrop-athy is seen in the multitude of disappointedinvalids who return unrelieved from its estab-lishments. I have been told, by persons whohave resided at Graefenberg, that funerals atthat place were of constant occurrence ; and itis well known that Priessnitz, himself a robustpeasant, died in the prime of life, in the midst ofhis own water-cure.The greatest benefit at hydropathic establish-

ments is obtained by those who reform theirmode of life by submitting to the restraints ofthe place. The luxurious, the indolent, the sed-entary, and the erratic, improve most under areturn to regular, natural, active and temperate^habits. Accordingly it is found that gout, dys-pepsia, lost appetite, hysteria, and the variousforms of nervous irritability, furnish the mosthopeful subjects for such institutions. The same-patients might, in many cases, obtain the ' samerelief in another place, by pursuing the water-cure without the water.


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The universality of hydropathic applicationlias been somewhat diminished by prolongedexperience. Priessnitz himself, although igno-rant of science, and incapable of distinguishingone disease -from another, at last became cau-tious in his selections, and nominally excludeddiseases of the lungs from his institution.

It is not necessary to dwell upon the variousexclusive modes of practice, more or less univer-sal in their ajDplication, with which the columnsof ne-vvspapers are daily filled. Mineral waters,taken at the fountain, are often of great use tothose who require a journey or a change ofscene. Particular springs also appear to exert abeneficial effect on particular maladies, thoughnot panaceas, for all ills. Watering-places, whichcombine amusement with exercise, are the tem-porary safety-valves of over-taxed physicians,and happily afford arks of refuge to multitudesof chronic valetudinarians. Electricity supportsone or more establishments in all large cities,both in its simple form, and combined with allother imponderable agencies of mind and matter.


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Few persons go uncured of clironic maladieswithout having given it a sufficient and satisfac-tory trial. Finally, the host of empirical reme-dies, which fill the attention of a very consider-able portion of this quack-ridden world, leave no

.

human maladies out of the catalogue of subjectsto their mysterious power. The drug aloes, inits hundred pill combinations, levies incessantcontributions on those who purchase the privi-lege of being slaves to its use. Opium, variouslydisguised with aromatics to conceal its presence,gives temporary but fallacious respite to fataldiseases, under the deceptive names of pectoralsand pulmonics.

It is superfluous to prolong the considerationof general and exclusive remedies. No personaccustomed to witness the various morbid con-ditions which invade and occupy the humanframe, active and passive, partial and general,trivial and dangerous, can ever consider themproper subjects for the same kind of treatment,unless, with Dr. Rush and Dr. Brandreth, hehappens to be a believer in the unity of dis-ease.


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5. The Rational Method. If no alternativewere left to the physician and patient but theextreme and frequently irrational methods whichhave now been briefly described, practical medi-cine might well take its rank as a pseudo-scienceby the side of astrology and spiritualism. Butthe labors of earnest and philanthropic men, dur-ing many centuries, though often speculative,misguided, and terminating in error, have never-theless elicited enough of general truth to serveas the foundation for a stable superstructure.And, that such truth may hereafter go on toaccumulate, it must be simply and honestlysought, even when its developments do not atonce promote the apparent interest of physicians,nor flatter their professional pride of opinion.

It is to sincere and intelligent observers, andnot to audacious charlatans, that we are to lookas the ultimate lawgivers of medical science.Our present defect is not that we know too little,but that we profess too much. We regard it asa sort of humiliation to acknowledge that wecannot always cure diseases, forgetting that inmany other sciences mankind have made no


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greater advances than ourselves, and are stillupon the threshold of their respective structures.Medical assumption may well feel humbled bythe most insignificant diseases of the humanbody. Take, for example, a common furunculusor boil. No physician can, by any internal treat-ment, produce it where it does not exist. Nophysician can, by any science, explain it, andsay why it came . on one' limb and not uponanother. No physician can, by any art, cure itafter it has arrived at a certain height. Nophysician can, by any art, delay or retain it afterit has passed the climax assigned to it by nature.And what is true in regard to a boil is equallytrue of common pneumonia, of typhoid fever, ofacute rheumatism, of cholera, and many otherdiseases.

In the present state of our knowledge thetruth appears to be simply this : Certain diseases,of which the number is not very great, are cura-ble, or have their cure promoted, by drugs, andby appliances which are strictly medicinal. Cer-tain other diseases, perhaps more numerous, arecurable in like manner by means which are

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strictly regiminal, and consist in changes ofplace, occupation, diet, and habits of life.Another class of diseases are self-limited, and canneither be expelled from the body by artificialmeans, nor retained in the body after theirnatural period of duration has expired. Finally,a large class of diseases have proved incurablefrom the beginning of history to the presenttime, and under some one of these the mostfavored members of the human race must finallysuccumb ; for even curable diseases become in-curable when they have reached a certain stage,extent, or complication.

It will be seen that the divisions last mentionedcannot be strictly reduced under the nomencla-ture of nosologies ; for cases, and groups ofcases, may begin in one category and end inanother.

It is the part of rational medicine to study in-telligently the nature, degree and tendenc}^, ofeach existing case, and afterwards to act, or toforbear acting, as the exigencies of such case mayrequire. To do all this wisely and efficiently, thepractitioner must possess, first, sufficient know-


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ledge to diagnosticate the disease ; ^and, secondly,sufl&cient sense as well as knowledge to makeup a correct judgment on the course to be pur-sued. In the first of these, if properly educatedand experienced, he will be able to make anapproximation to the truth sufficient for practicalpurposes. In the second he will have to dependmainly on his well-ordered and logical powers ofself-direction ; for he will find in the recordedevidence of his predecessors quite as much tomislead as to guide him rightly. He will findmany existing cases, in which for a time he willknow not what to do, and in which his safestcourse will be not to do he knows not what. Itis better to resort to a little expectancy than torush into blind and reckless action. Nature,when not encumbered with overwhelming bur-dens, and when not abused by unnatural andpernicious excesses, is, after all, the kindestmother still. Art may sometimes remove thoseburdens, and regulate those excesses ; but it isnot by imposing new burdens and instituting newexcesses that an end so desirable is to be at-tained. Before commencing any contemplated


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course of treatment, in a given case, two ques-tions should always be asked : 1. Will it dogood? 2. Will it do harm? A right answer tothese questions will not fail to produce a rightpractice.

It is the part of rational medicine to alleviatethe sufferings of the sick. And for this endalone, were there no other, physicians- wouldbe necessary as a profession. For this endalone, any person knowingly about to encounterthe confinement of a self-limited fever, or thelingering decay of a cancer or consumption,would invoke the guidance of a medical manwhose judgment and skill were better than hisown. The power of the medical art to palliatediseases is shown in a multitude of ways, active,cautious and expectant. The pain of acutepleurisy is relieved by venesection; that ofpleurodynia, by anodynes and external applica-tions. The pain of acute rheumatism is post-poned by opium; that of gout, by colchicum.Synovitis is favorably affected by rest ; chronicrheumatism more frequently by exercise. De-mulcents, opiates, and even astringents, have


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their use in various irritations of the mucous mem-branes. Cathartics, laxatives, emetics, leeches,counter-irritants, cupping, hot and cold applica-tions, etc., are of benefit in various local and gen-eral maladies. Yet these remedies, especiallythe more energetic of them, are often employedwhen not necessary, and become, by their degreeand frequency, rather sources of annoyance thanof relief. Violent cathartics are followed byincreased constipation, when milder laxatives orenemata would not have induced that evil. Blis-ters, antimonial ointments, salivation, etc., maycontinue to afflict the patient long after the dis-ease is gone. The effects of powerful depletionare felt for months, and sometimes for years.Excessive stimulation by vinous liquids may cre-ate or renew disease, or give rise to perniciousartificial wants. To prescribe blindly for symp-toms, irrespectively of their cause, is often in thehighest degree injudicious. The alvine dis-charges of dysentery and typhoid fever are thenatural ventings of an inflamed, perhaps ulcer-ated, membrane ; the pain and the excess maybe abated by the gentlest anodynes, hut the

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attempt to check them altogether would be likethe drying up of an external ulcer, of equaldimensions, by the sudden application of astrin-gents. The object might be attained for a day,but the result would be pernicious. Havingalready touched upon this subject, I have only toadd, that if many of the troublesome appliancesand severe exactions of modern practice weresuperseded by gentler, more soothing, and morenatural means, a good would be done to thehuman race comparable to the conversion ofswords into ploughshares..It is the part of rational medicine still to

strive and study for the cure of diseases ; not toassume fallacioush^ as practical truth what hasnever been shown to be true, but rather tosearch and labor for new truth, for which it isnever too late to hope. The rational physicianwill ever be ready to weigh and examine, can-didly and carefully, new practical questions andproposed modes of treatment, whether introducedfor the alleviation or the removal of diseases;and he will recollect that although nineteen outof every twenty of the new methods proposed


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may be worthless, yet the twentieth may perhapspossess some valuable quality. It is known thatthe most established laws of science cease to besuch when their exceptions have been detectedand made out. Some of the most importantadvances in human knowledge have been amongthe latest in date. The great American discov-ery of artificial ana3sthesia has been wished andwaited for by mankind ever since the flood ; yetthe effectual conquest of pain is as it were athing of yesterday.

It is the part of rational medicine to re-quire evidence for what it admits and believes.The cumbrous fabric now called therapeuticscience is, in a great measure, built up on theimperfect testimony of credulous, hasty, prej-udiced', or incompetent witnesses, such as haveafforded authorities -for books like Murray's Ap-paratus Medicaminum, and Hahnemann's Orga-non. The enormous polypharmacy of moderntimes is an excrescence on science, unsupportedby any evidence of necessity or fitness, and ofwhich the more complicated formulas are soarbitrary and useless, that, if by any chance they


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should be forgotten, npt one in a hundred ofthem would ever be reinvented. And as to thechronicles of cure of diseases that are not yetknown to be curable, they are written, not in thepages of philosophic observers, but in the tomesof compilers, the aspirations of journalists, andthe columns of advertisers.

It is the part of rational medicine to enlightenthe public and the profession in regard to thetrue powers of the healing art. The communityrequire to be undeceived and reeducated, so faras to know what is true and trustworthy fromwhat is gratuitous, unfounded and fallacious.And the profession themselves will proceed withconfidence, self-approval and success, in propor-tion as they shall have informed mankind onthese important subjects. The exaggerated im-pressions now prevalent in' the world, in regardto the powers of medicine, serve only to keepthe profession and the public in a false position,to encourage imposture, to augment the numberof candidates struggling for employment, toburden and disappoint the community alreadyovertaxed, to lower the standard of professional


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cliaracter, and raise empirics to the level of hon-est and enlightened physicians.

I AM not willing to leave the subject of Ra-tional Medicine without more earnestly callingthe attention of the profession in the UnitedStates to the admirable work of Sir John Forbes,already alluded to, on Nature and Art in theCure of Disease, of which an American editionhas recently appeared. No testimony of minecan be needed to make known the claims of oneof the most accomplished medical scholars ofEurope, of whose philosophic mind, vigorousperceptions, and clear, discriminating and impar-tial judgment, this volume is a legitimate productand a convincing evidence.

Neither is it necessary to inform the publicthat, as one of the pioneers in the reform now inprogress, the same author published, in 1846, inthe British and Foreign Medical Review, anelaborate article, bearing the title of YoungPhysic, which, though somewhat startling in


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the novelty of its positions, and by many disap-proved for the credit given to statements ofquestionable parties, had, nevertheless, the effect,both in England and this country, to increasepublic attention to inquiries Avhich the presentvolume is so well adapted to satisfy. Some ofthe concluding propositions of this able article,not everywhere accessible to American readers,are reprinted as an Appendix to the present littlevolume.

In France, perhaps more than any other coun-try, the natural history of disease has beenstudied irrespectively of artificial influences.When the modes of rigorous investigation, towhich, in that country, the laws of morbid affec-tions have been submitted, shall have been car-ried as far as possible into the more complex anddifficult subject of therapeutics, they will at leasthelp to guard it from the errors of prematureand speculative generalization to which the medi-cal world has in all ages been prone.*

* The numerical method, so advantageously applied by Louisand his successors to determine approximately the pathologicalcharacter of diseases, cannot be well applied to the more complex


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EXPOSITIONS OF EATIONAL MEDICIXE. 59

Of the contributions to rational medicine whichhave been made in this country, it gives megratification to refer to various able, just andeloquent discourses and essays, by my friendsand others, which have appeared at different

subject of medical treatment, without great caution and reserveon the score of inference. Things submitted to this ordeal mustbe such as have some obvious connection with each otlier ; other-wise we are liable to be led into error by the most careful observa-tion and analysis. Such would be the case if we were to attem^to settle numerically the questions, whether medicine applied to aweapon promoted the cure of a wound, whether the hanging ofwitches had favorably affected the duration of epidemics,whether it is safe for sailors to go to sea on Friday, etc. Theseare questions which are settled by the common sense of an enlight-ened age, and not by numerical analysis. The extensive numeri-cal trials, made in diflFerent countries, on the effect of bleedingin pneumonia, have not yet afforded results fully satisfactory toinquirers. It is worthy of notice that questions of relief are morepromptly settled than questions of duration and of safety. A mansuffering the orthopnoea of pleurisy will lie down and breathewith comparative ease after venesection ; and this is sufficientmotive for the reasonable use of that remedy. But the lengthand safety of the disease, under different modes of treatment,afford questions yet to be settled, if at all, by a vast amount ofobservation, by competent persons, under the various differencesof constitution, degree, complication, season, age, etc.


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APPENDIX.

The following are the principal remarks of SirJ. Forbe^, appended as a sort of recapitulation to hisarticle already referred to in the British and ForeignMedical Review, vol. xxi., p. 262. They are theresubmitted by him as things to be reflected and actedon by the medical profession. A great portion ofthem, though perhaps not all, are applicable in thiscountry as well as in England.

1. To endeavor to ascertain, much more 'pre-cisely than has been done hitherto, the naturalcourse and event of diseas.es, when uninterrupted byartificial interference ; in other words, to attempt toestablish a true natural history of human diseases.

2. To reconsider and study afresh the phj'^siolog-ical and curative effects of all our therapeutic

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62 APPENDIX.

agents, with a view to obtain more positive resultsthan Tve now possess.

3. To endeavor to establish, as far as is practi-cable, what diseases are curable, and what are notwhat are capable of receiving benefit from medicaltreatment, and what are not ; what treatment is thebest, the safest, the most agreeable ; when it isproper to administer medicine, and when to refrainfrom administering it, etc., etc.

4. To endeavor to introduce a more philosoph'ical and accurate view of the relations of remediesto the animal economy and to diseases, so as- to dis-sociate in the minds of practitioners the notions ofpost hoc and proptei^ /loc*

The general adoption by practitioners, in record-ing their experience, of the system known by thename of the Numerical Method, is essential to theattainment of the ends proposed in the precedingparagraphs, as well as in many that are to follow.

5. To endeavor to banish from the treatment ofacute and dangerous diseases, at least, the ancientaxiom, melius anceps remedium quam nuUu7n,'\' andto substitute in its place the safer and wiser dogma,

* Subsequent and consequent.t A doubtful remedy is better than none.


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APPENDIX. 63

that, where we are not certain of an indication,we should give nature the best chance of doing thework herself, by leaving her operations undisturbedby those of art.

6. To endeavor to substitute, for the monstroussystem of Polypharmacy now universally prevalent,one that is, at least, vastly more simple, more intel-ligible, more agreeable, and, it may be hoped, onemore rational, more scientific, more certain, andmore beneficial.

T. To direct redoubled attention to hygiene,public and private, with the view of preventing dis-eases on the large scale, and, individually, in oursphere of practice. Here the surest and mostglorious triumphs of medical science are achievingand to be achieved.

8. To inciilcate generally a milder and less ener-getic mode of practice, both in acute and chronicdiseases ; to encourage the Expectant preferably tothe Heroic system, at least where the indicationsof treatment are not manifest,

9. To discountenance all active and powerfulmedication in the acute exanthemata and fevers ofspecific type, as small-pox, measles, scarlatina,typhus, etc., until we obtain some evidence that the


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64 APPENDIX.

course of these diseases can be beneficially modifiedby remedies.

10. To discountenance, as much as possible,and eschew the habitual use without any suffi-cient reason of certain powerful medicines, in largedoses, in a multitude of different diseases ; a prac-tice now generally prevalent and fraught with themost baneful consequences.

This is one of the besetting sins of EnglisLpractice, and originates partly in false theory, andpartly in the desire to see manifest and -strong effectsresulting from the action of medicines. Mercury,iodine, colchicum, antimony, also purgatives ingeneral, and blood-letting, are frightfully misused inthis manner.

11. To encourage the administration of simple,feeble, or altogether powerless, non-perturbing med-icines, in all cases in which drugs are prescribedpro forma, for the satisfaction of the patient's mind,and not with the view of producing any directremedial effect.

One would hardly think such a caution necessary,were it not that every-day observation proves it tobe so. The system of giving and also of takingdrugs capable of producing some obvious, effect


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tion as to the enormous evils, speaking generally,resulting from them. Nothing has a greater ten-dency to dissociate practical medicine from science,and to stamp it as a trade, than this system of phar-maceutical artifice. It takes some, years of thestudent's life to learn the very things which are toblock up his path to future knowledge. A veryelegant prescriber is seldom a good physician.

13. To endeavor to break through the routinehabit, universally prevalent, of prescribing certaindeterminate remedies for certain determinate dis-eases, or symptoms of diseases, merely because theprescriber has been taught to do so, and on no bettergrounds than conventional tradition.

Even when the medicines so prescribed areinnocuous, the routine proceeding impedes realknowledge by satisfying the mind, and thus pro-ducing inaction. When the drugs are potent,the crime of mischief is superadded to the follyof empiricism. In illustration, we need merelynotice the usual reference, in this country, of almostall chronic diseases accompanied with derangementof the intestinal functions, to ' affection of theliver,' and the consequent prescription of mercuryin some of its forms. We do not hesitate to say


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APPENDIX. 67

that this theory is as far wrong as the practicefounded on it is injurious ; we can hardly furtherenhance the amount of its divarication from the truth.

14. To place in a more prominent point of viewthe great value and importance of what may betermed the physiological, hygienic, or natural sys-tem of curing diseases, especially chronic diseases,in contradistinction to the pharmaceutical or empir-ical drug-plan generally prevalent. This system,founded as it is on a more comprehensive inquiryinto all the remote and exciting causes of disease,and on a more thorough appreciation of all the dis-coverable disorders existing in all the organs andfunctions of the body, does not, of course, excludethe use of drugs, but regards them (generallyspeaking) as subservient to hygienic, regimenal,and external means, such as the rigid regulation ofthe diet, the temperature and purity of the air,clothing, the mental and bodily exercise, etc., baths,friction, change of air, travelling, change of occu-pation, etc., etc.

15. To endeavor to introduce a more comprehen-sive and philosophical system of Nosology, at leastin chronic diseases, whereby the practitioner maybe led less to consider the name of a disease, or


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some one symptom, or some one local affection ina disease, than the disease itself; that is, the wholeof the derangements existing in the body, and whichit is his object to remove, if possible.

16. To teach teachers to teach the. rising gen-eration of medical men that it is infinitely morepractical to be master of the elements of medicalscience, and to know diseases thoroughly, than toknow by rote a farrago of receipts, or to be awarethat certain doctors, of old or of recent times, havesaid that certain medicines are good for certaindiseases.

17. Also to teach students that no systematic ortheoretical classification of diseases, or of therapeu-tic agents, ever yet promulgated, is true, or anythinglike the truth, and that none can be adopted as asafe guide in practice. It is, however, well thatthese systems should be known, as most of theminvolve some pathological truths, and have left somepractical good behind them.

18. To endeavor to enlighten the public as tothe actual powers of medicines, with a view to recon-ciling them to simpler and milder plans of treatment.To teach them the great importance of having their.diseases treated in their earliest stages, in order to


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obtain a speedy and efficient cure ; and, by somemodification in the relations between the patient andpractitioner, to encourage and facilitate this earlyapplication for relief

19. To endeavor to abolish the system of med-ical practitioners being paid by the amount ofmedicine sent in to their patients ; and even thepractice of keeping and preparing medicines in theirown houses.

Were a proper system introduced for s.ecuringa good education to phemists and druggists, and forexamining and licensing them, all of easy adop-tion, there could be no necessity for continuingeven the latter practice ; while the former is one sodegrading to the medical character, and so fright-fully injurious to medicine in a thousand ways, that itought to.be abolished forthwith, utterly, and forever. 20. Lastly, and above all, to bring up the med-ical mind to the standard necessary for studying,comprehending, appreciating, and exercising, themost complex and difficult of the arts that are basedon a scientific foundation the art of PracticalMedicine. And this can only be done by elevatingthe preliminary and fundamental education of theMedical Practitioner.


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PHILLIPS, SAMPSON & CO.HAVE IN PRESS, AND WILL SHORTLY PUBLISH,

NATURE IN DISEASE,Illustrated in Various Discourses and Essays. To which are

added Miscellaneous Writings, chiefly onMedical subjects.

By JACOB BIGELOW, M.D.,PHYSICIAN AND LECT0KER ON CLINICAL MEDICINE IN THE MASSACHUSEIIS

GENERAL HOSPITAL; PROFESSOR OF MATERIA MEDICA IN HARVARDuniversity; president of THE AMERICAN ACADEMY OP

ARTS AND SCIENCES; AND LATE PRESIDENT OrTHE MASSACHUSETTS MEDICAL SOCIETY.

Naturam expellas furca, tamen usque recurret.HOR.

SECOND EDITION, ENLABGED.C O NTENTS.

I.

On Self-limited Diseases..II.

On the Treatment of Disease.HI.

Practical Views of Medical Education.

IV.Eeport on Homoeopathy.


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V.On the Medical Profession, and Quackery.

VI.On Gout and its Treatment.

vn.Aphorisms on Cholera.

VIII.On the Treatment of Injuries occasioned by Fire and Heated

Substances.

IX.On the Burial of the Dead ; and the Cemetery at Mount

Auburn.

X.On the Death of Pliny the Elder.

XI, . .Remarks and Experiments on Pneumothorax.

xn.On the Pharmacopoeia of the United States.

XIII.On the Mucuna Pruriens ; with Remarks on the Irritability

of different Textures.10*


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XIVOn the Poisonous Effects of the American Partridge, or

Ruffed Grouse.

XV.On Coffee and Tea ; arid their INIedicinal Effects.

XVI.Report on the Action of Cochituate Water on Lead Pipes ;

and the Influence of the same on Health.

XVII.On the Poisonous Properties of certain American species of

Rhus.

XVIII.On the History and Use of Tobacco.

XIX.On the Early History of Medicine.

XX.Address delivered before the American Academy of Arts and

Sciences, at the opening of their Course of Lectures, Oc-tober 27, 1852.


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PHILLIPS, SAMPSON & COHATE FOR SALENATUKE AND ARTCUHE OF DISEASE.

SIR JOHN FORBES, I. D., D. C. L. (AXON.), F. R. S.FEtLOW OF THE KOTAL COLLEGE OF PHYSICIANS, PHYSICIAN TO THE QUEISN'S

HOUSEHOLD, ETC. ETC. Quibusdam saltern profutura Tironibus ; quos ut per viarum tutissimarumcompendia ad saluberrimEe artis deducam cognitionem, allaborandum prEeciputi

duxi, hos docere, his scribere, animus erat, non Eruditis non Doctoribus ; quienim tam sim vanus, ut erudire eruditos ipse minime eruditus prresumam ?lias Camerarius.

FROM THE SECOND LONDON EDITION.

CONTENTS.CHAPTEK I.

The Author's Eeasons for wi-iting and publishing this volume(Introductory)

CHAPTER II.Of the Ignorance existing respecting the power of Nature

to cure diseases (Introductory)

CHAPTER in. .General Notions of

CHAPTER IV.Of the Causes, Mode of Production, and Nature of


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CHAPTER V.Of the Course or Progress of

CHAPTER VI.Of the Natural Terminations of Diseases, and the Modes in

which they take place.

CHAPTER Vll.Evidences in favor of the Curability of Diseases by Nature.

CHAPTER Vin.Of the Existence and General Nature of the Medical Art..

CHAPTER IX.Instruments of the jMedical Art.

CHAPTER X.Of the Mode of Action of the Instruments of the Medical

Art : Direct and Specific Action.

CHAPTER XI.Of the Mode of Action of the Instruments of the Medical

Art : Indirect or Vicarious Action.

CHAPTER XII.General Estimate of the Povfers of the Medical Art.


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Brief Expositions of Rational Medicine Bigelow 1858

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