sys

pathy, and strikingly accords with another propounded by a Saracenic writer, which we shall have to refer to, as tending to confirm the notion that that tem was practised at this early period (!) It runs thus, Mos medicinæ est ut aliquando similia similibus, aliquando contraria contrariis curet. Nam sæpe calida calidis, frigida frigidis, sæpe autem frigida calidis, calida frigidis sanare consuevit.' The identity of words renders it impossible to read the above paragraph without a suspicion than an old and obsolete tenet may have been reproduced to the world under the garb of a new discovery; but if it be not absolutely true that human nature is destined to renew its acquaintance from time to time with exploded doctrines, just as we renew our acquaintance with bygone diseases, it is an apt illustration of the proverb advanced by an authority far more unerring than we can pretend to, that there is nothing new under the

sun.'

It would be a pity to spoil the delicious effect of this passage by adding others to it, and we may leave the reader to form his estimate of Dr Meryon's capacity as a philosophic writer from this one sample.

We said that the History of Medicine is still to be written; and we fear there is but little probability of any one having the requisite erudition united to the requisite power. A more interesting subject it would be difficult to select. Up to the period of the fall of Troy the art was practised by princes, warriors, maidens, and, of course, old women. Those were early days, and human employments had not become "differentiated;" later on the "medicine man" became absorbed by the Priest, who, when he undertook to explain all phenomena as the will of the gods, of course took in the phenomena of disease. What chance had the simple prescription of ordinary men, who could only boast a small experience, compared with the power of the gods Much has been written about the hereditary caste of Asclepiads, but as very little is known, we need not dwell on them. This, however, is known, that they neglected Anatomy and Dietetics, and were copious in invocations and

supernatural explanations. When philosophy, gradually emancipated from the trammels of superstition, began to explain all phenomena as well as it could by the aid of reason and observation, the phenomena of disease could not escape it, and the philosophers became physicians; very bad physicians, it must be confessed they became; but it was a great step for Medicine when a spirit of actual inquiry was roused, and when, instead of thwarting all research, by attributing every disease to the will of the gods, an attempt was made to detect the proximate causes.

Thus with Pythagoras began a new era the era of Inquiry. If the want of a true conception of scientific Method, and, above all, the want of those Directive Maxims which make science progressive, prevented the philosophers from accomplishing much more than the substitution of metaphysical for theological explanations, there was at least a new path opened, and it soon became crowded with seekers. The structure and functions of the organism were studied; and the laws of health and disease were deduced. Absurd as these deductions were for the most part, they were such as may be met with in all the early efforts at scientific explanation. Slow and cautious induction could only come into favour after facile and misleading deduction had been tried and found wanting. There was too little actually known respecting organs and functions, to keep the impatient mind of man restricted to their study. Alluring speculations on the first and final causes called away the attention. The philosophers held it impossible "that any one should know how to cure a disease if he be ignorant of the causes whence they proceed." This, as Dr Russell remarks, was a very plausible proposition. "But what are we to understand by the causes of disease? If all that is meant be the external circumstances which induce unhealthy conditions of the human body, then the state

ment is incontrovertible: it is true the ague would never have been got rid of by draining the pestiferous marsh, unless it had been known that swamps produce disease. But the dogmatist went a step further; not only could he say that ague is caused by swamp, but it is caused by the swamp increasing, to a mischievous extent, the radical moisture of the body; and it must be cured by opposing to it some remedy which shall increase the radical dryness or heat." Here, like the modern quack, he proceeds to prescribe on the faith of an unverified hypothesis. No attempt is made to prove the increase of moisture, no attempt is made to show that an increase of dryness will cure the ague. How wildly and absurdly philosophers could confidently speculate in the absence of all attempt at proof, may be seen by opening Aristotle's important, but little-studied, work, De Partibus Animalium, which contains an exposition of the anatomy and physiology of his day. For example, it is stated as a fact about which there can be no doubt, that the blood in the upper part of the body is better than that in the lower, the reason assigned being that the upper is the nobler part. -"Thick and warm blood," he says, "is better adapted for plastic purposes; thin and cold blood better for sensation and thought. Hence, the bees and other such animals are more intelligent (ppovuάrepa) than many red-blooded animals; and of the red-blooded, those are the most intelligent which have the thinnest and coldest blood. But the best of all are those which have warm, thin, and pure blood: they are distinguished by fortitude (àvdpelav) and intelligence. Hence, the upper and lower parts the right and left sides -male and female-manifest their relative differences." * Elsewhere he says, man, of all animals, has the most hair on his head: "this is necessary because of the humidity

of the brain and the sutures of the skull: for growth must be greatest where there is greatest warmth and moisture." We have heard of a provincial hairdresser in our own time who held the same view, declaring that "the brain percolates through the skull, and nourishes the roots of the 'air, sir!" One more example, and we have done. The heart, says Aristotle, is placed in the centre because "Nature is wont to seat the noblest in the noblest place, unless any stronger reason prevails (ov μǹ TI KWλvei μeîŠov).”‡ And he refutes the opinion of those who assert that the origin of the veins is in the head on this ground: "They thus make the origin manifold and separate, and moreover in a cold place, whereas, the region of the heart is warm.

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These are specimens of the way the master-mind of antiquity could explain anatomical and physiological phenomena; how lesser minds would succeed may be easily imagined. "Ils substituèrent des hypothèses transcendantales," says Renouard, aux résultats simples de l'observation, et crurent avoir élevé l'édifice de la médecine sur un fondement inébranlable, parcequ'ils l'avaient établi sur des bases inaccessibles à l'appréciation des sens, et partant, disaient-ils, à l'abri de leurs illusions, de leur instabilité."§ The reign of the metaphysicians is not quite over yet. There still remain many of the old metaphysical entities, and many of the metaphysical explanations; but since the middle of the seventeenth century, when Science began to justify by the splendour of its discoveries the illimitable potency of its method, there has been an ever accelerating increase of observation and induction replacing the precipitancy of deduction. It was indeed time for a change. The old method had had its trial; and the consequences were increase of darkness instead of increase of light.

The History of Medicine under the dominion of the philosophers is a marvel of human folly. Nothing seemed too preposterous for the acutest intellects to believe. Let us glance at one of the most distinguished of what may be called the new school, as opposed to the Aristotelians and Galenists; we mean Van Helmont (of whom Dr Russell, by the way, knows nothing but at second-hand, and whom consequently he very imperfectly presents). Here was a man of genius, who had passionately studied Greek and Arabian authors, and whose learning and acuteness made him the wonder of his age; yet he could gravely affirm that in cases of dropsy, gout, or jaundice, "by including the warm blood of the patient in the shell and white of an egg, exposed to a gentle heat, and given to a hungry dog or swine with a bait of meat, the disease will instantly leave the patient and pass to the dog or swine."* Again, he amusingly says, "Doe you desire to be informed why the blood of a Bull is poisonous, but that of an Oxe, though brother to the Bull, is safe and harmlesse? The reason thus the Bull at the time of slaughter is full of secret reluctancy and vindictive murmurs, and firmly impresses upon his owne blood a character and potent signature of revenge. But if it chance that an Oxe brought to the slaughter fall not at one stroke of the axe, but grow enraged and furious and continue long in that violent madnesse: then he leaves a depraved and unwholesome tincture on his flesh unless he be first recalmed and pacified by darknesse and famine. A Bull therefore dies with a higher flame of revenge above him than any other animal whatever." +

The influence of philosophers was pernicious in another direction. By the despotic sway which they exercised over the respect of men, as the possessors of the highest wis

dom, they created the superstition of learning. A"learned physician," even in our own day, does not mean a man who has profoundly studied disease at the bedside, but a man whose memory is stored with the august trash of bygone years, who can quote the classics and the Arabians, who is versed in the elegancies of Greek and Latin, who knows intimately the opinions which advancing science have made every one else forget or neglect. To know what Galen or Avicenna thought upon any given point has long ceased to be a primal necessity; but for centuries it constituted the stockin-trade of the physician; even to this day it is supposed to give an increase of value to the physician's opinion; and but a few years ago, the Faculty of Paris insisted on a certain number of the aphorisms of Hippocrates being included in the theses of those who aspired to a diploma. Molière has embalmed the learned physician in imperishable humour; but the very public which cried with laughter at medical absurdities on the stage, listened with awe when they were gravely uttered in the sick-room.

Of the three types, the Physician as Priest, as Philosopher, and as Pedant, one knows not which can be selected as the most injurious; but not one of them is justified in flinging many stones at the Quack. In ignorance of the true knowledge required, they were all pretty nearly on a par. Still they must not on that ground alone be classed with the Quack; because they worked earnestly according to their lights. Once suppose that the wandering charlatan, who dosed the rustics at a fair as he would dose a horse, seriously believed that he knew the symptoms of a malady, and that his dose would cure it, and you have no more right to denounce him than to denounce the most learned physician. In our own day, however, one can hardly make such a suppo

sition. Those quacks who placard our walls, and obtrude themselves in advertising columns, may not, and perhaps do not know how supremely ignorant they are; but they do know that they have not taken any of the accessible open paths which might have led them to better knowledge; they do know that they have never studied the structure and functions of the human body in health and disease, and that their theories are mere guesses in the dark, their remedies mere impostures. "Man," says Channing, "is not accountable for the rightness, but he is accountable for the uprightness of his views." The physician cannot be blamed for not having found the truth; but the quack must be stigmatised for not having sought it. The one says to the sick man: I think this will cure you; at any rate you shall have the best advice I can give. The other says: This will infallibly cure you, nothing else will.

The Physician, as we have said, is an enlightened empiric. From whence comes his enlightenment? From two very different sources: first, from the science of his day; secondly, from his own experience at the bedside. He is necessarily determined by theory in his interpretation of disease, since even the commonest words he uses, such as inflammation, dyspepsia, biliousness, &c., all imply theories as to the processes of organic action; and every remedy implies a theory as to its effect on the organism. Hence it is that the medical doctrines of the day always reflect the biological science of the day; and they are at one time biassed by chemical, another time by mechanical, and another by metaphysical views. While the practice is thus generally determined by the scientific theories which the physician has adopted from the schools, or originated for himself in deviation from the schools, it is also and more immediately determined by his own personal experience, and his skill in interpreting symptoms and devising

remedies. This is the physician's art. It cannot be taught, but it may be improved by teaching. The penetrating sagacity which at once, amid a crowd of details, detects those that are significant the bold yet cautious invention which hits upon the mode of treatment suitable in the particular case

these are not qualities to

be acquired in the schools: they make the great physician, as they make the great statesman and great general. Hence it is that you may often talk with a physician of high repute, of deserved repute, and find him very backward in the science of his day; but place him at the bedside in a perilous case, and there, where another man equipped with all the newest views in science-a master of the microscope, a great organic chemist, a brilliant experimenter-will be paralysed by hesitation, the skilful physician will be prompt, vigilant, and assured.

The art of Medicine, while it rests on the science of Biology, ought, as a study, to be strictly demarcated from it. Until such a separation takes place, progress in both will necessarily be slow. In our day a man may become an eminent astronomer without being able to recognise a single star in the heavens, much less to navigate the safest seas; and the perfection of both astronomy and navigation is due to this very division of labour. In like manner, when Biology comes to be studied without reference to medicine, and by a class of biologists whose time and energies will not be chiefly given to practice, there will be a decided acceleration of progress, and the medical practitioner will have his energies mainly given to the mastery of his art. No one even superficially acquainted with the demands made on a physician's energies, will think it reasonable that, over and above these, he should be called upon to master the gigantic and encyclopædic science of Biology: it is enough if he can keep pace with the advance of the day, and receive from others what new lights they have struck

out; but unless medical men do also devote themselves to Biology in the intervals of practice, who is to further the science, since no separate class of biologists has yet been established? In Germany and France, thanks to numerous professorships, there is a small class which devotes itself exclusively to science; but in England every discouragement exists to keep men from such "unprofitable" labour. When young, and awaiting a practice, men may give their days and nights to science, which would far better have been given to the laborious accumulation of clinical experience; but no sooner are patients knocking at the door, than science is either kicked aside, or, if the passion of discovery be strong, pursued, at a terrible cost of health and energy, in the rare intervals of rest.

Can we then wonder if our enlightened empiric is but imperfectly enlightened? Can we wonder if the wise physician, in the very sincerity of his wisdom, recognises the imperfection of his knowledge, and the purely tentative character of his art; and thus seems at a disadvantage when compared with the Quack, who has no such doubts, but who vociferously declares his art is perfect Unhappily it is the tendency of the timorous to rely on confident assertion; and the sick man is more willing to trust one who emphatically declares that he will cure him, although this very declaration ought to act as a warning, than he is to trust a man who in all sincerity says, I will do my best to cure you.

And now, reader, for the moral; all these rambling remarks have had an aim; and that aim a practical one. You are mortal, and liable to all the ills that flesh is heir to. You are mortal, and, when ill, are timorous. You are mortal, and in your ignorance an easy dupe. Your ignorance respecting the mysteries of life and disease cannot be enlightened by a magazine article; but your ignorance of the danger

you run in distrusting physicians and relying on quacks may be enlightened. First, then, we hope to have made it clear that the Art of Medicine, over and above its own special difficulties, is rendered excessively uncertain because it necessarily rests upon the Science of Biology; and that Science is still in a chaotic condition. Next, we hope to have made it clear, that however imperfect the knowledge of the physican may be, it is necessarily of incalculably greater value than the knowledge of the quack, who, having never studied the organism in health and disease, is simply as ignorant as you are yourself. Thirdly, we hope to have made it clear that the physician relies more on experience and less on theory, the experience being much wider and more critical, the theory being less absolute and final, than is the case with the quack, who pretends to rely solely on experience, but does not rely on it at all. Finally, we hope to have made it clear that in the present state of human knowledge any man who announces that he has a panacea, or a system applicable to all, or most diseasesany man who announces that his drug, or his treatment, will in itself cure a disease, without regard to the variety of causes which may have produced the disease, or the organic changes which the disease may have produced-is either an ignoramus or an impostor, and his boast should act like a warning. His confidence is either crass ignorance, or artful reliance on your credulity. If you are ill, and distrust the medical aid of your town, or country, act courageously in that distrust, and leave the cure to Nature. But in no case withdraw your confidence from the imperfect skill of the physican, to place it on the perfect ignorance of the quack. The Medical Art of the day may be incompetent to restore the " digestive vigour" to your stomach which has "lost its tone;" but, oh! be not so misguided as to search for that "lost tone" in the advertisements. Are you so inex