weak, makes him more liable to other diseases for some years. Then the matter that created the rheumatism falls upon the lungs, in case the patient take cold, or from any other slight cause. By this the latent disposition exhibits itself in act and deed." What proof does he offer that without blood-letting the disease cannot be cured? It is mere reliance on medical dogmas. However, he ventured to try the effect of doing without it; he succeeded; but he had to bear the brunt of medical sarcasm for his innovation. Before leaving this case, let us call attention to the hypothesis which is implied respecting the "matter of rheumatism" which is to "fall upon the lungs." It might take its place in a quack advertisement of our day.

We need not pause to prove our assertion, that for many centuries there was as much impudent assertion, humbug, and ignorance, to be found in the Faculty, as may now be found in the Quack advertisements. In point of absurdity, of confident reliance upon wild conjecture and coincidences, it would be difficult to surpass many celebrated medical dogmas; nor have the Dulcamaras of provincial fairs treated the organism with more terrible recklessness than have the physicians of courts and cities. But there has been progress, and the art of medicine has kept pace with the progress of science. Many and bitter as have been the sarcasms and denunciations against medical ignorance and treatment, perhaps the most virulent attacks have issued from the body of the profession itself. It is a jealous body, and an honest body; both the jealousy and the honesty have prevented the perpetuity of error. Current dogmas have been eagerly criticised; fashionable treatments have been proved discrepant with existing knowledge. New lights from science have illuminated what was before obscure. And by dint of the perpetual insurgency of the sceptical spirit, the art and practice of Medi

cine have slowly advanced. Nay, in this general advance, even Quacks have been useful. They have kept alive the spirit of scepticism; by the vehemence of their coarse attacks on the science of their day, they have shaken the too absolute dominion of the schools. Still more beneficial have been the various onesided Systems, too often unjustly denounced as Quackeries by the Faculty, such as Homoeopathy, Hydropathy, Kinesopathy-which have impressed a twofold modification on the practice of Medicine: first a lessening of the recklessness of "Heroic medicine" (as it was styled), and secondly, a greater advance towards a true physiological medicine, by the increased attention to regi

men.

So far has this last named modification gone, that many men, and those men of repute, have been brought to doubt whether, after all, Regimen is not the only true Physician. Do we need medical aid, from Quack or Faculty Might not Nature be intrusted with the whole cure? Such questions have at all times pressed themselves on the minds of men, in moments of despair at witnessing the discordances in medical doctrine, and the incompetences of medical practice. The idea of relying implicitly on Nature has two supporting pillars-a pilla of philosophy, and a pillar of fact. It will not be impossible to show that both these pillars rest on shifting foundations. The philosophical one is a personification of Nature as a potent Intelligence, who only acts for our good, and knowing best what is best to be done, will do it, if not thwarted. The answer to this is, that such a personification is inadmissible; and that if Nature is to be invoked at all, she must be invoked as the cause of the very Evil which we now propose to leave to her cure. If Nature, by one of her pestiferous vapours, gives man a fever, she may, and often does, destroy instead of curing him. A reliance on such metaphysical abstractions, therefore, will not be

prudent. But there is another pillar we have to examine, and it is one of fact-namely, that many accidents and diseases are got rid of without medical aid, by the gradual reparative processes of growth: the wound heals, the disturbance subsides, the normal activity of the organs is regained. There is no doubt of this fact. It is as certain as that a "bad debt," and the danger it for a time may have threatened to the credit of a firm, will be "wiped off" and the balance restored by the slow accumulation of profits. On this fact mainly reposes the idea of a vis medicatrix naturæ. But its foundation is a shifting one. Just as there are "bad debts" which involve bankruptcies, unless some immediate external aid be secured, so are there accidents and diseases which cause a disturbance too great for Nature's normal rate of cure. There is no vis medicatrix commercii to save from bankruptcy. And there are diseases which must be arrested at once, or they will destroy the organism before the medicatrix naturæ has time to act.* Who would leave a ruptured artery to Nature? Unless the artery be tied, the very action of Nature will be destructive. Nature will not set a dislocated limb, nor eject a cancer. An inSamed lung, a congested brain, an arrested secretion, cannot always with safety be left to Nature. But in surgical cases it is much easier to know what precisely is the evil and what the remedy than in medical cases, and consequently there is less disputation in surgery than in medicine. A dislocated limb must be set; but a congested brain, how shall that be treated? It may arise from weakness of the vessels, and how to strengthen them is a difficult question to be answered in twenty different ways by twenty doctors. One bleeds, another feeds high, a third feeds low, a fourth employs a tonic, a fifth an altera

tive. Who is right? and who shall decide?

For ourselves, who, not being medical, have no right to take any side, and must merely view the whole subject from a distant philosophical and physiological station, we are quite clear that whatever part Regimen and "Nature" be allowed to play, there must always be an immense part for medical skill. In what will this mainly consist? Why, chiefly in accurately determining "what is the matter with the patient." This may seem an easy thing. It is the main difficulty of the Art. It is the guide of practice. The facility with which your ordinary acquaintance will make up their minds as to "what is the matter with you," on hearing one or two particulars related, is only equalled by their facility in prescribing for you a course of treatment which cured them, or their relative, of "precisely the same thing." The wise physician knows that the whole mystery of Medicine lies just here-in correctly discerning what are the indications of a particular malady, and in correctly discriminating what are the direct effects of certain remedies.

Experience must necessarily be the guide; but the difficulty is to light upon real experience. Suppose the physician has rightly discerned the nature of a malady, he has then to choose a remedy which has on former similar occasions been found beneficial. It is the only guide he has, and yet he cannot trust implicitly to it, for he knows that the remedy which in one case was found eminently beneficial, in another, apparently similar, case was a hopeless failure. Much depends on the peculiarities of the individual organism; much on its condition. Some drugs are potent in one organism, and impotent in another. Over and above this source of error, there is the principal difficulty of deciding whether the bene

VOL. XCI.-NO. DLVI.

M

ficial effect attributed to any particular drug really had any reference to the action of that drug, or to some concurrent action; and when we read the lists of cures effected by directly opposite methods, by medicaments having a directly opposite effect on the organism, we cannot withhold the suspicion that this is a constant source of fallacy. The main guide must be a reliance on empirical observation until certainty is secured on a scientific basis. If a treatment is found beneficial in a large number of cases, there is a presumption in its favour. It may be tried in each new similar case. And here it is that the Physician and the Quack, seemingly on common ground, are most decisively separated. Both rely on empirical observation; both are guided by the results of previous cases; both are ignorant of the real order and succession of the phenomena arising out of the administration of the drug. But the confidence of the Physician is relative and tentative; the confidence of the Quack is absolute and final. The Physician watches the result of his trial, and in case of ill success, tries a different course; he relies on past experience only as on a presumption, and gives it up on proof of error. The Quack never doubts, never watches. Until a perfect Science of Life has been elaborated by physiologists, there can be nothing more than an enlightened empiricism in Medicine. The Physician is an enlightened empiric; and it is only thus that he is distinguished from the Quack. Accordingly, as we glance back at the early periods in the history of Medicine, we see this mark of distinction becoming fainter and fainter; and as we look at the various quarrels of the Faculty with heterodox systems, such as Homoeopathy or Hydropathy, we learn that they are really disputes as to matters of doctrine, and should be conducted as such. The tone adopted by the Faculty towards such systems is unworthy and unwarrantable. To designate these systems as quack

eries is preposterous. They may be one-sided; they may be absurd; but is orthodox medicine in any condition to warrant unhesitating allegiance to its doctrines? The Homœopath and the Hydropath have their theories of the laws of healthy and diseased action, and of the effect of their remedial methods; these theories may be absurd; let it be granted that they are so ; they have the same legitimacy as the theories of the Faculty, which may also be absurd, and which many serious inquirers believe to be so. Let all serious doctrines receive earnest discussion, and let the practice of flinging "atheist" and "quack" at ever man who ventures to think differently from the "gowned doctors" be left to those who have bad temper and worse logic. If it is unjust to stigmatise the Physician because he is ignorant and incompetent, the existing state of knowledge leaving him no other alternative-if we respect him and reward him because he does his best, and acts according to the lights given him-not less unjust is it to stigmatise the Homœopath or Hydropath because he also is ignorant and incompetent. The real question in each case is, Has he any conviction guiding him? is his practice founded upon real study? or does he know that he is an impostor?

We have been led into these remarks by the recent publication of two Histories of Medicine-one by a Physician, the other by a Homœopath-both of which afford ample proof of the very slow growth which even the present small amount of medical certainty has had. Indeed, in one aspect, the history of Medicine is a chapter out of the long history of superstition; in another aspect it is a chapter in the history of science. By it all conceivable follies are illustrated; in it the premature attempts and slow conquests of inductive science are reflected. Is this chapter ended? Far from it. Certainty is almost as distant now as it was in the days of Hippocrates. Medicine is an Art

founded on a Science, yet unable to await the tardy conclusions of science. The sick man must be cured at once; he cannot wait till Physiology has acquired certainty, and Pathology has given a positive direction to the remedial art; he must therefore be treated according to the best lights at hand. These may be mere will-o'-wisps, the flickering flames of superstition, yet even these he prefers to darkness.

The History of Medicine is still to be written. Sprengel's learned work, from which every one pillages, has had no adequate successor. Isensee's Geschichte der Medicin is of great value as a bibliography; but it is no more. Wunderlich's Geschichte der Medicin is brief and dry. Renouard's Histoire de la Médecine is a work of no erudition, but is agreeably written, and has a polemical purpose running through it which gives it animation. The same may be said of Dr Russell's work, to which reference was made just now. It is as entertaining a survey as could be desired, and although written by a Homoeopath, who, of course, makes all the heroes of medicine lead up to Hahnemann, yet the theoretical bias has not materially affected the exposition; and every author must have some bias. Dr Russell does not exhibit much first-hand knowledge of the several writers whose biographies he narrates, and whose doctrines he expounds; nor does he seem extensively acquainted with the literature of his subject. But although a compilation, his book is a succinct and popular compilation, and the material has been rearranged by him. Careful readers will note that there is not only a deficiency of research, but a deficiency of criticism even of the materials employed. We will specify but two examples. He repeats, on the authority of others, a statement which the least cautious of critics might have sus

pected-namely, when speaking of Haller's prodigious activity, he says, "In Göttingen he pursued his career of almost superhuman activity, writing light reviews incessantly, to the total amount, it is said, of 12,000; publishing occasionally such works as the Life of Alfred, showing great study of a remote and difficult period; so that any one living in the literary world alone would naturally have supposed that this Haller was nothing but a littérateur, and one unusually busy and productive; whereas the fact was, that these efforts, which would have exhausted ordinary men, were to him only relaxation from his real work, which consisted in profound and original researches in anatomy and physiology." That Haller's activity was immense, both in literature and science, his published works amply prove; but if Dr Russell will calculate how long it would take to write 12,000 reviews, and compare it with the time Haller remained at Göttingen, he will find that in those sixteen years Haller must, every day, have written two reviews, besides all his other work of writing, dissecting, experimenting, and lecturing,—a calculation which at once points to some gross exaggeration.

Little less uncritical is his reproduction of the traditional statements about the treatment received by Harvey and Jenner. As we have already had occasion to state the real evidence on these points, it is unnecessary to reopen it.t We will merely add, that according to the evidence brought forward by Dr Russell, Jenner had only three months to endure neglect. These three months were doubtless very trying to his patience; but a historian might have taken a more impartial view of the trial. Russell asks how it happened that, among all the physicians and surgeons in London, none was found of

66

Dr