1852 > •: ■ SB ^JT^ ^ r*,' — -- --- • '-V*J* '<~"w —Sv, ■'(^f ■ - 9T. ,'»S * % I J4&f *J~lt*-J £**€«» HINTS TO THE PEOPLE UPON THE 4 PROFESSION OF MEDICINE. BY WM. MAXWELL WOOD, M. D. hi surgeon u. s. navy. author of "sketches of south america," "rolynesia," 40, BUFFALO: GEO. H. DERBY AND CO. 18 52. w 1252. f;)m tfo.Zi t Zj he. If. Entered according to Act of Congress, in the year 1851, by GEO. H. DERBY AND CO. In the Clerk's Office of the District C*hrt for the Northern District of New York. Stereotyped by BEADLE 4 BROTHER, BUFFALO. HINTS TO THE PEOPLE UPON THE PROFESSION OF MEDICINE. It is told of an ignorant, but shrewd and impu- dent individual, who became a wealthy and successful quack, that upon being called upon by a wondering friend who had known him in his lowly estate, and asked how, with so few claims, he had risen to fame and fortune, he took his friend to the window which looked out upon a crowded London street, and asked how many wise or sensible men might be in the passing crowd ? " Not more than one in a hundred," was the reply. "The remainder are mine." The success of quackery, and the popular obstacles thrown in the way of true medical science being based upon those deficiencies of human judgment which are generally called human folly, and which, 4 PROFESSION OF MEDICINE. proverbially, form so large a portion of human nature, it is almost a hopeless task to correct the evil, and the attempt to do so may be only another manifes- tation of the general infirmity. Individuals who oc- cupy positions of learning and influence, theologians and lawyers, and who in their general character have not the reputation of being either arrogant or con- ceited, constantly and confidently place their own views and opinions in opposition to those of the whole medical profession, and lend the influence of their names and position to the support of opinions which have not been to them a study, in opposition to the judgment of that profession which has made theni a matter of most careful investigation. This fact proves that folly is not confined to the illiterate or to those who are marked specimens of imbecility, but that it pervades all classes, dilutes learning, and humiliates station. It shows also that the nature of the profession of medicine is not *mderstood, and that the popular ideas in regard to it are formed from a most narrow and limited view of what con- stitutes the profession. These ideas are most probably PROFESSION OF MEDICINE. 5 derived from an acquaintance with but one class or division of the medical profession, that class which alone is brought into contact with the people. It is composed of those who pursue the profession as an art; its working men, who laboriously and carefully drudge in the application of its means and details to their designed end. It may be that this acquaint- anceship is limited to the medical working men of one locality, or at most of one country; and how- ever able and skillful the individuals of this class may be, still they constitute but one, though an essential one of the many divisions which are em- braced within the whole art and science of medicine. Again, the art of medicine is most probably under- stood as signifying only a mere routine acquaintance with the symptoms and names of diseases, and the application to those symptoms and diseases, of certain remedies which experience has taught to be available. Such limited views fall far short of the nature and scope of the profession of medicine. As well might the genius of Sir Humphrey Davy, the science which he adorned, and the philosophic inspiration which 6 PROFES-SION OF MEDICINE. deduced the safety lamp, be sunk in the wire gauze of the little implement, or a view limited only to the miner who carries it. But were such views correct, and sufficiently extensive, it would still seem that a decent modesty would teach those who feel the necessity of deferring to the judgment, in his vocation, of their tailor, shoemaker, or blacksmith, to pay a similar regard, upon medical subjects, to those who have made them their study. A very different, and much more expanded view is presented by the profession of medicine to one educated in it. He sees it in the various divisions, and vast arrangements spread out over the civilized world, and acting with all the power which can be derived from an aggregation of the highest order of intellect, disciplined and strengthened to the utmost for its work. In every one of the various departments of his profession, the medical student sees, not one only, but a collection of names desig- nating individuals whose mental power demands the admiration of all who can appreciate their labors, — labors to which nothing short of the greatest PROFESSION OF MEDICINE. 1 intellectual strength is adequate. Follow, then, the eye of this student, as it sweeps over the cities of his own country, of England, France, Germany, Egypt, Prussia, and Turkey, and see with him the several divisions of the profession, studying man in health and disease, from the microscopic elementary atom of each organ, up to his full development and arrangement in families, tribes, and nations. Medical chemists, day and night, amid the ma- chinery of their laboratories, are hunting nature in her hidden recesses, and exposing the principles and laws of combination. Medical microscopists are finding beauty of form and structure, where the naked eye sees not at all, or sees only a confused speck, and they are developing systems as wonderful in their minuteness, as that of astronomy in its magnitude. The anatomist, the physiologist, the pathologist, con- centrating all their powers and observations upon the various subdivisions of these extensive sciences; the medical statistician, estimating the influence upon health and life of social and political conditions; of occupations; of population; of concentration in 8 PROFESSION OF MEDICINE. towns or diffusion in the country; the medical psy- chologist, studying the health and morbid manifesta- tions of mind. Look, too, over distant parts of the globe, and see the medical corps of armies and navies adding to the common stock, their observa- tions upon climates, the habits, diseases and remedies of different nations. Specially devoted to such ob- servations and inquiries is the medical traveler, of whom the stationary practitioner may say, he "Seeks intelligence in every clime, And spreads the honey of his deep research At his return—a rich repast for me." The professional inquirer finds, in the large cities of Europe, Asia, and America, extensive hospitals and medical institutions: cities of disease in them- selves; some of them devoted to a single variety of disease; and most of them presided over by men whose names have been for years before the profes- sion associated with every constituent of professional greatness. These men, placed above the competition of general business, are occupied in gathering in discoveries, in trying supposed truths under every PROFESSION OF MEDICINE. 9 disadvantage, and with every precaution against fallacy, and then sending forth the proven results of their investigations. We must not, in this analysis of the components of the profession of medicine, lose sight of those professional martyrs, who, sacrificing all occupations of ease and profit, risk fortune, health, and life in the pursuit of scientific truth. Some inoculate themselves with disgusting and poisonous diseases; others pursue truth side by side with the pestilence, until the fearful race terminates in death. In this general survey of his profession, the physician sees yet other important aids and appliances. Asso- ciations of medical talent issuing annual and learned treatises in their volumes of "Transactions," giving an abiding place to every established fact, or subject for further investigation. Medical conventions and national pharmacopoeias, the latter treating of every remedy which has the least claim to respect, and the whole undergoing revision, addition, and improve- ment at stated periods. We have also before us medical missions and medical missionary societies, in the words of Professor Allison, of Edinburgh, 1* 10 PROFESSION OF MEDICINE. establishing " the intimate connection that should ever subsist between the pursuit of scientific knowledge, and the reception of the blessed truths of Christ- ianity." The glance we have so far taken over the pro- fession of medicine, rapid as it has been, is yet sufficient to show that it is not sought, in the words of Lord Bacon, "as a couch whereupon to rest a searching and restless spirit, or a wandering and variable mind to walk up and down with a fair prospect, or a tower of state for a proud mind to raise itself upon, or a fort or commanding ground for strife and contention, or a shop for profit and sale, and not a rich store-house for the glory of the Creator, and the relief of man's estate." All these various fountains of knowledge are irrigating the whole profession by the channels of the medical press, and bearing to its humblest and most remote member whatever of fact, truth, and wisdom has been found worth the freighting. In the various modern languages we have, going forth, W periodicals upon the profession in general, or upon PROFESSION OF MEDICINE. 11 branches of it Most of these journals are in charge of men of eminent literary and professional ability, and any one number of either of the leading jour- nals presents a specimen of intellectual ability of which not the profession only, but human nature may well be proud. Opening by chance one now lying on the table, we find thirty-two periodicals — English, French, German, American, on its exchange list for the quarter. To present an idea of the scope of such journals, we find a single chance number to contain thirteen analytical and critical reviews of works in German, French, Italian, and English, the works being generally by the most distinguished medical authors of their respective countries. Then, besides medical reports, memoirs, and cases, we have, in the same number, fifteen bibliographical notices of works upon chemistry, diseases, anatomy, social problems, and natural theology; each notice being an interesting synopsis of the work. Could all see the profession of medicine even in the dim and feeble light by which we have endeav- ored to show its broad and comprehensive operations, 12 PROFESSION OF MEDICINE. the mind which could charge upon such a pro- fession limited, selfish, and interested motives, op- posed to truth, would onlymanifest its own incom- petency to understand the nature and tendency of mental action; and nothing saves the many who utter such illiberal sentiments from contempt, but a general allowance for the blindness in which they are uttered — a blindness which must pertain to those not educated in the profession, and not living under its obligations. The professional man sees, with an enlarged vision, into regions closed to his unprofessional brother; in his discourse he proclaims results of this vast system of moral, intellectual, and mechanical machinery, while the latter forms his pos- itive opinions upon a few crude and disconnected facts, or supposed facts, seen in the limited circle of his own untutored experience and observation. It is, as though one upon an eminence looks over a broad landscape, and speaks of its brilliant light, varied hues, and strong contrasts of color, while the man blind from birth, obstinately contends that no such things exist, and that all is of one uniform PROFESSION OF MEDICINE. 13 darkness; or, it is, as though one by unaided vision sees only a black speck in the intellectual atmosphere, while the telescopic aid of art and science shows it to be brilliant with glittering stars. Such consider- ations prevent us from impugning either the honesty, or the absolute intellectual ability of those who dog- matize boldly upon medical subjects, and though we must still wonder at their imagining themselves more familiar with medicine, embracing a range of sciences, than with any other single science or language which they have not studied, the magnitude and boldness of their error become the measure of their ignorance, and present their claim for forgiveness. For the benefit of all 'such, and for those who illiberally charge upon the medical profession a bigoted adhe- rence to a limited system, or to selfish interests, inconsistent with its nature and mission, a few reasons will be presented why, upon the very constitution of human nature, such a limited action is morally impossible. The love of truth is a principle implanted in the human mind, and which, in all ages, and in all 14 PROFESSION OF MEDICINE. sciences, has asserted its influence against every op- posing circumstance. Under its direction men have surrendered every thing else dear to the human heart — suffered imprisonment, chains, ignominy, banish- ment, and death. None will deny these facts. The science of medicine, in its very nature, must be under the influence of this principle, because it is the study of the Deity through his works. Here, then, we have a law of nature, imposing upon the science of medicine a no less boundary than pure truth; and the next inquiry is whether the modes of medical investigation are those calculated to reach the truth. We, in pursuit of the answer to this inquiry, see the human mind, such as it is, working in the sci- ence of medicine, not on a prescribed line, and up to a limited mark, but spreading out in every direction, according to its inclination and powers, every man according to his "proper gift of God, one after this manner, and another after that," and each class of laborers presenting its claim to the discovery of any truth, and finding reward and honor in the PROFESSION OF MEDICINE. 15 approbation of the mass of his co-laborers. Here, then, we have every guarantee that attainable truth Bhall be' reached. We have the natural love of this virtue, we have the efficiency growing out of a chosen direction and concentration of power, we have scientific rivalry, vigilance and ambition, and, finally, we have the interests of every professional working man, stimulating him to make the acquaintance of these elaborated truths, and to apply them practically in the treatment of disease. Whilst the profession of medicine is thus working in the main business of its vocation, it casts rich contributions upon subordinate and collateral sciences. To these sciences and their contributions the popular mind gives its admiration, and does not see that they are but chance jewels dug up on the way to the great mine. Look at Comparative Anatomy and Chemistry, Botany and Zoology, Geology and Min- eralogy, and, in the words of a distinguished medical writer, "strip these sciences of what has been con- tributed to them by physicians, or by those who have had the discipline of a medical education, and 16 PROFESSION OF MEDICINE. a chasm is left which it would be difficult to fill." A profession such as this is, rests upon principles far above the dogmas of any master, school, or Sir Oracle. It has every protection against fallacy which human reason can know, and is alike independent of the eccentricities of brilliant individual genius, and of the follies and vices of its unworthy members. Whilst there can be no influence sufficiently exten- sive to warp the common sense and common judgment of all, the intellect of any single individual may be sub- jected to honest or dishonest influences leading to fallacy or to wilful deception: hence the student of medicine learns, as the first step in the search after truth, to place no reliance upon individual authority, farther than such authority may be sustained by rea- son, and the testimony of established facts. Brilliant names, therefore, when they leave the proper ground of scientific truth to wander in the regions of fancy, are no authority for him, however imposing they may be upon the public. They are not suns, but meteors, and equally uninfluential is the clamoring PROFESSION OF MEDICINE. 17 testimony of the applauding crowds who may be dazzled by them. The medical student is too famil- iar with such things in his profession; and out of it he remembers that Hume and Gibbon were infi- dels, and that France dethroned Christianity to set up the goddess of reason, and yet Christianity resumed its place and power — because it is true. The misapplication or misunderstanding of a single word is often a fruitful source of a train of false ideas, false reasoning, and false conclusions. This is the case in regard to the word "system," as used in popular conversation upon medical science, and some considerations will now be presented upon this subject, which should be borne in mind by all de- sirous of forming a correct judgment upon the pro- fession of medicine. The word " system" as applied to any medical dogma, theory, or scheme, on the one hand, and to the science of medicine on the other, naturally suggests the idea that the science of medicine is limited to some other and opposing dogma, or theory, to maintain which all its energies are directed. Hence, the advocates of any peculiar 18 PROFESSION OF MEDICINE. dogma are fond of using the terms — new system and old system — new school and old school — and by the acknowledgment of such distinctions, a whole train of error is founded. From what has already been said, the impropriety of such an application of terms, it is thought, must be apparent. A science which seeks for truth cannot be limited by any system, but must pick up truth how and where it can; hence, that of medicine, in its very nature, repudiates systems. " In the present state of medical science, we feel well assured that the only true system is the absence of all systems. No premature attempt to generalize can have more than a temporary success. Be it ours to seek for light wherever it shall break in; to amass knowledge, even if we have to pick it from the mire; to draw wisdom from the errors and fol- lies of our rivals, without disdaining to profit by their success;" and, then, "other systems will pass away, ours will be permanent; nourished, indeed, to some extent, by the very elements which come from their decay, as the eternal oak flourishes and grows green for ages from the decomposition of the tran- PROFESSION OF MEDICINE. 19 sient vegetation, of which generations are springing up and perishing around it." Before a correct and exact mode of investigation I was established, all science, morality, and religion, were wrapped up in the dogmas of the schools and of the fathers, and men surrendered their minds to captivity and submission. Astronomy and chemistry, so exact now, wandered in the mazes of astrology and alchemy. Visionary theories agitated the pro- fession of medicine; and as there was no law of truth and fact by which to try them, there was no I limit to the wildness of unrestrained and imaginative intellects. Taught by such experience, all true science now repudiates systems and theories, or only recog- nizes them as based upon established facts, and as offering a reasonable supposition or direction for seek- ing the law of those facts — a conjecture as to the right road, formed upon the best existing knowledge, but which conjecture a little farther progress may show to be wrong. That investigation Avhich works within a system, has too limited and narrow a space to embrace the 20 PROFESSION OF MEDICINE. whole truth: a system can no more contain the whole science of medicine than a part can contain the whole. But, in their subordinate relations, all systems may be made tributary to science. For in- stance, a certain series of facts is observed, their phenomena, and the relations of those facts are seen and admitted by all — there is no dispute or differ- ence in regard to them. Genius, taking the facts, endeavors to devise or discover a theory or law which shall embrace all of them. Different indi- viduals suggest equally plausible theories; each has its partizans, investigation is carried on in various directions, to confirm the views of one set of theo- rists, and to confute those of others. In the pro- gress of this investigation new facts are discovered which none of the theories will cover, and however satisfactory and beautiful they have, before this, appeared, they must now give way to those having a broader foundation in truth. The entire profession of medicine may, then, be in accord as to certain facts, but may differ as tc the general law influencing these facts. The facts PROFESSION OF MEDICINE. 21 alone are part of the profession. Such theories are very different from the wild schemes and visions which are engendered in some individual brain, and then the facts to sustain them imagined or asserted. Fever and inflammation have both afforded the mate- rial for many theories, and yet the facts constituting these diseases have been apparent to all. Difference of theory does not necessarily imply difference of treatment; indeed, the treatment of a disease upon which all are agreed, may be one of the facts upon which is founded different theories as to the nature of the disease. One set of theorists contend that the phenomena of inflammation depend upon an increased action of the blood-vessels of the part, and hence the heat, swelling, redness, and pain; other theorists say that these symptoms are the result of a dimin- ished action, a want of tone in the vessels, in con- sequence of which the blood accumulates and stagnates in them. Both theorists, however much they may argue about their opinions, agree upon their remedies, but one explains their action by say- ing that the remedies allay excitement, diminish tone, 22 PROFESSION OF MEDICINE. and the other contends that they impart strength and power to the debilitated vessels. Many of the theories and systems in medicine have been splendid monuments of the power and wealth of the human mind; but as the rich materi- als of their creation lie scattered in ruin, they emblem the fallibility of the most exalted human intellect, and show that no genius can dare to leave the foundation of fact and truth, and yet hope to erect a firm and enduring structure. The science of med- icine sits in judgment upon them all, and examines the claim of each in calm and philosophic impar- tiality, but refuses to any the privilege of fastening its link upon the chain of established law, until it presents that link in all the unyielding firmness and crystal transparency of truth. The science of medicine, then, by its very nature, by the principles which govern the human mind, by every stimulus of interest and ambition, can limit itself to nothing short of attainable truth, and it cannot be limited by, or bound to any system. In the science of medicine there can be no " old school" • PROFESSION OF MEDICINE. 23 or " new school," and the use of such terms creates a false impression, and misleads the popular judgment in regard to any scheme or pretension which aspires to independence of the profession of medicine. It has been endeavored to set forth the means, powers, combinations, and appliances necessary in so extensive an inquiry as that of professional truth, and they are seen to be such as impart efficiency to the hu- man intellect and offer the best guards against fallacy. The decision of such a scheme of mental and scien- tific operations ought surely to claim respect and confidence from the popular mind. History has sus- tained its decisions upon by-gone medical delusions, no matter how strongly those delusions have been supported by popular enthusiasm, and it is certain that, what the science of medicine now pronounces to be delusions will prove to be such. If any system or scheme sets itself above that professional investi- gation which is bound to seek for truth, and claims to be a new school or system, the claim and the pretension are alone proof that it is not true. If it contains any grain of truth, according to the laws 24 PROFESSION OF MEDICINE. which mind must obey, that single grain must be found and added to the stores of general medical science. It is no argument to say that any "new school" system or sect has its colleges, hospitals, and journals, independent of general medicine. If such is the case, it only proves that the disciples of such an arrangement have shut themselves within a nar- row circle, and prohibited themselves from the broad search for truth, wherever it may be found; they have bound themselves to a one-man dogma, to a system, and not to a science. As well might theo- logy be taught by schools of Swedenborgianism and Mormonism; and if they become schools of general science and theology, they cease, of course, to be those of a sect. Persons who regard with favor some new scheme or pretence in the art of healing, strengthen their faith, and justify their opinions, by pointing to peo- ple in the respectable ranks of society who have given it their support. It may be that they name those distinguished in the literary world, or famed for their eloquence in the pulpit, and ask triumphantly, PROFESSION OF MEDICINE. 25 if it be not true, would such intelligent persons as these be found supporting this system? It is, per- haps, too common a mistake to imagine, because some particular merit, or accidental circumstance, elevates an individual to a superior station, that he necessarily has a correct judgment upon all matters. It may be that the very qualities which give him distinction, unfit him for close reasoning, or accuracy of judgment. If an excursive imagination, ingenious speculations, or that faculty of view and argument which can make the bad appear the better reason, are the causes of distinction, the chances are that the individual would be a bad interpreter of the truth, even were he acquainted with the particular sciences in which it is sought. But when an indi- vidual, unacquainted with any one of the series of sciences which constitute the profession of medicine, undertakes to give the support of his name and opin- ions to some system in opposition to general medical science, this act proves him to be wanting in com- mon intelligence and correct judgment, whatever may be the general intelligence of the class or occupation 2 26 PROFESSION OF MEDICINE. he represents. His course is no less absurd than would be that of an individual who, without any knowledge of the sounds, letters, construction or meaning of a language, should dispute the inter- pretation of that language by those skilled in its knowledge. The adherents of any special system, whether they may be its professors, or its disciples and admirers, are incompetent to judge of truth independent of their system. Their minds are filled with that and nothing else. The student of general medical science sees, that while the stream of scientific truth has pursued its steady course from age to age, many such systems, schemes, and wild imaginings, have risen on its banks, and attracted the clamoring ad- miration of unthinking multitudes, whose fidelity only endures until a new pretence raises them from that which preceded it. The student of general medicine sees these peculiar notions in every age, making the same claims, presenting the same evidence, sus- tained by the same enthusiasm, and pointing among PROFESSION OF MEDICINE. 27 their followers to persons of the highest rank and respectability, and pretensions to intelligence. If the retrospect runs back into the days of classic antiquity, pagan gods are seen to have been infal- lible physicians, with emperors for their patients, and whole nations testifying to their skill and suc- cess. In more modern times and countries, the altars of saints are seen covered with votive offerings in wax, silver or gold, representing arms, legs, hearts, heads, and whole figures of those whom the saint has cured of disease. The medical student can refer to one pill whose virtues were testified to by seven- teen earls, eight viscounts, seventeen lords, fifteen bishops, six right honorables, seventeen coronets, five reverends, and many members of parliament, and yet the name of that pill is no longer heard. When any individual, representing a respectable station in society, is asked to give his name to the support of quackery, or novel and peculiar systems, let him remember that while he may be flattered by his importance in the eyes of charlatans, quacks, and pretenders, science smiles in pity and contempt, to 28 .PROFESSION OF MEDICINE. see him registering his name among the long list of those who have certified to their own ignorance, vanity and folly. Continuing our review of some of the prominent delusions to which reference has been made, it is remembered that all France was once mad after the quack Mantacino, when all the continent, with a Prussian empress and princess, were subject to the delusions of the count and countess Cagliostro, who professed to restore, not only health, but youth and beauty, and received five thousand louis d' ors as a single fee. Mrs. Mopps' " Crazy Sally," as she called herself, ruled the popular mind of England, patrician and plebeian, and drove once a week to the Grecian Coffee House in a coach and six, with outriders. " We all remember," says the historian of this folly, "that the absurdity and impracticability of her own promises and enjoyments, were by no means equal to the expectations and credulity of those who ran after her; that is, of all ranks and conditions of people, from the lowest laborer or mechanic, up to those of the most exalted station; several of whom PROFESSION OF MEDICINE. 29 not only did not hesitate to believe implicitly the most extravagant assertions, of an ignorant, illib- eral, drunken female savage, but even solicited her company — at least seemed to enjoy her society." Add to these, the advent of mesmerism, the reign of Perkinism and " tractoration." No delusion of the present, however strongly it may be supported, has more general, more respecta- ble, or more intelligent unprofessional advocates than had those past medical schemes which all unite now in calling folly and delusion. Familiar as the student of medicine is with such and similar transactions, he may well be excused for paying more deference to the calm, cautious, and philosophic decisions of his profession, than to vis- ionary schemes and fanciful systems, however sup- ported by the authority of names, rank, and numbers. Whilst showing the unavoidable obligations which the profession of medicine has to the pursuit of truth, and the varied means by which it pursues the in- vestigation, it cannot be supposed, by any, that it is 30 PROFESSION OF MEDICINE. claimed for every individual practicing the healing art, even under the sanction of a college certificate, that he represents that profession; — far from it. Unfortunately the popular judgment of the profession is generally formed from those members who mis- represent it; and the illiberal, and ungentlemanly intercourse which grows out of professional rivalry, has given rise to a proverb, which is passed from mouth to mouth, conveying a fallacy in reference to the profession at large. We shall endeavor to dis- abuse the public mind of that fallacy. "Doctors differ " is the general expression of the general senti- ment, and if it is meant that like rival statesmen, rival authors, rival mechanics, they manifest the jealousies, and business animosities of human nature, there is no disputing the unhappy fact; indeed, it may be admitted tliat their differences, or business quarrels, are more conspicuous, perhaps more frequent, because, in the pursuit of their vocation, they are brought into personal contact with each other. But the popular interpretation of the proverb, "Doctors differ," means much more than business quarrels. PROFESSION OF MEDICINE. 31 It means, that each individual of the profession, is the embodiment of certain professional principles, which differ from those held by each other individ- ual, and that the difference is a legitimate one. It implies the fallacy that each practitioner is the foun- der, or inventor of his own peculiar system of prac- tice. From the nature of the view we have taken of the profession of medicine, it must be seen that they cannot be so, but, in proportion as the prac- titioners of medicine are instructed in the scientific truths and principles of their profession, they must agree. They represent general truths, not individual opinions. Information, with honesty, must produce concord. But if illy instructed, each practitioner, instead of being influenced by fixed principles, may become the advocate of ignorant and opposite opin- ions. For instance: a case of disease may be marked by known and determined symptoms, and for these symptoms or their cause, there may be a fixed and rational mode of treatment. Now, gather around this case, practitioners who are badly informed, igno- rant of the mode of investigating disease, ignorant 32 PROFESSION OF MEDICINE. of the signification of symptoms, and ignorant of their management when ascertained, and each one will make his own guess, and maintain it with a warmth proportioned to its want of truth. Bring to the same case well informed practitioners from America, from England, from Germany, from France, and they will agree as to the nature of the disease, and as to the principles of its treatment. Differences, therefore, among medical men, however disgraceful to the individuals, cannot justly be im- puted to the profession of medicine. From these circumstances it is evident that none are worthy of confidence, as practitioners of medicine, but those who, with intellectual capacity for acquirement, have had mental training, time and opportunity for study- ing the vast range of medical science, and that in- dustry, application, and sense of moral obligation which ensure the fulfillment of the high responsibil- ities of the profession of medicine. Such a rule of judgment would exclude a great many who are now successful practitioners, but if people would only keep before them the common sense view of the PROFESSION OF MEDICINE. 33 science of medicine, and see it not a string of mys- tery and magic, but one requiring, for even the most talented, long and laborious application, they would exercise a safer discrimination as to the quali- fications of their medical attendants. There are, un- doubtedly, many practitioners who honestly believe themselves qualified for the duties they undertake, simply because they have not penetrated sufficiently far within the domain of medical knowledge to perceive its broad extent and varied character, or else are naturally incapable of this extended vision. Such ignorance may give a boldness in proffering relief, which better information would very much moderate. Besides those too credulous persons who believe in all medical novelties and pretensions, there are * others who repeat the maxim "nature is the best physician," and refuse all aid for their maladies. Such sceptics imagine that their view is sustained, because the most intelligent teachers of medical sci- ence inculcate that our wisdom is to be derived from the observation of the laws of nature. There is no 2* 34 PROFESSION OF MEDICINE. relation, whatever, between the popular opinion to which we have alluded, and scientific obedience to the laws of nature. An acquaintance with these laws implies a vast amount of information, and teaches the natural means by which their irregularities and aberrations are to be corrected; and teaches also the certain and overwhelming danger, which permits the aberrations of nature's laws to go without correction. If an individual had one of his arteries divided, and saw his life blood pouring forth with fearful rapidity, he would not wait and say " nature is the best phy- sician," but he would apply to some one who, from the observation of the processes of nature, has learned how to stop the flow of blood. As great and as fatal injuries, from the progress of disease, may be going on in internal organs; the truster in nature, or rather, the willful contemner of nature does not see it, and therefore does nothing and dies of a "medicable wound," which would be very apparent, to the physician whose eye had been taught to search it out. It is true, nature is the best physician, but she requires an industrious and devoted worship to PROFESSION OF MEDICINE. 35 secure her attendance, and is very apt to visit the penalty of disease and death upon those who neg- lect her. The best ministers of nature, then, are those who most assiduously study her laws; and an acquaintance with those laws constitutes extensive learning. Unfortunately, too many of those who look to the physicians for medical aid, expect him to be the bold controller of nature, instead of her vigilant observer, faithful follower, and intelligent assistant. Certain and mechanical results are confidently looked for where true and high science teach that nothing but probabilities could be reached by human skill. Correct scientific or professional knowledge increases those probabilities, but those who study the science of medicine most profoundly, know, that while their chances of arresting disease depend upon the extent and variety of their acquirements, nothing attainable by human faculties can give the power of certainty. Hence, the conscientious practitioner of medicine is stimulated to add to his professional attainments, and feels it to be a moral duty to go from one acquire- ment to another. 36 PROFESSION OF MEDICINE. One so enlightened will promise no certain cure for the slightest ailment, for he well knows that under the mysterious agency of vital laws, which are hidden by Providence from the scrutiny of man, death may result from the slightest derangement of the human organism: — a scratch may terminate in fatal mortification; lock-jaw and death result from the extraction of a tooth, or even a too close clipping of the nails; and the sting of a wasp has been known to terminate life in fifteen minutes. Hence the well informed physician, although he may be confident of his abilities to select with knowledge and judgment among the various remedies with which he may be familiar, and though he may know that they are naturally suited to the case he may be treating, awaits with cautious hope, rather than bold assurance, a result it is not with him to determine. The uncertainty which attends the profession of medicine, is applicable to every avocation connected with the laws of nature. All such professions must acknowledge the same subjection to influences beyond their control, as that which attaches to the art PROFESSION OF MEDICINE. 37 whose province is to deal with the living, thinking human being, and must submit all their hopes to contingencies, which they can never foresee nor prevent. The agriculturist, who, with a practical knowledge of his pursuit, has an intelligent acquaintance with the principles which influence it — with the control of climates and seasons, and with the nature of soils — has a much greater chance of success, than one who works in blindness and ignorance, and, du- ring a series of years, his average returns will be much greater and more secure; but with the appli- cation of all his knowledge and skill, he cannot, on any one year, feel an assurance of success. Droughts may parch his fields, or floods drown them, frosts nip his fruits in the bud, or blight his grain in the ear. The prudent and intelligent navigator, carefully studies the currents which sweep noiselessly through the ocean, and the laws which govern the winds blowing over its surface, and when his vessel is trusted to this vast machinery of nature, it is in no igno- ♦ 38 PROFESSION OF MEDICINE. ranee of the forces and powers to which it is sub- jected. The addition made of late years to the stores of nautical knowledge in all its branches, has not only shortened the time of distant voyages, but added to the total average security with which the ocean is traversed; and it is evident that the proba- bilities of a safe voyage will be greater for the vessel, in proportion to the intelligence and professional acquirements of those having her in charge. But, the finest ship that ever floated, navigated with all the skill that man's intellect can display, may never reach her port — may be cast, a shattered wreck, on the shore, or if she be brought into harbor, it may be dismantled, rigging, spars, and cargo all gone, and yet, in this crippled condition, she may be the witness and trophy of more nautical science than if she had made her voyage unharmed. Such considerations apply with yet greater force to the art of medicine, which deals, not only with nature and its physical law, but with the moral and intellectual constituent in man; and this wonderful combination of average and increasing success, with • PROFESSION OF MEDICINE. 39 an ever existing uncertainty, is a beautiful exhibition of the harmonious laws by which the wisdom of Providence reconciles apparent contrariety. A gen- eral and progressive success is given to stimulate man to general and progressive exertion; but were he to reach certainty, where the laws of nature are con- cerned, he would be robbing the Deity of his pre- rogative, and become independent of his Maker; and hence, all the arrangements and protections of science and philosophy are prostrated before the asserted omnipotence of the Deity, and yet man has no excuse to refrain from the acquisition of knowledge. It is an ignorance of, or want of reflection upon these principles which forms the foundation for the prevalence of quackery. The pretender to medical science meets the popular expectation by promising infallible remedies for every disease. The quack, however, is not always an imposter. He partakes of the popular ignorance, and popular expectation, and promises infallibility because he believes infalli- bility to be a possibility; and ignorant of the labo- rious process of scientific induction, believes that he 40 PROFESSION OF MEDICINE. can jump at the results of those processes, as cer- tainly as those who reach them by the steps of learning. The reasonable expectations of professional useful- ness being thus lost sight of—the common sense means — those in which cause and effect bear an apparent relation, are set aside also, and to accomplish wonderful expectations, wonderful means are resorted to — means whose mode of action is as incompre- hensible, as their expected effects are inconsistent with the teachings of nature, and the designs of Providence. For all this ignorance, misconception and error, a fearful retribution is visited upon the community. It pays the penalty of half its life, and consequently half its usefulness and happiness. With all the ele- ments of health and long life in our country, sta- tistics lead to the fearful conclusion that our average length of life is but little, if any more than half that enjoyed by overcrowded, overworked, vicious, and half-starved Europe. There, some care is taken that those to whom is entrusted the health and lives of PROFESSION OF MEDICINE. 41 the people shall be qualified for their duties by suitable education. Here, every ignorant or conceited pretender is permitted to assume the solemn respon- sibility of managing the health of his fellow-citizens, and their lives become the plaything of his blind folly and vain presumption. That so terrible an evil as that which results from the existing popular notions of the art of healing, should permanently continue in an enlightened com- munity or age is impossible. The dawn of a better day is seen in the fact that the Executive of the state of New York has made special mention of the subject of medical education. The following is taken from a message of the late governor of New York: "No subject more universally affects all classes, and all members of the community, than that of the public health. I therefore earnestly request your attention to the existing laws on the subject, and suggest their careful review and amendment, especially with a view to secure the benefit of the combined experience of scientific and learned men throughout the state, with respect to the origin, the causes, the 42 PROFESSION OF MEDICINE. progress and the treatment of all malignant or in- fectious diseases. It may also be well to consider whether the time has not arrived when the state is called upon to contribute its aid, more efficiently than it has hitherto done, to advance the cause of medical education. Every inhabitant of the state, at some time or other, feels the need of the physician, and is interested that he should be learned and skillful." "Learned and skillful," yes! these are. the requi- sites, but how are they to be attained? There are medical schools in the north, the south, the east, and the west, and every year sees these schools sending forth crowds of young men certified as being qualified, " learned and skillful" in the art of healing, and this after a term of study too short to acquire thoroughly any one of thes ciences, which, in the aggregate, make up the profession of medicine. Al- most every country neighborhood sees some young man too sickly, too lazy, or perhaps too stupid to learn a mechanical pursuit, go off to study medicine, provided that, for two or three winters, he, or his PROFESSION OF MEDICINE. 43 friends can raise a few hundred dollars; and at the end of this time he comes back a qualified doctor, with a diploma in his pocket. Every one knows that he was entirely deficient in that preliminary education which is the key to professional knowledge. The people soon learn to feel as much respect for the spontaneous quack of the neighborhood, as for him of college growth, or perhaps the natural shrewdness and intelligence of the former give him an advantage. Of course so long as the granting of diplomas is a mere trade, and medical schools are but shops for their sale, .the multiplicity of these shops begets a competition which lowers the terms and standaid so as to attract the greater number of customers, and those who should be the guardians of the profession of medicine, send forth such rep- resentatives of it, as lead to the erroneous popular opinions of the nature of the science itself. No one may here oppose the popular objection that we would limit the facility for acquiring a knowledge of the profession of medicine to the few whose wealth would enable to attend expensive 44 PROFESSION OF MEDICINE. schools remote from their homes. Just the reverse; we would make the domain of medicine a true republic, and only ask of its members if they have the requisite knowledge; not, where they got it; — whether amid the halls, laboratories, and libraries of large cities, or, through the inspiration of genius, by the light of a pine torch in a forest cabin. Let every village have its medical school, if it may be thought expedient. Indeed it is a question whether, if medical education, or a knowledge of the princi- ples of medicine, were a part of general education, there would not be greater confidence in the pro- fession, and more respect awarded to those who pursue it? An Illiterate person might apply to a quacking juggler, or to any one less illiterate than himself, for information upon some abstruse point of chemistry, geology, mineralogy, or astronomy, but all having only the ordinary school knowledge of these sciences, would know that only those eminent for their learning would be likely to give the required information. The same thing is seen when regularly instructed members of the profession .apply for PROFESSION OF MEDICINE. 45 information to those of the profession having greater skill and learning than themselves. Many gentlemen, particularly in the southern states, study medicine for the sake of mental occupation, with no intention of pursuing it as a business, and many who have been in the profession, abandon it for other pursuits; yet these gentlemen, who are informed upon the nature of the profession, seek the best attainable medical advice for the relief of the ailments of them- selves or their families. These facts lead very strongly to the inference that popular medical education 1 would be fatal to the existence of quackery, and would leave the practice of medicine in the hands of those having the best natural and acquired gifts for its pursuit; and those so gifted would occupy a high and honored place in the confidence of an intelligent constituency. Whilst, then, we make no objection to the multi- plication of schools and teachers of medicine, we doubt very much the expediency and propriety of these schools and teachers having the interested power to grant diplomas — to certify to the merits 46 PROFESSION OF MEDICINE. of their own numerous offspring; and while this system endures, the public is justified in its contempt for diplomas. It is suggested that a better mode would be to compose an examining board in each state, in which all the schools might be represented, and thus examine each other's pupils, or all candi- dates presenting themselves; the faculty of the state might also be represented, and even the people, through their executive, or a committee of their legislature. If some such system as this were adopted, the results would show what teachers and schools were worthy of most confidence; the despotism of insti- tutions which have grown powerful from adventitious circumstances would be broken down, and the people, having a part in the process of conferring medical degrees, would be more ready to oppose quackery by legislation. In setting forth the influences which tend to de- grade the profession of medicine from its true and high position, it would be a serious and disrespectful omission to say nothing of that of the public press, PROFESSION OF MEDICINE. 47 at once the exponent, and controlling power of public sentiment. If the stately essays and the dignified leaders of respectable papers are alone taken into consideration, the profession of medicine has nothing to complain of. These generally pay a formal trib- ute to scientific principles, institutions, and men. Their columns contain paragraphs for the instruction of the people, and cautions against humbug, deceit, and imposture; but turn to the page for advertise- ments, and, for the lure of an advertising fee, we find columns of absurd notices of quacking pills and potions, such palpable impostures as to have no in- fluence with the educated and discriminating, but intended, and too successfully effecting the intention of deceiving the ignorant and unthinking. None but those whose professional avocations bring them into association with the humble and laboring classes, can imagine the amount of money which is robbed from these classes by such advertisements, particularly in the country districts; and the amount of disease and suffering caused by these ignorantly compounded, and ignorantly administered poisons, is deplorable. 48 PROFESSION OF MEDICINE. r Many of these notices are upon subjects which should f never be obtruded upon the public eye, and convey •, i licentious and obscene ideas into the bosom of fami- lies, and they propagate the vices for whose effects <. they pretend to offer a remedy. All this is certainly "J a great moral wrong, and it argues much against * the moral sense of the community, that the press, ^ the assumed custodian of the public virtue, shall be guilty of this wrong, and yet claim to be respectable. The list of varied and contrary diseases which ; these nostrums pretend to cure, is alone sufficient ' evidence of their false pretension, and should be such to those who become the vehicle of imposing the falsehood upon the public. Any of the ordinary and every day diseases of which people complain, may have their origin in a variety of morbid changes, each one requiring a different mode of treatment, and of course, no one means of cure being applicable to all. We will take "headache" as an illustration. This painful and distressing affection may have its cause within the contents of the skull, or in its external covering, and may arise from PROFESSION OF MEDICINE. 49 different affections of these parts. It may, as is most frequently the case, depend upon derangement of remote organs — the stomach, liver, or bowels. It may be a symptom of debility or of a too full and plethoric habit The following list of causes which excite headache into action, is taken from the Cyclo- pedia of Practical Medicine, and they are sufficiently varied to show that no remedy will reach all. " 1. Rheumatic affection of the pericranium. 2. Inflammation, or a more chronic morbid condition of the pericranium, 3. Inflammation of the mucous lining of the frontal sinus. 4. Intense mental excite- ment. 5. Strong impressions on the external senses. 6. Excessive impetus of blood to the head. 7. Im- peded return of blood from the head. 8. Congestion within the head. 9. Suppression of accustomed evacuations. 10. Inflammation of the brain or its membranes. 11. Tumors, or other morbid changes of structure within the head. 12. Morbid affections of the stomach;—as from over excitation or disten- tion; from irritating ingesta; from imperfect diges- tion; the presence of bile in the stomach, V. j£*? 4fersi