Medical Essays, 1842-1882 Part 12

8. Whatever indulgence may be granted to those who have heretofore been the ignorant causes of so much misery, the time has come when the existence of a private pestilence in the sphere of a single physician should be looked upon, not as a misfortune, but a crime; and in the knowledge of such occurrences the duties of the pract.i.tioner to his profession should give way to his paramount obligations to society.

ADDITIONAL REFERENCES AND CASES.

Fifth Annual Report of the Registrar-General of England.

1843. Appendix. Letter from William Farr, Esq.--Several new series of cases are given in the Letter of Mr. Stows, contained in the Appendix to this Report. Mr. Stows suggests precautions similar to those I have laid down, and these precautions are strongly enforced by Mr. Farr, who is, therefore, obnoxious to the same criticisms as myself.

Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844.--Cases of puerperal fever seeming to originate in erysipelas.

Elkington, of Birmingham, in Provincial Med. Journal, cited in Am.

Journ. Med. Sc. for April, 1844.--Six cases in less than a fortnight, seeming to originate in a case of erysipelas.

West's Reports, in Brit. and For. Med. Review for October, 1845, and January, 1847.--Affection of the arm, resembling malignant pustule, after removing the placenta of a patient who died from puerperal fever.

Reference to cases at Wurzburg, as proving contagion, and to Keiller's cases in the Monthly Journal for February, 1846, as showing connection of puerperal fever and erysipelas.

Kneeland.--Contagiousness of Puerperal Fever. Am. Jour. Med. Se., January, 1846. Also, Connection between Puerperal Fever and Epidemic Erysipelas. Ibid., April, 1846.

Robert Storrs.--Contagious Effects of Puerperal Fever on the Male Subject; or on Persons not Child-bearing. (From Provincial Med. and Surg. Journal.) Am. Jour. Med. Sc., January, 184,6. Numerous cases. See also Dr. Reid's case in same Journal for April, 1846.

Routh's paper in Proc. of Royal Med. Chir. Soc., Am. Jour. Med. Sc., April, 1849, also in B. and F. Med. Chir. Review, April, 1850.

Hill, of Leuchars.--A Series of Cases ill.u.s.trating the Contagious Nature of Erysipelas and of Puerperal Fever, and their Intimate Pathological Connection. (From Monthly Journal of Med. Sc.) Am. Jour. Med. Se., July, 1850.

Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, from inoculation with different morbid secretions.) Am. Jour. Med. Se., October, 1850.

Arneth. Paper read before the National Academy of Medicine. Annales d'Hygiene, Tome LXV. 2e Partie. (Means of Disinfection proposed by M.

"Semmeliveis" (Semmelweiss.) Lotions of chloride of lime and use of nail-brush before admission to lying-in wards. Alleged sudden and great decrease of mortality from puerperal fever. Cause of disease attributed to inoculation with cadaveric matters.) See also Routh's paper, mentioned above.

Moir. Remarks at a meeting of the Edinburgh Medico-Chirurgical Society.

Refers to cases of Dr. Kellie, of Leith. Sixteen in succession, all fatal. Also to several instances of individual pupils having had a succession of cases in various quarters of the town, while others, practising as extensively in the same localities, had none. Also to several special cases not mentioned elsewhere. Am. Jour. Med. Se. for October, 1851. (From New Monthly Journal of Med. Science.)

Simpson.--Observations at a Meeting of the Edinburgh Obstetrical Society. (An "eminent gentleman," according to Dr. Meigs, whose "name is as well known in America as in (his) native land." Obstetrics.

Phil. 1852, pp. 368, 375.) The student is referred to this paper for a valuable resume of many of the facts, and the necessary inferences, relating to this subject. Also for another series of cases, Mr. Sidey's, five or six in rapid succession. Dr. Simpson attended the dissection of two of Dr. Sidey's cases, and freely handled the diseased parts. His next four child-bed patients were affected with puerperal fever, and it was the first time he had seen it in practice. As Dr. Simpson is a gentleman (Dr. Meigs, as above), and as "a gentleman's hands are clean"

(Dr. Meigs' Sixth Letter), it follows that a gentleman with clean hands may carry the disease. Am. Jour. Med. Sc., October, 1851.

Peddle.--The five or six cases of Dr. Sidey, followed by the four of Dr.

Simpson, did not end the series. A pract.i.tioner in Leith having examined in Dr. Simpson's house, a portion of the uterus obtained from one of the patients, had immediately afterwards three fatal cases of puerperal fever. Dr. Veddie referred to two distinct series of consecutive cases in his own practice. He had since taken precautions, and not met with any such cases. Am. Jour. Med. Sc., October, 1851.

Copland. Considers it proved that puerperal fever maybe propagated by the hands and the clothes, or either, of a third person, the bed-clothes or body-clothes of a patient. Mentions a new series of cases, one of which he saw, with the pract.i.tioner who had attended them. She was the sixth he had had within a few days. All died. Dr. Copland insisted that contagion had caused these cases; advised precautionary measures, and the pract.i.tioner had no other cases for a considerable time. Considers it criminal, after the evidence adduced,--which he could have quadrupled,--and the weight of authority brought forward, for a pract.i.tioner to be the medium of transmitting contagion and death to his patients. Dr. Copland lays down rules similar to those suggested by myself, and is therefore ent.i.tled to the same epithet for so doing.

Medical Dictionary, New York, 1852. Article, Puerperal States and Diseases.

If there is any appet.i.te for facts so craving as to be yet unappeased,--Lesotho, necdum satiata,--more can be obtained. Dr. Hodge remarks that "the frequency and importance of this singular circ.u.mstance (that the disease is occasionally more prevalent with one pract.i.tioner than another) has been exceedingly overrated." More than thirty strings of cases, more than two hundred and fifty sufferers from puerperal fever, more than one hundred and thirty deaths appear as the results of a sparing estimate of such among the facts I have gleaned as could be numerically valued. These facts const.i.tute, we may take it for granted, but a small fraction of those that have actually occurred. The number of them might be greater, but "'t is enough, 't will serve," in Mercutio's modest phrase, so far as frequency is concerned. For a just estimate of the importance of the singular circ.u.mstance, it might be proper to consult the languid survivors, the widowed husbands, and the motherless children, as well as "the unfortunate accoucheur."

CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE

An Address delivered before the Ma.s.sachusetts Medical Society, at the Annual Meeting, May 30, 1860.

"Facultate magis quam violentia."

HIPPOCRATES.

Our Annual Meeting never fails to teach us at least one lesson. The art whose province it is to heal and to save cannot protect its own ranks from the inroads of disease and the waste of the Destroyer.

Seventeen of our a.s.sociates have been taken from us since our last Anniversary. Most of them followed their calling in the villages or towns that lie among the hills or along the inland streams. Only those who have lived the kindly, mutually dependent life of the country, can tell how near the physician who is the main reliance in sickness of all the families throughout a thinly settled region comes to the hearts of the people among whom he labors, how they value him while living, how they cherish his memory when dead. For these friends of ours who have gone before, there is now no more toil; they start from their slumbers no more at the cry of pain; they sally forth no more into the storms; they ride no longer over the lonely roads that knew them so well; their wheels are rusting on their axles or rolling with other burdens; their watchful eyes are closed to all the sorrows they lived to soothe. Not one of these was famous in the great world; some were almost unknown beyond their own immediate circle. But they have left behind them that loving remembrance which is better than fame, and if their epitaphs are chiselled briefly in stone, they are written at full length on living tablets in a thousand homes to which they carried their ever-welcome aid and sympathy.

One whom we have lost, very widely known and honored, was a leading pract.i.tioner of this city. His image can hardly be dimmed in your recollection, as he stood before you only three years ago, filling the same place with which I am now honored. To speak of him at all worthily, would be to write the history of professional success, won without special aid at starting, by toil, patience, good sense, pure character, and pleasing manners; won in a straight uphill ascent, without one breathing-s.p.a.ce until he sat down, not to rest, but to die. If prayers could have s.h.i.+elded him from the stroke, if love could have drawn forth the weapon, and skill could have healed the wound, this pa.s.sing tribute might have been left to other lips and to another generation.

Let us hope that our dead have at last found that rest which neither summer nor winter, nor day nor night, had granted to their unending earthly labors! And let us remember that our duties to our brethren do not cease when they become unable to share our toils, or leave behind them in want and woe those whom their labor had supported. It is honorable to the Profession that it has organized an a.s.sociation a for the relief of its suffering members and their families; it owes this tribute to the ill-rewarded industry and sacrifices of its less fortunate brothers who wear out health and life in the service of humanity. I have great pleasure in referring to this excellent movement, which gives our liberal profession a chance to show its liberality, and serves to unite us all, the successful and those whom fortune has cast down, in the bonds of a true brotherhood.

A medical man, as he goes about his daily business after twenty years of practice, is apt to suppose that he treats his patients according to the teachings of his experience. No doubt this is true to some extent; to what extent depending much on the qualities of the individual. But it is easy to prove that the prescriptions of even wise physicians are very commonly founded on something quite different from experience.

Experience must be based on the permanent facts of nature. But a glance at the prevalent modes of treatment of any two successive generations will show that there is a changeable as well as a permanent element in the art of healing; not merely changeable as diseases vary, or as new remedies are introduced, but changeable by the going out of fas.h.i.+on of special remedies, by the decadence of a popular theory from which their fitness was deduced, or other cause not more significant. There is no reason to suppose that the present time is essentially different in this respect from any other. Much, therefore, which is now very commonly considered to be the result of experience, will be recognized in the next, or in some succeeding generation, as no such result at all, but as a foregone conclusion, based on some prevalent belief or fas.h.i.+on of the time.

There are, of course, in every calling, those who go about the work of the day before them, doing it according to the rules of their craft, and asking no questions of the past or of the future, or of the aim and end to which their special labor is contributing. These often consider and call themselves practical men. They pull the oars of society, and have no leisure to watch the currents running this or that way; let theorists and philosophers attend to them. In the mean time, however, these currents are carrying the practical men, too, and all their work may be thrown away, and worse than thrown away, if they do not take knowledge of them and get out of the wrong ones and into the right ones as soon as they may. Sir Edward Parry and his party were going straight towards the pole in one of their arctic expeditions, travelling at the rate of ten miles a day. But the ice over which they travelled was drifting straight towards the equator, at the rate of twelve miles a day, and yet no man among them would have known that he was travelling two miles a day backward unless he had lifted his eyes from the track in which he was plodding. It is not only going backward that the plain practical workman is liable to, if he will not look up and look around; he may go forward to ends he little dreams of. It is a simple business for a mason to build up a niche in a wall; but what if, a hundred years afterwards when the wall is torn down, the skeleton of a murdered man drop out of the niche? It was a plain practical piece of carpentry for a Jewish artisan to fit two pieces of timber together according to the legal pattern in the time of Pontius Pilate; he asked no questions, perhaps, but we know what burden the cross bore on the morrow! And so, with subtler tools than trowels or axes, the statesman who works in policy without principle, the theologian who works in forms without a soul, the physician who, calling himself a practical man, refuses to recognize the larger laws which govern his changing practice, may all find that they have been building truth into the wall, and hanging humanity upon the cross.

The truth is, that medicine, professedly founded on observation, is as sensitive to outside influences, political, religious, philosophical, imaginative, as is the barometer to the changes of atmospheric density.

Theoretically it ought to go on its own straightforward inductive path, without regard to changes of government or to fluctuations of public opinion. But look a moment while I clash a few facts together, and see if some sparks do not reveal by their light a closer relation between the Medical Sciences and the conditions of Society and the general thought of the time, than would at first be suspected.

Observe the coincidences between certain great political and intellectual periods and the appearance of ill.u.s.trious medical reformers and teachers. It was in the age of Pericles, of Socrates, of Plato, of Phidias, that Hippocrates gave to medical knowledge the form which it retained for twenty centuries. With the world-conquering Alexander, the world-embracing Aristotle, appropriating anatomy and physiology, among his manifold spoils of study, marched abreast of his royal pupil to wider conquests. Under the same Ptolemies who founded the Alexandrian Library and Museum, and ordered the Septuagint version of the Hebrew Scriptures, the infallible Herophilus ["Contradicere Herophilo in anatomicis, est contradicere evangelium," was a saying of Fallopius.]

made those six hundred dissections of which Tertullian accused him, and the sagacious Erasistratus introduced his mild antiphlogistic treatment in opposition to the polypharmacy and antidotal practice of his time.

It is significant that the large-minded Galen should have been the physician and friend of the imperial philosopher Marcus Aurelius. The Arabs gave laws in various branches of knowledge to those whom their arms had invaded, or the terror of their spreading dominion had reached, and the point from which they started was, as Humboldt acknowledges, "the study of medicine, by which they long ruled the Christian Schools,"

and to which they added the department of chemical pharmacy.

Look at Vesalius, the contemporary of Luther. Who can fail to see one common spirit in the radical ecclesiastic and the reforming court-physician? Both still to some extent under the dominion of the letter: Luther holding to the real presence; Vesalius actually causing to be drawn and engraved two muscles which he knew were not found in the human subject, because they had been described by Galen, from dissections of the lower animals. Both breaking through old traditions in the search of truth; one, knife in hand, at the risk of life and reputation, the other at the risk of fire and f.a.got, with that mightier weapon which all the devils could not silence, though they had been thicker than the tiles on the house-tops. How much the physician of the Catholic Charles V. had in common with the great religious destructive, may be guessed by the relish with which he tells the story how certain Pavian students exhumed the body of an "elegans scortum," or lovely dame of ill repute, the favorite of a monk of the order of St. Anthony, who does not seem to have resisted temptation so well as the founder of his order. We have always ranked the physician Rabelais among the early reformers, but I do not know that Vesalius has ever been thanked for his. .h.i.t at the morals of the religious orders, or for turning to the good of science what was intended for the "benefit of clergy."

Our unfortunate medical brother, Michael Servetus, the spiritual patient to whom the theological moxa was applied over the entire surface for the cure of his heresy, came very near antic.i.p.ating Harvey. The same quickened thought of the time which led him to dispute the dogma of the Church, opened his mind to the facts which contradicted the dogmas of the Faculty.

Harvey himself was but the posthumous child of the great Elizabethan period. Bacon was at once his teacher and his patient. The founder of the new inductive philosophy had only been dead two years when the treatise on the Circulation, the first-fruit of the Restoration of Science, was given to the world.

And is it to be looked at as a mere accidental coincidence, that while Napoleon was modernizing the political world, b.i.+.c.hat was revolutionizing the science of life and the art that is based upon it; that while the young general was scaling the Alps, the young surgeon was climbing the steeper summits of unexplored nature; that the same year read the announcement of those admirable "Researches on Life and Death," and the bulletins of the battle of Marengo?

If we come to our own country, who can fail to recognize that Benjamin Rush, the most conspicuous of American physicians, was the intellectual offspring of the movement which produced the Revolution? "The same hand," says one of his biographers, "which subscribed the declaration of the political independence of these States, accomplished their emanc.i.p.ation from medical systems formed in foreign countries, and wholly unsuitable to the state of diseases in America."

Following this general course of remark, I propose to indicate in a few words the direction of the main intellectual current of the time, and to point out more particularly some of the eddies which tend to keep the science and art of medicine from moving with it, or even to carry them backwards.

The two dominant words of our time are law and average, both pointing to the uniformity of the order of being in which we live. Statistics have tabulated everything,--population, growth, wealth, crime, disease. We have shaded maps showing the geographical distribution of larceny and suicide. a.n.a.lysis and cla.s.sification have been at work upon all tangible and visible objects. The Positive Philosophy of Comte has only given expression to the observing and computing mind of the nineteenth century.

In the mean time, the great stronghold of intellectual conservatism, traditional belief, has been a.s.sailed by facts which would have been indicted as blasphemy but a few generations ago. Those new tables of the law, placed in the hands of the geologist by the same living G.o.d who spoke from Sinai to the Israelites of old, have remodelled the beliefs of half the civilized world. The solemn scepticism of science has replaced the sneering doubts of witty philosophers. The more positive knowledge we gain, the more we incline to question all that has been received without absolute proof.

As a matter of course, this movement has its partial reactions. The province of faith is claimed as a port free of entry to unsupported individual convictions. The tendency to question is met by the una.n.a.lyzing instinct of reverence. The old church calls back its frightened truants. Some who have lost their hereditary religious belief find a resource in the revelations of Spiritualism. By a parallel movement, some of those who have become medical infidels pa.s.s over to the mystic band of believers in the fancied miracles of h.o.m.oeopathy.

Under these influences transmitted to, or at least shared by, the medical profession, the old question between "Nature," so called, and "Art," or professional tradition, has reappeared with new interest. I say the old question, for Hippocrates stated the case on the side of "Nature" more than two thousand years ago. Miss Florence Nightingale,--and if I name her next to the august Father of the Healing Art, its n.o.blest daughter well deserves that place of honor,--Miss Florence Nightingale begins her late volume with a paraphrase of his statement. But from a very early time to this there has always been a strong party against "Nature." Themison called the practice of Hippocrates "a meditation upon death." Dr. Rush says: "It is impossible to calculate the mischief which Hippocrates, has done, by first marking Nature with his name and afterwards letting her loose upon sick people.

Millions have perished by her hands in all ages and countries." Sir John Forbes, whose defence of "Nature" in disease you all know, and to the testimonial in whose honor four of your Presidents have contributed, has been recently greeted, on retiring from the profession, with a wish that his retirement had been twenty years sooner, and the opinion that no man had done so much to destroy the confidence of the public in the medical profession.

In this Society we have had the Hippocratic and the Themisonic side fairly represented. The treatise of one of your early Presidents on the Mercurial Treatment is familiar to my older listeners. Others who have held the same office have been noted for the boldness of their practice, and even for partiality to the use of complex medication.

On the side of "Nature" we have had, first of all, that remarkable discourse on Self-Limited Diseases, [On Self-Limited Diseases. A Discourse delivered before the Ma.s.sachusetts Medical Society, at their Annual Meeting, May 27, 1835. By Jacob Bigelow, M. D.] which has given the key-note to the prevailing medical tendency of this neighborhood, at least, for the quarter of a century since it was delivered. Nor have we forgotten the address delivered at Springfield twenty years later, [Search out the Secrets, of Nature. By Augustus A. Gould, M. D. Read at the Annual Meeting, June 27, 1855.] full of good sense and useful suggestions, to one of which suggestions we owe the learned, impartial, judicious, well-written Prize Essay of Dr. Worthington Hooker. [Rational Therapeutics. A Prize Essay. By Worthington Hooker, M. D., of New Haven.

Boston. 1857.] We should not omit from the list the important address of another of our colleagues, [On the Treatment of Compound and Complicated Fractures. By William J. Walker, M. D. Read at the Annual Meeting, May 29, 1845.] showing by numerous cases the power of Nature in healing compound fractures to be much greater than is frequently supposed,--affording, indeed, more striking ill.u.s.trations than can be obtained from the history of visceral disease, of the supreme wisdom, forethought, and adaptive dexterity of that divine Architect, as shown in repairing the shattered columns which support the living temple of the body.