Medical Fashions

THE excellent scholar, Camerarius, — not Joachim Camerarius, the botanist, who first clearly demonstrated the sexual system of plants, but John Camerarius of Dalberg, Bishop of Worms, who wrote the Life of Melanchthon and founded that famous academy the Rhenish Society of Heidelberg, a brotherhood of deep scholars who used to refresh themselves after laborious delving among Greek roots by shaking the tree of grosser joys until they “came down showerlike,” 1 — this Camerarius, in his Book of Emblems, relates how, once upon a time, an ass and a mule were called upon to carry their well-laden packs across the ford of a certain stream. The mule’s burthen was of salt, which, by chance getting wet, was melted, and the weight of the load thereby agreeably lessened. This fact coming to the ass’s ears, he straightway dipped his own load into the stream; but, unfortunately for asinine philosophy, his pack contained not salt, but wool, which instead of melting took up such a weight of water, and added so much to his burthen, that the poor ass’s back was broken straightway.

This parable expounds very precisely the whole philosophy of practical medicine. We give the bolus to B. which we have found to act well in A.’s case, and expect a similar result, although we do not know, and have no means of ascertaining, whether B.’s burthen be salt or wool, — whether there is any likelihood that what is good for A. will in its turn be good for B. In a word, the principles of the so-called science of medicine consist not only in a system of strictly empirical rules, but in a system of rules which, moreover, have only a tentative and probable generality, and which consequently must be put in operation from case to case empirically, as they were conceived.

It is to these facts, and to the circumstance that the practice of medicine is further confused by reason of its having to deal with the idiosyncrasies of men, which are unknown quantities and cannot be generalized, that we must turn when we seek the origin of the contradictions and the logical absurdities which have made every attempt to systematize physic an occasion for ridicule among the philosophers. When Ricardo and Malthus, assuming political economy to be a science, attempted to reduce its scanty and imperfectly determined facts into principles from which to deduce a system, the reductio ad absurdum into which they fell made them the laughing-stock of Europe. In face of the statistics proving that the average yield of wheat per acre in England had increased from ten to forty bushels in two generations, Ricardo, by his doctrine of rent, demonstrated beyond contravention that under cultivation land must continually grow poorer and poorer. The doctrine of population held by Malthus, by its elucidation of the immitigable evils consequent upon the inveterate propensity of our race to increase and multiply, logically removed murder from its unhonored conspicuousness as one of the highest of crimes, and placed it in a lofty niche in the temple of the beneficent virtues. And so, likewise, when we see the doctors of all ages squabbling about their systems and their practices, their fastings and their high diets, their phlebotomy and their tonic, their panaceas and their alexipharmics, their in-door regimen and their out-door regimen, their orthodox drugs and their heteroclitical drugs, their potions, pills, magistrals, mixtures, precepts, and palliatives, — as if mankind were a blank wall to be painted a certain color, a log to be hewn into a certain shape, a bottle to be filled with a certain measure, a lump of clay to be molded into a certain figure, instead of being, as it is, a mere aggregation, a society of individuals, each of whom measurably obeys his own individual law and develops largely his own personal idiosyncrasies; when we inquire a little into “ the old debate of medicine,” and discover how terribly all the professors therein halt between antagonistic opinions, how Herophilus wars with Erasistratus, how Alcmæon overthrows Asclepiades, how Hippocrates slaughters his predecessors and Galen slaughters Hippocrates, how Hoffmann and Stahl with scant ceremony dismiss Galen to “the demnition bowwows, " and Hahnemann and Priessnitz would dispatch all orthodoxy in search of the same unenviable bourne; when we discover, in fine, that medicine, as it is the most important art in the world to man, so also it is the most unstable, the most vacillating, the most unsatisfactory, and the worst founded of all arts, — when we awake to the consciousness of all these things, we are sorely tempted to confess that Rabelais was not even satirical and scarcely exaggerated when he parodied the logical method of “ the faculty,” and argued, in behalf of the blood of his beloved grape, that drunkenness is better for the body than physic, “ because there be more old drunkards than old physicians.”

The ancients had their musical medicine, as well as their unguents and baths, their purgings and fastings, their bloodletting, and their hellebore; the Middle Ages had their metaphysical medicine, as well as their mummies and their magnets, their amulets and their salves, their antimony and their mithridatics; while to-day, contemporary with orthodoxy and homœopathy and hydropathy, we have the medicine of clairvoyance, a spiritualistic medicine, and a newspaper medicine, all enacting miraculous cures, and all having followers most profitably numerous. We know more about anatomy than was known of old; we know more about pathology; and our materia medica ranges somewhat more rationally over a wider field than did that of the past generations. It must be admitted, however, that practice is as imperfect, diagnostic as bewildered, and pharmacy as absurd to-day as it was in the days of Dioscorides, or when the “ white witches ” of old England culled simples beneath a favoring moon. Disease is as rife now as it was then; treatment is of as little efficacy; and people take as many medicines, and are duped as grossly and as blindly in their mad pursuit of health, in the days of telegraphs, Pacific railroads, and universal suffrage, as in the days of Theophrastus and Galen, and of Aldrovandus and Gessner.

To do justice to the curiosities of medical literature would require the zeal of Peiresc, the industry of Burton, and the scope of Isaac Disraeli; the remarkable circumstance about this literature is that its authorities stand to-day almost precisely where they stood in the first ages of medicine, upon the very threshold of a science into which they cannot enter, but where each age fancies itself to have safely arrived. We change the venue, indeed, to borrow language from the courts, but the cause is still the same; no new testimony has been adduced, no new issue can be raised, and adverse judgment has long ago been rendered.

The ulmost possible action of medicine, it would seem, is to increase, diminish, or in some way modify the motions natural to the viscera with which it can be brought in contact, an effect which, as Montaigne has said, there are a thousand simples in every herb garden to produce; yet, what a weight of materials for fostering the diversity and adding to the confusion of prescriptions do the shelves of our apothecaries groan under! True, the superstition in regard to these things is not quite so apparent as it formerly was; drugs do not have to be gathered in certain stages of the moon and prescribed aspects of the stars, nor approached backwards with anointed bodies, nor plucked with prayer and incantation; we are not required to make use of profane oaths when we gather cumin seed, nor to draw a line about the black hellebore to insure its efficiency; nor are our pharmacopœias so full as those of the ancients were of heterogeneous and incompatible compounds, such as that Venetian mithridate which was made up of two hundred and fifty ingredients, ranging from aloes and red oak bark to the oil of live swallows and the moss from a human skull. But, that certain incongruities palpable to the eye have been expunged is no proof that the essential superstition which regulates the use of these substances has been dispensed with, in favor of a more rational theory of practice consonant with the demands of a more enlightened age. On the contrary, there is just as much pure and unadulterated sortilegy in physic, just as much wild conjecture and haphazard experiment with all the products of the vegetable and animal kingdoms, in insane pursuit of the impossible, as ever there was. There is more of it, probably, than ever before, proportioned to the greater activity of the human mind and the wider limits within which it has to play. There is no new herb or root nowadays fresh - brought to notice from California or Australia, but the faculty run just as mad about it as the populace run mad after the well-advertised new nostrum that takes their fancy in the papers. There is no new system or curative process set agog but the faculty hasten to bow before it as the great desideratum, “ long hoped for,” long expected. A while ago it was acupuncture, or medicated vapors, or iodine; today it is transfusion of blood, or hypodermic injection; to-morrow it will be something equally foolish and fully as ardently embraced. The case stands to-day precisely as it stood when Pliny wrote,2 and the shops, now as then, are full to overflowing of inexplicable compositions and mixtures, far-fetched, highpriced, promising much and accomplishing little. We have given up our faith in the herb balin, which was recommended by Xanthus as a specific to restore life to those slain by a dragon; but this is not because we have so much lost faith in the herbs, as in the dragons.

We do not mix quite so much morals with our medicine, nor take agate to make us witty and eloquent, laurel leaves for memory, bird’s brains to quicken our invention, lion’s marrow to give us strength, as Hercules is fabled to have done. But this is because we are grown more practical; because morals do not enter so deeply into the considerations of our daily life as of old; not because we are medically any wiser. The plain fact is, as it has been stated by Sir Benjamin Brodie,3 that “ there are epidemics of opinion as well as of disease, and they prevail at least as much among the well-educated as among the uneducated classes of society.” Man is just as foolish now as he ever was; the only difference between now and then is the different strain upon which his folly runs. What Homer and Plato said of the ancient Egyptians, the modern student of humanity is constrained to say of his contemporaries, that, blinded by the fear of death and the dread of pain, we make ourselves all doctors, and impatiently seek for and implicitly accept specifics and panaceas, because impatiently fancying ourselves to need them, Hence it is that medicine finds it not possible to shake off the trammels of metaphysical conceit, and walk alone in the paths of rational science. To-day, as of old, there is multa in pulsis superstitio ; to-day, as of old, we cannot bring ourselves not to believe, with Paracelsus and Van Helmont and the Rosierucians, that health is a specific force or vigor, controlled by the conditions of a certain archæus, or fixed principle; and if we can devise the drug or the treatment which will reach, touch, and properly regulate this principle, we shall be able to secure, clinch, and bind to our service the boon of boons forever. So it is that we are ever seeking for the universal remedy, the comprehensive method, the catholic system, and doctors and quacks alike are ever tempting us by holding up before our greedy, purblind eyes something that makes pretense to satisfy our desire. At one time it is hellebore, then it is laudanum Paracelsi, that is to save the nations; at one period it is mercury; at another, it is antimony, which, as Burton quaintly says, “ is like Scanderbeg’s sword, which is either good or bad, strong or weak, as the party that prescribes or useth it.” In the palmy days of Salerno, the archæus was thought to lie perdu in the juices of our common garden sage, so that it grew to be a proverb, “ Cur moriatur homo, eui salvia crescit in horto? ” John Wesley, who aspired to the cure of bodies as well as souls, and fancied himself — alas, it was only fancy! — as expert in the one office as he undoubtedly was in the other, put a very large trust in what a wicked propensity to alliteration has described as “sulphur and supplication;” while Priessnitz, in our own time, has seemed to find the unmitigated use of cold water a sufficient instrument by which to rescue man from the utmost extremity of any disease.

The faith with which man rushes to embrace all these new methods and cure himself by all these new cures, as soon as they are sprung upon him, is something wonderful, — something pitiful, indeed, and enough to justify the deepest wailings of Pascal and the loudest scorn of Juvenal. Doctor Paris relates that “ when the yellow fever raged in America, the practitioners trusted exclusively to the copious use of mercury; at first the plan was deemed so universally efficacious that in the enthusiasm of the moment it was triumphantly proclaimed that death never took place after the mercury had evinced its effect upon the system; all this was very true, but it furnished no proof of the efficacy of that metal, since the disease in its aggravated form was so rapid in its career that it swept away its victims long before the system could be brought under mercurial influence, while in its milder shape it passed off equally well without any assistance from art.” Who now depends upon mercury in the treatment of yellow fever? In the olden times the common plan for meeting the horrible emergency of hydrophobia was a rude sort of homæopathy, consisting in repeated duckings of the patient in sea-water, and the use of charms, amulets, prayer, etc. This treatment, indeed, did not cure, but it went quite as far towards being a specific as Spalding’s treatment went, in the end, although, in the first enthusiasm of its use, this was universally thought to have finally conquered that frightful disease, — if disease it be. Dr. Spalding, in 1819, published a pamphlet in which he attempted to show that a decoction of the dried plant of the common Virginia skull-cap4 was an infallible preventive against the attack of hydrophobia, as well as a cure for the disease after attack. He cited eight hundred and fifty cases of persons bitten, of whom only three were attacked, and these got well; and he likewise claimed to have used it with uniform success upon some eleven hundred animals. What has become of the skull-cap now? What has so speedily caused its specific functions towards that mysterious disease to become “inoperative, null, and void”? A few years ago a Dr. Fell discovered a certain and infallible treatment for cancer in the external and internal use of the Sanguinaria Canadensis, or bloodroot of our forests. He took his remedy to London with him, became rich and great, and was finally put in charge of the cancer-ward at Guy’s Hospital, where his system collapsed as suddenly as it had culminated. Not long since a famous doctor in New York introduced the treatment of lung diseases by caustic, and testified that he had performed the operation of passing the escharotic inside the glottis with a probang one hundred thousand times. He performed it once too often; in fact, his probang was said to have gone astray, he was indicted for manslaughter, and presto! there was another medical bubble pricked and burst. In the same manner, and about the same time, it was discovered that the compounds known as hypophosphites were specific for pulmonary affections; but consumption has survived even that enthusiasm, while the hypophosphites gather the dust of neglect upon apothecaries’ shelves.

What humorism, antipathies, signatures, and congenerous theories have been to the medical systems of the past,

solidism, allopathy, homœopathy, clairvoyance, etc., are to the medical systems of the present. And, in spite of all the progress and enlightenment so boisterously claimed for this age, I cannot see that its medical theories are better founded — if indeed so well founded, so far forth as they are theories — than those of Galen, Paracelsus, Van Helmont. Why should not dryness cause baldness, as well as disease of the scalp? Why may not mania and lunacy be attributed to vapors which mount from the stomach to the brain and “color the mind ” as the fumes of iodine color clear glass, as well as to any modern theory of excess or defect of function? If the blood be the fountain of disorder, why should not removing a part of it, that a new and purer fluid may take its place, be just as rational treatment as the present one restoring its normal condition by stimulants? Theoretically, solids have no greater claim upon our consideration than juices, stimulation than depletion, the tonic than the antiphlogistic treatment. Theoretically, one is quite as rational as the other; practically, we cannot say more than that experience seems to favor the modern method, as indeed it might be supposed to favor the system that yields scope to Nature to do her own work. Such a system, however, is not medicine, but common sense, — quite a different thing from medicine. Humorism, however good in theory, led to a reductio ad absurdum when it was attempted to reduce it to practice. But so did the antiphlogistic treatment, and so will the tonic treatment, in the end. There is hardly a surgeon of the present day who would venture to resort to trepanning in order to set the skull free from the fuliginous vapors that might be oppressing the brain, as certain disciples of Galen have done; but there are still living physicians who have sought to combat the inflammatory symptoms of consumption by reducing the blood antiphlogistically with repeated and powerful doses of calomel; and it is accepted practice to try to by feeding typhoid and bilious patients upon those benignant and genial remedies, brandy and quinine. To my notion, there is not much choice between these methods.

“ Stir a fever in the blood of age, And make the infant’s sinew strong as steel,'

There are some curious coincidences between the modern prepossession in favor of clairvoyance as a mode of medicine, and the ancient belief in the doctrine of " signatures.” “ Spirituales morbi spiritualiter curari debent,” said Paracelsus; and the principle is echoed by all the disciples of Mesmer, all the adherents of Swedenborg, and all the believers in spiritualism, od-force, magnetism, etc. That the remedy for a disease is written within the hyperæsthetic consciousness of the invalid himself, or some other nervous person, whence it is to be evoked by certain passes and gesticulations of the hands of a third and strong-minded party, is certainly not less absurd, and certainly not better founded, than that doctrine which assumed that “ every natural substance which possesses any medicinal virtue indicates by an obvious and well - marked external character the disease for which it is a remedy, or the object for which it should be employed.” 5 Thus, for instance, “Epar lupi epaticos curat; ” 6 thus the stone called chelidonius, said to be found in the belly of the swallow, cured lunatics, and made madmen “amiable and merry; ” the walnut, as its convolutions indicated, was suited to diseases of the brain; fox-lungs cured asthma; turmeric, because yellow, was effective against jaundice; agaric suited the kidneys; euphrasia, or eyebright, the eye; and cassia, the intestines. Thus also, because a wrong translation of Pliny made him say that goat’s blood had power to break the diamond, that albuminous substance was prescribed as a proper solvent for the stone;7 the leaves of spurge, according as they were plucked, were affirmed to purge upwards or downwards; and Paracelsus, like the homœopaths of the present day, tried to arrange a nomenclature for the herbs in his pharmacopœia, in which the name of each plant should express the disease for which it was a specific.

The conclusion towards which we are impelled by all these circumstances is that medicine, after having been in existence many thousands of years, has made but very little advancement; that it is not a science, nor is it likely to become one, at least until the human understanding has been purged of several of the errors which now, like bats, infest its secret, places. “ There is nothing in the whole workshop of nature,” it has been said, “ but conjectural medicine hath seized upon it; ” yet medicine abides conjectural still, and a thing “more labored than advanced.” We cannot even say that the cures it operates are its own work or the patient’s destiny; and, in the presence of serious disease, there is nothing so vain and so helpless as physic: —

“ Helleborum frustra cum jam cutis ægra tumebit
Poscentes videas.”

We see its career down the channel of the ages vexed by a constant ebb and flow of contrary opinions. We see its professors smitten with a constant tendency to rush into some blind enthusiasm, and take up some hour-long madness, in which they believe with all their souls while it is the fashion, and which they reject with fierce disgust after it has gone out of vogue; and we discover, in short, that there were no bigger fools in medicine formerly than there are at present. In this respect, indeed, the contemporaries of Velpeau and Holland, of Brodie and Nélaton, of Carnochan and Leidy, are not superior to the contemporaries of Dr. Slop. “ Life is short, cried my father, and the art of healing tedious! and who are we to thank for both the one and the other, but the ignorance of quacks themselves, and the stage-load of chemical nostrums and peripatetic lumber with which in all ages they have first flattered the world, and at last deceived it! ” 8

Philosophy has been called “ the medicine of the soul,” and we may style medicine the metaphysic of the body; and the comparison is as accurate in each case as the conclusion suggested is ominous. There is nothing more indeterminate, nothing more unsatisfactory, than philosophy, unless medicine be that thing. We cannot determine the principles of medicine upon such a basis of reason as will enable us to argue from them without falling into absurdity; nor can we sufficiently agree about, reconcile, and coördinate its facts to build upon them a rational theory. Thus medicine refuses both a priori and inductive treatment, and remains a barren wilderness haunted by strange sounds and echoing voices, predominated over by the strident yells of incessant controversy and strife. Meanwhile, those who fancy that, because a function is restored to action consecutively with the taking of a dose of physic, the restoration is due to the dose,— those, for instance, who believe that the exacerbation of a fever has yielded to calomel, or its cold stage been prevented by quinine, — I advise to read the well-known case cited by Dr. Paris, in his Life of Sir Humphry Davy. “ The enthusiastic Beddoes, having hypothetically inferred that the inhalation of the nitrous oxide might be a specific for palsy, a patient was selected for trial, and placed under the care of Davy, at the time assistant to Beddoes. Before administering the gas, Davy thought of ascertaining the temperature of the body by the thermometer placed under the tongue. The paralytic, deeply impressed by Dr. Beddoes with the certainty of the success of the remedy, of which he knew nothing, soon after the thermometer was placed in his mouth, believing that to be the great curative agent, declared that he felt somewhat better. Nothing more was therefore done, and he was requested to return on the following day. The same form was gone through, with the same results; and at the end of a fortnight the sick man was dismissed cured, no agent of any kind having been employed, except the thermometer.”9 Surely, if the bulb of a thermometer can cure palsy, a bread-pill can cure the fever and ague, and there is no need to buy quinine at half its weight in gold.

There are suggestions for serious thought in these considerations, and I am not prepared to say, in view of them, and in view of the impressible quality of man’s imagination, that Montaigne was so far wrong when he averred that experience had taught him to dread physic, because he saw no class of people so soon sick and so tardily well as that class which lived under its jurisdiction. It is a well-established fact that in 1832, when the cholera raged in this country, the doctors did a great deal to increase people’s liability to be seized by the disease, by the debilitating character of the regimen to which they insisted everybody should confine himself.

It is a nice question, in many cases, which has done the more hurt, the disease or the remedy; whether, for instance, the child’s health suffer more from the intestinal parasites which vex him, or from the destructive purgatives employed as anthelmintics; whether the cancer or the knife produces death more speedily; whether calomel and quinine be not pretty much such friends to the sick man as La Fontaine’s good-natured bear was to the gardener, whose mouth he crushed while trying to brush the flies off as he slept. It is an equally nice question to determine whether there ever really does occur a critical period in any disease, when the direct action of actual medicine, per se, can turn back the wavering life from the jaws of death to the flowery meads of reëstablished health; or, granting the possibility of such a rare occurrence, do we not run too great risk, as a rule, to be able to profit by it? These are nice questions, as I have called them, nor does the present condition of medicine entitle us to expect to see them answered. For these reasons, among many others, medicine cannot be called a science.

It must not be supposed, however, that the doctor’s office is to become a sinecure because his drugs are voted rubbish and his methods false. On the contrary, we shall need him quite as much, and his advice will be more vainable to us than ever. He will not have it in his power to do harm, and consequently can give his undivided energies to the pursuit of good. It shall be his office to teach us the fallacy of physic. He shall present to our minds in all its horrid array the atrocious enormity of medicine as once it was practiced, and so shall save many a poor sufferer amongst us from unconscious suicide. He shall be our perpetual beacon-light against the iron-bound, immitigable load-stone rock of quackery, where so many fair keels lie untimely wrecked. In fine, he shall become to us the counterpart of that invaluable member of another profession, known as the chamber - lawyer, a quiet man of skill and experience, who abounds with all the wisdom and unction of pertinent counsel, and who never takes his client into court, where he is bound to lose, no matter how his case is decided.

Edward Spencer.

  1. “ Nocturno nimirum tempore, defessi laboribus, ludere solebant, saltare, jocari cum mulierculis, epulari, ac more Germanorum inveterato strenue potare ” (Jugler, Historia Litteraria, quoted in Hallam’s Literary History, Part I., c. iii., note.)
  2. “ Fraudes hominum et ingeniorum capturæ, officinas in venire istas, in quibus sua cuique venalis promittitur vita ; statim compositiones et mixturæ inexplicabiles ex Arabia et India, ulteri parvo medicina a rubro mari importatur.” (Pliny, Natural History, xxiv.)
  3. Mind and Matter
  4. Scutellaria laterifolia.
  5. Paris, Pharmacologia.
  6. Galen.
  7. Sir Thomas Browne, Vulgar Errors.
  8. Sterne, Tristram Shandy.
  9. Dr. Dunglison’s New Remedies.