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NATTJEE AND AET
IN TUB
CURE  OT  DISEASE,
BY
    C. B. COVENTRY, M. D.,

EMERITUS PROFESSOR OF PHYSIOLOGY AND MEDICAL JCRISPRUDENCE IN
        THE UNIVERSITY OF BUFFALO.
READ BEFORE THE
ptfltal £m*ty *i to* tfMttttj of OuriM, gutti, 1859.
PUBLISHED BY THE SOCIETY
          UTIOA:
ROBERTS, BOOK & JOB PRINTER, HERALD OFFICE, CO GENESEE STREET.
            18 5 9. 
 
NATTJEE AND  AET
IN THE
CURE  OF  DISEASE,
    C. B. COVENTRY, M. D.,

EMERITUS PROFESSOR OF PHYSIOLOGY AND MEDICAL JURISPRUDENCE IN
        THE UNIVERSITY OF BUFFALO.
READ BEFORE THE
fgUAifftl Mutxj tft tUt $M»ttJ 0f m*mf lw%, 1859.
PUBLISHED BY THE SOCIETY.
          UTICA :
ROBERTS, BOOK & JOB PRINTER, HERALD OFFICE, 60 GENESEE STREET.
            1859. 
 
PREFACE.
  The following observations on Nature and Art in the Cure of Disease,
have been elicited by the recent publication, in this country, of the work
of Sir John Forbes, M.D., F.R.S., entitled, Nature and Art in the Cure
of Disease, and  a small work of Jacob Bigelow, M. D., of Boston, en-
titled,  Rational Medicine.  Though differing  in  title, the works  are
similar in  sentiment and character ; and both unite in professing to
expose what they consider the errors and faults of the profession to
which  the  writers  belong ;  and  both,  though  professedly addressed
to the profession, are evidently intended for non-professional readers.
Indeed, Dr.  Forbes says, " One object  has been to prepare a work
which, while  fulfilling  its strictly professional aim, should also be calcu-
lated  to  convey to educated and instructed persons  of all  classes, such
information respecting the real nature of disease, and the true  character
and power  of the medical art, as they would be capable of comprehend-
ing and appreciating."  Dr. Forbes admits that the doctrines promul-
gated in his work " are at variance with those entertained by many of
our best  informed medical men."  It would have been supposed that a
man who had long practiced, and  enjoyed the honors and emoluments
of the medical profession, would have  hesitated  in promulgating doc-
trines which  he  admits are at variance with the mass of the profession,
and of many of its best  informed  members ; or would  have,  at least,
been able  to give some  satisfactory reason for such a course.   A very
careful examination of the work of Dr. Forbes  has not  enabled the
writer  to discover the evidence that the Doctor is  right or the profes-
sion wrong, or to justify him in terming the medical profession an " inert
fraternity."  It is believed that no  intelligent and unbiassed person, out
of the profession, can rise from the perusal of the work of Dr. Forbes
without the conviction that it  is a labored effort  to destroy public con-
fidence in the medical profession.  And certainly no member of the pro-
fession can  read either the  works of Drs. Forbes or Bigelow without
feelings of mortification and humiliation.
  Believing  that both writers  are  mistaken as to the actual practice of
the profession, as well as to its  actual benefits to the community ; and
that the influence of both works is only evil to the community  as well
as to the profession ; the writer had  hoped that some more able and
influential  pen  than his  own,  would  have exposed the sophisms and 
4
errors of the writers under consideration ; or that some of the numerous
medical Journals and Reviews would have vindicated the character and
honor of the profession.   As yet, he has seen no such vindication.   On
the contrary, the notices which have met his eye, have been meager in
the extreme, and a kind of half-endorsement of the works.
   It was under these circumstances that the writer was induced to pre-
pare and read the following remarks before the Medical Society of the
County of Oneida, at its Annual Meeting in July,  1859.  The Society,
believing that the views  presented were just, and that the honor of the
profession would be promoted by  giving them a more extended circula-
tion and a  more permanent form, kindly asked a  copy for publication.
The writer  believes  that  thirty years' practice of his  profession, a con-
nection  at  different  times with three different Medical  Schools, and a
pretty extensive  consultation  business in Central New York, enabled
him to judge as to what is the practice of the intelligent portion of the
profession in this country.  Whether he is  right, or the writers of the
two works  under consideration, is  respectfully submitted to the medical
profession to judge. 
NATURE  AND  ART
                           IN THE

CURE   OF    DISEASE.
  All practitioners of medicine of much experience in the treat-
ment of disease, must have, often and painfully, felt how difficult
it was at times to determine how  far they should trust to the
unaided recuperative powers of nature ; and when, and to what
extent, they  should endeavor  to  aid, or assist, or modify such
efforts.  All  intelligent medical  men  admit and  bow  to  the
supremacy of the  principle implanted  in the constitution, which
the older writers  termed, the " vis medicatrix natura," and with-
out which our science  and art would  be comparatively useless.
It is believed that most practitioners will admit, that in all cases
where some definite good  or some precise object is not to be ac-
complished by the administration of medicine, it  is  better  to
abstain from its use, and trust the cure to nature, aided by such
regulations of diet, air and exercise,  as  the experience of the
medical profession, and of the individual practitioner, may direct.
Such was the doctrine which I was taught, and the correctness of
which has been confirmed by thirty years' experience in the prac-
tice of our profession.   Such  we  believed to be the established
practice of the profession  at the present time.  It is true that I
have heard of a practitioner in former times, who, when asked
the object of a prescription containing numerous  ingredients, some
of which were chemically  and others medically incompatible, re-
plied, " If you give a little of every thing, something will hit the
mark."  I trust no such practitioner, claiming  to be of the pro-
fession, can be found at the present day.
  It is a  common and vulgar error to suppose  that the whole of
the practice of medicine consists in the administration of medicine.
No  less skill and experience  is  required to direct the hygiene 
6
treatment, the regulation of the diet, rest, exercise, bathing and
fresh air, and to determine when and to what extent medicine is
necessary, than to direct what medicine should be given.
  Many diseases require no medicine ; a removal of the cause,
rest and abstinence is all  that is required.  Many others,  no
doubt, if left to  themselves, would in time subside, without any
aid from medicine.   It is, however, equally certain that the timely
interference of art in the early stage of a disease, will often check
and arrest its progress, or convert into a mild, what would have
otherwise been  a severe if not fatal disease.
  Many diseases, particularly the exanthemata,  run a  specific
course, and  may be considered self-limited ; too active or pertur-
bating treatment, adopted with the view of arresting or breaking
up the disease, may do more harm than good.   As much skill is
necessary in a pilot  to manage his vessel safely through a storm,
when  no harbor is nigh, as to run her safely into port when that
is  possible.   The wind may be trusted to propel a vessel, but a
skillful pilot is necessary to direct her course.  So, just as much
experience and  skill is necessary to conduct  a patient safely
through a self-limited  disease, as to arrest or cut short a disease
where this is possible.   Even  in  those fatal diseases, where both
nature and art are  powerless to save the patient from death, an
intelligent  and conscientious physician can do much to sooth  the
suffering of  his patient, and smooth the road, though he knows it
must lead  to the grave,  It is a peculiarity in the human consti-
tution, and one to which Americans are said to be particularly
prone, to run into extremes.   It is not improbable that the pro-
fession, as well as the  public, may formerly have run into the ex-
treme of placing too much reliance on  art, or the administration
of medicine, in  disease, and  too little  on the unaided efforts of
Nature.  When  we look  at  our papers, and  see column after
column filled by advertisements of pretended specifics for  every
imaginable form of disease, it is a certain evidence of the credu-
lity of the community as to the influence and power of medicine
in curing disease, and a foreshadowing  of what is  sure to follow
(and what  is even  now beginning to manifest itself), viz., a  dis-
trust  in the medical profession, and in the use of all medicine.
It is but a  short time since a distinguished lecturer and divine,*
* Henry Ward Becchcr. 
7
made the declaration, in a public lecture, that all that the doctors
did was to coax  their patients to cure themselves.  This was
about as rational as to assert that all the surgeon did was to coax
his patients to  dress their own fractured limbs, or restore their
dislocated joints.   That the mass of the  people, when they find
from  sad experience, how false and fallacious are the promises
made in the quack advertisements in the papers, should loose their
confidence in medicine, is perfectly natural; but  that educated
and intelligent  men should argue against  the medical profession,
because  charlatans and unprincipled individuals have made it a
cloak for practicing on the ignorance and credulity of the com-
munity, is  surpassing strange.  No class  in the community have
so perseveringly and unremittingly protested  against this fraud
and imposition, as the  medical profession ; and  for the best of
reasons,  because no other body of men could see or know so well
the evils it was  inflicting on a credulous community.  Medicines
are only useful when  adapted to the  particular stage of the
disease, and the actual condition of the patient.  Every intelli-
gent practitioner knows that the idea of any particular article of
medicine being adapted to all or different diseases, to the different
stages of the same disease, or to different constitutions, or to dif-
ferent conditions of the system, is  an absurdity.   It  would be  as
reasonable to hold  the Christian religion and its ministers  re-
sponsible for all the crimes and cruelties committed in the name
and under the cloak of  religion, as to hold the medical profession
responsible for the sins and errors of empiricism.  The delusion
of Homeopathy is  gradually dying out.   Already most of its pro
fessed advocates have  abandoned the  doctrine of infinitesimal
doses,  which  constituted  its   only  peculiarity.   Credulity,  in
medicine as in other matters, is apt to be followed by scepticism,
and those who  but a  short time  since were  ready to attribute
miraculous powers to little pellets of  sugar, are now ready  to
denounce all medicine and the medical profession.
  Under these  circumstances, it  becomes a question of serious
import, for the  profession to determine what  course to  pursue.
Shall they continue to  claim for their profession the  high and
dignified position which has been accorded to it in every civilized
community, and to which the character of  the  great body of its
members should entitle  it, or quietly submit to the taunts of Dr.
B., and  the thousands  who represent  the profession as simply 
8
coaxing the patient  to cure himself, or join those who, after par-
taking of the honors and profits of the profession, turn round and
abuse it; or to represent, with Dr. Forbes, that all the physician
does is to  amuse the patient whilst nature cures the disease, but
that the physician too often interferes with the kind provisions
of nature,  thwarts her  salutary efforts, and  injures  rather than
benefits his patient.
  In one sense, it is true that a physician has no power to cure
disease.  All that he can do is to place his patient, as far as pos-
sible, in that condition in which the ordinary laws of nature will
effect a restoration.   Art is but the minister  and handmaid of
Nature, fulfilling those conditions which  are  necessary to enable
Nature to act with success.  Thus the agriculturist, when he pre-
pares his soil with care, selects his seed and deposits  it in the
earth, at a  time when the warmth of the sun and timely showers,
tends to promote vegetation, only fulfills the necessary conditions
imposed by the laws of nature.   But this is  not all; he knows
that the young plant must  be supplied with nourishment, in the
form of manure, and that the weeds  must be  extirpated.   He
knows that he  has no power to make a single seed to vegetate,
but he also knows that nature never supplies the want of knowl-
edge and care  on his part.   The surgeon has no power  to unite
a fractured limb ; he can only place the parts in coaptation, keep
them quiet, and trust to nature to effect a union.  So in the prac-
tice of medicine.  Art has no power to cure disease ; it can only
aid,  as in  agriculture,  in fulfilling the  conditions under which
Nature acts.  In some cases, Art can remove the cause of disease.
In some, when the cause cannot be removed, it can neutralize or
modify its virulence.  In some, it may supply the means or agen-
cies  which Nature requires to effect  her purpose.   To speak,
then, of the powers  of Art as compared with Nature in the cure
of disease,  is simply an absurdity.  The true question is, How far
can Art assist Nature in the cure of disease ?   When we reflect
on the amount and  variety of knowledge required for this pur-
pose, humble as it  may appear, and the noble and benevolent
purposes for which it is acquired, it will detract nothing from the
honor or dignity of the medical profession.
  Lest I should be  charged with misrepresentation, I prefer to
let the authors to whom I have  referred, speak for themselves.
Dr. Bigelow says,—" I sincerely believe that the unbiased opinion 
9
 of most medical men of sound judgment and long experience, is
 made up,  that  the  amount of disease and  death in the world
 would  be  less,  if all disease were left to itself, than it now is,
 under  the multifarious, reckless  and  contradictory modes  of
 practice, good  and  bad,  with  which  practitioners of  adverse
 denominations carry on their differences at  the expense  of their
 patients.'7*

   If the Doctor, by  the term practitioners, means the regular pro-
 fession of medicine,  I think you will agree with me in pronouncing
 it a libel on the profession.  If he means to embrace every species
 of empirical practice, and the use of the numerous nostrums, the
 advertisement of [which disgrace  our papers, why introduce it
 here ? or,  why leave it to be inferred that he is  speaking of the
 medical profession ?  The Profession of Medicine is certainly not
 responsible for  it, for no  body of men have labored so  hard to
 suppress it.  But  even  admitting  all the evils of quackery and
 empiricism, there is one simple fact, which is a complete answer
 to the doctor's supposition ; and  that is, that the value of life has
 nearly if not  quite  doubled during the last one  hundred years,
 and that this amelioration was mainly effected through the instru-
 mentality of the medical profession.
   Dr. Bigelow says, " The cumbrous fabric now called Therapeu-
 tic science, is  in  a  great measure built up on the imperfect
 testimony of credulous,  hasty,  prejudiced and incompetent  wit-
 nesses : such as  have afforded authorities for books like Murray's
 Apparatus  Medicamentum  and  Hahnemann's Organon."   " The
 cumbrous polypharmacy of modern times, is an  excrescence on
 science, unsupported by any evidence of necessity or fitness ;  and
 of which  the  more  complicated formulas are so arbitrary and
 useless, that if by any chance they should be forgotten, not one
 in a  hundred of them would ever be reinvented."  Here, again,
 the Doctor leaves  it to be  inferred  that he is speaking of the
 medical profession, or of medical science ; and yet, by his speak-
ing of the  Organon,  we must suppose that he refers to the multi-
farious  systems  of empiricism, which  are only excrescences on
medical science.  Dr.  B. says, " To prescribe blindly for symp-
toms irrespectively of their cause, is often in the  highest degree
     * Exposition of Eational Medicine, page 41,
B 
10
injudicious."*  Every intelligent physician admits this, as it in
fact constitutes the true distinction between the empiric and the
educated  and intelligent physician.   As  far as can be judged
from the Doctor's book, he seems to make no distinction between
the regular profession of  medicine, and the hosts of  empiricism,
which  has  always  been its  worst enemies; thus he places Dr.
Rush and Brandreth in  the same category.
  Dr. Forbes starts with the proposition that the great defect in
the medical profession is a want of a  natural history of disease.
He says, " In a very early stage of my medical experience, I be-
came impressed with the  conviction that the most fruitful source
of false views, both in  pathology and  practice  in the profession
originated in ignorance  of the natural laws that govern  disease ;
in other words, in ignorance  of the natural history of disease."
  Whilst the Doctor admits that there has been some improve-
ment in certain departments  of medicine, he says, as  to  this par-
ticular department,  " Infinitely less progress has been made, inso-
much that it may be affirmed  that the practitioners of the present
day are, speaking generally, almost as  uninformed in  this partic-
ular, as were their predecessors fifty or a hundred years back."
  Speaking of the  object of the  work, Dr. F. says, " Its main
purpose  is  to prove the immense  power possessed by Nature to
cure disease of her own autocracy, and  without any aid from
Art."  Dr.  F. adds, " Such  has ever  been the want of trust in
Nature, and  the  over-trust in Art, prevalent among  members of
the medical  profession, that  the field of natural observation has
been to a great extent hidden actually from their eyes, or virtually
from their apprehension.   The  constant interference of Art, in
the form of medical treatment, with the normal process of disease,
has not only had  the frequent effect of distorting them in reality,
but even when it failed to do so, has  created a belief that it did
so ; leading, in either case, to an inference equally wrong ; the
false picture in one instance  supposed  to be true, the true picture
in the  other supposed to be false."  " With these impressions on
their minds, it was scarcely  possible for the practitioner  not to
form a false  estimate alike  of  the  power of Nature and of the
power of Art in  modifying and curing disease ; underrating the
former in  the same proportion as  they exaggerated the latter ;
* Exposition of Rational Medicine, p. 55. 
11
and  the  consequence has been, that diseases have been treated
mainly as if Nature had little or nothing to do in their cure, and
Art almost every thing."  In tbfe country, we do_not labor under
the same difficulty as Dr. Forbes, for whilst  cases, are not unfre"
quent where absolutely nothing is done in the way of medication,
we are frequently called to cases which are equivalent, where the
period is permitted  to  pass, in which treatment could be of any
possible  use, before a physician is  called ; so that ample oppor-
tunity is given  to learn the natural history of the disease, and
what the result when unaided by Art.
   Dr. Forbes says, " If it be true,  as I believe, that the doctrine
respecting the power of Nature to  cure disease, promulgated in
the present work,  are at variance  as regards degree, with those
entertained by many of our best informed and most experienced
medical  men, and at variance in every respect and in an extreme
degree, with those entertained by  a majority of  our junior and
ordinary practitioners, it seems requisite that the grounds of so
important a difference should be stated."*
   " Since the Medical Art assumed its present formal, bold and
complicated character,  it is only in rare and exceptional cases
that the disease is left to Nature or treated regimenally.  On the
contrary,  the strongest and most  effective  powers of Art are
usually employed, for the purpose of counteracting  or modifying
in some  way or other,  the powers of  Nature.  Generally speak-
ing, we  may say that all the heroic arms of physic are invoked
purposely to  disturb, and obstruct, and  overwhelm the normal
process."t
   Of course, I would not question  the truth of Dr. Forbes' state-
ment as applied  to  his own country and his own experience.  I
can only say, it is directly at variance with the  doctrines which
 I was taught; with the practice of the intelligent portion of the
profession in this country, so far as my knowledge extends ; and
 with the doctrines taught in most, if not all our medical schools.
   Dr. Forbes says, " The most zealous advocates of  the dignity
 of the medical art, must admit, that if it is not altogether conjec-
 tural, many of its most important  conclusions must be allowed to
 rest on  no better foundation than the balance of probabilities."}
   The  Doctor, however,  discovers that we  have  the  means of

   * Nature and Art in Disease, p. 24.      tlb-,page33.     Jib,, page 4G. 
12
testing the natural history of disease, 1, By its results in savage
and  uncivilized  nations, where they depend on charms and  in-
cantations, and where they give no medicines internally ; 2, The
results of Homeopathic  practice, which  he considers equivalent
to giving no medicine, and the results of disease in animals.   I
shall not stop to question the propriety or consistency of drawing
inferences from  the  diseases of animals, or  from persons in a
savage state of society, where the modes of living and habits are
so different from civilized life ; but shall examine,  very briefly,
his second proposition, viz.,  the  evidence drawn  from  Homeo-
pathy.
  Dr.  F. says, " The saphias or charms used by the Africans are
equally efficacious.   One popular form  of these, mentioned and
described by Mungo Park, consists in writing  the  charm on a
board, and drinking the matter of the words, when it  has been
carefully washed off.  A mode of practice very analogous  to, and
we doubt not as efficacious, as that of the Homeopathists, who, in
point of fact, if they adhere rigidly to the original Hahnemannic
doses, do literally prescribe words and not things."*
  Speaking of Homeopathy, Dr. F. says, " It can be demonstrated
that the treatment legitimately derived from it, of prescribing
infinitesimals,  in other words, imaginary doses of drugs, is en-
tirely incapable of modifying  the  animal organism,  in  any way
except through the medium of the patient's mind, or by  means of
dietetics and  other  regimenal means,  with which the treatment
may be combined."f   Inert as he considers these means,  he thinks
them  as successful as the  regular  practice of  the profession, or
rather professes so  to think.  He says, " And  yet, what is the
character of the results obtained under this system of imaginary
medication in the cure of disease ?  When fairly weighed, do not
these results exhibit, if not quite as large a proportion of cures as
ordinary medicine, still so  large  a proportion as to  demonstrate
at once the feebleness of what we regard as the best  form of Art,
and the immense strength of Nature in the same office."}
  Dr. Forbes  adds, " It  is unnecessary in this  place to  adduce
any fresh proofs of the truth of  the opinion here assumed, that
Homeopathic remedies, so called, are utterly inert and incapable
of influencing the body in any of its organs or functions, whether

  * Nature and Art in Disease, p. 145.    f lb., page 159.    X lb., page 160. 
13
in health or disease.  This, to  me, is a demonstrated fact, and
must remain a demonstrable fact so long as Homeopathy adheres
to the doctrine and  practice of  its founder in regard to infini-
tesimal doses.  It is, then,  in the system of Homeopathy alone
that we can find an example of expectation in its perfectly pure
state, as  it is only in the practice of its followers that we can find
an  entire  abstinence from  all  drugs of possible power.  It  is,
therefore, from this  source  that we  must  draw  our conclusions
respecting the value of pure Expectation as a form of therapeutics,
which, it need hardly be remarked, is  precisely the same as draw-
ing conclusions respecting the power of Nature in curing disease.
I know not if Homeopathy, whilst  rejecting all rational  medical
treatment, is inconsistent enough to sanction and adopt the regi-
menal  practice of ordinary  medicine.   If so, we  must go further
in our estimate,  that  it may be beneficial as well as innocent,
inasmuch as it  may positively  aid Nature to the extent of the
power of this foreign auxiliary."   " To those who have assented
to the  principles propounded and  the  conclusions arrived at in
the preceding parts  of this work, such an estimate of its value
will not appear  a very low one, when compared with several of
the modes of practice followed under the ordinary system."  Not
satisfied  with the degradation of the regular profession, below
Homeopathy, which  he considers absurd and worthless, he adds,
" But I will venture to go  still  further in the  attempt to restrict
the power, or rather, to define the real power of the medical Art,
without  any apprehension of thereby degrading it.  Not only in
the pestilential  epidemics  referred to, but even in the milder
zymotic  fevers, in the acute viceral inflammation, and in several
forms of acute disease of a severe kind, the power of the  Medical
Art to  positively save life, appears  to  be very  circumscribed."
Dr. F. says, " It  is  melancholy  to be forced to make admissions
in favor  of a system so utterly false and despicable as Homeo-
pathy, and in derogation of one which is both true and rational."*
   It seems difficult to conceive  what could have  been the motive
for publishing such a work.   The Doctor disclaims any intention
of degrading the medical profession ; at the same time, the most
labored effort of  an  open opponent would have  less  effect in so
doing.   He says, " It is as an old member of this inert fraternity,
* Nature and Art in Disease, p. 248. 
14
and as an expositor of doctrines sanctioned by their opinions and
practice, that I have ventured to take upon myself my present
task."*  If the propositions of  Dr. F. were indeed true, it would
be a matter of humiliation and mortification to every honorable
member of the profession, instead of the  arrogant  and exulting
manner in which  the work of Dr. F.  is written.   Fortunately
for the credit of the  medical  profession, there is but little diffi-
culty in exposing the sophisms and  errors of the Doctor's state-
ment.   Thus, in every instance where the subject has been fairly
tested, the vast superiority of the regular practice over Homeo-
pathy has been demonstrated.  A single instance, taken from the
testimony given on  a recent  trial  in  France, will be sufficient.
Dr.  Charge, a  Homeopathic  physician  of  Marseilles, France,
boasted that out of eighty (80) cases of cholera, he had not lost a
single patient.  When the disease broke out in 1856, the mayor
of the city called  on Dr. C, and delivered up to him one of the
wards of the  Hotel  Dieu, a hospital of Marseilles, where every
thing was arranged  according to his desire.  Dr. C, who had
boasted of  having never lost a cholera  patient,  lost,  in  eight
days, twenty-one patients out of twenty-six, whilst  in the adjoin-
ing ward, the regular practitioner lost but fourteen  out of twenty-
five patients.f   Dr. Forbes thinks we have a powerful argument
in favor of the admission  that an  average  amount  of recovery
takes place under Homeopathic treatment,  in the fact that no
public outcry has been raised against it on the score  of inefficiency,
 and  yet more of  mortality.  The facts, however, are equally un-
 fortunate for the  Doctor's  argument.   It is notorious, that, not-
 withstanding the  fact that many of the professed  Homeopathists
 do resort to active treatment, and that a  large proportion of the
 unfortunate  and  fatal cases  pass into the hands  of the regular
 practitioner when too late to be benefited,—that Homeopathy has
 seldom  or never  obtained  a  permanent  footing in Quia -country,
 where alone an opportunity is afforded of comparing and testing
 the result.
   Both Drs. Forbes and Bigelow are unfortunate in enumerating
 cholera among the  diseases that are  not amenable to treatment.
 It is a fact well established, and  for the correctness of which I
* Nature and Art in Disease, page 167.
t Boston Medical Journal, Vol. XL., No. 10, p. 195. 
                             15

can vouch from ample personal experience, that the disease can—
in its first stage—with almost certainty, be arrested by medical
treatment.   The Sanatory Commission of Great Britain were so
well satisfied of this fact, that they recommended the establish-
ment of Dispensaries, where those laboring under diarrhea—i. e.
the first stage of cholera—could apply.
  The Editor of the Medico-Chirurgical Review, says, " There can
be  no doubt of the  existence of a premonitory stage in many
cases.  It is well described by  Annesly, and others  since  his
time ; and it is also certain that it can be often and at once ar-
rested."*  It is no  argument against  these facts, to say that in
the stage of  collapse—when medicines are no longer absorbed—
they are powerless to cure the disease.  Were I to select a case
going to show the powers of Art in successfully aiding and modi-
fying the efforts of Nature in the cure of  disease, it would be  the
cholera.   It  is not our design to  discuss the merits or demerits of
Homeopathy.  If Dr. Forbes is correct in his supposition that it
is equally successful as the regular practice, it accomplishes what
was no doubt intended by its author, viz., to substitute an inno-
cent and harmless delusion, for  one which was less pleasant and
might be injurious.   Our object  has been to notice some of  the
mistakes, not to say misrepresentations, of the works under con-
sideration, and to show what is  believed to be their natural and
legitimate effect on the profession and the community.   The posi-
tion professedly  advocated  by  both Drs. Forbes and Bigelow,
that medicine should not be administered without clear and dis-
tinct views as to the nature of the  disease, and the actual patho-
logical condition, and the effect proposed to be  produced by  the
medicinal agent, is no doubt correct; it is precisely the course
adopted by every intelligent and well educated physician.  What
we object to in both works is, what we  believe to be a misrep-
resentation of the doctrine and practice of the regular profession,
and in confounding it with the hosts of empiricism ; pointing  out
no distinction, and thus  calculated  to  destroy public  confidence
in the whole profession,  and produce the very evil  which Dr.
Bigelow  professes to depricate,  viz., " to lower  the standard of
professional character, and raise  empiricism to the level of honest
and enlightened physicians,"—or rather,  in  public estimation, to
reduce the enlightened and educated physician to the level of the
             * Medico-Chirurgical Eeview, July, 1848, p. 106. 
16
 empiric.   It  is  believed  that Dr. Forbes places far too low an
 estimate on the exertions  and influence of the profession in inves-
 tigating the  causes and  preventives of  disease.  It is true that
 the great mass of the profession are actively  engaged in practice,
 and have but little time for investigation ; but many of the  ablest
 minds in the  profession are devoted to  such investigations, and
 every intelligent practitioner, in his own limited sphere, acts as a
 missionary to promulgate the truths they may discover.
   We believe, too, that both Dr. Forbes and Dr. Bigelow have
 too  little  confidence  in the  use of medicine.   Violent  diseases
 sometimes require  active treatment.   Medical  men, who  are
 familiar with the malignant diseases of our  Southern and  West-
 ern  States, would  smile  at the recommendations of Drs. Forbes
 and Bigelow.   It  is  another instance, showing how absurd it is
 for men accustomed  only to the diseases of London and Boston,
 to judge of what is necessary in the new  settlements of our coun-
 try.  Homeopathy has never obtained  a  foothold in such locali-
 ties.  In  the language of a  very intelligent practitioner from a
 Southern city, " The climate is  not congenial to it."  It is very
 certain that  a practitioner who adopted the  do-nothing practice,
 would soon have nothing to do.  This principle is well illustrated
 in the experience of your  former associate, Dr. Alex. Coventry,
 who  found that the  lessons  he had learned in the schools and
 lecture  rooms of Scotland, would not answer in the backwoods of
 America.   The older  members of the Society, who were familiar
 with  the practice of  Dr.  C, know how sparing and cautious he
 was in the use of medicine ;  and yet he  found from his experience
 in his own family and in his own person, that it was sometimes
 necessary to  resort  to active—what Dr. B. might  stigmatize  as
 heroic—trea tnient.*
  *Dr. Coventry says, 'Had I  remained iu the  country of my birth and educa-
 tion ; nay, had my location continued on the well cultivated banks of the North
 river, I should have probably to this day adhered to the doctrines I had imbibed
 from the venerable Cullen, and  pursued ihe plan of practice taught by the ad-
 mirable Gregory,  But it was my destiny to pass another ordeal ; to verify the
 observation that one-half of life is spent iu unlearning what was taught in the
 other half.  I soon found  that nosological arrangements, however applicable in
 the mild climate  of Europe, iu the healthy countries of England and France,
 availed but little  among the swamps and marshes of the New World ;  for there
 I often found fever  assuming such protean features, such varying appearances,
that before the ink was dry with which you had placed it iu a class and order, a
new symptom would arise,  calling on you to alter its nomenclature." 
17
  We cannot conceal from ourselves the fact, that medicine as a
profession has a very different position in the public estimation,
from what  it formerly had.  Though often  the subject of satire
and ridicule, medicine, by the mass of the community, was looked
upon with respect, amounting  almost to veneration.  The family
physician was an oracle as to all that concerned the health of his
employers.   This relation is in a great measure abolished.  Phy-
sicians and surgeons are employed as a mechanic or laborer, de-
pending  much upon locality or caprice.  One man is  employed
to-day, another may be employed to-morrow.  It is not unfre-
quent  that one member of a family will employ one  physician,
and another member another ; so that often two, sometimes three,
different medical men are in attendance on  different members of
the family at the same time.   It  cannot be  denied that medicine
as a  science and an art has continued to  improve in an equal
ratio with  the  other sciences, and that physicians of the  present
day are  better qualified to treat disease, and more entitled to
public confidence, than  their predecessors a  century since.   It is
notorious that as a profession they possess much less of the public
confidence, and that what  exists, is confidence in the individual
rather than in the profession.  This is, no doubt, the necessary
consequence,  to a  certain extent, of  the existing law regulating
the practice  of medicine.  Every man is at liberty to practice
medicine, and to attach M. D. to his name ; and the kind public
complacently dubs them all Doctors.  The  community generally
know nothing, and care as  little, for any distinction ;  they form
their opinion of the profession from their knowledge of those who
are styled Doctors.  Judged by this standard, I am free to confess
that it is scarcely possible to form too low an opinion.  As the
legitimate  practice of the  profession, by a  well educated,  intel-
ligent  and honest practitioner, is one  of  the most noble and
honorable  occupations in which a man  can engage ;  so, on the
other hand, for a man  without medical education, for the mere
sake of gain, to pretend to a knowledge of that of which he knows
himself to be ignorant, and thus trifles with the health and lives
of his  fellow-men, is one of the most dishonorable and contempt-
ible.   Our papers often contain accounts of crimes and outrages
committed by Dr.  so and  so ; though  it is not contended that
medical  men are  more free from crime than other professions, it
is notorious that in a very large proportion  of such cases, it will
         c 
18
be found, on investigation, to be persons who had no legitimate
claim to the title of doctor, but had assumed it for some sinister
purpose.   Another cause which has contributed materially to de-
stroy confidence in the medical profession, is that within the last
few years, men who have been educated, and practiced the pro-
fession for years, have come out and denounced it.  This embraces
a large proportion of those who have gone over from the regular
profession to embrace Homeopathy.  They quiet their conscience
—when they have any—by the argument, that the people will
have a Homeopathic physician, that it will not  lessen or destroy
their capacity to practice medicine, and if they refuse to gratify
them, they may fall into the  hands of some one more ignorant
than  themselves.   They seem  to forget that a  man  is morally
responsible, not only for the intention with which an act is com-
mitted, but for the influence which it is calculated to produce.  If
it is  for the interest and good of society to have an intelligent
and  educated  medical profession, then every encouragement to
empiricism, every act which has a tendency to break down  or de-
stroy confidence in the profession, is inflicting a positive  injury
on the community.  It was not, therefore, without reason that the
Rev.  Dr. Kennedy, in an address before the Albany Medical Col-
lege, June, 1858, made the following remarks:  "For myself,  I
believe I  would suffer long and  painfully, under the care of an
intelligent and  educated physician, before I would consent to re-
ceive a certain cure at the hands of an empiric ;  for admitting by
accident he cured me, yet by giving him my influence, he might
have the opportunity of killing others, and I would be partaker
of his sin."  A highly intelligent and influential member  of the
legal profession, who gave the weight of his example and precept
in support of Homeopathy, once told me that his medical attend-
ant, though  a  professed Homeopath, was an educated physician,
and he had confidence enough in his capacity and honesty, to be-
lieve  he would do what was for the best.  Admitting that he was
correct in his estimate, of which I have strong doubts, he seemed
entirely to overlook the deep moral responsibility he assumed in
lending his influence in support of Homeopathy, at the expense of
the regular profession.  Another cause, which has no little influ-
ence in lessening public confidence in the medical profession and
the use of medicine, is the promises held out, and the numerous
certificates of  cures  published in the advertising columns  of our 
19
 papers.   Every person of common .sense knows how totally un-
 reliable are such  promises and statements; and yet, there are
 thousands who, because they have been cheated by an advertising
 charlatan, denounce the doctors and the whole professson of medi-
 cine.  That these causes should operate with the ignorant, is not
 surprising ; but that intelligent and educated men should condemn
 the profession because our law-makers have unwisely encouraged
 the dishonest and unprincipled charlatan, to use it as a cloak for
 practicing on the credulity of the community, is strange.*
   It becomes a serious question to inquire what is to be the effect
 of this state of things, on the profession and the community.  As
 to the ultimate effect there  can be no doubt, if it continues, viz.,
 that of deterioration in the profession.  All incentive to a noble
 ambition is destroyed.  Young men of the proper  qualifications
 will be loath to enter a profession,  where success in  business, and
 where public  honor and  distinction, depend less upon a  knowl-
 edge of  their  profession,  and  upon  a  faithful discharge of its
 duties, than upon management, chicanery and  intrigue.  Where,
 in short, he must compete for public  favor with the charlatan.
 With a  firm reliance, however, on the ultimate good sense of the
 community, we believe that  the  medical profession  will not only
 come  out  of the present  ordeal unscathed, but more securely
 seated in the confidence and affections of the community.
   Quackery will no doubt continue, as  it always  has continued,
 to exist.  In every community, there are always a certain portion
 who are governed more by their love of  the marvellous and in-
 comprehensible, than the stern dictates of  their reason;  but to
 suppose the mass of the community would not learn that medicine
 is no exception to the ordinary rules of  reason, would be to ques-
 tion their capacity for self-government, or  to judge what is for
 their own interest.
   That the man who has faithfully devoted  many years to  the in-
 vestigation of  the  laws of health and disease,  is better qualified
 to judge and direct in those subjects, than one of equal capacity

  * Within the last few years many efforts have been made, by the organization
 of the American Medical Association, and by the  State  Medical Societies, to
 elevate the medical profession, and the standard of medical education ; but all
 such efforts must prove vain, unless some mode can be adopted to draw a line of
demarcation between the educated physician and those who only assume the title
from some selfish or sinister motive. 
20
who has had no such training, does not admit of a doubt.  " In
all cases, in the worst, there is one course more prudent than an-
other.  If the  ship is running on the shore, or is even breaking
up on the rocks, there may be one course better  than another in
the management of affairs.  In the worst peril, in  which you must
leave the bark  to which you have trusted yourself, in whose guid-
ance would you place most confidence ?  Would you leave your-
self  to the mercy of the waves ?   Would you  trust an ordinary
sailor, because  he bawled  the loudest ? or would you follow the
advice of the experienced shipmaster ?"* A physician is simply a
student of  nature, and as such, the whole of nature is open to his
investigation.   If he  has conformed  to  the requirements of the
law, and given satisfactory evidence of his capacity to judge, he
is not only at liberty, but is bound to adopt  any course of prac-
tice  which he conscientiously believes best for his patient.  If he
believes vegetable medicine preferable to minerals, he uses them.
If he believes cold bathing would be useful, he adopts it.   To say
that a man is a Botanic doctor, a Hydropath, or a Homeopath, is
simply to  say that he restricts himself to one  particular depart-
ment of Nature,  instead of availing himself  of the whole.  If a
regular practitioner abandons the regular profession, to adopt the
insignia of a particular clique, as Botanic doctor, Hydropath, or
Homeopath, we may justly question the motive,  for he voluntarily
—if he is honest  in his change—deprives himself  of some of the
most important resources of his art, and gets in return simply a
new name.  To suppose that such name could add anything to
his capacity to  treat disease,  would be an absurdity.
   Prof. Ware, of Boston, in an eloquent discourse, alludes to the
subject under consideration in the following terms :—
   " The following considerations, I cannot  but  think, have much
weight in enabling us to judge of the probable future and destiny
of our profession ; namely, that whatever may be the currency of
particular  opinions, or the  reputation of particular  bodies of
practitioners, the public will confide habitually and  mainly in
that body or that succession of men,  who show themselves to be
devoted to medicine, not merely as a  means of getting  a liveli-
hood, or even as  a means of treating  disease  and relieving suffer-
ing by the common routine practice ;  but who pursue it as a great

    * Letters to a Young  Physician, by James Jackson, M. D., LL. D., &c. 
21
subject, all the relations and bearings of which it is their duty to
investigate ;  who regard it as a science they are deputed to build
up and perfect; and who do all  as  diligent and disinterested in-
quirers after truth.  It is  this class of  men who, when they are
understood, will receive the permanent confidence of mankind ;
and  such, I  undertake to  assert, has been, and is, the  essential
character of our profession."*
   Dr. Ware refers  not only to the self-sacrificing devotion of
medical men in the practice of their profession, but to their con-
tributions to the collateral sciences.   He says, " These services of
the medical profession, upon the whole, have been among the most
disinterested ever rendered to mankind.   They have been dis-
tinctly governed by a desire of acquiring that knowledge which
will confer practical benefits on society, without reference to the
amount of reward, or  to  any fame except that of  doing good.
There is  no better  proof  of this than the fact already implied,
that the aim of those who are most prominent in medical history,
has been more to investigate the laws of  disease, and then pre-
vent  it, and raise the standard of health, than to acquire reputa-
tion and wealth by what is far easier and more lucrative—atten-
tion to  the ordinary details of medical practice.  And if it were
necessary to introduce a more striking example of what is to be
regarded as the governing spirit of those who are the true index
of professional character, we have but to name the discovery and
gift of vaccination to mankind by the illustrious Jenner."t  It
is, however, admitted that  there are members of  the profession
who are actuated by less lofty motives.  He says, " To them, the
practice of medicine is  like the practice of  any other occupation,
selected and followed  almost mechanically.   Hence, there are
always to be found physicians of sordid  minds and purely selfish
views, who  are yet high  in  professional rank and  emolument.
Such  men, naturally enough—but  unfortunately  for our  good
name—have often been the most prominent to the public eye, and
have been the chief recipients of public favor and patronage, just
as it  happens in all other departments ;  and they have been thus
sometimes taken as exponents of  the character of the profession.
But its true representatives are those to whose lives and labors I

  * Discourse on Medical Education, &c, by John Ware, M. D., Boston, p. 23.
  t lb. page 23.
(™,i 
22
have just referred ; and from these men the treasures of knowl-
edge, which they have accumulated in years of faithful and un-
ceasing labor, has descended to  us as  our  rich inheritance,
possessed  of which we  should feel safe as to our future destiny.
Whatever may be the accidental and temporary alienation of
portions of that public which we  serve, and whose confidence is
so necessary to our usefulness, if we are faithful to the true char-
acter of our profession, if we go forward in honest fidelity in the
path of our predecessors, governed by the same desire of knowl-
edge and of usefulness, we need  not fear but that the present
movement of opinion will be transient, and that our position will
become more durable than before."*
* Discourse on Medical Education, by John Ware, M. D., p. 23.