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THE MODERN THEORY AND PRACTICE OF MEDICINE.
278 an increased quantity was administered, when speedily a So it is with the 11 turba ingens stultorum," through manifest advancement again took place, and this con-whose successful labours in the cause of scientific mystitinued for a certain period, until a larger dose was againification those things are subdivided, which, for their eludemanded, in order still further to influence the disorder.. cidation, require no subdivision whatsoever; by rules the This course was very well marked and positive, and this9 most systematic and methodical, that which ’was previit was which encouraged and induced me still further to) ously clear as the mid-day sun is proved to demonstration increase the dose of belladonna, until eventually the the most exact; what was erstwhile well known is again, tetanus was entirely subdued. It was remarkable thatt under the garb of novelty, recommended to our serious the spasms at first yielded to a moderate dose, but after- contemplation. Thus, again and again, is "the robe’of wards remained unimproving, until increasing doses off freize retriinmed with copper lace ;" again and again the medicine were required to advance beyond the point are facts already known, hacked and hewed into of amendment already obtained ; this, to all observing; every impossible form to suit the interest or idea of the the case, was very clear and certain, and served to’ medical theorist, while any open question of real practical prove the beneficial influence that the belladonna ex- tendency is slurred over with ajuggling dexterity, solely erted over it. Indeed, the good effects of this medicine! acquirable by frequency of imitation. were very palpable ; nothing else was administered save! The study of final causes is in itself one. of the most purgatives occasionally, which the obstinate state ofabstruse to which the mind can be directed. Fraught, bowels required to be of a drastic character. however, though it be, with difficulties, still by it alone The success of these cases would induce me to urge a can we ever hope to arrive at an accurate knowledge of trial of the belladonna in large doses, in a very analogous the relation and proportion between the contingent effect affection to tetanus, viz., hydrophobia. In this appalling and its antecedent cause. Nowhere in the realms of disorder death is materially hastened by the suffocation science is there a more humiliating proof of our deficit in produced from spasms affecting the muscles of the glottis this indispensable and immeasurably valuable study than and larynx, so that the effects of medicine have not suffi- is found by reflecting on our ignorance of the mode in cient time allowed to act generally upon the system or to which vital phenomena are regulated during health, and influence the complaint. It has most wisely been sug- the adumbration of our reasoning faculties when we have gested to obviate this by making an artificial opening attempted to bring them to bear on the cause of that into the trachea. After this operation I should entertain aberration from the normal integrity of function or strucgreater hopes that the spasms accompanying hydropho- ture which we term disease. bia could be at least more sensibly relieved by the bellaHow’? why ? and wherefore ? are words expressive (as donna, given in large doses, than by any other remedy. far as words will permit) of the objects of all inquiry. The Tetanus and hydrophobia, although arising from different march of intellect has enabled us to solve the difficulties causes, in their ultimate symptoms much resemble each implied in the use of these interrogations when proother, and in both disorders the true spinal system of pounded relative to other matters of less importance as nerves appears to be the part upon which their violence is regards the welfare of mankind. Medicine is the only most displayed, so that it might be expected that what- subject of universal utility the study of which is wrapt as ever means relieved the one would not be entirely yet in mystery and uncertainty. Uncertainty caused in no inconsiderable degree by the transmission and propa- unavailing in the other. gation of scholastic dogmas which we are always but too THE MODERN THEORY AND PRACTICE OF willing to receive on trust, and place implicit faith in .
-
MEDICINE.
By
CHARLES
MACKIN,
M.D.
PERHAPS there is no subject connected with the art oj which has afforded in all ages such a field oj research to the sagacity of observers, upon which sc many hypotheses have been formed by the, at all times, exuberant imaginative powers of medical zealots, and to which the luminous and resplendent discoveries of latter days have added so little that can conduce either to the relief of disease or the certainty of practice, as the still
healing
embryonic science-therapeutics. The dreamy theories which have bourgeoned forth from that period when medicine was first practised as an art up to the present time, in which it is degraded far beneath the level of an "occupation," afford to the inquirer strong and irrefragable proof that the natural bent of the mind is towards the ideal, fashioning and picturing to itself the mountain, which is non-apparent, according to the molecule that is under its immediate cognisance. It has not inelegantly been remarked by Garth, that" the search of the uncommon may be compared to a distant view which the fancy invests with sundry ideal creations, but the reality to a near approach which disappoints the seeker." Thus it is with medical theories, no firm basis existing on which wemay found a future ascent towards final causes. No one system can withstand the impartial test of experience, each succeeding one proving more worthless than its predecessor, the base metal of hypothesis sooner or later appearing through the flimsy tinsel coating of specious argument and non-legitimate induction, facts and phenomena being assumed to be under the dominion of laws which have their sole existence in the fertile imaginations of that numerous and not very select class who, at the instigation of the cacoethes scribendi, fling to the medical public the fervid effervesBut what, cence of overweening confident ignorance. will not young ambition ? The great master of sarcasm says (using a somewhat hacknied quotation), "
Commentators each dark passage shun, Holding their farthing candle ta the sun."
what we have heard often and variously repeated ("the smoke from many chimneys alike darkens the clearest and most imperfect vision"). " Hence (in the forcible language of Dr. Turton) error is continued without detection, and the avenues of information are choked up by a sluggish acquiescence in received opinions, without proof or inquiry after proof." But " the evidences of authority are not to be so much sought as the evidences of reason, because the authority of those who teach is many times prejudicial to those who learn, for they leave off to try anything by their own judgment, accounting that firm which they see to be so judged by him they approve of; wherefore let ipse dixit not be held unanswerable ;let no authority be brought for an argument;--let no opinion have a prerogative so fixed, so immutable, that it shall not be subject at all times and seasons to the examination of reason ;-we should weigh the opinions of others not in the scale of authority, but in the scale of
truth."—Harvey’s Preface.
The redundant overflowings of that spurious kind of professional inspiration which appears to result from the fact of there being such an uncultivated extent of the
wide field of medicine hitherto "untouched and uninto the possession of which, "as to an a empty space, wise man may come," occlusion of which (inspiration) the callow imaginations of the major part of the " great unfee’d," would be unable to bear with anything like moderate composure, find appropriate outlets in " systems," "elements," monographs," and patchwork compilations of all kinds (as Horace says, "’Tis sweet to take from larger hoards"), from the weighty octavo, blazoned forth through the medium oftheperiodicals of the day in the 11 stupendous" hyperbole of remunerated criticism, down to the duodecimal compendium of knavery, " more nauseous than coloquintida," the advertisement of which is thrust into our unwilling hand as we hurry pass the dwellings of those warts upon the face of hygeia (I mean the " consulting surgeons," "matriculated members," " pill and ointment professors," and the like vermin, by which " fayre England," the " paradise of quacks," is overrun). These last named gentry are the
passageable,"
279 modern
prototypes of that migratory tribe of mountebankt
that through the miraculous
infallibility of hydropathy (in
"doctors" of the last century of whom graphic portraitss his hands) four hundred persons have been cured without have been handed down to us by Addison and others,, a single failure! An assertion which (if true) certainly insketched in the " imperishable colours of nature." Wheni dicates no insignificant share of instinctive worldly sagawe are thus inundated with such an irresistible flood ojf city and low cunning, without the most infinitesimal to select and arrange from the of individual research and communication, to) discover the two grains of wheat amongst the bushel oif chaff, and to make them available when found, is a task,, the successful completion of which would imply a greaterr share of patience and untiring vigour of investigationI than is probably allotted to any single intellect, howeverr inherently powerful, or however completely trained byr self-education to habits of observation and reflection. Of the correctness of the foregoing remarks the subjectt of therapeia is a not uninteresting exemplification. Forr instance, we have diseases cured (say their respective and1
gratuitous information, great
mass
of professional candour ; for he must have sured indeed accurately his proper objects, as
portion
mea-
"Foxes weigh the geese they carry, And ere they venture in the stream, Know how to save themselves and them."
Priessnitz (we know) picks his patients," and, with commendable solicitude for the well-doing of hydropathy, will subject none to the talismanic operation save those likely to be benefited by, or whowill be able to bear with a moderate share of impunity, the rigid exactitude of his sanatorial regulations with regard to diet and
exercise, rejecting, with a natural discrimination, respectable upholders) by liomeeopathy, hydropathy,, sharpened by long practice, those suffering under any dipsopathy, chronothermalism, expectance, and revulsion,, decidedly pronounced disorder of doubtful origin or with a long list of others 11 t’would burst a man to name." termination. Hence, when we take into our consideraThose who put forth these systems (assailing our credulity tion the undoubted fact that the major proportion of from behind the parchment banners of "vendable" those from this country who place themselves under the diplomas) are all " honourable men." Shall we class inl guardianship of the despotic ruler of dyspeptic patients, enviable cofraternity with the above the crowning; are persons necessarily from amongst the more affluent marvel," the chiefest thing of all-hygeism1 (That this; classes of society,-overfed gouty citizens, winebibbing last named is most successful no one will be hardy enoughL aristocrats, anxious to renovate const.itutions shattered to doubt,-the disease not seldom being carried off, by dissipation,-dyspeptic and despairing virgins of post as the professors term it, like 11 magic," leaving not ameridian bloom, with a leaven of hysterical damsels, wreck behind, but bearing also the patient along with it, amongst whom faith (the sheet-anchor betwixt doctor and a corollary they generally keep in the back-ground.) I patient), in general works marvels, surprise will cease will not take on myself the invidious task of awarding the at any success which may attend the practice of hydropapalm of superiority to one over the other of these " excel- thy, backed as it is by those all-powerful auxiliaries, lent good plots," trumpeted, though they be, in the true temperance, early rising, free and judiciously regulated " Cambyses vein," each as the one thing needful," exercise, a system of dietetics virtually Abernethian merely making a few cursory remarks (occasionally) to (methodised, like a certain leetureu’s, by a domudic (’ollegiate show that they are (for the most part), as Dr. Johnson MrfaMgeMMM), and though last, certainly not least, the might say, "parturient mountains which bring forth mus- recuperative powers of the constitution, often previously cipular abortions;" that in nine times in ten the vis 2netii- labouring under physical debility, produced by drugs catrix is the doctor par excellence, but for whose interposi- "heroically" administered according to the rules of art. tion physic as well as physician would cut too often a The exquisite absurdity of " dipsopathy" requires neiindeed. ther note, comment, or observation. Having already very sorry figure Cases will (I am aware) get well under treatment extended the limits of this letter further than I intended according to all these modes, differing each from the (led on by the varied aspects in which the harlequinade other in the principles, details, and views, on which it of modern therapeutics has presented itself), I beg to contakes its unstable foundation, and each laden with infalli- clude my observations for the present. London, May, 1844. bility which its rivals do not possess. By one we are gravely told that opium acts as a purgative, the most successful in the cure of constipation ; by another, that there ON THE ADVANCEMENT OF MEDICAL is no such thing as the" bugbear, congestion;" that we KNOWLEDGE. must forego bleeding in pneumonia, peritonitis, pleuritis, &c. (contrary to the experience of ages) ; that in an attack By EDWARD BINNS, M.D., Hounslow. of cerebral apoplexy the proper remedy is in the application of cold water (somewhat like the clown attempting THE remarks which appeared in THE LANCET of April 17th to steer the tide with a pitchfork) ; a change comes over relative to the improvement of medical knowledge and the the spirit, the hallucination has altered its type, and the practice of the profession generally, are so much in acpure element it is then which does the trick; -(in Gil cordance with my feelings and the section of medical Blas is found the " budding germ" of hydropathy, in- friends to whom I have the honour to be known, thatI stancing the old proverb that" there is nothing new cannot forbear expressing myself very strongly on the under the sun.")-the universal cure being a deluge of occasion, and recording an opinion to the effect that the cold water on the devoted heads of those who, like medical profession are deeply indebted to THE LANCET Sadak’s despot, not infrequently find it the true water of for the manner in which it has defended their art from ’
’
,
,
’
oblivion. (By the way, the 11 waterward" conrse of the auriferous stream of public opinion shows that want of education and intuitive knowledge are indispensable to
the attacks of Drs. Mackin and Livesay. Dr. Mackin’s paper I have not seen, and therefore can offer no opinion upon its merits, but as Dr. Livesay’s is before me, I will venture to offer a few comments upon it. The doctor, it success.") In experienced hands the " crystal fluid" becomes seems, has had charge of large bodies of men, and therelike the magic drops in the farce of The Apothecary. The fore has had ample opportunities of essaying practice ; patient asks 11 whether they cure gunshot wounds?" the but it does not follow that he has made ! with the works of those modern physicians who, though apothecary answers, " everything ?" The learned in entomology frequently observe the not so celebrated as Broussais, Sydenham, Baillie, interesting spectacle of a filth-hatched grub, after having Cheyne, Gregory, &c., were, nevertheless, men little undergone the intermediate changes, emerge from its inferior in acquirements, and quite as successful in pracheretofore congenial lodgment, take wing and flutter for tice. Many of the ancients, Celsus in particular, with a time—a painted butterfly." Not less parallel and regard to the pulse, entertained notions which, for a sublime is the metemphsychosis of the needy and unscru- period, were lost to the professional men of England, pulous adventurer into a soi-disunt water 11 doctor," because the country was in a semi-barbarous state, but. basking in the all-invigorating rays of the lux ex fulgore which came again, in process of time, to be admitted by of public infatuation. It is with us, as amongst the what are termed modern practitioners, in consequence of Romans, " impudence is made a divinity, and temples their following out the same train of reasoning by which Celsus had arrived at his conclusions. Among those who) are built to her worship by folly." One of those brazen-frontletted gentleman has told us distinguished themselves was Dr. Thomas Young, who,
himself acquainted
-
MEDICINE.
By
CHARLES
MACKIN,
M.D.
PERHAPS there is no subject connected with the art oj which has afforded in all ages such a field oj research to the sagacity of observers, upon which sc many hypotheses have been formed by the, at all times, exuberant imaginative powers of medical zealots, and to which the luminous and resplendent discoveries of latter days have added so little that can conduce either to the relief of disease or the certainty of practice, as the still
healing
embryonic science-therapeutics. The dreamy theories which have bourgeoned forth from that period when medicine was first practised as an art up to the present time, in which it is degraded far beneath the level of an "occupation," afford to the inquirer strong and irrefragable proof that the natural bent of the mind is towards the ideal, fashioning and picturing to itself the mountain, which is non-apparent, according to the molecule that is under its immediate cognisance. It has not inelegantly been remarked by Garth, that" the search of the uncommon may be compared to a distant view which the fancy invests with sundry ideal creations, but the reality to a near approach which disappoints the seeker." Thus it is with medical theories, no firm basis existing on which wemay found a future ascent towards final causes. No one system can withstand the impartial test of experience, each succeeding one proving more worthless than its predecessor, the base metal of hypothesis sooner or later appearing through the flimsy tinsel coating of specious argument and non-legitimate induction, facts and phenomena being assumed to be under the dominion of laws which have their sole existence in the fertile imaginations of that numerous and not very select class who, at the instigation of the cacoethes scribendi, fling to the medical public the fervid effervesBut what, cence of overweening confident ignorance. will not young ambition ? The great master of sarcasm says (using a somewhat hacknied quotation), "
Commentators each dark passage shun, Holding their farthing candle ta the sun."
what we have heard often and variously repeated ("the smoke from many chimneys alike darkens the clearest and most imperfect vision"). " Hence (in the forcible language of Dr. Turton) error is continued without detection, and the avenues of information are choked up by a sluggish acquiescence in received opinions, without proof or inquiry after proof." But " the evidences of authority are not to be so much sought as the evidences of reason, because the authority of those who teach is many times prejudicial to those who learn, for they leave off to try anything by their own judgment, accounting that firm which they see to be so judged by him they approve of; wherefore let ipse dixit not be held unanswerable ;let no authority be brought for an argument;--let no opinion have a prerogative so fixed, so immutable, that it shall not be subject at all times and seasons to the examination of reason ;-we should weigh the opinions of others not in the scale of authority, but in the scale of
truth."—Harvey’s Preface.
The redundant overflowings of that spurious kind of professional inspiration which appears to result from the fact of there being such an uncultivated extent of the
wide field of medicine hitherto "untouched and uninto the possession of which, "as to an a empty space, wise man may come," occlusion of which (inspiration) the callow imaginations of the major part of the " great unfee’d," would be unable to bear with anything like moderate composure, find appropriate outlets in " systems," "elements," monographs," and patchwork compilations of all kinds (as Horace says, "’Tis sweet to take from larger hoards"), from the weighty octavo, blazoned forth through the medium oftheperiodicals of the day in the 11 stupendous" hyperbole of remunerated criticism, down to the duodecimal compendium of knavery, " more nauseous than coloquintida," the advertisement of which is thrust into our unwilling hand as we hurry pass the dwellings of those warts upon the face of hygeia (I mean the " consulting surgeons," "matriculated members," " pill and ointment professors," and the like vermin, by which " fayre England," the " paradise of quacks," is overrun). These last named gentry are the
passageable,"
279 modern
prototypes of that migratory tribe of mountebankt
that through the miraculous
infallibility of hydropathy (in
"doctors" of the last century of whom graphic portraitss his hands) four hundred persons have been cured without have been handed down to us by Addison and others,, a single failure! An assertion which (if true) certainly insketched in the " imperishable colours of nature." Wheni dicates no insignificant share of instinctive worldly sagawe are thus inundated with such an irresistible flood ojf city and low cunning, without the most infinitesimal to select and arrange from the of individual research and communication, to) discover the two grains of wheat amongst the bushel oif chaff, and to make them available when found, is a task,, the successful completion of which would imply a greaterr share of patience and untiring vigour of investigationI than is probably allotted to any single intellect, howeverr inherently powerful, or however completely trained byr self-education to habits of observation and reflection. Of the correctness of the foregoing remarks the subjectt of therapeia is a not uninteresting exemplification. Forr instance, we have diseases cured (say their respective and1
gratuitous information, great
mass
of professional candour ; for he must have sured indeed accurately his proper objects, as
portion
mea-
"Foxes weigh the geese they carry, And ere they venture in the stream, Know how to save themselves and them."
Priessnitz (we know) picks his patients," and, with commendable solicitude for the well-doing of hydropathy, will subject none to the talismanic operation save those likely to be benefited by, or whowill be able to bear with a moderate share of impunity, the rigid exactitude of his sanatorial regulations with regard to diet and
exercise, rejecting, with a natural discrimination, respectable upholders) by liomeeopathy, hydropathy,, sharpened by long practice, those suffering under any dipsopathy, chronothermalism, expectance, and revulsion,, decidedly pronounced disorder of doubtful origin or with a long list of others 11 t’would burst a man to name." termination. Hence, when we take into our consideraThose who put forth these systems (assailing our credulity tion the undoubted fact that the major proportion of from behind the parchment banners of "vendable" those from this country who place themselves under the diplomas) are all " honourable men." Shall we class inl guardianship of the despotic ruler of dyspeptic patients, enviable cofraternity with the above the crowning; are persons necessarily from amongst the more affluent marvel," the chiefest thing of all-hygeism1 (That this; classes of society,-overfed gouty citizens, winebibbing last named is most successful no one will be hardy enoughL aristocrats, anxious to renovate const.itutions shattered to doubt,-the disease not seldom being carried off, by dissipation,-dyspeptic and despairing virgins of post as the professors term it, like 11 magic," leaving not ameridian bloom, with a leaven of hysterical damsels, wreck behind, but bearing also the patient along with it, amongst whom faith (the sheet-anchor betwixt doctor and a corollary they generally keep in the back-ground.) I patient), in general works marvels, surprise will cease will not take on myself the invidious task of awarding the at any success which may attend the practice of hydropapalm of superiority to one over the other of these " excel- thy, backed as it is by those all-powerful auxiliaries, lent good plots," trumpeted, though they be, in the true temperance, early rising, free and judiciously regulated " Cambyses vein," each as the one thing needful," exercise, a system of dietetics virtually Abernethian merely making a few cursory remarks (occasionally) to (methodised, like a certain leetureu’s, by a domudic (’ollegiate show that they are (for the most part), as Dr. Johnson MrfaMgeMMM), and though last, certainly not least, the might say, "parturient mountains which bring forth mus- recuperative powers of the constitution, often previously cipular abortions;" that in nine times in ten the vis 2netii- labouring under physical debility, produced by drugs catrix is the doctor par excellence, but for whose interposi- "heroically" administered according to the rules of art. tion physic as well as physician would cut too often a The exquisite absurdity of " dipsopathy" requires neiindeed. ther note, comment, or observation. Having already very sorry figure Cases will (I am aware) get well under treatment extended the limits of this letter further than I intended according to all these modes, differing each from the (led on by the varied aspects in which the harlequinade other in the principles, details, and views, on which it of modern therapeutics has presented itself), I beg to contakes its unstable foundation, and each laden with infalli- clude my observations for the present. London, May, 1844. bility which its rivals do not possess. By one we are gravely told that opium acts as a purgative, the most successful in the cure of constipation ; by another, that there ON THE ADVANCEMENT OF MEDICAL is no such thing as the" bugbear, congestion;" that we KNOWLEDGE. must forego bleeding in pneumonia, peritonitis, pleuritis, &c. (contrary to the experience of ages) ; that in an attack By EDWARD BINNS, M.D., Hounslow. of cerebral apoplexy the proper remedy is in the application of cold water (somewhat like the clown attempting THE remarks which appeared in THE LANCET of April 17th to steer the tide with a pitchfork) ; a change comes over relative to the improvement of medical knowledge and the the spirit, the hallucination has altered its type, and the practice of the profession generally, are so much in acpure element it is then which does the trick; -(in Gil cordance with my feelings and the section of medical Blas is found the " budding germ" of hydropathy, in- friends to whom I have the honour to be known, thatI stancing the old proverb that" there is nothing new cannot forbear expressing myself very strongly on the under the sun.")-the universal cure being a deluge of occasion, and recording an opinion to the effect that the cold water on the devoted heads of those who, like medical profession are deeply indebted to THE LANCET Sadak’s despot, not infrequently find it the true water of for the manner in which it has defended their art from ’
’
,
,
’
oblivion. (By the way, the 11 waterward" conrse of the auriferous stream of public opinion shows that want of education and intuitive knowledge are indispensable to
the attacks of Drs. Mackin and Livesay. Dr. Mackin’s paper I have not seen, and therefore can offer no opinion upon its merits, but as Dr. Livesay’s is before me, I will venture to offer a few comments upon it. The doctor, it success.") In experienced hands the " crystal fluid" becomes seems, has had charge of large bodies of men, and therelike the magic drops in the farce of The Apothecary. The fore has had ample opportunities of essaying practice ; patient asks 11 whether they cure gunshot wounds?" the but it does not follow that he has made ! with the works of those modern physicians who, though apothecary answers, " everything ?" The learned in entomology frequently observe the not so celebrated as Broussais, Sydenham, Baillie, interesting spectacle of a filth-hatched grub, after having Cheyne, Gregory, &c., were, nevertheless, men little undergone the intermediate changes, emerge from its inferior in acquirements, and quite as successful in pracheretofore congenial lodgment, take wing and flutter for tice. Many of the ancients, Celsus in particular, with a time—a painted butterfly." Not less parallel and regard to the pulse, entertained notions which, for a sublime is the metemphsychosis of the needy and unscru- period, were lost to the professional men of England, pulous adventurer into a soi-disunt water 11 doctor," because the country was in a semi-barbarous state, but. basking in the all-invigorating rays of the lux ex fulgore which came again, in process of time, to be admitted by of public infatuation. It is with us, as amongst the what are termed modern practitioners, in consequence of Romans, " impudence is made a divinity, and temples their following out the same train of reasoning by which Celsus had arrived at his conclusions. Among those who) are built to her worship by folly." One of those brazen-frontletted gentleman has told us distinguished themselves was Dr. Thomas Young, who,
himself acquainted