WITH THE AUTHOR'S COMPLIMENTS. 
ANNUAL ORATION 
BEFORE THE 
Medical and CirirnrEical Faculty ot Marlyand. 
1877. 
S. WEIR MITCHELL, M. D., Philadelphia 
Reprinted from the Transactions of the Medical and Chirurgical Faculty of 
Maryland, April, 1877. 
BALTIMORE: 
INNES & COMPANY, PRINTERS AND BINDERS 
1877. The Annual Oration. 
S. WEIR MITCHELL, M. D., Philadelphia. 
Gentlemen : 
I used to think, when I was a lad at school, that the choice 
of a subject was the hardest part of a composition ; and this 
view of the case lasted until, a theme being chosen, I came to 
think what I should say of it. At this somewhat later date, 
I find these difficulties of my childhood repeating themselves, 
as I reflect upon what I can have to say to a body of men 
whose distinctive qualities as physicians may well make any 
man hesitate before he gets up here to face their verdict. 
I incline most to talk to you of Therapeutics ; and there are 
two ways to talk of this. Either I may amuse you with our 
present theories of the manner in which drugs act, or, passing 
by this fascinating pursuit, I may drop down to the lower 
level of practical medication and try to tell you something out 
of my own experiences which may be of use. For, disguise it 
as I may, what you ask of your orator is of course something 
which shall have a flavor of the man himself. With this con- 
ception of my duties, I mean to talk to you about some of the 
therapeutic observations I have made while journeying along 
in my professional life, and especially concerning those 
extremes in therapeutics which are at times in some cases so 
valuable, but which are so very apt to be abused or misused. 
If, in trying to do you and myself justice, I wander from sub- 
ject to subject, you must reflect, alas, how terrible the task you 
put upon a man when you place hirp here to make an oratiop 
find rashly call him an orator, 2 
I doubt not that many of you, going back in memory to the 
days when you were turned out of the lecture-room to practise 
medicine, recall with amusement the experiences which taught 
you how little of a homoeopath is nature, and how hard it proved 
to fit each symptom or each disease with a drug. The relations 
of science to therapeutics were just then beginning to be drawn 
closer, and chemical explanations were coming into fashion. 
I have lived, as yet, no very long life, but I have lived to see 
the actions of many drugs submitted to divers explanations, 
which have had in turn their day and then dropped into the 
populous limbo of therapeutic theories. And yet, through all, 
I have observed that the drug, if useful, continued to be used. 
The later explanations of the mode of action of drugs seem to 
me to be more thoughtfully grounded than those which they 
supplanted ; and the reason for this is to be found in the fact 
that they have become the subjects of cautious laboratory 
investigations as exact as those used for physiological inquiry, 
and as likely to be still more fruitful in the future, unless 
broken up by the war which hysterically acute consciences are 
making against vivisection. But while, as Dr. Bartholow ably 
taught you last year, science is rapidly adding to her store of 
clearly-explained therapeutic activities, there yet remain a 
number of useful drugs as to which our whole knowledge con- 
sists in the fact that, given a certain complexus of symptoms, 
experience has shown them to be in this of value. 
Medicine to-day consists in these two forms of therapeutic 
work: the practical clinical determination of the uses of 
therapeutic means in the presence of disease, and those difficult 
investigations which profess to explain more or less clearly the 
manner in which medicinal agents act. The latter mode of 
study has found, like experimental physiology, few, alas, very 
few exponents in America,- a fact which seems hard to explain 
when we reflect how ably the natural sciences and physics have 
been pursued by numbers of our countrymen. Ou the other 
hand, the clinical study of drugs has found many competent 
investigators, and we have less reason to be ashamed of what 
we have done in this direction. But they who dream that it 
is easy to excel in this study of the direct application of new 3 
drugs to disease have only to turn over the pages of any journal 
ten years old, to see how pitilessly the experience of one decen- 
nial has consigned to forgetfulness a host of drugs, or applica- 
tions of drugs, which the writers once dreamed would be 
valuable. 
In fact, the capacity to judge of the true value of a thera- 
peutic method is one so rare that its history is full of 
humiliating lessons, and points us to the curious fact of the 
difference between the scientific, and still more the mathema- 
tical, mind, and that which I may call the medical mind. The 
mathematician reasons from certain premises to conclusions as 
certain. If the mental machine be good, he is sure of his 
results. The doctor, owing to the obscurity of his subject, 
reasons from doubtful premises to dubious conclusions. 
I do not know any more amusing lesson in this direction 
than the history of the therapeutics of serpent-poisoning. 
When first I studied this matter, I found in our journals and 
elsewhere the opinion that the bite of the rattlesnake is deadly. 
Then also I found reports of eighty cases of success in the 
treatment. This brilliant result was attained by the use of 
thirty different remedies. I had then to conclude either that 
almost anything would cure snake-bite, or else that it was far 
less fatal than had been believed ; and so at last I came to the 
conclusion that it was not as grave a disease as had been sup- 
posed, and also that there was for it no specific,- a result borne 
out by every later research. 
This is only too sad an illustration of the ancient moral con- 
tained in thej9ostf hoc and propter hoc,- a lesson we are being 
every day, every one of us, bribed to forget by our seeming 
triumphs at the bedside. 
Believe me, then, few men are really competent to decide on 
the true value of drugs. And if it becomes us to be humble 
in this matter, how sad is it that we stand or fall by the judg- 
ment of our patients, to the most of whom drugs are a kind of 
fetich possessed of mysterious values I 
And do you fail to go with me thus far? Recall, if it be so, 
the treatments of rheumatism which the elder of us can remem- 
ber to have seen. Once it was bled and blistered ; now it is 4 
blistered again. At one time it was treated with floods of 
alkalies ; then opium was the fashion ; and some one said it 
must have blankets and six weeks ; and propylamin had its 
day ; and once cold applied to the joints would have been 
thought to be death, and is, I can assure you, comfort, if it be 
not cure. An able name can be quoted for each of these plans 
of treatment, and of course some were right more or less, and 
some wrong ; but am I not correct when I said that if this be 
the record in such a malady, few men are competent thera- 
peutic investigators? Or is Flint right, and are mint-water 
and time as good as all the rest of the apothecary shop? Or 
are there more forms of rheumatism than one, and should we 
recommence our study from this fresh point of view? 
There are, of course, agents like chloral as to which it is safe 
to take the popular medical judgment; but when it is needful 
to decide as to drugs of less definite power, the opinions of 
men in private practice only are nearly valueless, and it is to 
the hospital physician and surgeon that we have a right to look 
for thoughtful and well-weighed verdicts. These men alone 
have the apparatus for observation,- trained nurses, watchful 
assistants, chemical and microscopical aids, and such accumu- 
lated chances for investigation as should make it a reproach 
and a scandal to any great hospital that year after year it adds 
nothing to the sum of accurate therapeutic knowledge. 
The last treatment for rheumatism, for the classic malady, 
acute rheumatism of thejoints with high fever, is salicylic acid. 
So far it is standing the trial well; and if it prove to be of 
decisive use it will possibly enable us to decide by a thera- 
peutic test whether muscular rheumatism, certain neuro- 
arthritic states, rheumatic gout, and local rheumatisms, are 
of the same parentage, just as a vermifuge is our sole diagnostic 
test for the existence of intestinal worms, and as iodide of potas- 
sium is often capable of deciding if an obscure nerve-lesion be 
or be not of syphilitic birth. 
I might go on to make you smile sadly over a therapeutic 
history of pneumonia and typhoid fever ; but time fails me, and 
the desire also, for out of all these dismal stories of endless 
therapeutic success contradicted flatly by the later research, we 5 
are by degrees corning to see light and to have rational hopes, 
as you all very well know. And let us not believe all this 
contradictory medication useless. There is no other way to a 
true therapeutics except by experiments on patients ; and there 
never will be any other until the laboratory is able to teach us 
how and when to use drugs ; and that is a far-away hope as yet. 
But out of these bewildering clinical failures, and out of the 
false pride of the laboratory and the scorn with which the 
accurate man of science looks down upon medical indefiniteness, 
has arisen the worse evil of medical nihilism, the utter dis- 
belief in the value of therapeutic means. Unhappily, this 
reigns most remarkably in the centres where the more exact 
branches of medicine, such as diagnosis, are most successfully 
taught and cultivated, and perhaps in no country so much as 
in Germany, and nowhere so notably as in Vienna. The evil 
is less in France, and is hardly to be complained of in England, 
nor as yet in this country are we in danger of altogether for- 
getting the art of curing, in the pride of successful diagnosis. 
It is a little curious that while European physicians have 
become unreasonably sceptical as to the value of drugs, they 
have gradually taken refuge in an extreme of what I must call 
credulity as to the influence of mineral springs. In this country 
a like belief has been fostered by a variety of causes, and waters 
as valueless as those of Gettysburg and some others as inert 
have won a wide-spread celebrity. In most cases these springs 
are to be found in healthy mountain regions, and it is the 
change of air, of diet, and of habits of life which deserves to be 
considered as curative, rather than the waters. So vast is the 
use of such total change that patients who go for treatment 
from the country to the cities are often the better merely for the 
change, and too often the city physician, as I well know, gets 
credit for that relief which was in large part owing to the vast 
alterative of change of air and of all the ordinary habits of life. 
And, lest I should be thought to make a charge against 
European physicians without some grounds for my belief, let 
me state in the words of a shrewd observer, a patient of mine, 
what befell him abroad. Of course I suppress the names. 
" I went," he says, " by your advice, to Dr. Blank in Paris. 6 
After an examination which lasted twelve minutes, he advised 
me to go at once to Vichy. Accordingly to Vichy I went, 
with a note to Dr. C. He thought that I had ' congestion bul- 
baire,' and, after three weeks, was persuaded that St. Moritz 
would aid me. I speut a month in the Engadine, and was then 
told that the waters of Schwalbach were now more suitable, 
and that I would do well to recreate my lazy spleen with their 
blood-making help. As my faith was still lively and in better 
order than my blood globules, to Schwalbach I went, and took 
iron waters anew. I hope my spleen liked them ; I did not; 
but by this time the autumn had come, and Dr. D. convinced 
me that all I wanted was a course of Carlsbad to make things 
straight, because my kidneys were inactive. Carlsbad finished 
my remnant of belief in spas and spa doctors. After I had 
taken warm Carlsbad water endlessly and adhered for a month 
to a very rigorous diet list, I met one day three people with 
whom I began to chat about our several organic griefs. Count 
L. had gall-stones, and was of a handsome mahogany tint ; Mr. 
C. was the victim of Bright's disease ; Mr. J. had enlarged 
heart and dyspepsia ; and I, as you know, have had cardiac 
trouble and emboli, which seem to be to the body what comets 
are to the solar system, - eccentric mischiefs going where they 
have no business to be, and disturbing sober planets in their 
daily work. On comparing notes, we found that the liver man 
and the kidney man and the man with a big heart and the one 
with a weak heart were all alike taking Carlsbad water and 
precisely the same accurate diet. We looked at one another 
and smiled a sickly smile each, and I lit my first cigar for two 
months, and ate a huge dinner, and paid a doctor's bill as large, 
and so left Carlsbad. I was also said to have an enlarged 
liver : I can only say that if my liver was reduced by Carlsbad 
water as much as was my faith in spa doctors, there can be 
little left of that unhappy organ." 
But humbug is not all transatlantic. I have been told 
gravely, by a patient with partial palsy of the legs, that at a 
certain spring she could walk easily in the bath which was up 
to her neck, and that the doctor told her this would be the 
case. a But," she said, u I could not walk much better after 7 
it, and I quite relapsed when I got home which I did not 
doubt, for water makes a very nice substitute for crutches. 
I have heard the nihilism of Europe variously defended or 
denied, but I think any one who has been much thrown into 
contact with European physicians must have been struck, in 
watching their treatment of ordinary illnesses, with a want of 
resources and a lack of those minuter attentions to the inter- 
current aches and ailments of patients, which both in England 
and with us would be thought remarkable. I think Anglo- 
Saxons and men of the later French school better therapeutists 
than the Germans ; and nothing seems to me more dangerous 
to the good of our profession than the tendency prevalent in 
some places to give up the use of drugs the action of which we 
cannot explain in such a fashion as to satisfy the exacting con- 
science of the laboratory. 
The old extremes in the use of drugs were possibly worse than 
the utter scepticism which thinks nothing of value, and which 
makes men proud to say that they never give calomel or never 
use the lancet; but surely there is place for that instructed 
confidence which has the intellectual courage to deprive itself 
of no resources, and to feel willing to treat one case with bread 
pills and to bleed another to faintness. 
There are yet triumphs to be won in medicine by therapeutic 
boldness, and by the use at times of enormous doses and of 
therapeutic extremes in diet, and even in blood-letting, which 
will never be won by the timid doctor who swings with the 
pendulum of medical fashions. 
I was taught that five grains was the dose of iodide of potas- 
sium; but, in common with some others, I have learned that 
in certain syphilitic neural troubles you cannot tell that you 
are going to fail in treatment until you have given steadily 
for a time one or two hundred grains a day. When once 
sufferance of the drug has been established, and the early 
catarrhs and face-aches it causes have passed away, it is a tonic 
of strange potency; and of its mode of action the laboratory 
has given us as yet no hint of explanation. 
I may surprise some of you when I state that just what I 
have said of syphilis applies also to certain asthmas, and that 8 
very large amounts of the iodide sometimes give not only 
temporary but also permanent relief in this distressing malady, 
as well as in chronic bronchitis. 
In like unexplained usefulness the laboratory has left, as 
yet, arsenic, another of the powerful drugs which has value 
from minute doses up to those which hold the patient on the 
limit of poisoning. I may perhaps be relating to some of you 
an every-day experience when I speak of this active agent, but 
I was taught by a happy accident that in obstinate cases of 
chorea not caused by organic disease, if we wish to cure with 
arsenic we must push it far enough to cause the face to swell 
and to stay swollen for a time. It is here not a question of so 
many drops, but of constitutional impression. There are 
parts of our country where it is used with equal boldness for 
malarial fevers and in the same heroic doses which Fowler 
himself employed, and which we had forgotten. We may 
speak in the same way of digitalis, and Harley has taught us 
a similar lesson as to conium ; while you will find also that in 
using gelseminum for neuralgia or local spasms, success is to 
be won by doses which give rise to strabismus and vertigo. In 
Paris two years ago I saw Prof. Charcot relieving the vertigo 
of Meniere's disease by doses of quinine which would appall a 
Western swamp doctor. Nor is it to-day useless to read books 
like Hamilton on purgatives because they teach us that the 
extreme and continuous use of purgatives, a practice now and 
for the most part wisely abandoned, may yet have its value, a 
value we still recognize in a somewhat oblique fashion when 
we send people to Saratoga. 
Some among my hearers are old enough to remember the 
days when to let blood was as common as it is now to give 
tonics. They must smile a little to see that what was then 
daily in practice is now looked upon as a therapeutic measure 
of heroic character,- as a thing really dangerous. So far, 
indeed, has this feeling been carried that precautions alrmst 
absurd are now taken to avoid loss of blood, even in operations 
on healthy, florid people. Perhaps some of you have seen, as 
I have, a surgeon squeeze all the blood of a leg into the well- 
filled vessels of the rest of the body with an Esmarch's baud-. 9 
age, and then cut off the depleted limb, without thinking that 
he has done something which lacks common sense. I believe 
with Paget and Richardson that there are still uses for the 
lancet, and I believe, personally, that the idea of a change of 
type in disease or in mankind of such a nature as to be a posi- 
tive bar in the way of bleeding is totally unproven. It is an 
old story, and you may find it in Cheyne, and in that curious 
old book, Hakewill's Apology, 1635, where he quotes a re- 
markable case of one Tristram who was bled very largely, and 
adds, "This is a most eminent instance against those who 
endeavor to prove the decay of the world because men cannot 
spare so much by blood-letting as in former ages." 
As a question of practice, we bleed people nowadays by 
dietaries when we need to lessen the amount of blood, and 
there are occasions when the need must be suddenly met, and 
then we want, even if rarely, the lancet. 
It is curious that an abrupt supply of new blood is so much 
more dangerous than the heaviest loss of blood. I have seen 
two sudden deaths from the transfusion of a small amount of 
blood; and, as far as the risk goes, I would rather lose a 
pound of blood than gain an ounce by injection. 
As illustrations of what I have said, and as examples of 
what are now and perhaps ever ought to be the curiosities of 
this subject, allow me to reJate briefly two amazing cases which 
I take from the note-books of my father, the late John K. 
Mitchell. You all know well that there are rare cases of 
psoriasis inveterata which yield permanently to no method of 
treatment as yet known. 
One of these occurred in the person of a gentleman who had 
spent some years patiently in Europe and America, vainly 
seeking relief. He came to Philadelphia, where I saw him 
when I was a student. He was then an object of such loath- 
ing to himself and to others that he had set a time when, all 
else failing, he considered that he would be justified in end- 
ing his life by his own hand. 
He had used every possible means of cure, and been again 
and again pronounced incurable. Arsenic, which aided him, 
did no more; and its permanent use in doses large enough 
caused violent emesis, 10 
I bled this man, under my father's instructions, two hundred 
ounces in three weeks, and when he was so feeble as to be 
hardly able to turn in bed we saw his scales fall off and his 
skin become as that of a child. After this he took arsenic 
with good effect in small doses, and the malady was cured, and 
remained cured. He became after the bleeding a stout and 
healthy man. 
A second case, precisely similar, with the same happy 
result, occurred in the person of a New Jersey physician. 
I find also in the same note-books the record of a case of 
syphilis in which there was extensive disease of both tibiae and 
enormous and horrible disease of many bones of the head. 
After long and vain treatment by several able surgeons, this 
man, in despair, resorted to a mulatto doctor who lived in the 
country. This person put him on his back in bed, and bled 
him freely, while also he dieted him closely. When the 
patient had become very feeble, he fed him at brief intervals 
with wild game and soups, and then bled him anew. This 
was repeated over and over ; but the result was a cure. 
This man also 1 saw, and, having seen him before when he 
had been called incurable, I was struck with the reality and 
completeness of his recovery. 
I am not advising any one to bleed in syphilis. I wish only 
to point the moral that even in such a malady bleeding may 
not be quite the utterly mischievous measure we have sup- 
posed it to be. 
I turn with pleasure to speak of the subject of extremes in 
the use of rest and that of absolute diets,-a matter to which I 
have given of late years increasing attention. 
We are apt, I think, to consider dietetics as almost entirely of 
modern birth. 
The practical use of precise dietaries is, however, not exclu- 
sively ours, as may be seen by the study of such authors as 
Celsus, Galen, Sydenham, and Cheyne. In this matter, as in 
others, certain of the elder physiciaps showed extreme saga- 
city, of which there is no better example than the advice given 
by Jerome Cardan to the Archbishop Hamilton in 1553, 
where we may observe, as our great-grandchildren will observe 11 
concerning us, that a man may be correct and successful in 
practice and perfectly absurd in theory. It is curious to find 
how often these Middle-Age physicians resorted to milk diet; 
and those of you who like old books may still read in Cheyne 
on the English Malady how much he effected by the use of 
exclusive diets of milk, or milk and vegetables. I am satis- 
fied that, despite all that has been written of late on this 
subject, the exclusive diets for various purposes are too little 
made use of. 
In diabetes, in Bright's disease, in many cases of obstinate 
irritative dyspepsia, in chronic diarrhoeas with ulceration of 
the bowels, in asthma, in hypertrophy of the heart, an abso- 
lute diet of skimmed milk is, as I have many times seen, of 
value when every other method fails. But success in this 
mode of treatment depends on attention to a number of 
minute details as to which Carell, in his article on milk cure, 
has given valuable information. It is less well known that 
in cases where milk disagrees, buttermilk may be used as an 
exclusive diet, and that a man may live and fatten while using 
no other diet than this, as I saw notably in the case of a 
physician who had chronic inflammation of the kidneys. This 
gentleman says, " I had albuminuria fifty months, and lived 
for eleven months on four hundred gallons of buttermilk, and 
six or seven lemons daily. I lived out of doors all the summer 
days, and had a pail of buttermilk and a dipper, and took no 
solid food. I lived on this diet alone, and I got well on this, 
and fat on this, after a host of remedies had failed." 
There are other uses of skimmed milk which you will not 
find in the books. The most remarkable is in cystitis and in 
all forms of irritable bladder. There is something in its ex- 
clusive use inexplicably soothing to the genito-urinary organs. 
So true is this that again and again I have seen persons with 
stones in the bladder lose all pain, and for a week or two 
urinate easily only three or four times a day. 
You have all used the Banting treatment at times, and like 
myself, no doubt, have found that while in many cases it 
answers well, in others it gives rise to sudden and unpleasant 
failures in the general health. In England, where you see 12 
every day women so obese that here they would excite atten- 
tion and remark, this plan of thinning has met with the em- 
barrassment I mention. Of later years, when I have met 
with this difficulty in reducing the flesh of any one, I have 
found that it could always be done with safety by keeping the 
person at rest and on a somewhat insufficient milk diet, devoid 
of cream. After a time a modified Banting diet may be 
reached ; but this plan of denutrition under milk is of most 
value in fat, anaemic people, who, when allowed the Banting 
diet afoot, lose health no matter with what caution it be 
employed.* 
In this country and in many others we are, however, far 
more concerned with the question of how to make people fat 
than how to make them lean. 
Of course there are plenty of healthy people who are thin ; 
but even for them there is a standard of fatness, and we feel 
anxious at once, and with reason, when any one is losing fat 
at all rapidly ; while, on the other hand, when a man previ- 
ously thin and weak begins to fatten we look on it as a valu- 
able gain and an indication of returning health. In women, 
however, loss and gain of fat mean less pathologically than in 
men. The laws of functional activity in the female are in this 
respect different from those of the male, as we see illustrated 
in the way in which pregnant women take on flesh, and in the 
variations in weight which even healthy women undergo 
without apparent loss of vigor. 
I may add that probably our whole active population loses 
weight in summer. Many years ago I had occasion to weigh 
every individual of our Philadelphia police force in May and again 
in September. The sum total of loss was found to be enormous : 
so that in this country at least our fat varies with the seasons. 
*Milk is, as some of you well know, a perfectly competent diet for the 
adult, but even with all that has been said of it I have failed to find anywhere 
all that is needful to know in order to use milk properly. For example, I 
have looked in vain for statements of how much skimmed milk is required to 
sustain life when at rest in bed and when afoot. 
I have now a patient, a lady, who has lived two years a reasonably active 
life on two quarts of milk a day. She weighs ninety eight pounds, and is five 
feet high. Two women weighing respectively eighty-eight and ninety-six 
pounds, kept their weight precisely when at rest in bed by taking three pints 
of milk daily, and fatten f lowly on five pints. 13 
To be making fat is, as I have said, a welcome sign of conva- 
lescence ; but mere gain in flesh is not an evidence of nutri- 
tive prosperity, and the true reason why this change is desir- 
able lies in the remarkable fact that with increase of fat come 
almost surely increase in the coloring-matters of the blood, 
gain in amount of pigment in each corpuscle, and gain in 
number of corpuscles ; for anaemia with increase of fat is rare. 
But if it be easy to fatten and redden some people, we know, 
alas, that it is hard to compass this in others. In our great 
cities there exist a host of influences for evil which result in 
all classes, and especially in women, in the gradual creation 
of patients who, having lost weight and become anaemic, find 
it hard to regain that competency of capital in fat and blood 
without which the business of life is carried on at dangerous 
cost. We search in vain in these cases for organic changes 
which may explain their condition. No function is well per- 
formed ; but it is useless to correct digestion or treat an 
ulcerated womb or order exercise. The blood is lacking to aid 
in the little gains we win, and exercise is valueless or worse 
when it exhausts tissues which lack the means of being 
rebuilded. 
I need not dwell on points so obvious to educated physicians. 
For many years past I have had my thoughts directed to this 
subject, and, like every one here, I have gone on month after 
month treating such cases with no better and, I hope, no worse 
fortune than has fallen to others. A moment of happy thought, 
and much reflection since, led me to a method of treatment 
which has rewarded me over and over with successes so bril- 
liant that, as the plan of cure involves the use of some of those 
extreme measures of which I have been speaking, I may be 
pardoned for calling them to your attention. 
And perhaps also the path by which I reached my conclusions 
may not lack interest. 
Some years ago I saw a woman who was like half a dozen 
any of you can now recall,-a pallid, feeble creature, who had 
menstruated irregularly until two years before, and then stopped 
at the age of thirty. She was the type of a class. Everything 
wearied her,--to walk, to read, to drive, to sew. She was the 14 
woman with a back, and a shawl on her shoulders, and a sofa 
for a home, and hysterics for a diversion. She had tired out 
the doctors, and exhausted drug-shops and spas and travel, 
and outlived a nurse or two. The deformity man had found 
a spinal curvature and put on a brace; the gynaecologist had 
had his turn ; the quacks had had their share ; and she wore 
blue glasses to keep out the blessing of daylight. She was five 
feet four, and weighed ninety-four pounds, and had as much 
figure as a hat-rack, and had no more bosom than the average 
chicken of a boarding-house table. Nature had wisely pro- 
hibited this being from increasing her breed. How many of 
you have stood helpless before this woman I Like you, I had 
had my failures with such cases, and I was driven to reflect as 
to what new device I could try. Because everything tired her, 
I put her at rest in bed. I made rest despotic, absolute. Then 
I fed her with milk at brief intervals. But in a few days my 
plan failed. Rest she took to well enough, but attempts to 
feed resulted in sick stomach and diarrhoea and new loathing 
of food. Then I said, I must find some way to give exercise 
without exertion. I had seen in Europe how much use was 
made of systematic massage or kneading of the muscles. I 
knew that under its use the feeble limbs of ataxies strengthen 
for a time, so that hopeful friends even dream of a cure, and I 
was aware that it improved the local blood-circulation in a re- 
markable way and gave to feeble and flabby tissues increase of 
tone and firm plumpness. It seemed to me that it could take 
the place of exercise for persons at rest. 
I had also in electricity another means of causing muscles to 
contract without the action of will or the exhausting use of 
nerve-force. 
For the first time, then, I used on a woman at rest, 
thorough massage and the abrupt muscle-stirring of an induc- 
tion current. 
To my great pleasure, I found in a few days a return of ap- 
petite and digestion. But is kneading of muscles a mere fetich 
also ? What scientific test have we of its activity ? One, and 
a sure one, which I have lately found. In weakly people, de- 
spite the exposure to the air it involves, this process raises the 15 
general temperature |° to lj° F. And as I discovered this 
winter, to my surprise and pleasure, an induction current, 
either localized or merely allowed to pass to and fro from neck 
to feet, does precisely the same. They effect tissue metamor- 
phosis for the patient in tissues little used in bed. 
I have employed every degree of rest; but in this woman's 
case, as usually, I permitted no exertion which could be 
avoided, and I carried it to such an extreme as to have the 
patient fed by hand, because it is tiresome while recumbent 
to use the arms, and because I have found that human beings, 
like turkeys, can be made to eat more when fed by another 
agent. 
To this treatment in a few days may be added raw soup, and 
butter, and malt extracts, and iron in large doses. 
I fed this woman, with growing surprise at her power to 
digest as she reddened and fattened. And how did she fatten 
and redden ? The nails became pink ; the veins began to show 
in the limbs. At first, as always, the extremities became cold 
under massage, then they grew warm, and at last, when she 
was well, the massage no longer elevated her temperature. 
And this is the rule. And as to fat, it comes first on the 
face and neck, and then on the back and belly, and last on the 
limbs. 
By absolute rest, with massage and induction currents, you 
acquire power to over-feed, and the tissues are enabled to re- 
clothe themselves with fat, and, what is better, you can thus 
refill the blood-vessels. This woman came to me, thin, sallow, 
ugly? and feeble. I sent her home fat and well and vigorous 
and handsome, and menstruating steadily; and then nature 
relented and gave her a baby. 
This treatment has been to me new light. 1 use it now 
without fear or hesitation, and think that I have learned at 
last how to re-create the blood and how to fatten. I have 
quoted one real case,-my first. But this is no place or occa- 
sion to relate cases, or to enter into details, as I shall else- 
where ; but I may venture again to say a word as to two 
facts, even at the risk of being minute. During the treat- 
ment slight hemorrhages from the nose are not uncommon, 16 
but the return of regular menstruation is a better test of 
the rapid gain in blood. It nearly always becomes regular, 
and in three cases has returned during the first month of 
treatment, after absence respectively, of three, five, and eight 
years. 
The gain of fat is sometimes at the rate of one-half pound a 
day. I have seen it reach three-fourths of a pound a day ; but 
these rates are rare. 
The applications of this treatment are many. I have used 
it in numbers of cases, selecting at'first such as had no hope- 
less organic disease. I have also used it to prepare feeble 
people for surgical operations, and within a year I have ven- 
tured to treat in this peculiar way people in the early stages 
of pulmonary phthisis. I have seen as to these some notable 
facts, and have learned that in some such cases rest and over- 
feeding are of true curative value ; for this is one of the doc- 
tor's best lessons that there may be one way or several to a 
cure. In the early stages of phthisis we have all come to 
think air and exercise and out-door life the one thing needful 
or hopeful, and I may be thought insane to propose to treat 
such cases by rest and excessive feeding ; but I promised at 
the outset to give you personal and practical experiences, and 
this is one; and now and then I have seen it do good service. 
I have said so much as to there being in the medicine of to- 
day a chemical aspect and a scientific aspect, that I would not 
end without a word or two to guard my previous statements 
from misapprehension. 
The doctor's qualities of diagnostician and therapeutist are 
those which concern most his own prosperity and the welfare 
of his patients; but unless the profession can also show its 
capacity for accurate scientific pursuits, for chemical and physio- 
logical and toxicological investigation, it will not hold before 
the general public the lofty place which belongs to it. It must 
furnish the every-day, ready, acute practitioner ; it must supply 
the hospital surgeon and physician with capacities for large 
investigation of disease and remedies ; and it must also afford 
a limited number devoted to the arduous work of laboratory 
research. 17 
The latter is the true test by which we stand or fall in the 
eyes of the vast jury of other workers in science. The public 
also are beginning to comprehend this, and to feel that a doctor 
who has signalized himself by physiological and chemical 
studies is a man who has a double claim to respect. It is, 
besides, by our activity in such matters that we stand apart 
from the organized quackeries ; for who to-day can put his finger 
on one important step in physiology or the chemistry of disease 
made by a homoeopath ? The test is a good one. You ask me 
where among medical men we are to find those who have leisure 
for the work of the laboratory and for its side of scientific 
therapeutics. And to this I answer that there are long years 
of but partial occupation in the early life of every physician in 
which he can find ample time for such employment. Will it 
help or hurt him in his after-life? The day has gone when a 
man may not dare to be just only a prescribing doctor. It has 
gone, I trust, forever. Many years ago the late Prof. Samuel 
Jackson said to me most earnestly, " If you want to practise 
medicine, do not venture to be an experimental physiologist. 
It will ruin you." I did not take his advice ; and I dare now 
to counsel any young and able man among you, that to spend a 
few years in such work is not only to give himself the best of 
intellectual training, but is also one of the best means of advan- 
cing himself and fortifying his position when by degrees he 
becomes absorbed in clinical pursuits and daily practice. I 
could point out in this country a few cases of brilliant success 
in practice, built upon reputations won by scientific labors, and 
I could call off for you dozens of names of physicians abroad 
whose splendid careers illustrate my meaning, and show that 
the most perfect practical skill is compatible with that form of 
mental discipline which is won best in the laboratory. 
In thanking you, gentlemen, for the distinguished honor 
you have conferred upon me, I ought to add that since my stay 
in Baltimore I have seen the noble laboratories to which the 
wise generosity of Johns Hopkins's trustees invites the pro- 
fession. I congratulate you warmly, I congratulate you 
honestly, on this opportunity put at the disposal of the young 
profession. When I wrote that the laboratory was and is one 18 
of the best roads to preferment, I might have said that it is also 
one of the happiest, and I should have added, alas, that its 
pursuits involve the expenditure of more money than young 
doctors find it convenient to spend. I did not then imagine 
that I was to see among you this path to fame and honor opened 
so nobly wide that the poorest can enter in. I assure you that 
as I walked through these laboratories and saw with what 
splendid hospitality and to what opportunities you invite the 
young and eager investigator, I had but two regrets,- that I 
am not twenty-one, and that I was not born in Baltimore.