THE PART TAKEN BY 
NATURE AND TIME 
IN THE CUKE OF DISEASES. 
A DISSERTATION 
FOlt WHICH A PRIZE WAS AWARDED 
TO 
JAMES F. HIBBERD, M.D. 
BY THE 
MASSACIIUSETTS MEDICAL SOCIETY, 
1868. j t 
[It is understood that the Society is not to be considered as approving 
the doctrines contained in this Dissertation.] 
B OSTON: 
DAVID CLAPP & SON, 334 WASHINGTON ST. 
1 8 tJ 8 . THE PART TAKEN BY 
NATURE AND TIME 
IN THE CURE OF DISEASES. 
A DISSERTATION 
FOIl WHICH A PRIZE WAS AWARDED 
TOl/ 
JAMES F. HIBBERD, M.D. 
BY THE 
MASSACHUSETTS M EDIC AL SOCIETY, 
1868. 
[It is understood that the Society is not to be considered as approving 
the doctrines contained Dissertation.] 
BOSTON: ‘ 
DAVID CLAPP & SON, 334 WASHINGTON ST. 
1 86 8. “ Nalure dominant—Art ancillary PREFACE. 
In the abundant and diversified literature of medi- 
cine, the diligent bibliographer may find authority 
for almost any position assumed. The writer has 
not, therefore, in the following pages, sought to 
sustain his views by an array of cited professional 
opinions, although he has not failed to quote authori- 
ty for particular facts, for prevailing professional 
sentiment, and for historical data ; and when so quot- 
ing, an earnest effort has been made to select from 
writers more distinguished as representatives of the 
profession than for the individuality of their charac- 
teristics. 
The aim has been to inductively demonstrate “ the 
part performed by nature and time in the cure of 
diseases,” and to substantiate the point in a scientific 
and philosophic manner, beginning with such general 
principles, facts and assumptions as are acknowledged 
truths by intelligent persons, and arguing from the 
premises to logical conclusions. 
The author has an unfaltering conviction, that no 
right estimate of the relative parts performed by 4 
PREFACE. 
nature and by art in the cure of disease can be made, 
except the initial movement be from the stand-point 
of biology—normal and abnormal. In this paper it 
is, of course, only possible to lay down the broader 
generalities that should guide in this direction ; still 
it is hoped enough is said to indicate the value and 
necessity of this line of study. 
Some readers are apt to credit an author, not only 
with the views and opinions expressed in his writings, 
but also with others that they infer his reasoning 
would lead to. This is more than an author should 
have done for him. In the ensuing dissertation there 
is no design to discuss principles, practices or agents, 
farther, nor in any other direction than will illustrate 
the main object; and if the legitimate interpretation 
of the language used carries the reader beyond this, 
it will do what the writer is studiously anxious to 
avoid. DISSERTATION. 
“In no class of human events is the reasoning of ‘post hoc propter hoc,' so 
commonly applied, by the world at large, as in what relates to the symptoms and 
treatment of disease. In none is this judgment so frequently both erroneous and 
prejudicial.” Holland. 
To answer the question propounded for a dissertation, 
accurately and with such perspicuity that all candid and 
unprejudiced professional minds should recognize the answer 
as truth, is of prime importance: its accomplishment would 
mark the beginning of the epoch of perfection in medicine. 
In the study of this subject, it will, perhaps, be best to 
present it, first, in its relations to 
BIOLOGY. 
In approaching this part of the task, it will be well to lay 
down some postulates, which shall have the force of axioms 
in guiding our investigations and in controlling our conclu- 
sions. 
1. Every class of vitalized matter is the subject of a 
natural law, peculiar to itself, whicli maintains its class 
identity. 
2. In the human family, this law determines that in the 
development of an impregnated ovum, the educt shall be a 
man and not an ape, an elephant, or any other animal. 6 
3. By this law man’s stature at maturity averages, perhaps, 
5.6 ft., but his normal height may vary from 4.8 ft. to 6.4 ft. 
His weight averages 140 lbs., but weight may normally range 
from 80 lbs. to 250 lbs. 
4. Man has a period of growth, maturity and decline, and 
is not a constant quantity at either period. There is no 
closer relative approximation to unity in stature or weight, 
during growth or decline, than there is at maturity. 
5. While, therefore, the law of reproduction in man, as 
to kind is imperative, considerable latitude is allowed in the 
details of the fulfilment of that law; and this latitude extends 
to all parts of man—two men of equal stature may not have 
equal weight, nor equal length of limbs, nor equal develop- 
ment of viscera, nor equal functions, either corporeal or 
psychical. 
6. This inexorable law of reproduction and latitudinous 
development of individuals under it, is not peculiar to the 
human family, nor even to animated existences; it runs 
through all organic nature, sometimes more restricted, some- 
times more amplified. Cats will produce cats, but the mem- 
bers of this domestic branch of the feline family will vary in 
size, color and disposition. Six seeds of an apple will pro- 
duce six apple trees, but they will be diverse in size and shape, 
and the appearance and flavor of their fruit, but not one of 
them will bear a plum, a walnut, or an acorn. 
7. Accepting these statements as great truths in nature, 
we must not fail to recognize, that accident or design may 
interfere to make still greater variety in the development 
of vitalized organisms. Tom Thumb, 28 inches high and 
weighing 45 lbs., and the so-called Scotch giant, 7.6 ft. high, 
and weighing nearly 600 lbs., are wide departures from the 
Standard of normal physical development in man, from 
accidental causes; and the American idiots, so long exhibited 
to the public under the name of the Aztec children, are 
examples of accidental psychical abnormities. 7 
Whole classes of people produce distortions by voluntary 
efforts. A tribe of North American Indians have flattened 
sinciputs consequent upon compression in infancy. Some of 
the Chinese have feet scarcely a tithe of the natural dimen- 
sions, produced by an arrest of development in infancy by 
intentional compression. The Jews are still looking for the 
advent of the Messiah, by virtue of an education running 
through all the generations of Israel. 
8. We see, therefore, that large variations in the results 
of the operations of nature’s law are effected by impedi- 
ments to its operation in the ordinary channel, and these 
impediments may be voluntary or uncontrollable, patent or 
impenetrable. 
It is important to remember, however, that the results, 
such as given above, are only accomplished by the consump- 
tion of much time in the application of the impediment to 
normal developement. An Indian cannot alter the shape of 
his father’s skull, nor can he permanently flatten the head of 
his child by a few minutes’ pressure, nor by hammering it as 
lie would a lump of lead. He must keep the compressing 
board in service until, in the process of nutrition, the bones 
of the cranium have all their tissues organized to the 
abnormal figure. The Chinese cannot take an adult human 
foot and compress it to one tenth its existing dimensions, 
nor shave it down as they would a piece of wood, nor chip 
it off as a block of stone. They must take it when it is 
small, in infancy, and arrest its development by such care- 
fully adjusted envelopes as will retard its growth without 
destroying its vitality. 
Psychical abnormities are produced also by the aid of 
time. No Moslem may be filled with the doctrines of the 
Hebrews by the most earnest reasoning of an hour’s dura- 
tion ; but if a Mahomedan neonatus shall be reared in a 
Jewish family, the religious conclusions of its mature years 8 
will be the abiding faith of its foster parents and their 
ancestors. 
These postulates, besides establishing certain truths for 
further future purposes, allow us to draw the following coral- 
lary; that when a surgeon has distorted members of the body 
to restore, nature and time must be his chief reliance, and his 
appliances, whatever they may be, only serve to guide and 
encourage the physiological forces. 
PHYSIOLOGY. 
Our next proper inquiry is into the functional activity of 
the human system, and this cannot well be understood except 
as we glance, in connexion therewith, at the structure and 
development of the body, both as a whole and in detail. 
The body consists of members, apparatus, organs, tissues, 
and proximate principles. Each of its parts has reached the 
position it occupies, and attained the development it presents, 
in obedience to the great natural law especially governing 
its organization. But this body does not have any activity 
per se. Physical organizations are not endowed with activity, 
but with a capability of activity, which must be excited by a 
stimulant* before there can be any dynamic phenomena. 
Let there be no misapprehension of this point, for it is the 
paramount idea in pathology as well as in physiology, and 
without a clear conception of it in the latter, its importance 
in the former will not be maintained. To repeat—an organ- 
ization is not active by virtue of its organization, it is only 
capable of action when prompted thereto by a stimulant that 
calls out this capability, and this is true of the body as a 
whole, and in all its parts, even to each ultimate “ vital unity 
and farther, this activity is continued so long as the stimu- 
* The general term stimulant is used here and throughout the biological part 
of this dissertation, in its comprehensive signification, meaning anything that 
excites activity. 9 
lant is operative, and no longer. In this particular the 
human body may be likened to a great manufacturing estab- 
lishment :—on Sunday the machinery is all in place and quiet, 
but ready for activity; on Monday afire is kindled under the 
boiler, and presently the whole establishment is resonant 
with the hum of machinery in motion. The difference 
between the two, in part, is, that the human body has no Sun- 
day, and in the origin and manner of application of the stim- 
ulant. Take a man at any given period of his existence, and 
he has been brought to that point by an active vitality, and 
he is equally ready to be carried farther by a continued 
active vitality, but this activity does not pertain to his organ- 
ization per se, it is the result of a stimulant applied to his 
organic structure, and the stimulant must be continued or 
activity will cease. 
Proper stimulation is not a single phase of force; the 
stimulant is different for different organs; even for the same 
organ it is not always identical; and for the multiform stages 
of existence it is varied to suit the condition. All that 
appears to be required to stimulate the fecundated egg to 
vital activity is an adequate degree of warmth maintained 
for a sufficient time. Certainly this is true in birds, and 
analogy convinces that it is the same in man. Having 
reference to birds, warmth, continued within certain narrow 
limits, will cause the segmentation of the vitellus; the forma- 
tion of the blastodermic membrane and its division into an 
external and an internal membrane. From these proceed 
the orderly development of one tissue and organ after 
another, until the age and state is attained when the new 
being is extruded from its foetal surroundings, and taking 
food through its buccal orifice, digests it in its internal 
organs and maintains its own animal heat. During the 
period of incubation the heat supplied to the embryo must be 
maintained comparatively close to a central degree, for if it 10 
rise above the maximum, or fall below the minimum, at any 
stage, vital activity would be destroyed, and no re-application 
of the proper degree of heat, nor any other means, could 
re-establish it. 
Caloric is essential to the development of the foetus, but it 
is not all that is essential. Nutrition must be furnished, 
and this is prepared and presented by the maternal parent, 
involuntarily and unconsciously, under the law of her being, 
and is absorbed through the membranes of the foetus. After 
birth the food is taken into the interior through the mouth, 
is there dissolved, and is absorbed through the membrane of 
the alimentary canal into the circulation, and then distributed 
to all parts of the system. 
The instinct of hunger stimulates to the taking of food; 
food stimulates to its solution in the digestive tube; and the 
solution stimulates to its own absorption: then, through a 
series of actions, reactions, and associations, all vital activi- 
ties are maintained ; and the energy of vital action within 
natural limits is proportioned to the amount of stimulation. 
In the protozoa, the medium in which they live, and which 
is at the same time the bearer of their food, is, with caloric, 
the sufficient stimulant to excite their full activity; but as we 
rise in the scale of animal organization, the affair becomes 
more hidden from observation, and is soon lost to view ex- 
cept in its results. 
At least three kinds of activity must be recognized in man : 
namely, a functional activity, as when a muscle contracts; a 
structural activity, as when a part simply maintains its struc- 
tural integrity; and a developmental activity, as when a 
part increases the number or size of its elements. So inti- 
mate is the relation among these activities that frequently 
they are inseparable, and doubtless they are sometimes 
correlative. 
The stimulant necessary to excite these several activities 11 
varies, and in so complex an organization as that of man, 
where the resultant of the activity of one organ is often the 
stimulant to action in another, and where the nervous system 
comes in to complicate the subject by making a stimulant 
that impinges at one point, operative at another and remote 
point, the whole affair becomes exceedingly intricate, and 
too profound for full elucidation with our present knowledge. 
For the purpose we aim at, the idea that must be made 
clearly manifest and kept constantly in view is, that a vital 
organism is not of itself active, and not endowed with acti- 
vity, but with a capability of activity under appropriate sti- 
mulation ; and that such activity continues as long as the in- 
fluence of that stimulant is maintained, and no longer. This is 
the grand, central, fundamental idea of physiology, and with- 
out its broad and distinct recognition we cannot take a 
single satisfactory step in the domain of biology. 
A man, then, consists of a mass of organized, vitalized 
matter, having a certain form; made up of a certain arrange- 
ment of members; constituted of certain tissues, organs and 
apparatus; and these composed of “vital unities” or “proxi- 
mate principles,” each endowed with a capability of activity 
by the allwise Creator in the beginning; and this capability 
of activity constantly operative under the stimulation of a 
force also ordained to the purpose by the Creator. The 
sum of these activities constitutes the phenomena of human 
life. Human life is never a static, nor a constant quantity. 
That “nature abhors a vacuum” is an old scientific adage; 
we might originate another—nature abhors rest. Nothing in 
nature has absolute rest, so far as we know. Motion, cease- 
less motion, is the universal law of all things of which we 
have cognizance. Man’s organization is constantly changing, 
in some parts more rapidly, in others more slowly, but still 
always changing, even from before conception until after 
death. 12 
An adult man consumes an amount of nutrient material 
equal to the weight of his body in about twenty-seven days 
(Dalton), and consequently the complete metamorphosis of 
all his tissues must take place in periods, the average of 
which is twenty-seven days. But the blood and other of the 
more plastic and more active tissues change very rapidly, 
while the cartilages and other firm and slightly yielding 
tissues occupy much time in their physiological molecular 
changes. 
Not only is the molecular metamorphosis ceaselessly 
going on, but the tissues have a life to live and a time to 
perish in, shorter or longer according to the nature of the 
tissue, and as the period of observation is closer or more 
remote from the date of conception: the umbilical vesicle as 
a medium of nutrition is supplanted early in embryonic life 
by the more elaborate placenta, and this in turn gives way 
to another method at the conclusion of parturition. The 
deciduous teeth come and go in the early years of indepen- 
dent life; and as old age creeps on, one organ after another 
arrives at that stage of its existence when its functions are 
so imperfectly performed, that they cannot do their duty in 
the general life of the body, and somatic death ensues. 
Before closing this section, reference must be made to the 
influence that mental processes exercise over physiological 
functions. That such influence is powerful and persistent, 
even in the modification of nutrition and development, must 
be obvious to any one who contrasts the actions and appear- 
ance of an affluent, educated man, with the illiterate navvy 
who only delves and eats. To fulfil the needs of our present 
study, this allusion to physiological stimulants will suffice. 
PATHOLOGY. 
If the foregoing broad and comprehensive statements 
convey the great and fundamental truths of general physi- 13 
ology, then we shall have but little difficulty in understand- 
ing, in an equally broad and comprehensive sense, the essen- 
tial features of general pathology. 
Beside the normal stimulant that calls forth normal or 
physiological activity, constituting health, an abnormal stimu- 
lant may be applied to a part and cause an abnormal activi- 
ty, producing abnormal or pathological results. This is 
known as disease, and this may pertain to either or both of 
the activities of function and development, already men- 
tioned. But in the case of development, instead of produc- 
ing an increase in the number or size of the proximate con- 
stituents of the part affected, it establishes a decrease; or 
more commonly the direction of its activity is perverted, and 
products abnormal in constitution, time, or locality, are the 
result. 
Pathological stimulants in their nature, source, and mode 
of application are as profound, intricate and difficult of 
observation as physiological stimulants. They are some- 
times of external and sometimes of internal origin, and 
quite frequently the resultant of diseased action in one part 
is the excitor of diseased action in another. In such case 
the pathological stimulant passes through the same channels, 
and is carried by the same agencies provided for, and used 
by, physiological stimulants. The nervous system is as 
ready to transmit pathological as physiological stimulants, 
the excitor impinging upon one point and the excitement 
showing itself at a remote point. 
Furthermore, many things that in one quantity would be a 
physiological stimulant, would in another quantity be a patho- 
logical stimulant. For examples:—let a man drink half a 
pint- of water and it will serve a normal purpose in his 
economy ; but let him drink half a gallon and it will prove an 
emetic or a stimulant to some other abnormal activity: let a 
man eat six ounces of beef and it will prove a healthful 14 
nutrient, but let him eat six pounds of the same and it will 
act as an excitor of disease. Let a man, unaccustomed to 
manual labor, chop wood earnestly for a few hours, and his 
hands will be blistered; but let him apply the same friction 
of the axe helve gently and slowly, and in a few months his 
palmar cuticle will acquire several fold its former thickness 
and be almost as insensitive as leather. 
It has already been shown that physiological activity is 
allowed considerable latitude for its operations, and we have 
just seen that pathological activity is but a diminution, an 
excess or a distortion of the former. Hence we easily 
deduce the fact, that physiological activity may shade off 
into pathological activity in such manner that the most 
acute observer will not be able to say where the one ends 
or the other begins. 
Pathological activity does not continue of its own force, 
but is maintained only by the persistent application of a 
stimulant that compels the part, as it were, to violate the 
physiological law; and as soon as the unnatural stimulant is 
withdrawn, the physiological activity is resumed as before, 
or as nearly so as the altered structure will admit. 
If a pathological stimulant be so powerful, or so long con- 
tinued, as to induce activity beyond physiological restraint 
or recuperation, the affected part loses its vitality and is no 
longer under any biological law, but is controlled by the 
ordinary affinities of inanimate matter. 
The initial point, then, of all abnormal function and struc- 
ture is the influence of an unnatural stimulant upon the vital 
units of the tissue or organ affected. The particular nature 
of the departure from health that may ensue depends upon 
the nature of the stimulant, the structure and condition of 
the part stimulated, and other circumstances of accidental 
association. In the great majority of internal diseases, the 
exciting causes are shut out from our knowledge. We use 15 
certain conventional terms which, by common consent, signal- 
ize something that produces recognized results, but convey 
no definite idea of what that something is, or how it acts. 
We say often that cold produces pneumonia, but it is some- 
thing more than the absence of caloric, for according to the 
United States mortality census, District No. 1, composed of 
New England and New York, has a mean winter tempera- 
ture of 22.96°, with one death from pneumonia in every 
12,873 inhabitants; while in District No. 8, composed of 
the four South Western States, the mean winter temperature 
was 53.10,° and the deaths from pneumonia equal one in 
every 3,250 of inhabitants. Telluric miasmata produce 
intermittent fever; but what is a miasm ? The virus of a 
rabid dog will create a hydrophobia; but what is the virus 
of rabies canina ? The effluvia from one suffering from 
measles will communicate the disease to another who has a 
liability; but what is the effluvia of measles ? If the kidneys 
fail to excrete the urea a train of morbid symptoms ensues, 
due to an excess of urea in the system; if the liver do not 
eliminate the cholesterine, a disease known as cholesterernia 
will follow. Each of these excrementitious matters acts in 
the blood the role of a pathological stimulant to certain 
tissues, and brings on its-respective disease; but what was 
the morbid stimulant that disordered the kidneys and liver, 
and arrested their legitimate service ? 
When we find gummata in an infant six years old, we 
know that it is the victim of the syphilitic poison, and has 
been, for months at least, most likely Tor years; but where 
was the primary sore ? on the infant, on the mother, or on 
the father? and how many phases has the virus assumed 
between the chancre and this tertiary manifestation of its 
continuance ? Here, plainly enough, is an instance where 
the resultant of diseased activity in one tissue has become 
the stimulant that excited disease in another tissue. 16 
Traumatic diseases have their causes more open to recog- 
nition. If incandescent iron come into contact with the skin 
we know the cause of the ulcer that ensues. If, by a blow 
upon the head with a club, a man be knocked senseless, wo 
know the cause of the concussion that oppresses him. If a 
man have his limb crushed under the moving wheel of a rail- 
road car, we understand very well the cause of the gangrene 
which follows. 
Neither must we overlook nor underrate the mental states 
as pathological stimulants. One cannot read the classic 
work of Montgomery (Signs and Syrup, of Preg.), without 
being convinced that the mental state of the mother may 
distemper the physical formation of the foetus in her womb. 
Bennett tells us that in Edinburgh a “ man on trying to 
hook up a heavy piece of meat above his head, slipped, and 
the sharp hook penetrated his arm, so that lie himself wras 
suspended. On being examined, he was pale, almost pulse- 
less, and expressed himself as suffering acute agony. The 
arm could not be moved without causing excessive pain, and 
in cutting off the sleeve he frequently cried out, yet when 
the arm was exposed it was found to be quite uninjured, the 
hook having traversed only the sleeve of his coat.” “ A 
Avoman was supposed to have poisoned her newly-born infant. 
The coffin was exhumed, and the procurator-fiscal, avIio 
attended with the medical men to examine the body, declared 
that he already perceived the odor of decomposition, which 
made him feel faint, and in consequence he withdrew. But, 
on opening the coffin, it was found to be empty, and it was 
afterwards ascertained that no child had been born, and con- 
sequently no murder committed. Numerous instances 
might be gi\'cn of individuals engaged in duels, or on other 
occasions, who have supposed themselves to be wounded, 
and have fallen down as if dead, withbut having received the 
slightest injury.” The experience of every practitioner will 17 
give him cases where great sorrow, or sudden grief, brought 
him patients with bodily ailments most difficult to heal; and 
most of us can recall instances where sudden joy has proved 
the stroke of death. Every reader’s memory will enable 
him to review a host of such instances as have been recited, 
or even more striking ones, for medical literature, whether 
ancient, mediawal or modern, is dotted over with illustrative 
narratives of this tenor. 
THERAPEUTICS. 
11 Remedies do not act upon dead bodies." 
There is a world of wisdom in this maxim of Cullen’s, and, 
constantly remembered, it would prevent a continent of 
errors, and an ocean of mischief. It should be the starting 
point for every student who sets out to acquire the science 
and art of treating disease; over every chair from which 
therapeutics is taught, it should be inscribed in attractive 
and legible letters; and it should be a necessary imprimatur 
to every text-book upon the same subject. 
The therapeutist must, therefore, have a living body to 
exercise his skill upon; and not only this, but he must have 
a diseased one. Etymologically, therapeutics signifies the 
art of curing, healing, and this must be its practical defini- 
tion likewise. Prophylactics is the art of maintaining health 
or preventing disease, and however intimate these two 
branches of medicine may be, we must not lose sight of the 
distinction between them. 
A physician, being consulted by a party, his first point is 
to ascertain whether the party is diseased (for certainly he 
is alive). Here the physician should be careful to discrimi- 
nate between the great latitude in physiological activity and 
its results, and actual pathological activity and its results. 
It would not do to consider the Scotch giant a case of 
pathological hypertrophy, and undertake to reduce him 18 
by medication to the average standard of human weight 
and stature. It would be equally mis«hievous to regard 
Tom Thumb as an instance of faulty assimilation, and 
endeavor to force his nutrition until he attained the dimen- 
sions of average man. 
When a man is recognized as sick, the question generally 
propounded by the physician to himself is—what medicine 
shall the invalid take ? Whereas it should be—does he 
need to take any medicine ? To answer this question aright, 
presupposes a perfect acquaintance, not with the name mere- 
ly, but with the nature and course of disease, and with the 
force and virtue of remedies. That our acquaintance with 
these particulars is not perfect, but on the contrary lamen- 
tably deficient, is as patent as the noon-day sun. 
At the recent opening ceremonies of the Clinical Society 
in London, the venerable and eminent Sir Thomas Watson 
said, “ Certainly the greatest gap in the science of medicine 
is to be found in its final and supreme stage—the stage of 
therapeutics.” “ We know tolerably well what it is we have 
to deal with, but we do not know so well, nor anything like 
so well, how to deal with it.” “ To me it has been a lifelong 
wonder how vaguely, how ignorantly, how rashly, drugs are 
often prescribed. We try this, and, not succeeding, we try 
that; and, baffled again, we try something else.” “ Our pro- 
fession is continually fluctuating on a sea of doubts about 
questions of the gravest importance.” “ Of Therapeutics, as 
a trustworthy science, it is certain that we have as yet only 
the expectation.” Now if Sir Thomas Watson—a man who 
has had, perhaps, near half a century of close and thought- 
ful observation, of acknowledged eminence as a practitioner, 
a teacher and an author—bears this testimony to the status 
of therapeutics in the year 1868, before the elite of the pro- 
fession in London, shall we not receive it as conclusive, that 
much of the teaching in this department of medicine from 19 
the professors in our colleges, from the text books in our 
libraries, and from the overflowing of our abundant periodical 
literature, should be taken, not as fixed scientific truth, but 
at least cum grcino sails ? 
This vacillation spoken of by Sir Thomas, this jumping 
from one remedy, if the patient does not quickly improve, to 
another, and another, is the joint offspring of the error so 
prevalent, already mentioned, that an ailing man must always 
take medicine; and another equally popular mistake, that 
every disorder might be cured by drugs if we could only 
hit on the right ones. Practitioners with these notions 
ignore the fact that most of human diseases tend toward 
spontaneous recovery, and count as nothing the unaided 
efforts of nature. But with the light and knowledge we 
now possess of pathological activity, and with the uncer- 
tainty that overhangs the action of medicines, we ought to lay 
it down as a guiding maxim, that all disease should he left to 
the hazard of nature where art cannot establish an indefeasible 
right to interfere. c 
Too many active therapeutists are careless of the distur- 
bance made by potent medicines. Such disturbance is 
never a matter of indifference. If it is not curative, it must 
necessarily be detrimental. Perhaps it was Abercrombie 
who compared a physician, heroic in the administration of 
medicine, to a courageous man who went in the night to as- 
sist a neighbor who was grappling with a burglar. Entering 
a dark room where the two men were scuffling, he laid about 
him with a club, breaking the first head he struck, fully hop- 
ing and expecting it would be the burglar’s, but, unfortu- 
nately for his good intentions, just as likely to be that of 
his friend. 
Medicines which would create disease if given to a man 
in a normal physiological state, should be withheld from a 
sick man, except upon indubitable evidence that they will 20 
act beneficially. Otherwise they may continue morbid 
activity, after nature and time have cured the original dis- 
ease despite them. Indeed all therapeutists should have still 
an additional maxim, viz.: All perturbating medicines are, 
themselves, pathological stimulants. This would teach that the 
administration of such agents is always an evil, and never to 
be voluntarily incurred except under a certainty of abating a 
greater evil. 
But let us proceed to examine therapeutics philosophic- 
ally, in the light of our recent biological studies. And as a 
proem thereto, it may not be amiss to state, by way of 
reminder, what every intelligent physician is fully conscious 
of, viz., that disease is not an entity—a something tangible 
—supplanting, or overpowering another entity, called health, 
and reigning in its stead; but a condition, a new order of 
phenomena in the part diseased, differing from the healthy 
phenomena of the same part by virtue of its vital forces 
taking a new direction, under the impulse of an excitor of 
unnatural attributes. 
If it be true that pathological activity ceases to progress 
as soon as the exciting cause is removed, then it is clear that 
to cure disease we have but to remove the cause. In some 
traumatic diseases this is done with success. If a thorn be 
driven into the flesh and immediately removed, nature will 
restore the continuity, as soon as her means have time to act. 
But generally the cause of disease is unknown, and we 
have no opportunity to remove it; and with equal frequency 
we only know that a cause has been operative, when we find 
its effects at a stage of its progress remote from the initial 
point. A physician may be called to see a patient with 
such violent pyrexia that he watches it with anxiety until, on 
the third day, he observes a cutaneous eruption making its 
appearance, when he knows that he has a case of variola, 
and that his patient was exposed to the effluvia of some other 21 
person having variola twelve days before; or had some of 
the virus inserted into his system seven days before the 
manifestation of morbid symptoms. All that time the cause 
had been doing its perfect work in the victim’s organization, 
entirely concealed from observation, and it is only known 
when no possibility of removal exists. 
So of your neighbor whom you find sick of cholera, and 
learn that he has just ended a journey of a thousand miles 
since he was in a region where cholera prevailed. You feel 
that the seeds of the disease were planted at or before the 
beginning of the journey, to germinate unseen and unfelt 
during the travel, and to blossom and fructify at its termina- 
tion, presenting no opening for dealing with its cause. 
In the instance of cholera, even if we knew the cause had 
a productive lodgment in a man’s system, we have no means 
of arresting its development; and in variola we could only 
succeed in stopping its manifestation, by making use of nature 
and time to supersede it with vaccinia. 
Unfortunately, then, we have but little opportuuity to cure 
disease by removal of its cause; and when we do so, it is, 
for the most part, through sanitary and hygienic measures 
having nature and time for their chief efficient factors. 
Generally, therefore, we are summoned to prescribe for 
disease after it has gone through the stage of incubation, 
and is made manifest to our physical senses by its grosser 
symptoms. What can we do to cure it ? 
A very important class of human disorders all acknowledge 
we have nothing available to cure. The disturbance must 
prove mortal, and our whole attention is addressed to molli- 
fying the suffering. Hydrophobia may be presented as a 
paradigm of this class. 
Another class, now large and constantly increasing, con- 
sists of diseases having a recognized definite course to run 
that may not be curtailed by any known process. Some of 22 
this class are but a slight departure from health, a mere 
unwellness, as varicella. Others are of very serious import, 
often causing great mortality, especially in the character of 
epidemics. Variola may be cited as an example of this 
variety. Before the time of Sydenham variola was treated 
actively, under a distorted phase of the ancient coction and 
crisis theory, and the results were most disastrous to life, as 
well as the cause of terrible suffering while the victim was 
alive. Now the cure is entrusted entirely to nature and 
time, and whatever medication is resorted, to, it is with the 
sole idea of ameliorating the symptoms, and mitigating the 
severity of the sequel®. 
With fevers as a class, we are learning to meddle less and 
less. For intermittent, and a certain form of remittent fever, 
it is true we have a specific, and it is the only specific in the 
whole range of medicine. A quarter of a century ago it 
was deemed necessary to prepare the system by bleeding, 
emetics, cathartics, &c., for the administration of the cinchona 
or its salt. At present physicians use few or no preparatory 
measures. In regions where malarial fevers most abound, 
the people keep by them and prescribe quinia, without con- 
sulting the doctor, neither do they institute any domestic 
measures of preparation, trusting to nature and time, success- 
fully, for what is not done by the great antiperiodic. 
Typhus and typhoid fevers are now classed among the 
self-limited diseases, and no efforts are made to arrest them 
by the most enlightened physicians; but they are managed 
through their natural career with no other effort than to 
assist nature and time in bringing about a favorable termi- 
nation. Nevertheless there are practitioners who hope to 
cure such fevers with drugs, and one cannot read the treat- 
ment of them with alterants, with counter-irritants, with 
opiates, with stimulants, with mineral acid juleps, with milk, 
and with divers other articles as leading medicaments, with- 23 
out being forced to the conviction, that the course of the dis- 
ease is in no wise altered for the better except by such 
articles and such management as assist nature in bearing up, 
supporting and nourishing the system, until the pathological 
condition finishes its career under its own law of existence. 
In the phlegmasia) we have a class of diseases which have 
been supposed to make the most urgent demand for thera- 
peutic interference. The word inflammation implies a fire, 
and the theory wa§, it must be smothered, quenched, stamped 
out, the sooner the better, as you would suppress a rising 
conflagration in your house. Can this be done ? Let us 
inquire what inflammation is, before we essay an answer to 
this query. 
For our present purpose it is not material whether we 
adopt the pathology of inflammation so beautifully presented 
by Paget; or that originated by Bennett; or that derived 
from the writings of Virchow, or as modified by the views 
of Robin, or the cellular theory of Beale. In either case the 
inflammatory genesis is a local disturbance of the nutrition 
of the part affected, so occult as to be discernible only by 
the aid of a great magnifying power, and it has advanced 
through all its primary stages before it advertises itself to 
the ordinary senses of the medical observer. Inflammation 
now is an accomplished fact, and of course cannot be arrest- 
ed. Whatever power medication can exert would be avail- 
able only to confine the inflammation to its present limits. 
This could be done, undoubtedly, if we could remove the 
pathological stimulant that is exciting the mischief. If a 
thorn have penetrated the flesh and is left there, it will excite 
inflammation, in the suppuration of which it will be loosened 
and flow away in the debris of the disease, and the disturbed 
tissues will speedily regain their normal condition and func- 
tions. If the thorn be withdrawn by art, at any stage of the 
process, the diseased activity will cease to progress, as it did 24 
when the thorn was removed by the natural process, and 
restoration will begin; but no interference whatever will 
arrest the inflammation until the thorn is removed or, ceases 
to act as a pathological stimulant. 
But in internal inflammations we do not know what the 
pathological stimulant is; and if we did, in most instances it 
would probably be beyond reach. Internal inflammations 
are not of traumatic origin, and often, at least, are excited in 
one part through the mysterious agency of the nervous system 
by a pathological stimulant applied to another part; as when 
humid cold comes in contact with feet accustomed to dry 
warmth, there will follow a cynanche within twelve to forty- 
eight hours. Of course there can be no removal of the cause 
in a case of this kind. And, moreover, there is fair ground 
to suppose inflammations of this character partake of the 
nature of self-limited diseases, which have a definite order of 
phenomena to pass through, that can neither be arrested nor 
abridged. 
It is not within the purview of this dissertation to seek 
largely into the uncertain proof of numerical statistics for 
support, but it may not be improper, in this connection, to 
adduce something in relation to a single point, from the 
stores so largely accumulated by the late controversialists 
over the therapeutics of pneumonia. 
The average natural duration of uncomplicated pneumonia 
is about fourteen days, but it varies probably from 'five to 
twenty-eight days. And in this variation is found the great 
difference between many of the specific diseases and com- 
mon inflammation. An inflammation of the lung may involve 
but a small portion of one lobe and run its course in five 
days, or it may spread over an entire lung and occupy four 
weeks in its progressive development and decline; while an 
uncomplicated rubeola will consume four days with its/ 
initiatory fever, and four more with its rubeoloid eruption to 25 
the beginning of convalescence. Here then clearly is a dis- 
tinction between measles and inflammation of the lungs. In 
the former, the whole system is involved in the same patho- 
logical movement, at nearly the same moment, and for about 
the same period; while the latter, beginning at a point, may 
be confined to that point, or may spread over an indefinite 
space, the pathological activity at the starting place having 
passed its maturity, and be on the decline before the remotest 
point that is to become involved loses its physiological 
integrity. If this position be well taken—and its truth is 
probably clear to the apprehension of every biological stu- 
dent—much of the doubt and uncertainty that hang over the 
therapeutics of the phlegmasiae ought to be dissipated by the 
light it reflects on the natural progress and termination of 
these disorders. The cause of this contrast in the two patho- 
logical activities is to be sought for in the operation of that 
triune biological law, which teaches, that all pathological 
activity is the result of a pathological stimulant, coequal 
with its application a<pd coeval with its duration. 
The aim of this paper does not admit a farther pursuit of 
this topic, nor an inquiry into the kindred subject of the 
diverse natures of many of the plegmasiae. For example, 
rheumatism and white swelling are both inflammations; but 
how different! Croup and tonsillitis are both inflammations; 
but how unlike! 
From the foregoing we deduce this corollary:—that when 
a part is inflamed we have no power to jugulate the disease ; all 
we can do with medicaments is to conduct it to a safe termina- 
tion, through assisting a natural process by the aid of time. 
And if we have the ability to arrest the spread of inflamma- 
tion, it is done by virtue of our suppressing the pathological 
stimulant, or by raising the depressed vital power of the 
part threatened, to a degree that will enable it to resist the 
morbid stimulant. 26 
If there be such a disease as a mere exaltation or diminu- 
tion of the function of an organ, without being dependent on 
change of structure, and that organ is one to which avc can 
directly apply medicine, we might possibly accomplish a 
cure with our remedy per se. But have wo such condition 
of any organ ? Let us suppose, for argument, there may be 
an error of function without structural change; to what organ 
can we directly apply our remedy ? If it be the kidneys that 
are in error, avc can only reach them through the circulation ,* 
if the liver, the same, and thus we appeal to both nature and 
time. Common diarrhoea might, at first sight, seem to fulfil 
the condition of the premises, but diarrhoea is composed of at 
least two pathological factors, viz.: increased secretion by 
the intestinal secerncnts, and an increase in the peristaltic 
action of the muscular tissue of the bowel; and when avc 
give medicine by the stomach it is cither absorbed and 
reaches the seat of disease by the circulation, or passing 
over the face of the mucous membrane, floAvs by the mouths 
of the secernents—not into them—and produces its good 
effects through reflex action of the wondrous nervous system. 
Even then, in the so-called functional disorders, the thera- 
peutist can do nothing except as he appeals to nature and 
waits upon time. 
Diversity in therapeutics affords another stand-point from 
which to view our subject. An example or tAvo will suffice. 
Stille’s Therapeutics and Materia Medica is a representa- 
tive work, a monument of erudite literary investigation and 
faithful labor. Turning to his index of “ Diseases and their 
Remedies,” Ave find that under the head of rheumatism he 
gives the following catalogue of remedies for that disease: 
u feodae carbonas, sabina, cantharis, cinchona, liquor ammonia}, 
capsicum, pix abietis, sabina, oleum monarda punctatae, 
oleum anthemedis, eupatorium, monarda, calor, creasotum| 
oleum terebinthinas, ammonias carbonas, opium, stramonium, 27 
humulus, dulcamara, succinum, camphora, frigus, veratrmn 
viride, aconitum, tabacum, veratria, antimonii et potassae 
tartras, sulphur, cimicifuga, pulvis ipecacuanha et opii, guaia- 
cum, potass® nitras, potass® acetas, ammoniac phosphas? 
chimaphila, colchicum, hydrargyrum, arsenicum, iodinum, 
oleum morrhu®.” Of these, sabina is twice mentioned. 
Correcting this, it leaves forty medicines for rheumatism, and 
a glance of the eye will show that the list does not include 
bleeding,-the various purgatives, warm water, vapor and hot 
air baths, lemon juice, lamb’s wool, carded cotton, and a few 
others among the standard remedies, to say nothing of that 
host of drugs which have, individually, one or more enthusi- 
astic advocates, who assure us that they have had ample 
clinical experience that their favorite is, under all ordinary 
circumstances, a specific. Beside all these, there are eclec- 
tics, homoeopathists, hydropathists and other medicasters who 
treat rheumatism by other methods, and yet the patients of 
all recover in about the same proportion and in nearly the 
same time, so far as we can judge from the statistics pre- 
sented. 
Can a logical mind come to any other conclusion than 
that nature and time cure rheumatism, whether the patient 
have any medical attendance or not, provided he has appro- 
priate nursing attendance? Notwithstanding the valuable 
labors of Fuller, Garrod and others, we are still in possession 
of nothing that militates against either the wisdom or the 
wit of the London surgeon, who on being asked by a junior 
“ what would cure rheumatism,” replied, “ six weeks.” 
Is some one ready to say that rheumatism is a unique 
pathological condition, protracted in its course and naturally 
tending to recuperation, and, therefore, not suited to be a 
test of our therapeutic skill. He might be answered that 
such are just the conditions affording the very best oppor- 
tunity for a successful application of our means of cure. But 28 
not to take advantage of this fact, let us turn to a disease 
rapid in its course, often fatal in its result, and, from its 
recent visitation over the civilized world, fresh in the memory 
of all—epidemic cholera. 
During the years 1865, ’66, ’67, foreign and domestic pro- 
fessional literature, monographic and periodical, has teemed 
with the treatment of cholera. For the obvious reason that 
the ground is too extensive to be gone over in this connection? 
no attempt will be made to rehearse the almost .countless 
methods of treatment that have been reported; but the atten- 
tive student cannot fail to observe, that they have been of 
the most diverse character, and not infrequently diametri- 
cally antagonistic. Nevertheless, whenever there has been 
unusually small or great mortality, research has shown that 
the result was not attributable to the activity of the treat- 
ment, nor the want of it, but to certain extraneous conditions 
having little or no relation to either. The lessons to be 
gathered from the recent visitation of cholera are these : that 
physicians have not been able to settle upon a definite treat- 
ment of cholera in any of its stages; that after the disease is 
fully developed, no treatment has been of much avail for 
good, and that proplndaxis through hygienic and sanitary 
measures is of vastly more importance than therapeusis 
through drugs and medicaments. 
Cholera, therefore, as well as rheumatism, helps to bring 
us to the decision that nature and time are the prime agents 
to cure disease, while physicians are but the helpmen to as- 
sist the process when opportunity opens the way. These 
examples will serve to illustrate the point involved, and no 
value will come of pursuing the line of argument further. 
Turning from the contemplation of diseases and their 
multifarious treatment, let us consider for a space the 
MATERIA MEDIC A. 29 
remedies themselves and their application, and determine 
whether the conclusions it leads to are in unison with those 
already attained. 
The primary list of U. S. Pharmacopoeia embraces over 
three hundred drugs, the secondary about seventy-five drugs, 
and the preparations number about five hundred, making an 
aggregate of nearly nine hundred officinal articles. The 
medical virtues of all these and their therapeutic application 
are duly chronicled in our text-books and proclaimed by our 
college teachers, but in nearly all instances from the errone- 
ous stand-point that regards diseased activity as something 
to be taken out of nature’s hands and be made subject only 
to the controlling power of medicaments. 
Inferentially, if not positively, every student of medicine 
is indoctrinated with the idea that medicines are to be his 
sole reliance in combating all serious disease; that patholo- 
gical activity is nature off the track, running wild, and that 
she will continue to go from bad to worse, until wreck and 
ruin are the result, if fie does not check her in her evil course, 
and restore her to, and keep her in, her normal way, by the 
superior force of his remedies. This error has not seized 
upon physicians only, but the wrong opinion has become 
almost universal among the people through the propagandism 
of medical men. It is in obedience to this mischievous 
education that ailing people'are continually changing from 
one physician to another, from physicians to medicasters, and 
from these to the countless nostrums that line the shelves of 
every apothecary. When an invalid takes medicine and is 
not restored to health at once, his belief is that he did not 
have the right remedy, or not enough of it, and, nothing 
doubting, he recommences and continues until he recovers or 
ends his existence. 
To such an extent does this practice prevail, leading to 
the consumption of such vast quantities of medicine—much 30 
of it under the patient’s own prescription for a supposed dis- 
ease diagnosed under the instigation of groundless and 
vague apprehension; more of it under the delusion purposely 
thrown around him by the maker or vender of nostrums— 
that much mischief is done by the improper use of medicines; 
so much, indeed, that it overbalances the good arising from 
the proper administration of them, and authorizes one to say, 
without hazard of error, that the aggregate effect of all 
medication in the civilized world is the reverse of what is 
intended. And this will continue to be so until the pro- 
fession fully realize the fact that nature and time are the 
main factors in the cure of disease, and that the use of medi- 
caments is of secondary importance and must be strictly 
subservient thereto. 
When the profession shall be filled with this faith, and 
proselyte the people to the same standard of belief, the day 
of the medicaster will have passed, the nostrum-maker’s 
occupation be gone, and the physician will have no more 
cause to lament that every pretender who dubs himself 
doctor, and assumes the role of prescribing medicines, shall 
be esteemed a physician by the community. 
A brief review of two leading classes of medicines, and 
of two important individual remedies outside of these classes, 
will serve to illustrate the whole range of medicaments. 
Cathartics.—“ Purgatives,” says Stille, “continue to be 
regarded by the vulgar as the most efficient of all remedies. 
This partiality arises, in some degree, from the prejudice 
which the coarse and ignorant have in favor of whatever is 
vigorous or even rude in its action, but, it must be confessed, 
from the unquestionable relief also which cathartic medicines 
afford in many of the ailments of this class of persons, whom 
the habitual use of coarse food, as well as the neglect of 
personal cleanliness and of the calls of nature, render pd£u- 
liarly apt to be benefited by purgatives and depurative 31 
agents.” “ The evacuant method,” says Hufeland, “ has 
outlived all medical fashions and hypotheses, and we may 
with truth declare that in a great number of cases the intes- 
tinal canal is the field of battle upon which the issue of the 
most important diseases is determined.” 
Medicines of no other class are, or have been, so con- 
stantly used as cathartics, but fewer of the drastic variety 
are now prescribed than formerly. These evacuants, 
however, have not had an uninterrupted popularity from the 
beginning. Hippocrates inculcates caution in their use in 
fevers, and the methodic sect among the ancients discarded 
them. Galen, Celsus, and Sydenham, like the “ old man of 
Cos,” insisted on moderation, while Hoffman Avrote an essay 
“ on the propriety of rejecting them entirely from the materia 
medica.” Rush was a warm advocate for cathartics in yellow 
fever, while Hamilton magnified their therapeutic importance 
to the highest. 
At present, although not so freely used by the people as 
they were a decade ago, they are still popular, while, on the 
other hand, a prominent class of medicasters proscribe them 
altogether. Physicians hold very different opinions and 
practice about cathartics. Some, adhering to the ancient 
ideas of the virtue of drastics, give them with great 
while others confine their prescriptions to the mildest laxa- 
tives or the simplest enemata for general purposes. 
This abundant variety in the past and present status of 
cathartics carries as irresistibly to the conclusion, that they 
are not an essential element in the general management of 
disease; that something else is the primary agent, and they 
are but auxiliary. 
Emetics.—Another important class of remedies of long 
time renown is emetics. Stille says, “ Emetics, or medicines 
given to produce vomiting, are among the most anciently, 
the most universally, and the most constantly employed of 32 
all remedial agents.” “ At the commencement of every dis- 
ease, whether idiopathic or symptomatic, its material ele- 
ments are mobile, and may be readily dispersed by a prompt 
and energetic movement. Like the particles of a saline sub- 
stance in solution, if allowed to repose they speedily crys- 
tallize in a solid and permanent form, when a little agitation 
of the liquid would have effectually prevented the result.” 
Although a broader or more mischievous pathological and 
therapeutical error could scarcely be compassed in as many 
words as this last quotation, it must be accepted as a general 
exposition of the views of a large and learned proportion of 
the fraternity of medicine. 
Notwithstanding the hypothetical necessity for emesis in 
disease, the practical application of emetics has not been 
constant, but widely fluctuating, and just now has fallen into 
desuetude, except for special purposes. This is acknow- 
ledged by Stille, who says, in speaking of natural vomiting 
in the early stages of acute internal disease, that it has 
“always been regarded as one of the most important indica- 
tions for the guidance of the physician, and it cannot be 
doubted that the emetic treatment derived from it will again 
acquire the credit which it once of right possessed.” 
However this may be, the fact that their estimated value 
and practical use vacillated between wide extremes, and that 
they arc now but sparsely administered by physicians, is 
enough for our present lesson; and if to this we add that 
emetics like cathartics are utterly discarded by a large and 
influential class of medicasters, we cannot fail to see that at 
best, emetics, as remedial agents, can only be adjuvants to 
the more constant and more important power of nature and 
time. 
These two classes of medicaments, cathartics and emetics, 
have been selected as paradigms for all the classes 
materia medica, because they have had a more stneient stand- 33 
ing, and a greater range of application, and are still looked 
upon as of leading importance. If the argument in their 
cases has established the point aimed at, we can by a parity 
of reasoning reach the same conclusion, more readily, in 
regard to every other class of remedies extant. 
Bleeding.—Perhaps the first case of bleeding to cure dis- 
ease was the daughter of the Carian King Damoetas, bled by 
Podalirius more than a thousand years before the Christian 
era; certainly bleeding long antedated the time of Hippo- 
crates. Galen was an enormous bleeder. And since the 
first installation of bleeding it has never been abandoned by 
the profession, but various sects and medicasters have dis- 
carded it for a time. Yan Helmont and some of his succes- 
sors, on theoretical grounds about coction and crisis, utterly 
condemned it, and just now it has fallen into general disuse : 
by several classes of medicasters through mere opposition to 
scientific medicine; and by physicians themselves on theo- 
retical grounds of improved biological knowledge, or on 
theoretical grounds of a change in the type of disease. 
A quarter of a century ago a fluent author (Harrison) of 
a text- book on Therapeutics and Materia Medica wrote of 
bleeding: “ Experience has placed its brightest and most 
enduring signature on the great and varied beneficent 
results which arise from the use of sanguineous evacuations 
in morbid actions of a diversified character. Two of the 
most general and fatal generic divisions of disease are in an 
especial manner amenable to the curative power of this 
remedy. Fever and inflammation assume many forms, and 
in most of these forms bleeding, as a topical or general 
evacuant, is required.” That was the prevailing professional 
sentiment at that time, and the guiding rule of practice. 
Sick people in that day got well of both fevers and inflam- 
mations. Now-a-days no one bleeds for any form of fever, 
and inflammations are treated by all classes of medicasters 34 
without any kind of bleeding, and by most physicians with 
only limited topical bleeding, and many of them without 
even that, and yet now, as twenty-five years ago, patients 
recover from fever and inflammation, under all kinds of man- 
agement. No question can, consequently, remain that bleed- 
ing, general or partial, is not essential to the restoration of 
the victims of these two classes of disease. 
Most certainly, if, in all the revolving centuries through 
which the practice of bleeding has been fluctuating, its 
agency, or any degree of it, had been essential to the cure 
of disease of any character, it would have been recognized, 
and so remained. That pathological activity was arrested 
and the subject of it recovered his health whether bled or 
not, must be taken as conclusive testimony that something 
other than bleeding was the cause of recovery, and that 
bleeding, at best, could only have been opiferous. 
Mercury.—Mercury is another of those powerful agents 
which has had many and violent oscillations of reputation 
among persons who practise, as well as among those who 
consume remedies, for the relief of illness. 
Mercury was introduced into medicine about the close of 
the dark ages, and has maintained a position among the 
important remedies ever since. A third of a century ago it 
was exhibited in nearly all forms of disease by most physi- 
cians, and its virtues were lauded to the highest by many, 
as a very catholicon. 
Now among the most acute physicians its employment is 
limited to a few specific purposes, while many do not pre- 
scribe it at all, and for years several leading classes of med- 
icasters have pursued it with a hue-and-cry, until it is some- 
what under the ban of popular prejudice. All this leads to the 
inevitable conclusion, that whatever the real merits of 
mercury may be, there is another something that abatesVlis- 
eased conditions, whether mercury be among the medica- 
ments applied to, or not. 35 
In the whole armament of the physician, no other remedy 
has had so much reputation as either bleeding or mercury, 
and if the attempt has been successful to show, that neither 
of them is at best other than a hand-maiden to the restorative 
powers of nature and time, it must be received as tantamount 
to having established the same status for every article and 
appliance that medical men use for the reestablishment of 
the physiological state, when it has been lost from any cause. 
Mental Influences.—Mental conditions have a marked 
power over the recovery of persons from a pathological 
state. All teachers inculcate this idea, and yet there can be 
no shadow of doubt that the great body of practitioners 
overlook, or disregard, the importance that should be at- 
tached to it. No reference is here intended to the insane, 
neither to those who labor under hysteria or hypochandriasis, 
but to the ordinary patients that are encountered in general 
practice. 
Stahl was perhaps the originator of the idea of the con- 
trolling power of the mind over the functions of the body, 
but he saw as through a glass darkly; while we of to-day, 
who choose to avail ourselves of the knowledge within our 
reach, will find much of the obscurity of Stahl’s age vanished 
and out of our way. 
Presenting countless phases, and coming from unknown 
sources, the drift of a patient’s thoughts will frequently deter- 
mine whether he shall recover his health or succumb to the 
disease. A conviction of restoration, and faith in the means 
used to that end, will carry an ill man through what might, 
without these, prove his fatal sickness. No physician can 
be a successful or popular practitioner, no matter what 
science he may have compassed, or to what art he may have 
attained, if he lack the ability to inspire his patrons with 
faith in his therapeutic skill. Possessed of this, a man will 
outstrip those who are his peers in everything else, but lack 36 
this; nay more, an inferior man imbued with this attribute 
will have the rank, standing and success with the populace? 
of the most gifted and accomplished. 
Stille says, “ Sentiments of partiality or aversion, and 
indeed all preconceived ideas respecting the operation of 
medicines, in many instances, determine their effects. The 
cures of the charlatan, whether lie be an itinerant vender of 
panaceas, or a smug exhibitor of mesmeric jugglery, and those 
of the self-deluded enthusiast confident in an imaginary 
power, are often real, and at times so wonderful as to pass 
with the populace for miraculous. The same power, honestly 
employed, is the secret of success of many physicians, who, 
inferior, perhaps, to others in knowledge of disease and the 
use of medicines, are superior to them in their ability to 
control the will of the patient, and inspire unquestioning 
faith in the remedies which they employ. Philosophy is 
never so unfitly introduced as at the bedside of the sick. 
By a judicious use of the patient’s belief, not only may recog- 
nized medicines become the means of accomplishing purposes 
which they are physically incompetent to fulfil, but inert 
matter, imbued with faith, may produce important physical 
effects. Simple neutral substances, such as a few grains of 
salt, or bread pills, may induce vomiting or purging; some 
colored drops may assuage a violent nervous headache, 
excite diaphoresis, or promote sleep. In this connection, it 
is sufficient to refer to the salutary influence of cheerfulness 
and hope, and the depressing effects of a dull tone and des- 
pairing manner, not only on the comfort of the sick, and 
their progress toward health, but absolutely on the issue of 
their sickness.” 
Habershon gives this instance: “In a patient who had 
suffered from hemiplegia, and was in a nervous condition, 
but who could not be persuaded to discontinue medicine, two, 
tablespoonfuls of spring water were followed by violent 37 
purging, and when changed for a pill of bread the same 
effect was produced, and nothing could induce her to take 
another pill. She believed them to be powerfully aperient, 
and purging took place.” 
Plenty of such examples are to be found in the books, and 
the experience of every practitioner of a few year’s standing, 
who has kept his eyes open, will furnish him others. 
Every rational man knows, that so far as true homoeopathic 
remedies have any physical effect whatever, it is accomplished 
entirely through the mental force of the patient; yet many 
sick persons get well who take only real homoeopathic medi- 
cines, and this recovery must be ascribed to nature in some 
form—surely not to medicine. 
As a further general illustration of the idea presented, 
reference may be made to the oft-recited fact in military 
surgery, that after a decisive battle the wounded men of the 
victorious army will recover faster, and from more serious 
injuries, than those of the defeated army, although they be 
subjected to the same treatment, and have the same sanitary 
and hygienic surroundings. 
But enough, except that as a fitting close to this recital, 
allusion may be made to that poetical instance where Dr. 
Rush called back to fullest flame the flickering vital spark in 
a lady, who had been borne to the verge of life by typhus 
fever, to whose wandering senses he presented the talismanic 
shibboleth of “ hawk’s nest,” which called up such inspiring 
reminiscences, associated with an object in the past, which, 
through the years of their common youth, had had their 
untiring united adoration, as to initiate her return toward 
complete recuperation. 
Looking squarely at the position of mental processes as a 
modifying force in the progress of pathological activity; and 
remembering, that they are but rarely considered in the 
evidence upon which the profession rests for the status of 38 
any given medicine; we are fully justified in asserting, that 
science, philosophy and prudence alike dictate that the 
present reputation of drugs should be received Tby the stu- 
dent with many grains of allowance. 
The lesson we are taught by this division of our study, 
applicable to our present purpose, is to be found in the fact, 
that this mental force is one of the natural powers brought 
to bear for the relief of disease; and whatever value attaches 
to it in this behalf, must go to the credit of nature and time 
in any correct estimate of therapeutic factors. 
Uncertainty in Drugs.—It is not an easy problem to deter- 
mine the amount of adulterated and sophisticated medicines 
that are dispensed on physicians’ prescriptions. That many 
of the drugs are impure, and imperfect, and some of them 
inert, is conceded on all hands. The sources of the informa- 
tion on which this conclusion rests are abundant and con- 
stantly accumulating with the observant. It will answer all 
our ends, however, to refer only to the reports made to the 
American Medical Association. 
In 1848 the report says about $1,500,000 worth of drugs 
were imported, and more than one half of many of the most 
important chemical and medical preparations were worth- 
less, and often dangerous; and these facts were reiterated 
in 1849. About this time the United States Drug Inspection 
Law went into operation, and its first effect appears to have 
been to impede and lessen the importation of foreign sophis- 
ticated drugs, while it gave an impetus to domestic rascality 
of the same stamp, so that quinirn sulphas and morphia) 
sulphas, bearing the genuine labels of the most reliable man- 
ufacturing pharmaceutists, were found adulterated to the ex- 
tent of twenty-five to thirty per cent. This abasement was 
in no wise the act of the party whose label the medicine here, 
but was done by the dealers to whom the manufacturers sold 
in good faith. In 1850 the report assures us that while the 39 
foreign adulteration is now small, the domestic is still increas- 
ing. After this date there appears to have been a looseness 
or dishonesty in the. work of the inspection of imported drugs, 
or otherwise, an incompetency in the inspector; for in 1864 
we have the report of Dr. Squibb, that the drug inspection 
law has been a failure, and that worthless drugs are as com- 
mon now in the markets as they were before the enactment 
had an existence. 
Nostrums.—And there is still another and a broader field 
wherein to cultivate our doubts of, and lessen our faith in, 
the sanitary efficacy of our prescriptions, viz., the thousand 
and one proprietary medicines and quack nostrums which 
constitute the major part of the sales of medicines by retail 
druggists throughout the country, and after the use of which, 
we have ample testimony that the takers not only get well, 
but honestly believe their cure to be due to the use of the 
nostrums. 
Thus again we are admonished not to fall into the delu- 
sion, that, with our drugs of uncertain reputation and unde- 
termined strength, we cure the distempers of man, but let us 
reverently acknowledge the saving power of nature and time. 
Increased Life-time.—During the last fifty years a conceded 
increase in the length of human life has taken place in many 
of the larger cities and more densely populated districts of 
the civilized world. In no quarter is there an assumption 
that this percentage added to the general term of human 
existence is due to the more artificial management of disease; 
on the contrary, it is acknowledged by all competent parties 
that the causes of premature death arise from the neglect of 
the natural laws of health, and the increased longevity has 
its sole foundation in the better hygiene of the people, and 
the more thorough enforcement of sanitary regulations around 
them; thus demonstrating, that it is the prevention of disease, 
and not its cure, to which we are indebted for the lengthen- 
ing of the span of life. 40 
Hospital Testimony.—On the supposition that the more 
regularly the medicines prescribed were given, and the more 
carefully the attending physician’s instructions were carried 
out, the more certain and the more speedy would be the 
relief of the sick, we should expect that in the hospitals, 
where the medical officer is supreme, where the medicines 
can be kept pure, and the dietetic and general management 
made as artificial as may be esteemed best, there would be 
the maximum of recoveries, and the minimum of time wasted 
in sickness. There are no statistics accessible to the writer 
to elucidate this point except from Paris, and these show 
conclusively that the sickness-time and death-rate of the 
poor who are treated in their hovels, amongst filth, without 
adequate nourishment, and under many unfavorable hygienic 
surroundings, is less than amongst the inmates of the great 
Paris hospitals. The' same state of affairs is most likely 
true of every large hospital fully occupied, wherever situated, 
and is probably properly ascribed to the depressing influence 
upon vitality of large numbers of sick kept in close proximity 
for a great length of time. However this may be, and what- 
ever the true explanation, it is entirely safe for us to draw 
the conclusion that the most accomplished and autocratic art 
cannot afford to ignore nature and time in the cure of 
diseases. 
Historical Review.—The paramount importance of nature 
in the restoration from disease has been recognized by nearly 
all the leading minds in medicine since the earliest historical 
times; and there cannot be much doubt that it will continue 
more and more to claim the consideration of enlightened 
men, as candid observation and just induction add to our 
stock of positive knowledge. 
Before the time of Hippocrates medicine was too 
for us to learn anything of its positive tenets. But the 
Father of Medicine himself, in direct terms, instructs, us to 41 
wait upon nature for the cure of disease, while his doctrine 
of crisis was based upon the power of nature to work off her 
pathological ills, and his system of diet was an important 
part of his remedial agencies. 
The precepts of Hippocrates governed the medical world 
for ages after his demise, with here and there a member of 
the fraternity who denied his authority and discarded his 
teachings. Arcagathus, a learned and accomplished gentle- 
man, was banished from Rome because of the activity of his 
remedial agents, and his want of success in battling with 
disease; while Asclcpiades, a rude ignoramus, who gave little 
or no medicine, but watched and flattered his patients, trust- 
ing to nature to cure their maladies, had great success and 
attained to highest professional honors. 
Celsus followed the lead of Asclepiades, and adopted “the 
Hippocratean method of observing and watching over the 
operations of nature, and rather regulating than opposing 
themand, says the historian (Bostock): “We here see 
the germ of the doctrine of the vis medicatrix naturae, which 
has had so much influence over enlightened physicians of 
modern times, and which, although erroneous, has perhaps 
led to less hazardous practice than the hypotheses which 
have been substituted in its room.” 
Galen espoused the views and followed the practice of 
Hippocrates; and the Arabian physicians followed the Greeks 
and Latins, and especially Galen. Willis’s doctrine of 
fermentation belonged to the same category • and Sydenham 
“ in one important particular very nearly agreed with Hip- 
pocrates, that diseased action consists essentially in an effort 
of nature to remove some morbid or noxious cause, and the 
great object of the practitioner is to assist in bringing about 
the proper crisis.” 
Barelli’s motto was, “Attempt nothing without an urgent 
necessity,” while the archeus of Van Helmont, and the 42 
anima of Stahl, were fanciful names given to the vital force 
■which in their shadowy knowledge they conceived to be a 
distinct spirit in the human organization, that controlled all 
biological activity, normal and morbid. 
These names of leading men embrace representatives of 
every school, sect and division of medicine, from the time of 
“ The Old Man of Cos,” to that of the great Scotch genius 
who wrote the “ First Lines of the Practice of Physic.”' 
And now comes Cullen with his vis medicatrix natures, which 
has been the polar star guiding all true and rational thera- 
peutics from the time of its proclamation to this day. The 
principle so named by Cullen “ is not supposed to be any- 
thing superadded to the body, but one of the powers or pro- 
perties necessary to its constitution as a living system, and 
the existence of which is recognized by its effects.” “ The 
school of Cos, the Hippocratists, the Animists, the Vitalists, 
had already proclaimed this truth; but they had all supposed 
the existence of a principle distinct from the organs,” and 
this constitutes the difference between the present doctrine 
of the vis medicatrix natura and the idea of an interior gov- 
erning and preservative power, presented under multiplied 
names and phases, that runs through all medical history 
antedating the advent of Cullen. 
The antagonistic idea, that nature in disease is to be op- 
posed, her course arrested and her purpose thwarted, though 
frequently presented and sometimes taken quick root and 
had rapid growth, has never been enduring, but, on the con- 
trary, has soon faded, perished and been forgotten, except 
as a historical fact. Even the Brunonian theory, which 
was conceived in opposition to, and was cotemporary with, 
the doctrine of Cullen, and which was so attractive and allur- 
ing as to captivate many minds, and even control national 
schools, is gone, having maintained itself but for a day, as it 
were, and is now known only as an integer in that vast 43 
monument made up of scientific errors and professional 
follies. 
A principle that was recognized by, and controlled the 
practice of, the acutest and wisest among medical men 
from the beginning through all the revolving centuries to the 
present; that has withstood the assaults of all manner of 
opponents; that has outlived every hypothesis and theory 
but those now in vogue; and that has gleamed like an un- 
tarnished jewel through all the ignorance, superstition and 
debauchery of the professional world; surely such a princi- 
ple can have nothing less than truth for its foundation, is as 
certain of immortality as any conception of the human mind, 
and in its very nature must grow and expand as perfect 
knowledge more abounds, until it moulds, governs, and 
directs all prophylactic and therapeutic labor, even as the 
currents of the air mould, govern, and direct the clouds of 
the firmament. 
Conclusion. 
Let no one for a moment imagine that the views herein 
promulgated have a tendency to undervalue the importance 
of medicine in the management of disease, or detract one 
iota from the responsibility, the dignity, or the usefulness of 
the accomplished physician. 
Medicines have a positive power that can be, and should 
be, made available to assist nature in the removal of patho- 
logical stimulants, and in the arrest of pathological activity. 
No one doubts the power of anaesthetics to abolish sensi- 
bility; of opiates to allay pain; of aloes to evacuate the 
bowels; of veratrum to lessen the heart’s action; or of quinia 
to arrest malarial periodic disease. All these, and many 
more, are in constant demand for proper and prudent thera- 
peutic purposes; and that all of them, not nutrients, and 
forcible enough to make an impression, are pathological 44 
stimulants and of themselves an evil, militates nothing 
against their legitimate use, or their positive value. It only 
signalizes that a wise judgment, a sound discretion, and a 
just discrimination should dictate and control their prescrip- 
tion, to the end that one evil should be brought into requi- 
sition voluntarily, only when it will, with certainty, assist to 
abate a greater evil. It is the training, the skill, the acumen, 
that is necessary to the exercise of a sound discretion and 
a wise judgment in the selection and administration of medi- 
cines, that distinguishes the good physician from the pre- 
sumptuous pretender. One cannot attain to this accomplish- 
ment without a clear and intelligent insight into biology, both 
normal and abnormal. 
While the faith is that medicine is paramount, and the rule 
under it is to give active remedies continually, and the per- 
turbations which accompany their operation are deemed an 
essential and desirable service preliminary to improvement, 
almost any numbskull can claim to be a physician and have 
the claim allowed by the populate; because they cannot dis- 
criminate between the means and the result in his practice, 
and in that of the educated man of science. But when an 
appreciative conception of what nature is doing and can 
accomplish, must precede the determination of what aid can 
and should be rendered her, and how and when, the pre- 
tender must stand back abashed, while the man properly 
trained and with real knowledge will step forth in all the 
glory of a high priest of nature, offering acceptable service 
at her shrine; and all who witness his labor shall know that 
it is good, and say, well done. 45 
The prominent points presented in the foregoing disserta- 
tion may be enumerated as follqws :— 
1. All vitalized matter is the subject of a law of develop- 
ment peculiar to its class. 
2. Vital organizations are not active per se, but are en- 
dowed with a capability of activity under stimula- 
tion. 
3. Normal stimulants produce physiological activity or 
health; abnormal stimulants produce pathological 
activity or disease. 
4. Human maladies are always the result of abnormal 
stimulants acting on the histological elements of the 
body. 
5. Disease in any part continues as long as the pathologi- 
cal stimulant is operative; when this ceases, the 
part returns to its physiological state. 
6. To cure disease it is only necessary to remove the 
stimulant exciting it. 
7. This stimulant is rarely known, and still more rarely ' 
can it be removed. 
8. In most diseases we only recognize the grosser symp- 
toms, after the initial processes have completed their 
course. 
9. After the stage of recognition most diseases must pur- 
sue their course through a series of phenomena under 
an inexorable biological law. 
10. The duty of the physician is to watch nature and assist 
her as opportunity may offer. 
11. All perturbating medicines are themselves pathological 
stimulants, and should not be 
under a certainty of abating a greater evil. 
Summary. 46 
12. The present popular professional estimate of the medi- 
cal virtues of drugs rests, mainly., on the vicious 
logic of post hoc ergo propter hoc. 
13. That this estimate is erroneous, is proven by: 
a. Curable diseases are recovered from in the ab- 
sence of all kinds of drugs. 
b. Curable diseases are recovered from under the 
most diverse treatment. 
c. The adulteration of drugs makes their strength 
uncertain. 
d. The state of the patient’s mind makes the opera- 
tion of even pure drugs uncertain. 
14. A recognition of the doctrine of the vis medicatrix na- 
tures must underlie all rational therapeutics. 
15. The principle involved in this phrase has been recog- 
nized and deferred to, since the earliest historical 
era of medicine, and is likely to be immortal. 
16. It derogates nothing from the physician, or the agents 
he uses, that nature is predominant, and art opiferous.