We must not forget the various medical libraries which preceded this: that of an earlier period, when Boston contained about seventy regular practitioners, the collection afterwards transferred to the Boston Athenaeum; the two collections belonging to the University; the Treadwell Library at the Massachusetts General Hospital; the collections of the two societies, that for Medical Improvement and that for Medical Observation; and more especially the ten thousand volumes relating to medicine belonging to our noble public city library,–too many blossoms on the tree of knowledge, perhaps, for the best fruit to ripen. But the Massachusetts Medical Society now numbers nearly four hundred members in the city of Boston. The time had arrived for a new and larger movement. There was needed a place to which every respectable member of the medical profession could obtain easy access; where, under one roof, all might find the special information they were seeking; where the latest medical intelligence should be spread out daily as the shipping news is posted on the bulletins of the exchange; where men engaged in a common pursuit could meet, surrounded by the mute oracles of science and art; where the whole atmosphere should be as full of professional knowledge as the apothecary’s shop is of the odor of his medicaments. This was what the old men longed for,–the prophets and kings of the profession, who
“Desired it long,
But died without the sight.”
This is what the young men and those who worked under their guidance undertook to give us. And now such a library, such a reading-room, such an exchange, such an intellectual and social meeting place, we be hold a fact, plain before us. The medical profession of our city, and, let us add, of all those neighboring places which it can reach with its iron arms, is united as never before by the commune vinculum, the common bond of a large, enduring, ennobling, unselfish interest. It breathes a new air of awakened intelligence. It marches abreast of the other learned professions, which have long had their extensive and valuable centralized libraries; abreast of them, but not promising to be content with that position. What glorifies a town like a cathedral? What dignifies a province like a university? What illuminates a country like its scholarship, and what is the nest that hatches scholars but a library?
The physician, some may say, is a practical man and has little use for all this book-learning. Every student has heard Sydenham’s reply to Sir Richard Blackmore’s question as to what books he should read, –meaning medical books. “Read Don Quixote,” was his famous answer. But Sydenham himself made medical books and may be presumed to have thought those at least worth reading. Descartes was asked where was his library, and in reply held up the dissected body of an animal. But Descartes made books, great books, and a great many of them. A physician of common sense without erudition is better than a learned one without common sense, but the thorough master of his profession must have learning added to his natural gifts.
It is not necessary to maintain the direct practical utility of all kinds of learning. Our shelves contain many books which only a certain class of medical scholars will be likely to consult. There is a dead medical literature, and there is a live one. The dead is not all ancient, the live is not all modern. There is none, modern or ancient, which, if it has no living value for the student, will not teach him something by its autopsy. But it is with the live literature of his profession that the medical practitioner is first of all concerned.
Now there has come a great change in our time over the form in which living thought presents itself. The first printed books,–the incunabula,–were inclosed in boards of solid oak, with brazen clasps and corners; the boards by and by were replaced by pasteboard covered with calf or sheepskin; then cloth came in and took the place of leather; then the pasteboard was covered with paper instead of cloth; and at this day the quarterly, the monthly, the weekly periodical in its flimsy unsupported dress of paper, and the daily journal, naked as it came from the womb of the press, hold the larger part of the fresh reading we live upon. We must have the latest thought in its latest expression; the page must be newly turned like the morning bannock; the pamphlet must be newly opened like the ante-prandial oyster.
Thus a library, to meet the need of our time, must take, and must spread out in a convenient form, a great array of periodicals. Our active practitioners read these by preference over almost everything else. Our specialists, more particularly, depend on the month’s product, on the yearly crop of new facts, new suggestions, new contrivances, as much as the farmer on the annual yield of his acres. One of the first wants, then, of the profession is supplied by our library in its great array of periodicals from many lands, in many languages. Such a number of medical periodicals no private library would have room for, no private person would pay for, or flood his tables with if they were sent him for nothing. These, I think, with the reports of medical societies and the papers contributed to them, will form the most attractive part of our accumulated medical treasures. They will be also one of our chief expenses, for these journals must be bound in volumes and they require a great amount of shelf-room; all this, in addition to the cost of subscription for those which are not furnished us gratuitously.
It is true that the value of old scientific periodicals is, other things being equal, in the inverse ratio of their age, for the obvious reason that what is most valuable in the earlier volumes of a series is drained off into the standard works with which the intelligent practitioner is supposed to be familiar. But no extended record of facts grows too old to be useful, provided only that we have a ready and sure way of getting at the particular fact or facts we are in search of.
And this leads me to speak of what I conceive to be one of the principal tasks to be performed by the present and the coming generation of scholars, not only in the medical, but in every department of knowledge. I mean the formation of indexes, and more especially of indexes to periodical literature.
This idea has long been working in the minds of scholars, and all who have had occasion to follow out any special subject. I have a right to speak of it, for I long ago attempted to supply the want of indexes in some small measure for my own need. I had a very complete set of the “American Journal of the Medical Sciences;” an entire set of the “North American Review,” and many volumes of the reprints of the three leading British quarterlies. Of what use were they to me without general indexes? I looked them all through carefully and made classified lists of all the articles I thought I should most care to read. But they soon outgrew my lists. The “North American Review” kept filling up shelf after shelf, rich in articles which I often wanted to consult, but what a labor to find them, until the index of Mr. Gushing, published a few months since, made the contents of these hundred and twenty volumes as easily accessible as the words in a dictionary! I had a, copy of good Dr. Abraham Rees’s Cyclopaedia, a treasure-house to my boyhood which has not lost its value for me in later years. But where to look for what I wanted? I wished to know, for instance, what Dr. Burney had to say about singing. Who would have looked for it under the Italian word cantare? I was curious to learn something of the etchings of Rembrandt, and where should I find it but under the head “Low Countries, Engravers of the,”–an elaborate and most valuable article of a hundred double-columned close-printed quarto pages, to which no reference, even, is made under the title Rembrandt.
There was nothing to be done, if I wanted to know where that which I specially cared for was to be found in my Rees’s Cyclopaedia, but to look over every page of its forty-one quarto volumes and make out a brief list of matters of interest which I could not find by their titles, and this I did, at no small expense of time and trouble.
Nothing, therefore, could be more pleasing to me than to see the attention which has been given of late years to the great work of indexing. It is a quarter of a century since Mr. Poole published his “Index to Periodical Literature,” which it is much to be hoped is soon to appear in a new edition, grown as it must be to formidable dimensions by the additions of so long a period. The “British and Foreign Medical Review,” edited by the late Sir John Forties, contributed to by Huxley, Carpenter, Laycock, and others of the most distinguished scientific men of Great Britain, has an index to its twenty-four volumes, and by its aid I find this valuable series as manageable as a lexicon. The last edition of the “Encyclopaedia Britannica” had a complete index in a separate volume, and the publishers of Appletons’ “American Cyclopaedia” have recently issued an index to their useful work, which must greatly add to its value. I have already referred to the index to the “North American Review,” which to an American, and especially to a New Englander, is the most interesting and most valuable addition of its kind to our literary apparatus since the publication of Mr. Allibone’s “Dictionary of Authors.” I might almost dare to parody Mr. Webster’s words in speaking of Hamilton, to describe what Mr. Gushing did for the solemn rows of back volumes of our honored old Review which had been long fossilizing on our shelves: “He touched the dead corpse of the ‘North American,’ and it sprang to its feet.” A library of the best thought of the best American scholars during the greater portion of the century was brought to light by the work of the indexmaker as truly as were the Assyrian tablets by the labors of Layard.
A great portion of the best writing and reading literary, scientific, professional, miscellaneous–comes to us now, at stated intervals, in paper covers. The writer appears, as it were, in his shirt-sleeves. As soon as he has delivered his message the book-binder puts a coat on his back, and he joins the forlorn brotherhood of “back volumes,” than which, so long as they are unindexed, nothing can be more exasperating. Who wants a lock without a key, a ship without a rudder, a binnacle without a compass, a check without a signature, a greenback without a goldback behind it?
I have referred chiefly to the medical journals, but I would include with these the reports of medical associations, and those separate publications which, coming in the form of pamphlets, heap themselves into chaotic piles and bundles which are worse than useless, taking up a great deal of room, and frightening everything away but mice and mousing antiquarians, or possibly at long intervals some terebrating specialist.
Arranged, bound, indexed, all these at once become accessible and valuable. I will take the first instance which happens to suggest itself. How many who know all about osteoblasts and the experiments of Ollier, and all that has grown out of them, know where to go for a paper by the late Dr. A. L. Peirson of Salem, published in the year 1840, under the modest title, Remarks on Fractures? And if any practitioner who has to deal with broken bones does not know that most excellent and practical essay, it is a great pity, for it answers very numerous questions which will be sure to suggest themselves to the surgeon and the patient as no one of the recent treatises, on my own shelves, at least, can do.
But if indexing is the special need of our time in medical literature, as in every department of knowledge, it must be remembered that it is not only an immense labor, but one that never ends. It requires, therefore, the cooperation of a large number of individuals to do the work, and a large amount of money to pay for making its results public through the press. When it is remembered that the catalogue of the library of the British Museum is contained in nearly three thousand large folios of manuscript, and not all its books are yet included, the task of indexing any considerable branch of science or literature looks as if it were well nigh impossible. But many hands make light work. An “Index Society” has been formed in England, already numbering about one hundred and seventy members. It aims at “supplying thorough indexes to valuable works and collections which have hitherto lacked them; at issuing indexes to the literature of special subjects; and at gathering materials for a general reference index.” This society has published a little treatise setting forth the history and the art of indexing, which I trust is in the hands of some of our members, if not upon our shelves.
Something has been done in the same direction by individuals in our own country, as we have already seen. The need of it in the department of medicine is beginning to be clearly felt. Our library has already an admirable catalogue with cross references, the work of a number of its younger members cooperating in the task. A very intelligent medical student, Mr. William D. Chapin, whose excellent project is indorsed by well-known New York physicians and professors, proposes to publish a yearly index to original communications in the medical journals of the United States, classified by authors and subjects. But it is from the National Medical Library at Washington that we have the best promise and the largest expectations. That great and growing collection of fifty thousand volumes is under the eye and hand of a librarian who knows books and how to manage them. For libraries are the standing armies of civilization, and an army is but a mob without a general who can organize and marshal it so as to make it effective. The “Specimen Fasciculus of a Catalogue of the National Medical Library,” prepared under the direction of Dr. Billings, the librarian, would have excited the admiration of Haller, the master scholar in medical science of the last century, or rather of the profession in all centuries, and if carried out as it is begun will be to the nineteenth all and more than all that the three Bibliothecae–Anatomica, Chirurgica, and Medicinae-Practicae–were to the eighteenth century. I cannot forget the story that Agassiz was so fond of telling of the king of Prussia and Fichte. It was after the humiliation and spoliation of the kingdom by Napoleon that the monarch asked the philosopher what could be done to regain the lost position of the nation. “Found a great university, Sire,” was the answer, and so it was that in the year 1810 the world-renowned University of Berlin came into being. I believe that we in this country can do better than found a national university, whose professors shall be nominated in caucuses, go in and out, perhaps, like postmasters, with every change of administration, and deal with science in the face of their constituency as the courtier did with time when his sovereign asked him what o’clock it was: “Whatever hour your majesty pleases.” But when we have a noble library like that at Washington, and a librarian of exceptional qualifications like the gentleman who now holds that office, I believe that a liberal appropriation by Congress to carry out a conscientious work for the advancement of sound knowledge and the bettering of human conditions, like this which Dr. Billings has so well begun, would redound greatly to the honor of the nation. It ought to be willing to be at some charge to make its treasures useful to its citizens, and, for its own sake, especially to that class which has charge of health, public and private. This country abounds in what are called “self-made men,” and is justly proud of many whom it thus designates. In one sense no man is self-made who breathes the air of a civilized community. In another sense every man who is anything other than a phonograph on legs is self-made. But if we award his just praise to the man who has attained any kind of excellence without having had the same advantages as others whom, nevertheless, he has equalled or surpassed, let us not be betrayed into undervaluing the mechanic’s careful training to his business, the thorough and laborious education of the scholar and the professional man.
Our American atmosphere is vocal with the flippant loquacity of half knowledge. We must accept whatever good can be got out of it, and keep it under as we do sorrel and mullein and witchgrass, by enriching the soil, and sowing good seed in plenty; by good teaching and good books, rather than by wasting our time in talking against it. Half knowledge dreads nothing but whole knowledge.
I have spoken of the importance and the predominance of periodical literature, and have attempted to do justice to its value. But the almost exclusive reading of it is not without its dangers. The journals contain much that is crude and unsound; the presumption; it might be maintained, is against their novelties, unless they come from observers of established credit. Yet I have known a practitioner,–perhaps more than one,–who was as much under the dominant influence of the last article he had read in his favorite medical journal as a milliner under the sway of the last fashion- plate. The difference between green and seasoned knowledge is very great, and such practitioners never hold long enough to any of their knowledge to have it get seasoned.
It is needless to say, then, that all the substantial and permanent literature of the profession should be represented upon our shelves. Much of it is there already, and as one private library after another falls into this by the natural law of gravitation, it will gradually acquire all that is most valuable almost without effort. A scholar should not be in a hurry to part with his books. They are probably more valuable to him than they can be to any other individual. What Swedenborg called “correspondence” has established itself between his intelligence and the volumes which wall him within their sacred inclosure. Napoleon said that his mind was as if furnished with drawers,–he drew out each as he wanted its contents, and closed it at will when done with them. The scholar’s mind, to use a similar comparison, is furnished with shelves, like his library. Each book knows its place in the brain as well as against the wall or in the alcove. His consciousness is doubled by the books which encircle him, as the trees that surround a lake repeat themselves in its unruffled waters. Men talk of the nerve that runs to the pocket, but one who loves his books, and has lived long with them, has a nervous filament which runs from his sensorium to every one of them. Or, if I may still let my fancy draw its pictures, a scholar’s library is to him what a temple is to the worshipper who frequents it. There is the altar sacred to his holiest experiences. There is the font where his new-born thought was baptized and first had a name in his consciousness. There is the monumental tablet of a dead belief, sacred still in the memory of what it was while yet alive. No visitor can read all this on the lettered backs of the books that have gathered around the scholar, but for him, from the Aldus on the lowest shelf to the Elzevir on the highest, every volume has a language which none but be can interpret. Be patient with the book- collector who loves his companions too well to let them go. Books are not buried with their owners, and the veriest book-miser that ever lived was probably doing far more for his successors than his more liberal neighbor who despised his learned or unlearned avarice. Let the fruit fall with the leaves still clinging round it. Who would have stripped Southey’s walls of the books that filled them, when, his mind no longer capable of taking in their meaning, he would still pat and fondle them with the vague loving sense of what they had once been to him,–to him, the great scholar, now like a little child among his playthings?
We need in this country not only the scholar, but the virtuoso, who hoards the treasures which he loves, it may be chiefly for their rarity and because others who know more than he does of their value set a high price upon them. As the wine of old vintages is gently decanted out of its cobwebbed bottles with their rotten corks into clean new receptacles, so the wealth of the New World is quietly emptying many of the libraries and galleries of the Old World into its newly formed collections and newly raised edifices. And this process must go on in an accelerating ratio. No Englishman will be offended if I say that before the New Zealander takes his stand on a broken arch of London Bridge to sketch the ruins of St. Paul’s in the midst of a vast solitude, the treasures of the British Museum will have found a new shelter in the halls of New York or Boston. No Catholic will think hardly of my saying that before the Coliseum falls, and with it the imperial city, whose doom prophecy has linked with that of the almost eternal amphitheatre, the marbles, the bronzes, the paintings, the manuscripts of the Vatican will have left the shores of the Tiber for those of the Potomac, the Hudson, the Mississippi, or the Sacramento. And what a delight in the pursuit of the rarities which the eager book-hunter follows with the scent of a beagle!
Shall I ever forget that rainy day in Lyons, that dingy bookshop, where I found the Aetius, long missing from my Artis bledicae Principes, and where I bought for a small pecuniary consideration, though it was marked rare, and was really tres rare, the Aphorisms of Hippocrates, edited by and with a preface from the hand of Francis Rabelais? And the vellum-bound Tulpius, which I came upon in Venice, afterwards my only reading when imprisoned in quarantine at Marseilles, so that the two hundred and twenty-eight cases he has recorded are, many of them, to this day still fresh in my memory. And the Schenckius,–the folio filled with casus rariores, which had strayed in among the rubbish of the bookstall on the boulevard,–and the noble old Vesalius with its grand frontispiece not unworthy of Titian, and the fine old Ambroise Pare, long waited for even in Paris and long ago, and the colossal Spigelius with his eviscerated beauties, and Dutch Bidloo with its miracles of fine engraving and bad dissection, and Italian Mascagni, the despair of all would-be imitators, and pre-Adamite John de Ketam, and antediluvian Berengarius Carpensis,–but why multiply names, every one of which brings back the accession of a book which was an event almost like the birth of an infant?
A library like ours must exercise the largest hospitality. A great many books may be found in every large collection which remind us of those apostolic looking old men who figure on the platform at our political and other assemblages. Some of them have spoken words of wisdom in their day, but they have ceased to be oracles; some of them never had any particularly important message for humanity, but they add dignity to the meeting by their presence; they look wise, whether they are so or not, and no one grudges them their places of honor. Venerable figure-heads, what would our platforms be without you?
Just so with our libraries. Without their rows of folios in creamy vellum, or showing their black backs with antique lettering of tarnished gold, our shelves would look as insufficient and unbalanced as a column without its base, as a statue without its pedestal. And do not think they are kept only to be spanked and dusted during that dreadful period when their owner is but too thankful to become an exile and a wanderer from the scene of single combats between dead authors and living housemaids. Men were not all cowards before Agamemnon or all fools before the days of Virchow and Billroth. And apart from any practical use to be derived from the older medical authors, is there not a true pleasure in reading the accounts of great discoverers in their own words? I do not pretend to hoist up the Bibliotheca Anatomica of Mangetus and spread it on my table every day. I do not get out my great Albinus before every lecture on the muscles, nor disturb the majestic repose of Vesalius every time I speak of the bones he has so admirably described and figured. But it does please me to read the first descriptions of parts to which the names of their discoverers or those who have first described them have become so joined that not even modern science can part them; to listen to the talk of my old volume as Willis describes his circle and Fallopius his aqueduct and Varolius his bridge and Eustachius his tube and Monro his foramen,–all so well known to us in the human body; it does please me to know the very words in which Winslow described the opening which bears his name, and Glisson his capsule and De Graaf his vesicle; I am not content until I know in what language Harvey announced his discovery of the circulation, and how Spigelius made the liver his perpetual memorial, and Malpighi found a monument more enduring than brass in the corpuscles of the spleen and the kidney.
But after all, the readers who care most for the early records of medical science and art are the specialists who are dividing up the practice of medicine and surgery as they were parcelled out, according to Herodotus, by the Egyptians. For them nothing is too old, nothing is too new, for to their books of ail others is applicable the saying of D’Alembert that the author kills himself in lengthening out what the reader kills himself in trying to shorten.
There are practical books among these ancient volumes which can never grow old. Would you know how to recognize “male hysteria” and to treat it, take down your Sydenham; would you read the experience of a physician who was himself the subject of asthma, and who, notwithstanding that, in the words of Dr. Johnson, “panted on till ninety,” you will find it in the venerable treatise of Sir John Floyer; would you listen to the story of the King’s Evil cured by the royal touch, as told by a famous chirurgeon who fully believed in it, go to Wiseman; would you get at first hand the description of the spinal disease which long bore his name, do not be startled if I tell you to go to Pott,–to Percival Pott, the great surgeon of the last century.
There comes a time for every book in a library when it is wanted by somebody. It is but a few weeks since one of the most celebrated physicians in the country wrote to me from a great centre of medical education to know if I had the works of Sanctorius, which he had tried in vain to find. I could have lent him the “Medicina Statica,” with its frontispiece showing Sanctorius with his dinner on the table before him, in his balanced chair which sunk with him below the level of his banquet-board when he had swallowed a certain number of ounces,–an early foreshadowing of Pettenkofer’s chamber and quantitative physiology,–but the “Opera Omnia” of Sanctorius I had never met with, and I fear he had to do without it.
I would extend the hospitality of these shelves to a class of works which we are in the habit of considering as being outside of the pale of medical science, properly so called, and sometimes of coupling with a disrespectful name. Such has always been my own practice. I have welcomed Culpeper and Salmon to my bookcase as willingly as Dioscorides or Quincy, or Paris or Wood and Bache. I have found a place for St. John Long, and read the story of his trial for manslaughter with as much interest as the laurel-water case in which John Hunter figured as a witness. I would give Samuel Hahnemann a place by the side of Samuel Thomson. Am I not afraid that some student of imaginative turn and not provided with the needful cerebral strainers without which all the refuse of gimcrack intelligences gets into the mental drains and chokes them up,–am I not afraid that some such student will get hold of the “Organon” or the “Maladies Chroniques” and be won over by their delusions, and so be lost to those that love him as a man of common sense and a brother in their high calling? Not in the least. If he showed any symptoms of infection I would for once have recourse to the principle of similia similibus. To cure him of Hahnemann I would prescribe my favorite homoeopathic antidote, Okie’s Bonninghausen. If that failed, I would order Grauvogl as a heroic remedy, and if he survived that uncured, I would give him my blessing, if I thought him honest, and bid him depart in peace. For me he is no longer an individual. He belongs to a class of minds which we are bound to be patient with if their Maker sees fit to indulge them with existence. We must accept the conjuring ultra-ritualist, the dreamy second adventist, the erratic spiritualist, the fantastic homoeopathist, as not unworthy of philosophic study; not more unworthy of it than the squarers of the circle and the inventors of perpetual motion, and the other whimsical visionaries to whom De Morgan has devoted his most instructive and entertaining “Budget of Paradoxes.” I hope, therefore, that our library will admit the works of the so-called Eclectics, of the Thomsonians, if any are in existence, of the Clairvoyants, if they have a literature, and especially of the Homoeopathists. This country seems to be the place for such a collection, which will by and by be curious and of more value than at present, for Homoeopathy seems to be following the pathological law of erysipelas, fading out where it originated as it spreads to new regions. At least I judge so by the following translated extract from a criticism of an American work in the “Homoeopatische Rundschau” of Leipzig for October, 1878, which I find in the “Homoeopathic Bulletin” for the month of November just passed: “While we feel proud of the spread and rise of Homoeopathy across the ocean, and while the Homoeopathic works reaching us from there, and published in a style such as is unknown in Germany, bear eloquent testimony to the eminent activity of our transatlantic colleagues, we are overcome by sorrowful regrets at the position Homoeopathy occupies in Germany. Such a work [as the American one referred to] with us would be impossible; it would lack the necessary support.”
By all means let our library secure a good representation of the literature of Homoeopathy before it leaves us its “sorrowful regrets” and migrates with its sugar of milk pellets, which have taken the place of the old pilulae micae panis, to Alaska, to “Nova Zembla, or the Lord knows where.”
What shall I say in this presence of the duties of a Librarian? Where have they ever been better performed than in our own public city library, where the late Mr. Jewett and the living Mr. Winsor have shown us what a librarian ought to be,–the organizing head, the vigilant guardian, the seeker’s index, the scholar’s counsellor? His work is not merely that of administration, manifold and laborious as its duties are. He must have a quick intelligence and a retentive memory. He is a public carrier of knowledge in its germs. His office is like that which naturalists attribute to the bumble-bee,– he lays up little honey for himself, but he conveys the fertilizing pollen from flower to flower.
Our undertaking, just completed,–and just begun–has come at the right time, not a day too soon. Our practitioners need a library like this, for with all their skill and devotion there is too little genuine erudition, such as a liberal profession ought to be able to claim for many of its members. In reading the recent obituary notices of the late Dr. Geddings of South Carolina, I recalled what our lamented friend Dr. Coale used to tell me of his learning and accomplishments, and I could not help reflecting how few such medical scholars we had to show in Boston or New England. We must clear up this unilluminated atmosphere, and here,–here is the true electric light which will irradiate its darkness.
The public will catch the rays reflected from the same source of light, and it needs instruction on the great subjects of health and disease,–needs it sadly. It is preyed upon by every kind of imposition almost without hindrance. Its ignorance and prejudices react upon the profession to the great injury of both. The jealous feeling, for instance, with regard to such provisions for the study of anatomy as are sanctioned by the laws in this State and carried out with strict regard to those laws, threatens the welfare, if not the existence of institutions for medical instruction wherever it is not held in check by enlightened intelligence. And on the other hand the profession has just been startled by a verdict against a physician, ruinous in its amount,–enough to drive many a hard- working young practitioner out of house and home,–a verdict which leads to the fear that suits for malpractice may take the place of the panel game and child-stealing as a means of extorting money. If the profession in this State, which claims a high standard of civilization, is to be crushed and ground beneath the upper millstone of the dearth of educational advantages and the lower millstone of ruinous penalties for what the ignorant ignorantly shall decide to be ignorance, all I can say is
God save the Commonhealth of Massachusetts!
Once more, we cannot fail to see that just as astrology has given place to astronomy, so theology, the science of Him whom by searching no man can find out, is fast being replaced by what we may not improperly call theonomy, or the science of the laws according to which the Creator acts. And since these laws find their fullest manifestations for us, at least, in rational human natures, the study of anthropology is largely replacing that of scholastic divinity. We must contemplate our Maker indirectly in human attributes as we talk of Him in human parts of speech. And this gives a sacredness to the study of man in his physical, mental, moral, social, and religious nature which elevates the faithful students of anthropology to the dignity of a priesthood, and sheds a holy light on the recorded results of their labors, brought together as they are in such a collection as this which is now spread out before us.
Thus, then, our library is a temple as truly as the dome-crowned cathedral hallowed by the breath of prayer and praise, where the dead repose and the living worship. May it, with all its treasures, be consecrated like that to the glory of God, through the contributions it shall make to the advancement of sound knowledge, to the relief of human suffering, to the promotion of harmonious relations between the members of the two noble professions which deal with the diseases of the soul and with those of the body, and to the common cause in which all good men are working, the furtherance of the well-being of their fellow-creatures!
NOTE.–As an illustration of the statement in the last paragraph but one, I take the following notice from the “Boston Daily Advertiser,” of December 4th, the day after the delivery of the address: “Prince Lucien Bonaparte is now living in London, and is devoting himself to the work of collecting the creeds of all religions and sects, with a view to their classification,–his object being simply scientific or anthropological.”
Since delivering the address, also, I find a leading article in the “Cincinnati Lancet and Clinic” of November 30th, headed “The Decadence of Homoeopathy,” abundantly illustrated by extracts from the “Homoeopathic Times,” the leading American organ of that sect.
In the New York “Medical Record” of the same date, which I had not seen before the delivery of my address, is an account of the action of the Homoeopathic Medical Society of Northern New York, in which Hahnemann’s theory of “dynamization” is characterized in a formal resolve as “unworthy the confidence of the Homoeopathic profession.”
It will be a disappointment to the German Homoeopathists to read in the “Homoeopathic Times” such a statement as the following: “Whatever the influences have been which have checked the outward development of Homoeopathy, it is plainly evident that the Homoeopathic school, as regards the number of its openly avowed representatives, has attained its majority, and has begun to decline both in this country and in England.”
All which is an additional reason for making a collection of the incredibly curious literature of Homoeopathy before that pseudological inanity has faded out like so many other delusions.
SOME OF MY EARLY TEACHERS
[A Farewell Address to the Medical School of Harvard University, November 28, 1882.]
I had intended that the recitation of Friday last should be followed by a few parting words to my class and any friends who might happen to be in the lecture-room. But I learned on the preceding evening that there was an expectation, a desire, that my farewell should take a somewhat different form; and not to disappoint the wishes of those whom I was anxious to gratify, I made up my mind to appear before you with such hasty preparation as the scanty time admitted.
There are three occasions upon which a human being has a right to consider himself as a centre of interest to those about him: when he is christened, when he is married, and when he is buried. Every one is the chief personage, the hero, of his own baptism, his own wedding, and his own funeral.
There are other occasions, less momentous, in which one may make more of himself than under ordinary circumstances he would think it proper to do; when he may talk about himself, and tell his own experiences, in fact, indulge in a more or less egotistic monologue without fear or reproach.
I think I may claim that this is one of those occasions. I have delivered my last anatomical lecture and heard my class recite for the last time. They wish to hear from me again in a less scholastic mood than that in which they have known me. Will you not indulge me in telling you something of my own story?
This is the thirty-sixth Course of Lectures in which I have taken my place and performed my duties as Professor of Anatomy. For more than half of my term of office I gave instruction in Physiology, after the fashion of my predecessors and in the manner then generally prevalent in our schools, where the physiological laboratory was not a necessary part of the apparatus of instruction. It was with my hearty approval that the teaching of Physiology was constituted a separate department and made an independent Professorship. Before my time, Dr. Warren had taught Anatomy, Physiology, and Surgery in the same course of Lectures, lasting only three or four months. As the boundaries of science are enlarged, new divisions and subdivisions of its territories become necessary. In the place of six Professors in 1847, when I first became a member of the Faculty, I count twelve upon the Catalogue before me, and I find the whole number engaged in the work of instruction in the Medical School amounts to no less than fifty.
Since I began teaching in this school, the aspect of many branches of science has undergone a very remarkable transformation. Chemistry and Physiology are no longer what they were, as taught by the instructors of that time. We are looking forward to the synthesis of new organic compounds; our artificial madder is already in the market, and the indigo-raisers are now fearing that their crop will be supplanted by the manufactured article. In the living body we talk of fuel supplied and work done, in movement, in heat, just as if we were dealing with a machine of our own contrivance.
A physiological laboratory of to-day is equipped with instruments of research of such ingenious contrivance, such elaborate construction, that one might suppose himself in a workshop where some exquisite fabric was to be wrought, such as Queens love to wear, and Kings do not always love to pay for. They are, indeed, weaving a charmed web, for these are the looms from which comes the knowledge that clothes the nakedness of the intellect. Here are the mills that grind food for its hunger, and “is not the life more than meat, and the body than raiment?”
But while many of the sciences have so changed that the teachers of the past would hardly know them, it has not been so with the branch I teach, or, rather, with that division of it which is chiefly taught in this amphitheatre. General anatomy, or histology, on the other hand, is almost all new; it has grown up, mainly, since I began my medical studies. I never saw a compound microscope during my years of study in Paris. Individuals had begun to use the instrument, but I never heard it alluded to by either Professors or students. In descriptive anatomy I have found little to unlearn, and not a great deal that was both new and important to learn. Trifling additions are made from year to year, not to be despised and not to be overvalued. Some of the older anatomical works are still admirable, some of the newer ones very much the contrary. I have had recent anatomical plates brought me for inspection, and I have actually button-holed the book-agent, a being commonly as hard to get rid of as the tar-baby in the negro legend, that I might put him to shame with the imperial illustrations of the bones and muscles in the great folio of Albinus, published in 1747, and the unapproached figures of the lymphatic system of Mascagni, now within a very few years of a century old, and still copied, or, rather, pretended to be copied, in the most recent works on anatomy.
I am afraid that it is a good plan to get rid of old Professors, and I am thankful to hear that there is a movement for making provision for those who are left in need when they lose their offices and their salaries. I remember one of our ancient Cambridge Doctors once asked me to get into his rickety chaise, and said to me, half humorously, half sadly, that he was like an old horse,–they had taken off his saddle and turned him out to pasture. I fear the grass was pretty short where that old servant of the public found himself grazing. If I myself needed an apology for holding my office so long, I should find it in the fact that human anatomy is much the same study that it was in the days of Vesalius and Fallopius, and that the greater part of my teaching was of such a nature that it could never become antiquated.
Let me begin with my first experience as a medical student. I had come from the lessons of Judge Story and Mr. Ashmun in the Law School at Cambridge. I had been busy, more or less, with the pages of Blackstone and Chitty, and other text-books of the first year of legal study. More or less, I say, but I am afraid it was less rather than more. For during that year I first tasted the intoxicating pleasure of authorship. A college periodical, conducted by friends of mine, still undergraduates, tempted me into print, and there is no form of lead-poisoning which more rapidly and thoroughly pervades the blood and bones and marrow than that which reaches the young author through mental contact with type-metal. Qui a bu, boira,–he who has once been a drinker will drink again, says the French proverb. So the man or woman who has tasted type is sure to return to his old indulgence sooner or later. In that fatal year I had my first attack of authors’ lead-poisoning, and I have never got quite rid of it from that day to this. But for that I might have applied myself more diligently to my legal studies, and carried a green bag in place of a stethoscope and a thermometer up to the present day.
What determined me to give up Law and apply myself to Medicine I can hardly say, but I had from the first looked upon that year’s study as an experiment. At any rate, I made the change, and soon found myself introduced to new scenes and new companionships.
I can scarcely credit my memory when I recall the first impressions produced upon me by sights afterwards become so familiar that they could no more disturb a pulse-beat than the commonest of every-day experiences. The skeleton, hung aloft like a gibbeted criminal, looked grimly at me as I entered the room devoted to the students of the school I had joined, just as the fleshless figure of Time, with the hour-glass and scythe, used to glare upon me in my childhood from the “New England Primer.” The white faces in the beds at the Hospital found their reflection in my own cheeks, which lost their color as I looked upon them. All this had to pass away in a little time; I had chosen my profession, and must meet its painful and repulsive aspects until they lost their power over my sensibilities.
The private medical school which I had joined was one established by Dr. James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow Lewis, and Dr. George W. Otis. Of the first three gentlemen I have either spoken elsewhere or may find occasion to speak hereafter. The two younger members of this association of teachers were both graduates of our University, one of the year 1819, the other of 1818.
Dr. Lewis was a great favorite with students. He was a man of very lively temperament, fond of old books and young people, open-hearted, free-spoken, an enthusiast in teaching, and especially at home in that apartment of the temple of science where nature is seen in undress, the anthropotomic laboratory, known to common speech as the dissecting-room. He had that quality which is the special gift of the man born for a teacher,–the power of exciting an interest in that which he taught. While he was present the apartment I speak of was the sunniest of studios in spite of its mortuary spectacles. Of the students I met there I best remember James Jackson, Junior, full of zeal and playful as a boy, a young man whose early death was a calamity to the profession of which he promised to be a chief ornament; the late Reverend J. S. C. Greene, who, as the prefix to his name signifies, afterwards changed his profession, but one of whose dissections I remember looking upon with admiration; and my friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is entitled to be called, then, as now and always, a favorite with all about him. He had come to us from the schools of Germany, and brought with him recollections of the teachings of Blumenbach and the elder Langenbeck, father of him whose portrait hangs in our Museum. Dr. Lewis was our companion as well as our teacher. A good demonstrator is,–I will not say as important as a good Professor in the teaching of Anatomy, because I am not sure that he is not more important. He comes into direct personal relations with the students,–he is one of them, in fact, as the Professor cannot be from the nature of his duties. The Professor’s chair is an insulating stool, so to speak; his age, his knowledge, real or supposed, his official station, are like the glass legs which support the electrician’s piece of furniture, and cut it off from the common currents of the floor upon which it stands. Dr. Lewis enjoyed teaching and made his students enjoy being taught. He delighted in those anatomical conundrums to answer which keeps the student’s eyes open and his wits awake. He was happy as he dexterously performed the tour de maitre of the old barber-surgeons, or applied the spica bandage and taught his scholars to do it, so neatly and symmetrically that the aesthetic missionary from the older centre of civilization would bend over it in blissful contemplation, as if it were a sunflower. Dr. Lewis had many other tastes, and was a favorite, not only with students, but in a wide circle, professional, antiquarian, masonic, and social.
Dr. Otis was less widely known, but was a fluent and agreeable lecturer, and esteemed as a good surgeon.
I must content myself with this glimpse at myself and a few of my fellow-students in Boston. After attending two courses of Lectures in the school of the University, I went to Europe to continue my studies.
You may like to hear something of the famous Professors of Paris in the days when I was a student in the Ecole de Medicine, and following the great Hospital teachers.
I can hardly believe my own memory when I recall the old practitioners and Professors who were still going round the hospitals when I mingled with the train of students that attended the morning visits. See that bent old man who is groping his way through the wards of La Charity. That is the famous Baron Boyer, author of the great work on surgery in nine volumes, a writer whose clearness of style commends his treatise to general admiration, and makes it a kind of classic. He slashes away at a terrible rate, they say, when he gets hold of the subject of fistula in its most frequent habitat, –but I never saw him do more than look as if he wanted to cut a good dollop out of a patient he was examining. The short, square, substantial man with iron-gray hair, ruddy face, and white apron is Baron Larrey, Napoleon’s favorite surgeon, the most honest man he ever saw,–it is reputed that he called him. To go round the Hotel des Invalides with Larrey was to live over the campaigns of Napoleon, to look on the sun of Austerlitz, to hear the cannons of Marengo, to struggle through the icy waters of the Beresina, to shiver in the snows of the Russian retreat, and to gaze through the battle smoke upon the last charge of the red lancers on the redder field of Waterloo. Larrey was still strong and sturdy as I saw him, and few portraits remain printed in livelier colors on the tablet of my memory.
Leave the little group of students which gathers about Larrey beneath the gilded dome of the Invalides and follow me to the Hotel Dieu, where rules and reigns the master-surgeon of his day, at least so far as Paris and France are concerned,–the illustrious Baron Dupuytren. No man disputed his reign, some envied his supremacy. Lisfranc shrugged his shoulders as he spoke of “ce grand homme de l’autre cots de la riviere,” that great man on the other side of the river, but the great man he remained, until he bowed before the mandate which none may disobey. “Three times,” said Bouillaud, “did the apoplectic thunderbolt fall on that robust brain,”–it yielded at last as the old bald cliff that is riven and crashes down into the valley. I saw him before the first thunderbolt had descended: a square, solid man, with a high and full-domed head, oracular in his utterances, indifferent to those around him, sometimes, it was said, very rough with them. He spoke in low, even tones, with quiet fluency, and was listened to with that hush of rapt attention which I have hardly seen in any circle of listeners unless when such men as ex-President John Quincy Adams or Daniel Webster were the speakers. I do not think that Dupuytren has left a record which explains his influence, but in point of fact he dominated those around him in a remarkable manner. You must have all witnessed something of the same kind. The personal presence of some men carries command with it, and their accents silence the crowd around them, when the same words from other lips might fall comparatively unheeded.
As for Lisfranc, I can say little more of him than that he was a great drawer of blood and hewer of members. I remember his ordering a wholesale bleeding of his patients, right and left, whatever might be the matter with them, one morning when a phlebotomizing fit was on him. I recollect his regretting the splendid guardsmen of the old Empire,–for what? because they had such magnificent thighs to amputate. I got along about as far as that with him, when I ceased to be a follower of M. Lisfranc.
The name of Velpeau must have reached many of you, for he died in 1867, and his many works made his name widely known. Coming to Paris in wooden shoes, starving, almost, at first, he raised himself to great eminence as a surgeon and as an author, and at last obtained the Professorship to which his talents and learning entitled him. His example may be an encouragement to some of my younger hearers who are born, not with the silver spoon in their mouths, but with the two-tined iron fork in their hands. It is a poor thing to take up their milk porridge with in their young days, but in after years it will often transfix the solid dumplings that roll out of the silver spoon. So Velpeau found it. He had not what is called genius, he was far from prepossessing in aspect, looking as if he might have wielded the sledge-hammer (as I think he had done in early life) rather than the lancet, but he had industry, determination, intelligence, character, and he made his way to distinction and prosperity, as some of you sitting on these benches and wondering anxiously what is to become of you in the struggle for life will have done before the twentieth century has got halfway through its first quarter. A good sound head over a pair of wooden shoes is a great deal better than a wooden head belonging to an owner who cases his feet in calf-skin, but a good brain is not enough without a stout heart to fill the four great conduits which carry at once fuel and fire to that mightiest of engines.
How many of you who are before me are familiarly acquainted with the name of Broussais, or even with that of Andral? Both were lecturing at the Ecole de Medicine, and I often heard them. Broussais was in those days like an old volcano, which has pretty nearly used up its fire and brimstone, but is still boiling and bubbling in its interior, and now and then sends up a spirt of lava and a volley of pebbles. His theories of gastro-enteritis, of irritation and inflammation as the cause of disease, and the practice which sprang from them, ran over the fields of medicine for a time like flame over the grass of the prairies. The way in which that knotty-featured, savage old man would bring out the word irritation–with rattling and rolling reduplication of the resonant letter r–might have taught a lesson in articulation to Salvini. But Broussais’s theory was languishing and well-nigh become obsolete, and this, no doubt, added vehemence to his defence of his cherished dogmas.
Old theories, and old men who cling to them, must take themselves out of the way as the new generation with its fresh thoughts and altered habits of mind comes forward to take the place of that which is dying out. This was a truth which the fiery old theorist found it very hard to learn, and harder to bear, as it was forced upon him. For the hour of his lecture was succeeded by that of a younger and far more popular professor. As his lecture drew towards its close, the benches, thinly sprinkled with students, began to fill up; the doors creaked open and banged back oftener and oftener, until at last the sound grew almost continuous, and the voice of the lecturer became a leonine growl as he strove in vain to be heard over the noise of doors and footsteps.
Broussais was now sixty-two years old. The new generation had outgrown his doctrines, and the Professor for whose hour the benches had filled themselves belonged to that new generation. Gabriel Andral was little more than half the age of Broussais, in the full prime and vigor of manhood at thirty-seven years. He was a rapid, fluent, fervid, and imaginative speaker, pleasing in aspect and manner,–a strong contrast to the harsh, vituperative old man who had just preceded him. His Clinique Medicale is still valuable as a collection of cases, and his researches on the blood, conducted in association with Gavarret, contributed new and valuable facts to science. But I remember him chiefly as one of those instructors whose natural eloquence made it delightful to listen to him. I doubt if I or my fellow-students did full justice either to him or to the famous physician of Hotel Dieu, Chomel. We had addicted ourselves almost too closely to the words of another master, by whom we were ready to swear as against all teachers that ever were or ever would be.
This object of our reverence, I might almost say idolatry, was one whose name is well known to most of the young men before me, even to those who may know comparatively little of his works and teachings. Pierre Charles Alexandre Louis, at the age of forty-seven, as I recall him, was a tall, rather spare, dignified personage, of serene and grave aspect, but with a pleasant smile and kindly voice for the student with whom he came into personal relations. If I summed up the lessons of Louis in two expressions, they would be these; I do not hold him answerable for the words, but I will condense them after my own fashion in French, and then give them to you, expanded somewhat, in English:
Formez toujours des idees nettes. Fuyez toujours les a peu pres.
Always make sure that you form a distinct and clear idea of the matter you are considering.
Always avoid vague approximations where exact estimates are possible; about so many,–about so much, instead of the precise number and quantity.
Now, if there is anything on which the biological sciences have prided themselves in these latter years it is the substitution of quantitative for qualitative formulae. The “numerical system,” of which Louis was the great advocate, if not the absolute originator, was an attempt to substitute series of carefully recorded facts, rigidly counted and closely compared, for those never-ending records of vague, unverifiable conclusions with which the classics of the healing art were overloaded. The history of practical medicine had been like the story of the Danaides. “Experience” had been, from time immemorial, pouring its flowing treasures into buckets full of holes. At the existing rate of supply and leakage they would never be filled; nothing would ever be settled in medicine. But cases thoroughly recorded and mathematically analyzed would always be available for future use, and when accumulated in sufficient number would lead to results which would be trustworthy, and belong to science.
You young men who are following the hospitals hardly know how much you are indebted to Louis. I say nothing of his Researches on Phthisis or his great work on Typhoid Fever. But I consider his modest and brief Essay on Bleeding in some Inflammatory Diseases, based on cases carefully observed and numerically analyzed, one of the most important written contributions to practical medicine, to the treatment of internal disease, of this century, if not since the days of Sydenham. The lancet was the magician’s wand of the dark ages of medicine. The old physicians not only believed in its general efficacy as a wonder-worker in disease, but they believed that each malady could be successfully attacked from some special part of the body,–the strategic point which commanded the seat of the morbid affection. On a figure given in the curious old work of John de Ketam, no less than thirty-eight separate places are marked as the proper ones to bleed from, in different diseases. Even Louis, who had not wholly given up venesection, used now and then to order that a patient suffering from headache should be bled in the foot, in preference to any other part.
But what Louis did was this: he showed by a strict analysis of numerous cases that bleeding did not strangle,–jugulate was the word then used,–acute diseases, more especially pneumonia. This was not a reform,–it was a revolution. It was followed up in this country by the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited Diseases, which has, I believe, done more than any other work or essay in our own language to rescue the practice of medicine from the slavery to the drugging system which was a part of the inheritance of the profession.
Yes, I say, as I look back on the long hours of the many days I spent in the wards and in the autopsy room of La Pitie, where Louis was one of the attending physicians,–yes, Louis did a great work for practical medicine. Modest in the presence of nature, fearless in the face of authority, unwearying in the pursuit of truth, he was a man whom any student might be happy and proud to claim as his teacher and his friend, and yet, as I look back on the days when I followed his teachings, I feel that I gave myself up too exclusively to his methods of thought and study.
There is one part of their business which certain medical practitioners are too apt to forget; namely, that what they should most of all try to do is to ward off disease, to alleviate suffering, to preserve life, or at least to prolong it if possible. It is not of the slightest interest to the patient to know whether three or three and a quarter cubic inches of his lung are hepatized. His mind is not occupied with thinking of the curious problems which are to be solved by his own autopsy,–whether this or that strand of the spinal marrow is the seat of this or that form of degeneration. He wants something to relieve his pain, to mitigate the anguish of dyspnea, to bring back motion and sensibility to the dead limb, to still the tortures of neuralgia. What is it to him that you can localize and name by some uncouth term the disease which you could not prevent and which you cannot cure? An old woman who knows how to make a poultice and how to put it on, and does it tuto, eito, jucunde, just when and where it is wanted, is better,–a thousand times better in many cases,–than a staring pathologist, who explores and thumps and doubts and guesses, and tells his patient be will be better tomorrow, and so goes home to tumble his books over and make out a diagnosis.
But in those days, I, like most of my fellow students, was thinking much more of “science” than of practical medicine, and I believe if we had not clung so closely to the skirts of Louis and had followed some of the courses of men like Trousseau,–therapeutists, who gave special attention to curative methods, and not chiefly to diagnosis, –it would have been better for me and others. One thing, at any rate, we did learn in the wards of Louis. We learned that a very large proportion of diseases get well of themselves, without any special medication,–the great fact formulated, enforced, and popularized by Dr. Jacob Bigelow in the Discourse referred to. We unlearned the habit of drugging for its own sake. This detestable practice, which I was almost proscribed for condemning somewhat too epigrammatically a little more than twenty years ago, came to us, I suspect, in a considerable measure from the English “general practitioners,” a sort of prescribing apothecaries. You remember how, when the city was besieged, each artisan who was called upon in council to suggest the best means of defence recommended the articles he dealt in: the carpenter, wood; the blacksmith, iron; the mason, brick; until it came to be a puzzle to know which to adopt. Then the shoemaker said, “Hang your walls with new boots,” and gave good reasons why these should be the best of all possible defences. Now the “general practitioner” charged, as I understand, for his medicine, and in that way got paid for his visit. Wherever this is the practice, medicine is sure to become a trade, and the people learn to expect drugging, and to consider it necessary, because drugs are so universally given to the patients of the man who gets his living by them.
It was something to have unlearned the pernicious habit of constantly giving poisons to a patient, as if they were good in themselves, of drawing off the blood which he would want in his struggle with disease, of making him sore and wretched with needless blisters, of turning his stomach with unnecessary nauseous draught and mixtures, –only because he was sick and something must be done. But there were positive as well as negative facts to be learned, and some of us, I fear, came home rich in the negatives of the expectant practice, poor in the resources which many a plain country practitioner had ready in abundance for the relief and the cure of disease. No one instructor can be expected to do all for a student which he requires. Louis taught us who followed him the love of truth, the habit of passionless listening to the teachings of nature, the most careful and searching methods of observation, and the sure means of getting at the results to be obtained from them in the constant employment of accurate tabulation. He was not a showy, or eloquent, or, I should say, a very generally popular man, though the favorite, almost the idol, of many students, especially Genevese and Bostonians. But he was a man of lofty and admirable scientific character, and his work will endure in its influences long after his name is lost sight of save to the faded eyes of the student of medical literature.
Many other names of men more or less famous in their day, and who were teaching while I was in Paris, come up before me. They are but empty sounds for the most part in the ears of persons of not more than middle age. Who of you knows anything of Richerand, author of a very popular work on Physiology, commonly put into the student’s hands when I first began to ask for medical text-books? I heard him lecture once, and have had his image with me ever since as that of an old, worn-out man,–a venerable but dilapidated relic of an effete antiquity. To verify this impression I have just looked out the dates of his birth and death, and find that he was eighteen years younger than the speaker who is now addressing you. There is a terrible parallax between the period before thirty and that after threescore and ten, as two men of those ages look, one with naked eyes, one through his spectacles, at the man of fifty and thereabout. Magendie, I doubt not you have all heard of. I attended but one of his lectures. I question if one here, unless some contemporary of my own has strayed into the amphitheatre,–knows anything about Marjolin. I remember two things about his lectures on surgery, the deep tones of his voice as he referred to his oracle,–the earlier writer, Jean Louis Petit,–and his formidable snuffbox. What he taught me lies far down, I doubt not, among the roots of my knowledge, but it does not flower out in any noticeable blossoms, or offer me any very obvious fruits. Where now is the fame of Bouillaud, Professor and Deputy, the Sangrado of his time? Where is the renown of Piorry, percussionist and poet, expert alike in the resonances of the thoracic cavity and those of the rhyming vocabulary?–I think life has not yet done with the vivacious Ricord, whom I remember calling the Voltaire of pelvic literature,–a sceptic as to the morality of the race in general, who would have submitted Diana to treatment with his mineral specifics, and ordered a course of blue pills for the vestal virgins.
Ricord was born at the beginning of the century, and Piorry some years earlier. Cruveilhier, who died in 1874, is still remembered by his great work on pathological anatomy; his work on descriptive anatomy has some things which I look in vain for elsewhere. But where is Civiale,–where are Orfila, Gendrin, Rostan, Biett, Alibert, –jolly old Baron Alibert, whom I remember so well in his broad- brimmed hat, worn a little jauntily on one side, calling out to the students in the court-yard of the Hospital St. Louis, “Enfans de la methode naturelle, etes-vous tous ici?” “Children of the natural method [his own method of classification of skin diseases,] are you all here? “All here, then, perhaps; all where, now?
My show of ghosts is over. It is always the same story that old men tell to younger ones, some few of whom will in their turn repeat the tale, only with altered names, to their children’s children.
Like phantoms painted on the magic slide, Forth from the darkness of the past we glide, As living shadows for a moment seen
In airy pageant on the eternal screen, Traced by a ray from one unchanging flame, Then seek the dust and stillness whence we came.
Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden, where he had written his Latin graduating thesis, talking of the learned Gaubius and the late illustrious Boerhaave and other dead Dutchmen, of whom you know as much, most of you, as you do of Noah’s apothecary and the family physician of Methuselah, whose prescriptions seem to have been lost to posterity. Dr. Lloyd came back to Boston full of the teachings of Cheselden and Sharpe, William Hunter, Smellie, and Warner; Dr. James Jackson loved to tell of Mr. Cline and to talk of Mr. John Hunter; Dr. Reynolds would give you his recollections of Sir Astley Cooper and Mr. Abernethy; I have named the famous Frenchmen of my student days; Leyden, Edinburgh, London, Paris, were each in turn the Mecca of medical students, just as at the present day Vienna and Berlin are the centres where our young men crowd for instruction. These also must sooner or later yield their precedence and pass the torch they hold to other hands. Where shall it next flame at the head of the long procession? Shall it find its old place on the shores of the Gulf of Salerno, or shall it mingle its rays with the northern aurora up among the fiords of Norway,–or shall it be borne across the Atlantic and reach the banks of the Charles, where Agassiz and Wyman have taught, where Hagen still teaches, glowing like his own Lampyris splendidula, with enthusiasm, where the first of American botanists and the ablest of American surgeons are still counted in the roll of honor of our great University?
Let me add a few words which shall not be other than cheerful, as I bid farewell to this edifice which I have known so long. I am grateful to the roof which has sheltered me, to the floors which have sustained me, though I have thought it safest always to abstain from anything like eloquence, lest a burst of too emphatic applause might land my class and myself in the cellar of the collapsing structure, and bury us in the fate of Korah, Dathan, and Abiram. I have helped to wear these stairs into hollows,–stairs which I trod when they were smooth and level, fresh from the plane. There are just thirty- two of them, as there were five and thirty years ago, but they are steeper and harder to climb, it seems to me, than they were then. I remember that in the early youth of this building, the late Dr. John K. Mitchell, father of our famous Dr. Weir Mitchell, said to me as we came out of the Demonstrator’s room, that some day or other a whole class would go heels over head down this graded precipice, like the herd told of in Scripture story. This has never happened as yet; I trust it never will. I have never been proud of the apartment beneath the seats, in which my preparations for lecture were made. But I chose it because I could have it to myself, and I resign it, with a wish that it were more worthy of regret, into the hands of my successor, with my parting benediction. Within its twilight precincts I have often prayed for light, like Ajax, for the daylight found scanty entrance, and the gaslight never illuminated its dark recesses. May it prove to him who comes after me like the cave of the Sibyl, out of the gloomy depths of which came the oracles which shone with the rays of truth and wisdom!
This temple of learning is not surrounded by the mansions of the great and the wealthy. No stately avenues lead up to its facades and porticoes. I have sometimes felt, when convoying a distinguished stranger through its precincts to its door, that he might question whether star-eyed Science had not missed her way when she found herself in this not too attractive locality. I cannot regret that we–you, I should say–are soon to migrate to a more favored region, and carry on your work as teachers and as learners in ampler halls and under far more favorable conditions.
I hope that I may have the privilege of meeting you there, possibly may be allowed to add my words of welcome to those of my former colleagues, and in that pleasing anticipation I bid good-by to this scene of my long labors, and, for the present at least, to the friends with whom I have been associated.
APPENDUM
NOTES TO THE ADDRESS ON CURRENTS AND COUNTER CURRENTS IN MEDICAL SCIENCE.
Some passages contained in the original manuscript of the Address, and omitted in the delivery on account of its length, are restored in the text or incorporated with these Notes.
NOTE A.–
There is good reason to doubt whether the nitrate of silver has any real efficacy in epilepsy. It has seemed to cure many cases, but epilepsy is a very uncertain disease, and there is hardly anything which has not been supposed to cure it. Dr. Copland cites many authorities in its favor, most especially Lombard’s cases. But De la Berge and Monneret (Comp. de Med. Paris), 1839, analyze these same cases, eleven in number, and can only draw the inference of a very questionable value in the supposed remedy. Dr. James Jackson says that relief of epilepsy is not to be attained by any medicine with which he is acquainted, but by diet. (Letters to a Young Physician, p. 67.) Guy Patin, Dean of the Faculty of Paris, Professor at the Royal College, Author of the Antimonial Martyrology, a wit and a man of sense and learning, who died almost two hundred years ago, had come to the same conclusion, though the chemists of his time boasted of their remedies. “Did, you ever see a case of epilepsy cured by nitrate of silver?” I said to one of the oldest and most experienced surgeons in this country. “Never,” was his instant reply. Dr. Twitchell’s experience was very similar. How, then, did nitrate of silver come to be given for epilepsy? Because, as Dr. Martin has so well reminded us, lunatics were considered formerly to be under the special influence of Luna, the moon (which Esquirol, be it observed, utterly denies), and lunar caustic, or nitrate of silver, is a salt of that metal which was called luna from its whiteness, and of course must be in the closest relations with the moon. It follows beyond all reasonable question that the moon’s metal, silver, and its preparations, must be the specific remedy for moonblasted maniacs and epileptics!
Yet the practitioner who prescribes the nitrate of silver supposes he is guided by the solemn experience of the past, instead of by its idle fancies. He laughs at those old physicians who placed such confidence in the right hind hoof of an elk as a remedy for the same disease, and leaves the record of his own belief in a treatment quite as fanciful and far more objectionable, written in indelible ink upon a living tablet where he who runs may read it for a whole generation, if nature spares his walking advertisement so long.
NOTE B.–
The presumption that a man is innocent until he is proved guilty, does not mean that there are no rogues, but lays the onus probandi on the party to which it properly belongs. So with this proposition. A noxious agent should never be employed in sickness unless there is ample evidence in the particular case to overcome the general presumption against all such agents, and the evidence is very apt to be defective.
The miserable delusion of Homoeopathy builds itself upon an axiom directly the opposite of this; namely, that the sick are to be cured by poisons. Similia similibus curantur means exactly this. It is simply a theory of universal poisoning, nullified in practice by the infinitesimal contrivance. The only way to kill it and all similar fancies, and to throw every quack nostrum into discredit, is to root out completely the suckers of the old rotten superstition that whatever is odious or noxious is likely to be good for disease. The current of sound practice with ourselves is, I believe, setting fast in the direction I have indicated in the above proposition. To uphold the exhibition of noxious agents in disease, as the rule, instead of admitting them cautiously and reluctantly as the exception, is, as I think, an eddy of opinion in the direction of the barbarism out of which we believe our art is escaping. It is only through the enlightened sentiment and action of the Medical Profession that the community can be brought to acknowledge that drugs should always be regarded as evils.
It is true that some suppose, and our scientific and thoughtful associate, Dr. Gould, has half countenanced the opinion, that there may yet be discovered a specific for every disease. Let us not despair of the future, but let us be moderate in our expectations. When an oil is discovered that will make a bad watch keep good time; when a recipe is given which will turn an acephalous foetus into a promising child; when a man can enter the second time into his mother’s womb and give her back the infirmities which twenty generations have stirred into her blood, and infused into his own through hers, we may be prepared to enlarge the National Pharmacopoeia with a list of specifies for everything but old age, –and possibly for that also.
NOTE C.–
The term specific is used here in its ordinary sense, without raising the question of the propriety of its application to these or other remedies.
The credit of introducing Cinchona rests between the Jesuits, the Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor, who employed it as a secret remedy. (Pereira.) Mercury as an internal specific remedy was brought into use by that impudent and presumptuous quack, as he was considered, Paracelsus. (Encyc. Brit. art. “Paracelsus.”) Arsenic was introduced into England as a remedy for intermittents by Dr. Fowler, in consequence of the success of a patent medicine, the Tasteless Ague Drops, which were supposed, “probably with reason,” to be a preparation of that mineral. (Rees’s Cyc. art. “Arsenic.”) Colchicum came into notice in a similar way, from the success of the Eau Medicinale of M. Husson, a French military officer. (Pereira.) Iodine was discovered by a saltpetre manufacturer, but applied by a physician in place of the old remedy, burnt sponge, which seems to owe its efficacy to it. (Dunglison, New Remedies.) As for Sulphur, “the common people have long used it as an ointment” for scabies. (Rees’s Cyc. art. “Scabies.”) The modern cantiscorbutic regimen is credited to Captain Cook. “To his sagacity we are indebted for the first impulse to those regulations by which scorbutus is so successfully prevented in our navy.” (Lond. Cyc. Prac. Med. art. “Scorbutus.”) Iron and various salts which enter into the normal composition of the human body do not belong to the materia medica by our definition, but to the materia alimentaria.
For the first introduction of iron as a remedy, see Pereira, who gives a very curious old story.
The statement in the text concerning a portion of the materia medica stands exactly as delivered, and is meant exactly as it stands. No denunciation of drugs, as sparingly employed by a wise physician, was or is intended. If, however, as Dr. Gould stated in his “valuable and practical discourse” to which the Massachusetts Medical Society “listened with profit as well as interest,” “Drugs, in themselves considered, may always be regarded as evils,”–any one who chooses may question whether the evils from their abuse are, on the whole, greater or less than the undoubted benefits obtained from their proper use. The large exception of opium, wine, specifics, and anaesthetics, made in the text, takes off enough from the useful side, as I fully believe, to turn the balance; so that a vessel containing none of these, but loaded with antimony, strychnine, acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus diaboli, tormentilla, and other approved, and, in skilful hands, really useful remedies, brings, on the whole, more harm than good to the port it enters.
It is a very narrow and unjust view of the practice of medicine, to suppose it to consist altogether in the use of powerful drugs, or of drugs of any kind. Far from it. “The physician may do very much for the welfare of the sick, more than others can do, although he does not, even in the major part of cases, undertake to control and overcome the disease by art. It was with these views that I never reported any patient cured at our hospital. Those who recovered their health were reported as well; not implying that they were made so by the active treatment they had received there. But it was to be understood that all patients received in that house were to be cured, that is, taken care of.” (Letters to a Young Physician, by James Jackson, M. D., Boston, 1855.)
“Hygienic rules, properly enforced, fresh air, change of air, travel, attention to diet, good and appropriate food judiciously regulated, together with the administration of our tonics, porter, ale, wine, iron, etc., supply the diseased or impoverished system with what Mr. Gull, of St. Bartholomew’s Hospital, aptly calls the ‘raw material of the blood;’ and we believe that if any real improvement has taken place in medical practice, independently of those truly valuable contributions we have before described, it is in the substitution of tonics, stimulants, and general management, for drastic cathartics, for bleeding, depressing agents, including mercury, tartar emetics, etc., so much in vogue during the early part even of this century.” (F. P. Porcher, in Charleston Med. Journal and Review for January, 1860.)