Disease, — a Part of the Plan of Creation. 
T II E 
ANNUAL DISCOURSE 
BEFOKK THE 
MASSACHUSETTS MEDICAL SOCIETY, 
MAY 3 1, 1 8 6 5. 
Bv BENJAMIN E. COTTING, M.D. 
“ A mighty maze ! but not without a Plan.” 
BOSTON : 
DAVID CLAPP & SON—334 WASHINGTON STREET. 
1866. Disease, — a Part of the Plan of Creation. 
THE 
ANNUAL DISCOURSE 
BEFORE THE 
MASSACHUSETTS MEDICAL SOCIETY, 
MAY 3 1, 1 8 6 5. 
BENJAMIN E. COTTING, M. D. 
“ A mighty maze ! but not without a Plan.” 
BOSTON : 
DAVID CLAPP & SON—334 WASHINGTON STREET. 
1866. Re-printed from the 
“Medical Communications of the Massachusetts Medical Society,” 
Vol. X No. y 1865. 
David Clapp & Son, Printers. PEAELEGENDA. 
Tiie Massachusetts Medical Society includes nearly every regularly- 
educated physician in the State of Massachusetts, and numbers at the 
present time more than nine hundred members in active practice. For 
the convenience of the members, the Society is divided into seventeen 
“ District Societies,” corresponding to the several Counties, or convenient 
portions thereof, in the State. The District Societies have frequent 
meetings for scientific and social purposes; and appoint Delegates or 
“Councillors ” (one for every eight members), who, at stated and other 
meetings, choose all the officers, and manage all the business of the Gen- 
eral Society. Once a year also, in the true Harveian spirit, there is 
usually “a general feast for all the members; and on the day of such 
feast, a solemn Oration, by some member previously selected,—to com- 
memorate the dead; to exhort the living; and to advance the cause of 
science, the honor of the profession, and the fraternal intercourse of the 
members.”* 
In obedience to such a call from the Society, the following “Discourse” 
was prepared. The Author being unexpectedly absent from the country 
on the day of the “Annual Meeting,” the Discourse was most acceptably 
read by a professional friend. As the Society went without its dinner, 
in view of the unusual festivities then in preparation for the “ American 
Medical Association” (a National Society), which had accepted an invita- 
tion to meet in Boston the following week, the Reader very properly 
omitted the closing paragraph of the Discourse. But as the paper seems 
to the Author to terminate rather abruptly without this paragraph, as 
well as thus to leave the pleasantest portion of the prescribed duties of 
the day unalluded to, the whole is now printed as it was originally 
written,—advantage being taken, however, of the opportunity in re-print- 
ing, to make a few verbal emendations, which would have been attended 
to previously had the proof-sheets passed under the Author’s supervision 
in the first instance. 
The Society’s caveat on the next page intimates the risk incurred in 
deviating from the current course of “opinions or sentiments.” Any 
one, therefore, who feels impelled to do this, must singly take the respon- 
sibility; and, if in earnest, be quite ready to reply to objectors, in the 
Avords of an Athenian soldier and statesman,— 
yev uxovoov <Jt. 
Roxbury, Massachusetts, 
December, 1865. 
* The words of Harvey, nearly. See “ Life of Harvey,” by R. Willis, M.D., London, 1847 
[Sydenham Soc.]. See, also, “ Oratio Harveiana—a Jacobo A. Wilson, M.D., Londoni, Mdcccl.” At an Adjourned Meeting of the Massachusetts Medical Society, held Oct. 3d, 1860, it was 
Resolved, “ That the Massachusetts Medical Society hereby declares that it does not consider 
itself as having endorsed or censured the opinions in former published Annual Discourses, nor 
will it hold itself responsible for any opinions or sentiments advanced in any future similar 
discourses.” 
Resolved, “ That the Committee on Publication be directed to print a statement to that effect 
at the commencement of each Annual Discourse which may hereafter be published.” 
“These results without doubt will be fur from satisfactory ; but of what consequence is that, 
if they are true; since, whatever has this character, cannot fail in the end to be of real utility.” 
Louis, “On the Effects of Bloodletting," 
Translated by C. Q. Putnam, M.D., Boston, 1836, p. 2. DISCOURSE. 
Mr. President, and Fellows 
of the Massachusetts Medical Society : 
The profession we follow is capable alike of 
the divincst endeavor and the meanest purpose. To 
save it from degradation, and to elevate it to its true 
position as one of the noblest of human vocations, 
its faithful votaries have labored with untiring en- 
ergy in past times and in our own, down to the 
present hour.1* 
To understand disease, and to “cure” it, are the 
great objects and the laudable aspirations of the 
Medical Profession. The former is difficult; the 
latter often impossible. Notwithstanding the ad- 
vanced state of medical science, numbers are at all 
times prostrate by sickness, and most of the race die 
prematurely. So uncertain are the effects of dis- 
* The numerals in the text refer to notes at the end of the Discourse. 6 
DISEASE, A PART OF 
eases, and so disastrous often their termination, that 
even the simplest attack may become a source of 
personal anxiety and alarm. Such, too, are the sym- 
pathies of our nature, and so constantly are they 
thus called into action, that experienced attendants 
upon the sick frequently grasp blindly and fortui- 
tously at a multitude of heterogeneous appliances 
which have obtained the name of remedies, in the 
hope that some one of the number may perchance 
rescue or relieve the sufferer. In this way physi- 
cians themselves, even the more eminent, are im- 
perceptibly and almost inevitably brought to the 
practical belief, that, in the officious administration 
of drugs sanctioned by custom or prevailing preju- 
dice,—the superintending “ a course of treatment,” 
as it is called,—lies the chief end and aim of their 
calling. So thoroughly at last does this idea per- 
meate the very life and thought of the daily routine 
of our profession, that the mere suggestion of a more 
comprehensive and a more scientific view, or a more 
rational motive, if suspected of any accompanying 
distrust of popular or fashionable professional mea- 
sures, is liable to be frowned upon as heresy. And 
thus it happens, that in every generation the strug- 
gle must be renewed to re-establish principles, and to 
arrest the mechanical, downward, trade-like ten- 
dency of our art; and good men and true arc called 
upon, and must be willing, to go to the front and 
bear the brunt of the battle. 
Grand forward movements in behalf of medical 
truth have been made in various directions in our own 
time, and with various success f but it is well known THE PLAN OF CREATION. 
7 
to the members of this Society, that the great vic- 
tory of the present century was achieved in this place 
just thirty years ago. Carefully and irresistibly the 
first advances were then made, and the first positions 
gained, until at length the whole argument was driv- 
en home, and the stronghold impregnably secured. 
From henceforth, wherever the English language is 
spoken or read, the doctrine of self-limitation* will 
be a ruling influence in the profession until a new 
era shall require a further advance, or science de- 
mand another expression. 
Thrown out as a “ picket ” on this occasion, I will 
essay my little skirmish and return as speedily as 
possible to the main column, fortunate if the soli- 
tary shot bring down a single resisting error ; more 
fortunate if it serve to open on any point a clearer 
view for the progress of the advancing hosts. 
“ Who did sin, this man, or his parents ? ” is a 
question daily asked, in one form or another, at the 
bedside of the sick The frequent response, as well 
as the query, presupposes, in general, that disease 
is undoubtedly referable to some indiscretion on the 
* In the discourse on “ Self-limited Diseases,” delivered before this Society 
at its Annual Meeting in May, 1835, by Jacob Bigelow, M.D., the author gives 
the following definition: 
“ By a self-limited disease, I would be understood to express one which receives 
limits from its own nature, and not from foreign influences; one which, after 
it has obtained foothold in the system, cannot in the present state of our 
knowledge be eradicated or abridged by art,—but to which there is due a cer- 
tain succession of processes, to be completed in a certain time, which time and 
processes may vary with the constitution and condition of the patient, and may 
tend to death or to recovery, but are not known to be shortened or greatly 
changed by medical treatment.” 8 
DISEASE, A PART OF 
part of the sufferer, to the errors of his progeni- 
tors, or, at least, to that 
“ first disobedience, and the fruit 
Of that forbidden tree, whose mortal taste 
Brought death into the world and all our woe.”3 
To show the fallacy involved in this question, and 
that the original answer4 was the true one,—to show 
that disease is not a mere accident in the history of 
our race, or due only to unwarrantable experiments 
upon our powers of endurance, but rather, that 
Disease is a part of the Plan of Creation,—one 
of the myriad expressions of Divine thought,—will 
form a leading object of the present discourse. 
Modem geology has brought to light many won- 
ders of the past. It has revealed to us unmistakable 
evidences of the existence on the earth of numerous 
classes of organized beings, long ages before the 
appearance of the human race.5 Animals then lived, 
flourished, and passed away. Individuals, then as 
now, had a limited existence, which death terminated. 
Some whole tribes, then as now, were so constituted 
that they could live only by the destruction of others. 
For this purpose they were provided with organs for 
seizing, tearing, and devouring their prey ; while in 
some instances they seem to have been armed not 
only to destroy but to torture their victims.6 On the 
other hand, organs of defence were furnished to those 
in danger of assault, and means of escape given to 
the weak.7 So that it is evident that the same strife 
prevailed in those early periods of the world’s his- 
tory as in the present times. In short, there were THE PLAN OF CREATION. 
9 
voracious mammalia before man, voracious reptiles 
before mammalia, and voracious fishes before rep- 
tiles. Moreover, much curious information has been 
acquired with regard to the structure and functions 
of the internal organs of these extinct animals. 
Not only has the nature of their food been ascer- 
tained by the half-digested remains of other animals 
found within some of these creatures, but the size 
and structure of the digestive organs themselves, their 
vascular surface, and the mucous membrane which 
lined them, have also been made evident by unequi- 
vocal marks on the surfaces of their contents.8 
From these and other appearances found in such 
fossil remains, the inference is unavoidable, that 
these creatures must have been liable to functional 
disorders of the abdominal organs similar to those 
affecting animals of analogous structure at the pre- 
sent day.9 
While such indications of the nature and habits of 
these remote animals, and their consequent liability 
to derangement of function, are thus plainly manifest- 
ed, the proofs of their liability to organic or struc- 
tural diseases arc complete and unassailable. Exten- 
sive enlargements by ossific inflammation have been 
discovered ; as also cavities and outgrowths produced 
by abcesses. Specimens of caries and necrosis are 
not infrequent. Other marks of scrofuloid diseases 
are also recorded. Instances of anchylosis have been 
noticed; and re-union of fractured bones, with 
exostosis at the points of junction, have been de- 
scribed and figured. And, more than this, evidences 10 
DISEASE, A PART OF 
have been found of recovery from the most extensive 
lacerations, involving bony structures, by the fangs 
of other animals, where the individual must have 
lived long enough afterward to allow the injuries to 
be repaired, as far as is ever possible after great loss 
of substance.10 
All these things we have most clearly demonstrat- 
ed to us in addition to the necessary lethific action 
of physical causes, burning, freezing, suffocation, 
storms, natural poisons and the like, which also have 
existed through all time. 
Thus it is evident that, from the beginning (using 
here the word in its widest geological meaning, and 
not simply in the narrow sense of the beginning of 
human existence), life has been subject to dangers, 
disorders, and diseases, such as beset it in these latter 
days ; and that it has ever had essentially the same 
means of escape and modes of recovery. So that we 
are led to the inevitable conclusion, that, if the ex- 
istence and peculiar structure of these ancient ani- 
mals afford proofs of design, generally acknowledg- 
ed* to be most wonderful and convincing, so also 
their diseases, in the same way made known to us, 
and their processes of recovery from disease and 
* We are aware that the idea of a “ Great Artificer” is considered a “ fetish- 
istic conception,” unworthy an educated man or an enlightened age, hy some 
philosophers, who find an easy solution of all the phenomena of Creation in 
“ Persistence of Force,” spontaneously generated, acting upon matter itself 
uncreatable. According to this theory all evils are incidental, to be self-elimi- 
nated at some future period. Till a nearer approach of that good time coming, 
our manner of dealing with the subject may be permitted, leaving the facts 
presented to be translated into other language, should any one ever think it 
worth the while. THE PLAN OF CREATION. 
11 
accident, no art having intervened, must be accepted 
as equally the result of intelligent contrivance. 
In like manner animals now living, whether spe- 
cies continued from former ages, or introduced in 
more recent periods, all are liable to disease and 
bodily infirmities.11 Though they prey upon each 
other, the numbers thus destroyed probably bear but 
a limited proportion to those swept away by occa- 
sional pestilence. Singly and silently, however, the 
many, when overtaken by disease, withdraw to some 
obscure and sheltered nook to await their fate, — of 
recovery or death. If health returns, they crawl 
out by degrees to the warmth of day; and many an 
awkward sportsman has rejoiced over captures due 
less to his own skill than to the weakness of the 
convalescing victim. Usually such cases are isolat- 
ed ; and each individual passes away like a falling 
leaf, unnoticed and unmissed. Occasionally an epi- 
demic rages, and the destruction becomes excessive; 
while, at times, “ diseases of mysterious origin break 
out in the animal kingdom, and well nigh extermi- 
nate the tribes on which they fall.”12 
As it is with wild, so it is with domestic animals. 
Diseases seize upon them in obedience to laws of 
which as yet little or nothing is known. Ordinarily 
they succumb, one by one, unnoticed except by their 
owners, the scavenger, and the drayman. Now and 
then, however, the fold is infected, and its future 
hope endangered.13 Then the alarm spreads, and the 
whole country is aroused. In its ignorance and 
terror it sacrifices life without mercy, and treasure 
without discretion.14 12 
DISEASE, A PART OF 
It were well for communities in general to give 
such, subjects more careful study ; and especially so 
for physicians, since “ there is every reason,” says 
an eminent authority,15 “ for believing that pathology 
in man would be greatly benefited by investigations 
of the diseases of animals.” 
And so it appears that disease is not only a part of 
the constant experience of animals, which cannot 
have any agency in the matter, and only submit to 
the conditions imposed upon them, but that it ob- 
tained in the earliest originations of organized exist- 
ence, and has continued uninterruptedly to the 
present time. No “mortal taste,” but the will of 
the Creator, determined and fashioned such a system 
of diseases, — the evidences of which, foreshadowed 
in the beginning, become more and more apparent 
in the subsequent phases of Creation. 
Turning now to the human family, whatever 
may have been its original condition, we find the 
“ lapsed race,” from the first pair, brought under the 
same general scheme. In no period of his life is 
man exempt from the incursions of disease, from 
infancy which wakes into an exanthem, to old age 
which sleeps “ sans everything.” Every organ has 
its peculiar diseases, every system of the body its 
own affections. No forecast or wisdom of the indi- 
vidual can with absolute certainty ward off or delay 
these attacks. To such an extent is this recognized, 
that the young adult who has passed through the 
diseases of childhood, so called, is considered by sta- 
tists of greater merchantable or insurable value, than THE PLAN OF CREATION. 
13 
one who lias still to incur such dangers. Theories 
have been abundant to show how single diseases 
may be avoided; but it does not appear that any dis- 
ease has as yet been removed from off the globe 
through man’s agency. Flight to the mountains, or 
to the uttermost parts of the earth, can at no period 
of life insure perfect exemption, and always at 
last proves unavailing. We know not even the 
secondary causes by which diseases are propagated, 
whether they arc atmospheric, miasmatic, or anirnal- 
cular.10 They have existed from the beginning, and, 
so far as we can at present divine, they will continue 
to exist through all time to come, or until they reach 
the termination assigned to them. So little arc 
these causes understood, in the usual incursion, 
spread, and progress of the common diseases of suc- 
cessive years, that not even the wind, that blowcth 
where it listeth, is less under the guidance or control 
of human agency or power. Though in all proba- 
bility obedient to some general law, too subtile to be 
apprehended as yet, we are utterly unable to predict 
with certainty what even a day may bring forth of 
any disease in progress. When an epidemic appears, 
it often completely confounds all our conceptions of 
hygienic laws, as well as our preconceived notions 
of its nature or proper treatment. We cannot tell 
why it came, or when it will depart; or whether, 
under similar circumstances, it will again return. It 
marches on, often apparently without discrimination, 
over districts reputed to be healthy ; not unfrequcntly 
seizes on purified places, and avoids the polluted; at- 14 
DISEASE, A PART OF 
tacks tlie rich as well as the poor; subverting the theo- 
ries of the learned and the predictions of the wise.17 
Now and then we proclaim preventives, destined 
only to fail as the announcement escapes our lips. 
As we cannot bind the sweet influences of Pleiades, 
or loose the bands of Orion, neither can we arrest 
the midnight pestilence or the noonday destruction ; 
much less can we control in any degree the approach 
or progress of those terrific scourges which, in their 
appointed times and preordained courses, sweep over 
the nations, obeying Him only who rides on the 
whirlwind and directs the storm. 
Let us take a single case of disease, and observe 
what evidences of Design are exhibited in its regu- 
lar series of phenomena and modifications. For 
example, let us take one of the simplest exanthems. 
It is unnecessary to particularize the minuter symp- 
toms. It will be sufficient to notice its general his- 
tory. For ten or fifteen days, more or less, after 
exposure to the morbific cause, called the period of 
incubation, the individual, though unaware of his 
condition, is as completely under the influence of 
the disease as at any subsequent period of its pro- 
gress. As this stage closes, that of fever sets in, 
perhaps with some considerable degree of severity. 
Then, in two or three days, an eruption appears, be- 
ginning on the face and neck. On the fifth day, it 
covers the body and extends to the extremities. On 
the sixth it begins to decline on the parts first affect- 
ed, whilst it is vivid on the general surface. On the 
seventh, eighth and ninth, the eruption fades, in the THE PLAN OF CREATION. 
15 
order in which it came on, leaving the cuticle in a 
state of exfoliation.18 
Such is the history of one of the most common 
exanthems. Others of the class are not unlike it 
in their general onset, progress, and termination. 
No evidence of an intelligent contrivance can more 
distinctly indicate a plan, than that furnished by any 
of these diseases. In their invasion, incubation, pro- 
gress, culmination, decline, and disappearance, they 
are as systematically pre-arranged, and as wonder- 
fully wrought out, as is the life-history of any exist- 
ence, vegetable or animal, in its conception, embryo- 
nic state, infancy, puberty, and adult, middle, and 
declining age. There cannot be adduced a greater 
proof of inventive thought, or varied contrivance, 
perfect in itself, in all its parts and as a whole, than 
that exhibited in any one of these diseases. 
What is thus true with regard to exanthems, is 
also true of other diseases to a greater extent than 
might at first be imagined.19 It may hereafter be 
shown that a state of incubation belongs to all dis- 
eases. One can hardly doubt it in acute cases ; 
much less in chronic. How seldom is health found 
to have been perfect up to the very moment of ap- 
parent invasion in typhus, and typhoid, and inflam- 
matory affections ! How often rather is it observable 
that some unappreciated discomfort, or perhaps some 
exaltation of spirits, is confessed to, when a thorough 
investigation is attempted ! It is often found that 
the more obstinate and ordinarily fatal diseases in- 
clude multifarious weakening disorders, endured by 16 
DISEASE, A PART OF 
the victim some time before their true nature is fully 
realized. Be this as it may, after a disease has once 
taken up its occupancy it follows certain laws pecu- 
liar to itself, as the lengthened histories of the books 
amply testify. These, though written for an entirely 
different purpose, reveal, if we read aright, a remark- 
able conformity to the idea which we have tried to 
develope. 
May not what we have shown of the simplest 
morbid affections be also true of the more compli- 
cated and less understood diseases, such as those of 
the blood, for instance, or of the nervous system, 
which the acutest observers have failed to explain ? 
We hear often of metastasis. An internal organ 
gives evidence of a severe attack. All at once the 
local symptoms abate, and a distant part, an extre- 
mity perhaps, becomes the seat of exquisite tender- 
ness and intolerable pain. Hardly do these subside 
before terrific agony affects the head, and the patient 
sinks in the frightful struggles of mania. Theory 
explains, that, in the internal organ first attacked, 
pus or such-like morbid matter was evolved; that 
this, taken up by the adjacent veins, was carried to 
the extremity by the veins of that part; and that, 
when the last change occurred, it was effected in a 
similar way in the direction of the head, — post- 
mortem existence of pus in the several parts being 
considered proof positive of the truth of the hypo- 
thesis. Or else, that the pus taken up by the veins 
and carried to the heart, is forced through the 
arteries by that organ to the other parts subsequently THE PLAN OF CREATION. 
17 
affected.20 But how, in the first instance, can veins 
whose currents run in the same direction or towards 
a common centre, carry fluids or other matter in op- 
posite directions'? Or, on the second supposition, 
can we imagine that pus can go unaltered through 
the whole circuit of the circulation without poison- 
ing the whole system rather than a remote part"? 
Besides, the primitive formation of pus is left wholly 
unaccounted for. Is it not more rational to 
think that the original morbific cause, after incuba- 
tion sufficient to pervade the system, revealed itself, 
first, in the internal organ, next, in the extremity, 
and lastly, in the head; the outward demonstrations 
being only consecutive manifestations of the one un- 
explained moving cause % 
Acute rheumatism may also further illustrate our 
meaning. This disease, with one central, constitu- 
tional morbific cause, shows itself on the outposts in 
most astonishing ways, — now at the end of one 
extremity, and in a moment, as it were, leaving that 
part to appear in a distant one, on the other side of 
the body. When fixed upon any portion, no one 
can with any certainty hasten or retard its departure, 
say how long it will remain, or predict what will be 
its next point of attack. Each new case is a new 
enigma. How curiously planned, how varied in uni- 
formity, how singularly wrought out! No finite 
intelligence could ever have originated such a com- 
bination ; no human intellect ever approached it in 
subtilty of contrivance. 
But instances need not be multiplied. There is 18 
DISEASE, A PART OF 
hardly a disease which, if studied in this view, will 
not afford an example of wondrous designing power. 
All the resources of art would be unavailing in an 
attempt to originate even one of the simplest specific 
diseases. Great is the mystery that overhangs the 
nature of morbific causes. The highest intellects 
have proved incompetent to its solution. Volumes 
have been written to elucidate it, still the mystery 
remains as obscure as in the days of the earliest 
observers. But the inference is unavoidable, that, 
if the human mind cannot unfold the marvels of a 
disease with all its attendant and antecedent phe- 
nomena, and much less find its morbific cause, it must 
have required a higher intellect, than any created, to 
have combined these agents, and arranged the laws 
by which they all are governed. 
Not less worthy of notice are the different suscep- 
tibilities of different individuals to any single disease ; 
and of a single individual to different diseases. When 
the seeds of disease are scattered abroad, many fall 
into unprepared systems, and after springing up, 
quickly wither away; not every acorn becomes an 
oak. Let a large number of persons be simultane- 
ously exposed to contagion: one portion of them 
would soon sink under its influence ; another would 
be severely affected ; still another, and perhaps the 
largest, would suffer moderately; while a few 
would pass unscathed, entirely unaffected by its pre- 
sence. In a great number this susceptibility would 
be exhausted by one attack, so that the subjects of it 
could bear any amount of subsequent exposure with THE PLAN OF CREATION. 
19 
impunity. On the other hand, a few would receive 
the disease a second, and some even a third time. 
This difference of susceptibility obtains in regard to 
most if not all diseases, and to the protective power 
in many, — how many, is not yet fully ascertained. 
In other cases, however, one attack only predisposes 
to a repetition. In this respect, also, there seems to 
be a graduated scale, arranged with forethought and 
planned by intelligence. And all this is true no less 
of individuals than of classes. 
Again, diseases are distributed through the differ- 
ent seasons of the year with such a degree of con- 
stancy, that the seasons themselves are sometimes 
spoken of as the causes of the diseases. But a little 
reflection will enable one to see, that, in the nature 
of things, there is no essential or known reason why 
diseases of the bronchial mucous membrane should 
prevail in winter, or those of the intestinal mucous 
membrane in the summer ; why the plague should 
prefer heat, and variola cold, for its devastations. 
In like manner the appearance and peculiar cha- 
racteristics of common diseases in ordinary seasons, 
or the severer cases of epidemics in all seasons, may 
never be satisfactorily accounted for by the ex- 
ternal surroundings of the victims. After most 
careful investigations, writers are still compelled 
to admit that there must be some unknown condi- 
tion, some cause not understood, other than the 
poverty, privations, filth, and locality of those at- 
tacked.21 The simple explanation is to be found in 
the idea of an original Plan, as we are attempting DISEASE, A PART OF 
to demonstrate. With this as the guiding idea, how 
much more intelligible become such investigations 
of disease ; how much easier the unravelling of the 
laws which govern organized existence ; how much 
time saved, now lost in a fruitless search for specific 
causes! 
Other evidences of Design and fixed law may be 
noticed in the general averages of sickness and 
mortality. These are such and so constant, that in- 
surers can calculate, with accuracy their probable 
losses from one decade to another, though their 
patrons are selected from the most vigorous and 
favored classes; and any community can estimate, 
if it chooses, its loss of time by sickness, so as to 
provide beforehand for the coming emergencies of 
future years.22 
The geographical distribution of the various ani- 
mals and plants within certain limits,23 a discovery 
which has given additional interest to natural sci- 
ence in our day, is not more remarkable than the 
geographical distribution of diseases.24 While some 
of them seem to be almost cosmopolitan in their ex- 
tent, others are confined to restricted localities, beyond 
which, without any apparent reason, they seem un- 
willing to go. As some plants thrive best in connec- 
tion with others, or in near proximity, so there are 
diseases which seem to have a mutual affinity, or 
appear generally in connection with each other; 
while, on the other hand, some unexplained antago- 
nisms' and complements exist among diseases, not 
unlike those observed in the vegetable kingdom.25 21 
THE PLAN OF CREATION. 
Furthermore, that power peculiar to organized 
beings, which enables them to endure, within wide 
limits, all kinds of physical changes and exhausting 
influences, is no less remarkable in the tolerance of 
diseases. This “ reserved force ” seems a necessity 
preliminary to the possibility of disease, or at least 
to recovery from it. Without this reserved force, 
ordinary functions would be in constant danger of 
interruption or absolute destruction. With it, the 
severest malady may pass through all its stages to 
perfect recovery, without, in the end, greatly injur- 
ing the individual. This will appear a more re- 
markable provision when we consider, that during 
disease the ordinary supply of nourishment for the 
development of force is refused by the patient, and 
often only so much is accepted as may be barely 
sufficient to continue existence. We do wrong to 
call this, or any phase of it, a vis medicatrix,— 
a term (the sooner discarded the better) involving 
theories long since abandoned, and now almost for- 
gotten. It is simply a vital principle of endurance, 
sustaining the organism through all the period of 
disease, as necessary at the outset as at the close. 
Such are some of the evidences of forethought 
and design in the introduction of diseases. These 
evidences are to be seen in the fossil remains of 
animals which lived and suffered long before man 
appeared upon the earth. They are to be seen in 
the diseases of animals now existing, — in the wild 
which avoid, and in the domestic which cling to, the 22 
DISEASE, A PART OF 
abodes of the human race. They are to be seen 
more universally, and more completely, developed 
in man himself, as, from the cradle to the grave, he 
passes through one experience to another by allotted 
stages. They are to be seen in the histories of 
separate diseases so systematically and mysteriously 
constructed; and in their geographical distribution, 
periodicity, and modes of onset and of decline. Ad- 
ditional evidences are also to be seen in the different 
susceptibilities of individuals, and in the power of 
endurance possessed by all. From whatever point 
the subject is viewed, multiplied evidences arise of 
intelligent and inventive authorship. On all sides 
these evidences are of the same kind as are adduced 
to show Design in other operations of nature; and, 
if admitted anywhere, we must admit its manifest 
revelation in the devising and the orderly contrivance 
of diseases.* 
Thus it appears that the idea of Diseases must 
have originated in the Creator’s mind, and its deve- 
lopment formed a part of the Plan of Creation from 
the beginning. The ultimate purpose of such a 
Plan it is not for man to determine.26 Deliberately 
devised, diseases do not necessarily imply “ gratuitous 
* N. B. The limits of this Discourse admitted only of a restricted develop- 
ment of the argument from diseases in animals; that from diseases in the 
vegetable kingdom, exhibited in every forest, grove, and orchard, is equally 
impressive and convincing. 
For the same reason idiopathic diseases only (those “ realities ” manifested 
in “a series of consecutive changes”) have been considered. Disorders 
(irregular or disturbed performance of function) afford equally good illus- 
trations of plan, in the laws which govern them, and in the subsequent 
restoration from their effects. THE PLAN OF CREATION. 
malevolence”; for, despite of some philosophers, it 
is quite possible to conceive of the earth and all 
that is therein, simply as an expression of Divine 
thought, without reference to the question of good 
and evil. But to repel such censure is foreign to 
our present purpose; whatever is, is enough for us 
as scientific men now to consider, humbly acknow- 
ledging, that “ in the Divine government the matter 
of fact always determines the question of right, and 
that whatever has been done by Him, who rendereth 
no account to man of his matters, He had in all ages, 
and in all places, an unchallengeable right to do.”27 
Such being the facts, though it may never be 
explained why organized existences always have 
been, and until a new order of things has arisen 
always will be, subject to diseases, yet the extrication 
of what cannot be explained from what may be, is 
no small addition to any science. Recognizing such 
limitations, we shall not, like the great men whom 
Hippocrates so ingeniously refuted (for there were 
great physicians before his time), labor to refer all 
the afflictions of the race “to hot, or cold, or wet, or 
dry ;”28 nor to “figments called inflammations,” which 
have been so quick to disappear under the tests of 
our own day; nor to any of the many other theo- 
ries which between those have had their short-lived 
career. But we shall consider the causes of diseases 
to be primitive purposes, as much so as electricity or 
gravitation, and, proceeding as we do with those 
subjects, we shall study their development, and the 24 
DISEASE, A PART OF 
phenomena to which they give rise, with more satis- 
faction to ourselves and benefit to the sick, and with 
the positive enlargement of our science. 
Since these things are so, it may perhaps be said 
that we may as well fold our hands, and resign our- 
selves with indifference to whatever fate may befall 
us. By no means. The storm may arise and the 
winds may blow, but we may seek shelter from the 
former, or wrap our mantles closer to exclude the 
latter. Even against the inconveniences of a summer 
shower we may oppose the delicate contrivances of 
modern invention. But it does follow that we may 
not attempt to attack the laws of nature with any 
hope of arresting the fury of the elements, or the 
influence of their disturbances. We may indeed esti- 
mate their forces, calculate their movements, and, 
having possessed ourselves of all that is known of 
them, govern our conduct so as in many cases to avoid 
them in the outset, or at least to mitigate the evils 
in their train, or to take advantage of whatever of 
good can be derived from their presence. 
So with regard to diseases, we may not have it in 
our power to banish their elements from existence ; 
we may not often prevent their coming, or be able 
to stay their progress ; we may not jugulate or break 
them up at pleasure when once they have seized 
upon us, or greatly shorten their continuance; we 
may not amend their destructive characters, or very 
sensibly diminish average mortality;29 — neverthe- 
less, suitably recognizing their place in the great 
Plan of Creation, and acquiring as full a knowledge THE ELAN OF CSlEATION. 
as possible of their phenomena, with a just estimate 
of human power, we may seek, with some certainty 
of success, to evade their approach, or to save our- 
selves from many of the inconveniences and dangers 
of their attacks.30 Thus, when a disease “ has ob- 
tained foothold in the system,” we may remove as 
far as possible obstacles to the natural progress of 
its “ succession of processes,” and sustain the system 
as well as may be in its power of endurance, until 
these processes are duly and safely completed. To 
do this to perfection, is no easy matter. It will re- 
quire a greater knowledge of disease than any indi- 
vidual, however learned, has yet acquired; a more 
thorough investigation of each separate case than 
is now made by the most pains-taking practitioner; 
a more complete mastery and discriminating use of 
all the appliances of our art than has been heretofore 
possessed and practised; and a more absolute and 
abiding control of the patient and his surroundings 
than was ever yet granted to any medical attendant.31 
Possibly the Profession and the Public may hereafter 
be educated up to such a state of perfection in the 
management of the sick; though, as yet, even the 
profession seems not quite willing to fully accept all 
that is now known of the nature and laws of disease.32 
“ The physician, ” says the learned translator of 
Hippocrates,33 “ who cannot inform his patient what 
wxmld be the probable issue of his complaint, if 
allowed to follow its natural course, is not qualified 
to prescribe any rational plan for its cure.” But 
how small a proportion of the profession could con- 26 
DISEASE, A PART OF 
sistently practise their calling for a single day, were 
this test strictly exacted! Who among us ever saw 
a disease allowed to follow its natural course to its 
termination, unless, bolder than his neighbors, he 
risked the denunciation of his peers and dared by 
himself to try the experiment \ Yet the trial is not 
so dangerous as was formerly believed ;34 and, if 
entered upon as unhesitatingly and with the same 
confident expectation with which newly vaunted 
remedies are often given, more “ wonderful cures ” 
would be witnessed than were ever related in the 
books. The time is coming, perhaps it is nearer 
than we are aware of, when the public shall no 
longer consider the proper care of the sick (their 
true cure) to consist in a mysterious and indispensa- 
ble administration of drugs, but in rationally and 
understandingly attending to all their necessities ;35 
when the young aspirant for patronage shall not find 
it necessary, in order to satisfy the bystanders, to 
write his recipe before he has examined his patient,36 
or to authoritatively announce the name of the dis- 
ease before he has had time to comprehend the 
symptoms; — and there is no reason why the pro- 
fession should not now, by lofty endeavor and com- 
bined- action, strive with success to bring about such 
a desirable result. When this is accomplished, the 
not unreasonable requirement above quoted may be 
fully accepted. At any rate, it is time that the edu- 
cation of pupils in the study of disease should be 
founded on a new basis. Not a school in Christen- 
dom ever yet afforded proper opportunities, if any THE PLAN OF CREATION. 
at all, for studying the natural course of diseases.37 
Under different teachers, if we may credit eminent 
authorities and our own observations, the same dis- 
ease may assume different outward appearances, 
according as the several “ courses of treatment ” may 
differ from each other.38 Although the immediate 
effects of drugs, and their strictly therapeutic influ- 
ence, if any, are very different matters, and ought 
never to be confounded,39 — students are too often led 
to believe that all the recoveries they have seen 
have been due to the prescriptions selected ; and 
they go out into the world under the apprehension, 
that, if they do not generally “ cure ” disease, it will 
be from not having the good fortune to hit upon the 
right course of medication. The exhibition of a 
multifarious mixture, in order perchance to include 
the right ingredient, is not merely a fitting, but the 
most obvious, corollary to their previous instruction. 
To most men, years of anxious and much unsatisfac- 
tory experience ; to some, a whole life of disappoint- 
ment ending in utter scepticism of the value of medi- 
cine, are the results of such erroneous beginnings.40 
The doctrine we have advanced and advocated 
leads to a different procedure. It leads to an aban- 
donment of the old notions of the primary causes 
of diseases. It leads to a new view of the purpose 
of diseases themselves. It shows the idea untena- 
ble, that disease, an evil, is to be expelled from the 
system by some antagonistic power only, the vis medi- 
catrix, for example ; or by a new and incompatible 
disease artificially induced; or that it is in itself an DISEASE, A PART OF 
effort (conamen) to expel from the body an enemy 
already in possession;41—but that it is one of the 
attendants of life, instituted in the Beginning. And, 
ignoring none of the real acquisitions of the past, 
this doctrine divests the truth of many of the errors 
which have thus far impeded its progress. 
This doctrine being accepted, the proper acquisi- 
tion of our art will demand of students, in the first 
place, a thorough knowledge of the body in its 
healthy condition, — its organic structure, its outward 
form,42 and its internal functions; and, secondly, the 
investigation of the natural phenomena of disease 
undisturbed by medication, as a necessary prelimi- 
nary to its proper management. It will require of 
them also a careful study of the operations of the 
mind as affecting the body, and their mutual reac- 
tions upon each other, in health as well as in dis- 
ease, — health and disease being parts of one great 
Plan, and often intricately involved in each other. 
In these directions medical education has been defi- 
cient, and subsequent attention in after-life remiss. 
Let coming students take warning from the defi- 
ciencies and failings of those who have preceded 
them.43 Let them, thus properly grounded, and not 
till then, proceed to study all the effects of accepted 
remedial agents. Every step from such a base will 
be a true progress for themselves and their science, 
no disappointment or scepticism ensuing. Every 
advance in this way will be in the right direction,— 
vestigia nulla retrorsum. 
Of late years it has been quite common to vaunt THE PLAN OF CREATION. 
29 
tlic power man may have over plants and animals 
in modifying their form, color, growth, and other 
qualities, and to adduce this as an argument in favor 
of a similar power over diseases. But the two 
cases are far from being analogous. It is one thing 
to raise a few deformed sheep, or to increase the 
number of vertebra? of birds from generation to 
generation,44 by “ selective breeding,” so called ; and 
quite another thing to modify the course and ter- 
mination of disease in a particular individual. They 
are separate matters, connected by no logical se- 
quence. The one is necessarily limited to the life of 
an individual, or only to the duration of a disease in 
an individual; the other may, nay, must extend 
through successive generations, or successive ages. 
Besides, the permanency of species has not yet been 
disproved, and it will be time enough to use such 
arguments when dogs shall be actually bred from 
wolves, or an ape be unquestionably transformed into 
a human being. 
While admiring the activity in our medical schools, 
the facilities of instruction and for clinical observa- 
tions at our hospitals, the zeal of societies, the energy 
of individuals, and all the various helps to profession- 
al advancement, now so multiplied and abundant, one 
cannot but regret the still prevalent tendency to recur 
so readily to second causes, and to impede the ad- 
vancement of medical science by claiming for it 
more than is consistent with actual truth. The 
medical press, so often boasted of as the great dis- 
seminator of medical knowledge, is still too often 30 
DISEASE, A PART OF 
the vehicle of false philosophy and unworthy as- 
sumptions. False facts, false reasoning, and non- 
sequitur conclusions fill up a large portion of peri- 
odical publications. Even the more stately volume 
seems incomplete without its remarkable cases se- 
lected for an object, and its infallible formulae, which 
perhaps have never had a trial.45 An author who 
shall candidly relate his own experience, in ordinary 
cases, of expectations disappointed and unsuccessful 
issues following the employment of reputed infalli- 
ble agents (and such experience only), will richly 
deserve, if he does not receive, the thanks of the 
profession, and be indeed “ more than armies to the 
common weal.”40 
Brethren: 
Fashions in medication are fluctuating and fleet- 
ing. Each age flatters itself that it has made a 
great advance over the previous one, and has reached 
at last something established and permanent. But 
we smile at the notions of our predecessors, only to 
be laughed at by those who come after us. Time 
was (men are living who remember it) when pneu- 
monia was considered a fatal complaint, unless sub- 
dued by venesection at its onset; now it is instanced, 
by an eminent observer, as the purest example of a 
self-limited disease.47 Time was (physicians are with 
us who thus practised) when spasmodic croup, so 
called, was believed to be an imminently dangerous 
disease if the external jugular vein were not imme- THE PLAN OF CREATION. 
31 
diately opened; now it is known to be a compara- 
tively harmless accompaniment of another disorder, 
and needing in itself no special interference. Time 
was (our own day embraces it) when it was publicly 
taught, that mercury given to salivation was not only 
the specific, or antidote, for iritis, but absolutely es- 
sential to its successful treatment; now, one of our 
number has been justly called a public benefactor 
for showing that such practice is not only unneces- 
sary, but often grievously detrimental in that affec- 
tion.'18 But why multiply examples ? So it has been, 
and so it will ever continue to be, until more correct 
views are acquired of the Plan of Creation, and of 
human powers under it. The great facts of our 
science are permanent, and, however feebly stated 
from time to time, or hesitatingly received, will at 
last prevail and triumph. False assumptions are 
dangerous expedients, and the most ignorant will 
ever be the most likely to practise upon them.49 
Truth is weakened by any addition of error ; and the 
profession that allows it must in the end abandon its 
own self-respect. The remedy is in our own hands; 
let us be heroic enough to apply it in season. 
“ Medicine,” says our American Hippocrates, “ is 
the art of understanding diseases, and of curing or 
relieving them when possible.”50 To this sage remark 
it may be added, that a Doctor of medicine should 
also teach the patient and his friends to acquiesce 
in an intelligent submission to the laws of disease ;51 
laws as manifest and inflexible as those of health. 
This done, the Profession will acquire a dignity be- 32 
DISEASE, A TART OF 
fore unknown to it; and the Attendant will become 
an enlightened guide, instead of an uncertain and 
bewildering dealer-out of nostrums. 
To turn increasing attention in the direction indi- 
cated, we ventured on the perilous duty of to-day. 
Let us hope, that, as impediments are one by one 
removed, progress may be easier in time to come. 
There is nothing in time past to discourage renewed 
effort. Though yet afar off, the goal is nevertheless 
in sight. The present time is propitious. Allied 
sciences arc on the move. It is for us to hasten on, 
and to display our standard in the foremost ranks. 
Thus shall we better satisfy the demands of the age, 
and truly ennoble our Profession. 
Brethren : 
During the past year, twenty-two of our num* 
her have yielded to the common fate of mortality. 
The Secretary’s list, which he read to-day, has 
given us, name by name, the melancholy announce- 
ment. The courteous Bartlett, the munificent 
Walker, the genial and true-hearted Coale, the brave 
and tender-hearted Sargent, and our other martyrs, 
Fox, Heath and Hoyt, with other well-known and 
cherished friends, have gone to their rest. We strew 
the fresh-formed mound with cypress mingled with 
laurel, and kindly drop the tear of friendship, as, 
imitating their example, we press earnestly forward 
to the struggles awaiting us. Faithfully and loyally THE PLAN OF CREATION. 
33 
they served the cause of humanity and of their 
country; ardently would we recount their virtues, 
and for-ever hold them in honored remembrance. 
And now, Brethren, having attempted the weightier 
duty of the hour, and paid a tribute to the memory 
of those who have “ passed over to the majority,”52 
let us, as the quick-step follows the dirge and the 
volley, hasten with cheerful pace to the pleasanter 
task reserved for us at the festive board. In all ages 
weariness and sorrow have in this way sought appro- 
priate relief. Thus it is that Old Homer closes the 
solemn meeting of Priam and Achilles ; and fortifies 
the latter with a stronger instance in justification 
of his own course. Let us, in obedience to a 
common nature, imitate such high examples, and 
becomingly conform to the time-honored custom 
of our Society,— 
Now feast we, — not in griefs severest mood 
The bright-haired Niobe forgot her food; 
Then let us now, ere coming cares annoy, 
Our thoughts awhile on needful food employ; 
To-morrow range the vales and hill-sides o’er, 
The weak to succor and the dead deplore.5* NOTES. 
1. Page 5, Line 7. 
“ II faut toujours en revenir k cette triste verit6, que la la 
plus noble des professions et le plus triste des metiers.”— Gaz. Med. de 
Paris, 1851, Tom. v. p. 448. 
“ Medicus sum, non vero formularum medicarum prooscriptor; quas 
ego duas, sive artes, sive dotes, sive etiam provincias, appellare libeat, 
toto coelo a se invicem distare arbitror.” Sydenham, “ I)iss. Epist." §42. 
Said an esteemed friend, as we left the hall at the last annual meeting, 
“ So, you read next year ; well, don’t give us any of your heresy ! ” 
The exordium of this Discourse was written that evening. 
2. Page 6, Line 32. 
See a list of publications in “ Expositions of Rational Medicine,” by 
Jacob Bigelow, M.D., Boston, 1858, pp. 57-60. Several other well-known 
papers have been published since that date. 
3. Page 8, Line 5. 
“ Upon his taking his place as lord of the terrestrial creations, a specific 
injunction was given, guarded by a penalty for its violation: ‘In the 
day thou eatest thereof thou shalt surely die.’ But, having taken upon 
himself the fearful responsibility of casting off the authority of his right- 
ful sovereign, he came to disregard all wholesome laws, whether out- 
spoken from the cloud upon Sinai, or written upon the organism of his 
physical nature ; hence the insane perversions in physiology and psycho- 
logy, including the poisoning of the senses of taste and smell, those faith- 
ful guardians of life and health and beauty; and hence the thousand 
forms of disease that flesh is now heir to.” — “ Health : its Friends and 
its Foes," by R. D. Mussey, M.D., LL.D., Boston, 1862, pp. 190, 191. 
‘ ‘ Hence the disorder and disease ; hence the groaning and travailing 
together of the whole creation; it is all the supernatural work, the bad 
miracle of 6in.” BushnclVs “Nature and the Supernatural," New 
York, 1861, p. 218. 36 
NOTES 
“ Medicines are created by our offended God to relieve diseases which 
all originate in sin.” “ Scott’s Commentary, Matt.—John,” p. 650, 
Philadelphia, 1860. 
Miss Nightingale, whose influence exceeds in effect a score of such 
writers, takes a diametrically opposite view of these matters. She speaks 
of diseases as “ conditions, like a dirty and a clean condition, and just as 
much under our control, # # * conditions in which we have placed 
ourselves;” and seems to think that we can originate diseases at will. 
She says: 
‘ ‘ I have seen with my eyes and smelt with my nose smallpox growing 
up in first specimens, either in close rooms, or in over-crowded wards, 
where it could not by any possibility have been ‘ caught,’ but must have 
begun.” 
“Nay more, I have seen diseases begin, grow up, and pass into one 
another.” “ Notes on Nursing,” p. 26, note. 
Disrespectful as it may seem, one can hardly repress the exclamation, 
“ Oh, Gammer, what big eyes you’ve got! ” 
4. Page 8, Line 7. 
We quote the answer, for the benefit of those who may not remember 
it! “ Jesus answered, Neither hath this man sinned, nor his parents ; 
but that the works of God should be made manifest in him.” John ix. 3. 
5. Page 8, Line 18. 
See Hugh Miller, “ Testimony of the RocksBuckland, “ Reliquiae 
Diluvianae;” “ Bridgewater Treatise; ” Mantell ; and others. 
6. Page 8, Line 26. 
“ Fossil sharks, with weapons so murderous, that they must have been, 
according to Agassiz, the pirates of that period.” Miller, “ Old Red 
Sandstone,” p. 215. 
7. Page 8, Line 29. 
For a description of the sting of the Pleuracanthus, offensive organs, 
and defensive armor of other animals, see Miller, “ Testimony of the 
Rocks,” pp. 99 et seq. 
8. Page 9, Line 12. 
See Buckland, “ Bridgewater Treatise,” pp. 187-201. NOTES 
9. Page 9, Line 18. 
Buckland, ib. p. 190, note. “ The quantity of this coprolite is pro- 
digious, when compared with the size of the animal in which it occurs ; 
and, if we were not acquainted with the powers of the digestive organs 
of reptiles and fishes, and their capacity of gorging the larger animals 
that form their prey, the great space within these fossil skeletons of 
Ichthyosauri, which is occasionally filled with coprolitic matter, would 
appear inexplicable.” 
10. Page 10, Line 6. 
Mr. Clift’s case, see Buckland, “ Reliquiae Diluvianae,” p. 74. Cuvier, 
“ Ossemens Fossiles, ” Vol. iv. p. 396, and plate. See also Zies, 
“ Beschreibung mehrerer kranker Knochen vorweltliche Thiere,” Leipzig, 
1856. A resum6, with additional descriptions of specimens in the 
Dresden Collections. 
11. Page 11, Line 6. 
According to Dr. Livingston, “ many diseases prevail among wild ani- 
mals ” in South Africa. “Researches,” p. 149. 
See “ Recherches de Pathologie Comparee, ” Ch. F. Heusinger. 
Cassel, 1848. 
12. Page 11, Line 22. 
Hugh Miller, “ Old Red Sandstone,” p. 222; which see also for several 
noted instances of epidemics. 
See “ Traite d’Hygiene Agricole, par F. A. Rufener.” 8vo., Fribourg, 
1858. 
See also a valuable work, “Die Einimpfung der Lungenseuche des 
Ilindviehes,” &c. By Prof. J. M. Kreutzer, 8vo., Erlangen, 1854. 
13. Page 11, Line 29. 
“ Spemque, gregemque simul, cunctamque ab origine gentem.” 
Georgic, iii., 1. 473. 
14. Page 11, Line 32. 
“ At length she strikes a universal blow ; 
To death at once whole herds of cattle go.” 
Dryden's Georgies, iii., lines 827-8. 
15. Page 12, Line 4. 
Sir James Forbes, M.D., “Nature and Art in the Cure of Disease,” 
p. 46. 38 
NOTES 
16. Page 13, Line 11. 
Sir Henry Holland, M.D., “Medical Notes and Reflections,” Chap, 
xxvi. T. Thompson, “ Annals of Influenza,” p. 385 ; and others. 
17. Page 14, Line 2. 
In November, 1848, cholera broke out, nearly simultaneously, in two 
vessels in mid-ocean, about a thousand miles apart, one sixteen days out, 
and the other twenty-seven, from an unaffected port. “ British and 
Foreign Medico-Chirurgical Review,” No. lxxii., pp. 444-5. 
In the summer there was a severe outbreak in the island of The Grand 
Canary. No other of the group was affected. The origin of the disease 
could not be traced.—lb. p. 447. 
In 1832, a vessel from New York to Newport, carrying a cargo of dis- 
infectants, and being completely saturated with their odors, had her 
crew attacked with cholera, at sea, and lost several on the passage, or on 
arrival. This we have on indubitable authority. 
“ It is a fact that the Asiatic cholera twice spared the poor Jews, in 
‘ The Ghetto,’ who live most crowded, filthily, and with bad nourish- 
ment.” Letter to the Author from Dr. Valerj, of Rome, Italy. 
Like instances abound in all authors on such subjects. 
18. Page 15, Line 2. 
Marshall Hall, “ Theory and Practice.” Article, Measles. 
19. Page 15, Line 20. 
“ The poison which generates cholera ” “ certainly possesses in an ex- 
traordinary degree the properties, which all other morbid poisons possess 
in some degree, of lying latent for a length of time, in certain localities, 
or in the constitutions of individuals, or both,” &c. “ Cyclop. Bract. 
Med.," Vol. iii. p. 253. 
20. Page 17, Line 1. 
This case occurred while writing this part of the Discourse. The ex- 
planations given are those of the eminent gentlemen in attendance. 
Copland says of another case of Metastasis, “ The transfer was instant- 
aneous, * * * the medium being evidently the nervous system.” 
“Diet. Brae. Med.," Article Disease, §173a. 
21. Page 19, Line 30. 
“ Cyclopedia of Practical Medicine,” Vol. iii. pp. 23 i,and 251, et seq. NOTES, 
39 
22. Page 20, Line 16. 
So stated to me by agents of known ability. See also Reports to the 
Legislature on Insurance, &c. 
Memorial of the Boston Sanitary Association, pp. 9 et seq., Boston, 
1861. 
23. Page 20, Line 18. 
First sketched in its great outlines by Humboldt, and most fully 
demonstrated for the class of mollusks in their distribution along our 
coast by our President, Dr. A. A. Gould, in 1840. See “ Invertebrata of 
Massachusetts,” p. 315. Also “ Proceedings of Boston Nat. Hist. Soc.,” 
Vol. iii. p. 483. “ U. S. Exploring Expedition, Mollusca,” pp. 9 et seq. 
24. Page 20, Line 21. 
“ On peut done dire avec une parfaite exactitude, des maladies, con- 
au point de vue geographique, comme des qu’elles ont 
leurs habitats, leurs stations, leurs limites, sous le triple rapport de la 
latitude, de l’altitude et m6me de la longitude geographique.”—Boudin, 
“ Traili de Geographic et de Statistique Medicate,” Paris, 1857, Vol. ii. 
p. 227. 
25. Page 20, Line 31. 
Cretinism denotes Goitre in the same country. In Central Europe, 
typhoid fever accompanies phthisis.—Boudin. 
Intermittent fever and phthisis are not usually prevalent in the same 
locality. 
Wherever Calopogon is met with, one may expect to find Arcthusa in 
close proximity. 
The thistle is destructive to oats ; erigeron, to wheat; scabious, to flax. 
In the United States, some diseases (phthisis, for example) diminish 
from the North to the South, while others (abdominal fevers) increase in 
the same direction.— Dr. A. A. Gould, Resume U. S. Census, 1860, in 
Massachusetts Registration Report, 1861, p. 53, and 1862, p. 48. 
26. Page 22, Line 23. 
Dr. Brown thus quaintly states a popular belief: “ A brisk fever clari- 
fies the entire man ; * * * it is like cleaning a chimney by setting 
it on fire ; it is perilous, but thorough.”—“ Horce Subsecivoe,” p. 100 ; 
“ Spare Hours,’’ p. 206. 
Said El Hadgi the Fakir, quite as sensibly, “ Welcome the disease, if 
it bring thee acquainted with a wise physician. For saith the poet, ‘ It 
is well to have fallen to the earth, if, while grovelling there, thou shalt 
discover a diamond.’ ” — “ Chronicles of the Canongate,” Vol. ii. p. 139. 40 
NOTES 
27. Page 23, Line 12. 
Hugh Miller, “ Testimony of the Rocks,” p. 104. 
28. Page 23, Line 23. 
Hippocrates, “ Ancient Medicine,” §15, Ed. Sydenham Soc. 
“ Argument ” by Dr. Adams, ib. p. 158. 
29. Page 24, Line 29. 
“ La proportion des dec&s est loin d’avoir diminu6 avec l’accroissement 
du nombre des medecins.”—Boudin, Yol. ii. p. 84. 
30. Page 25, Line 5. 
“ Dit M. Quetelet, ‘ L’art de guerir exerce peu d’influence sur le nom- 
bre des deces, mais il en a beau coup pour ameliorer physiquement le 
peuple. II diminue la somme des douleurs,’ &c.”—Ib. p. 86. 
31. Page 25, Line 20. 
Any one who may fear that his occupation will be gone, should he ad- 
mit the possibility of treating disease without drugs, will find the daily 
routine of a Rational Physician well set forth in the following extracts: 
‘ ‘ The medical man will find ample scope for the exercise of his facul- 
ties, even in cases where special drugging may not be requisite. Close 
attention, acute observation, and the expenditure of not a little time, 
will be indispensable on his part, in order to effectually act upon modified 
health,— laws in regard to rest, the many nice points connected with diet, 
the hygrometric condition, temperature, and free circulation of the air, 
change of air, clothing, cleanliness, &c. His attention must also be 
directed to exciting or aggravating causes of disease in the locality, the 
residence, the room, or the person of the patient. He will, moreover, 
have to take care that the mind of the sufferer is kept in as tranquil a 
condition as circumstances will admit of,” &c.— “Rational Medicine; 
The Hunterian Oration for I860,” by S. H. Ward, M.D., &c., p. 48. 
‘ ‘ What we desire is a statement of the excess of benefit derived .... 
over that from careful treatment without drugs (which we pray for, 
should we have cholera ourselves) and over other systems of medication. 
When we say careful treatment, we mean the giving of nourishment, and 
the comforting the patient in those small details which can only be attend- 
ed to by a kind and skilful Medical attendant, who does not conceive 
himself bound to try something for the sake of appearances.” London 
“ Medical Times and Gazette,” Nov., 1865, p. 577. NOTES. 
41 
The idea that “according to the author’s theory of disease,” and we 
may add or that of any other, except, perhaps, the Russians’ (see note 
37), “judicious medical treatment,” at the hands of an enlightened and 
“ careful ” physician, “ is of no use,” has been justly characterized by a 
writer in the Boston Medical and Surgical-Journal, Nov. 23/1865, p. 336, 
as being “os absurd as it is untrue.” 
32. Page 25, Line 25. 
“ If what is really known of the laws of disease were told to the mem- 
bers of the profession, more than half of them would indignantly dis- 
credit it,” said an eminent pathologist to the author a few months since. 
33. Page 25, Line 27. 
Dr. Francis Adams, LL.D., “ Life of Hippocrates,” p. 18. Sydenham 
Society's Edition. 
34. Page 26, Line 7. 
For “ baneful effects ” of trusting to nature, see Cullen’s preface to 
his “ Practice of Physic.” 
35. Page 26, Line 17. 
“ He who gives the least medicine, and that of the least offensive kind, 
is coming to be regarded as the best physician. It is, by the intelligent 
head of the family, held no impeachment of a physician’s skill that he 
leaves no recipe, and directs measures so simple as to reflect no mystery 
on his craft.”—Boston Post (newspaper), July, 1864. 
36. Page 26, Line 20. 
Baglivi, Hippocrates Romanus ab Aliberto vocatus, ait: “ In curatione 
morborum, qui moram aliquam admittunt, hoc ordine progredior. Prima 
die totus sum in examinando, &c. * * * Secund& die, diligentius 
consideratis rebus antedictis, morbi speciem tandem decemo, et exinde 
remedia opportuna praescribere incipio.”—Prcuc. Med., p. 110. 
37. Page 27, Line 1. 
Possibly there may be an exception in Russia. “ Dr. Ilawrowitz, Physi- 
cian to Prince Constantine, told me,” said Dr. Roeser, Physician to the 
late King Otho, to the author, “ that the mortality in the hospital of the 
old Russians at Moskowa,—who consider by their faith disease as a pun- 
ishment by God, and the application of medicines for that reason a sin,— 42 
NOTES 
is not greater, if not less, than in other hospitals. They apply only clean- 
liness and good nourishment.”—MS. Notes of a Visit to Athens, Greece 
1860. 
The result thus stated agrees with the author’s experience. In the epi- 
demics of 1847-8, he took care of over three hundred cases of typhus 
fever without administering drugs. The cases were taken indiscrimi- 
nately, including those in a dying state when first seen. The result was 
thirty-one deaths in three hundred and seven cases.* In an epidemic 
of scarlet fever in 1848-9, out of eighty-one cases so cared for, seventy- 
seven recovered. With every attention to the comfort of the sick and as 
thorough nursing as possible, the progress of the disease was as tolerable 
as, its continuance as short as, and dangerous sequelae less frequent than 
in other cases more “ actively treated.” In 1849, of forty cases of mea- 
sles, thirty-nine recovered. The author sometimes takes care of the more 
painful diseases, rheumatism for instance, without drugs. It requires 
greater patience and painstaking on the part of the practitioner, but the 
result is satisfactory. “ I had not time,” said a prominent physician the 
other day in the author’s hearing, “ to persuade the family that the pa- 
tient did not need any medicine, so I wrote a prescription and departed.” 
38. Page 27, Line 6. 
“Nam saepe accidit ut facies morbi variet pro vario medicandi processu, 
ac nonnulla symptomata non tarn morbo, quam medico, debentur.” 
Sydenham, “ Observationes Mediae,” §10. 
Baglivi and others have similar expressions. 
“The constant interference of art, in the form of medical treatment, 
with the normal processes of disease, has not only had the frequent effect 
of distorting them in reality, but, even when it failed to do so, has creat- 
ed the belief that it did so; leading in either case to an inference equally 
wrong — the false picture, in the one instance, being supposed to be true; 
the true picture, in the other, being supposed to be false.”—Sir J. 
Forbes, “Nature and Art,’’'’ p. 6. 
39. Page 27, Line 9. 
“ Objections may still be made to the inferences, which I think may be 
rigorously deduced, from the fact that patients attacked with erysipelas 
of the face are very often sensibly relieved, have much less redness of 
* “ The proportion of deaths from typhus may seem large (427 in 2009 cases), yet so fatal 
is that disease, that, on comparison with the medical statistics of such other hospitals as the 
Board have at present the opportunity of examining, the practice at Ward’s Island has been 
among the most successful.” Annual Reports of Commissioners of Emigration, State 
of New York,” 8 vo. pp. 100-101. (Report for 1851.) NOTES 
43 
face, during, or immediately after the bloodletting than before. This 
relief and paleness of the face do indeed take place sometimes; but these 
effects are momentary, and the progress of cure is not more rapid in these 
cases than in others. So that the only conclusion from this fact is, that 
the immediate and the strictly therapeutic effects of remedies must not 
be confounded.” — Louis, “On the Effects of Bloodletting,” &c., Dr. 
Putnam’s Translation, p. 17. 
“ In about a thousand cases [of Plague] # * * although the medi- 
cines produced their wonted effects upon the organism, the malady 
neither ceasod nor changed.” “Cyclopedia of Practical Medicine,” Vol, 
iii. p. 552, b. 
40. Page 27, Line 22. 
Or, possibly, some abate at last their hyperpraxis, and adopt in part a 
more rational method; and, finding that diseases pass off, to say the least, 
quite as readily as under the previous management, and with fewer severe 
or abnormal symptoms, they comfort themselves with the absurd conclu- 
sion that disease has changed its character during their short day and 
generation. 
“ The failure of the various medications advocated,” said Velpeau in 
reply to Le Verrier, at a recent meeting of the Academy of Sciences, “ is 
attributable to a grievous mistake of the public, and even of professional 
men, who are under the impression that diseases are not susceptible of a 
spontaneous cure. Many affections yield without treatment, and, it must 
be acknowledged, sometimes in spite of all treatment. To this fact we 
must not be wilfully blind. An opposite opinion unfortunately prevails 
After the exhibition of a remedy the symptoms have yielded 
once, twice, thrice, or oftener; hence it is inferred that the cure has been 
the consequence of the treatment. The inference is a natural one, but 
almost invariably incorrect.”—“Journal de Midecine et de Chirurgie 
Pratiques,” Nov., 1856, art. 6981—Eng. Ed. 
41. Page 28, Line 2. 
“ ‘Vis medicatrix naturae ’ is a favorite professional expression, a time- 
hallowed portion of medical phraseology. * * * Is there indeed, 
among other wonders of our corporeal being, a subtile force, inherent in 
the very organization itself, whose office it is to protect vitality, in its 
very arcana — to correct errors of function, and restore lesions of struc- 
ture ? So our accepted phraseology implies.’‘ ‘ Address before the Ken- 
tucky State Medical Society,” by J. B. Flint, M.D., Pres’t Soc., 1859, 
pp. 8-9. 44 
NOTES 
“ The conversion of the original disease into another is occasionally 
salutary. * * * It is a very common object of art to produce this 
kind of conversion.”—“Pract. Principles of Medicine," by J. Conolly 
—11 Cyclop. Pract. Med.," Vol. iii. p. 272. 
“ Dictat Ratio (si quid ego hie judico), Morbum, quantumlibet ejus 
causae humano corpori adversentur, nihil esse aliud quam Naturae cona- 
men, materiae morbificae exterminationem in aegri salutem omni ope moli- 
entis.” — Sydenham, “Observations Mediae," §1. Quis circulus in 
probando! 
“ Helmetius, et, parum ab eo discedens, Campanella crediderunt febrem 
non esse morbum, sed morbi remedium, * * * ut peccantem rnateri- 
em humoribus confusam eliminaret.”—Baglivi, Prax. Med., p. 72. 
42. Page 28, Line 11. 
As one illustration of the little estimation in which even now such mat- 
ters arc held, it may be stated that, winter before last, of a class of more 
than two hundred students invited by the author to attend a free course 
of lessons in Art-Anatomy by a competent teacher, with living models, 
less than twenty-five ever made their appearance, and only three or four 
continued through the course. One of these last has since had abundant 
reason to congratulate himself on his attention to these teachings. 
43. Page 28, Line 24. 
“ It may now be affirmed that the practitioners of the present day are, 
speaking generally, almost as uninformed in this particular [the natural 
course and event of diseases] as were their predecessors fifty or a hundred 
years back.”—Sir J. Forbes, “ Nature and Art," p. 5. 
44. Page 29, Line 8. 
See “ Origin of Species,” by T. H. Huxley, F.R.S., 1863, pp. 94-100. 
45. Page 30, Line 7. 
“ I remember to have been shown a manuscript copy of a New Prac- 
tice of Physic, wherein the first article that catchcd my eye was on the 
scrofulous distemper, towards the end of which I perceived the word 
CURE in capital letters, followed by a number of recipes, which I imme- 
diately perused with the greatest eagerness, and then asked the author 
if he had known many instances of cures performed by those prescrip- 
tions. ‘ I never knew one in my life,’ replied he; ‘but of what service 
would it be to describe a disease, if after the description I did not add 
the cure?’ ” — “Medical Sketches," by J. Moore, M.D., Lond., 1786, 
p. 64. NOTES 
45 
46. Page 30, Line 14. 
It is not improbable that such a work from a fully competent hand may 
be given to the Profession before many years. 
47. Page 30, Line 27. 
See “ Medical Communications of the Massachusetts Medical Society,” 
1863, p. 260. 
48. Page 31, Line 11. 
Sec “ Practical Guide to the Study of the Diseases of the Eye,” by 
Henry W. Williams, M.D., Boston, 1862, pp. 126-30. 
49. Page 31, Line 19. 
“ Un signe infaillible qu’unc science n’est pas constitute, c’est quand 
clle est encore une sorte de propriete commune. Mon portier n’hesitera 
pas & definir la maladie, & indiquer la cause, pregcrire le remede, et ci 
predire Tissue. II s’en croit le droit; et il parait l’avoir, car on n’hesi- 
tera pas da vantage k tcouter son avis et sou vent <i le suivre.”—“La Mide- 
cine et les Midecins,” Paris, 1857, Yol. i. chap. i. 
50. Page 31, Line 26. 
See “ Rational Medicine,” by Jacob Bigelow, M.D., p. 29. 
51. Page 31, Line 29. 
“ Even a moderate amount of knowledge of the general nature of dis- 
eases, and of the mode of operation and powers of the medical art, will 
make a man a better patient; make him more content with the treatment 
prescribed, be it energetic or inert; and make him repose greater confi- 
dence in his physician.”—Sir J. Forbes, “Nature and Arty" p. 14. 
52. Page 33, Line 6. 
“ Ad plures migrabat.” Sydenham, Ob. Med. i. 5, §61. 
53. Page 33, Last Line. 
Iliad, xxiv. 601, &c. Southeby’s Translation, somewhat altered, and 
adapted.