THE

MEDICAL TIMES AND GAZETTE:

A

JOURNAL OF MEDICAL SCIENCE,

LITERATURE, CRITICISM, AND NEWS.

NEW SERIES.-VOLUME THE SEVENTH.

OLD SERIES.-VOL XXVIII.

JULY 2 TO DECEMBER 31, 1853.

L...

L

2003

LONDON:

PUBLISHED BY JOHN CHURCHILL, 46, PRINCES-STREET, SOHO;

AND SOLD BY ALL BOOKSELLERS.

MDCCCLIII.

Medical Times & Gazette.

LECTURE I.

MR. PRESIDENT AND GENTLEMEN,-Before I undertook the honourable task of delivering in this theatre the course of lectures which I am about to commence, I ascertained that it was neither indispensable, nor, indeed, very desirable, that the materia medica,(a) in a limited sense of the term, should form their chief subject; and that I might strictly fulfil the intention of the lectures by taking a wider scope, provided that the end and object of my discourses were, the prevention and the cure of disease,-provided, too, that my efforts were directed towards the attainment of that very important object, the right use of the materia medica.

Now, it is manifest that the right use of the materia medica implies a knowledge,-1st, of the materials themselves; of their physical and chemical properties; of their effects upon the healthy living body; of the doses, and of the modes in which they may best be administered. 2ndly. There is required for this end a knowledge of disease; of its causes, its nature, and its consequences; and, 3rdly, the most important knowledge is that which relates to the influence of the materia medica upon morbid processes, whether in preventing, modifying, or entirely arresting them. My design in the present lectures is, to consider the materia medica only in the last-mentioned relationship-with reference, that is, to the connexion between therapeutics and pathology. There are, probably, few subjects respecting which there exist so many conflicting opinions as with regard to the effects of remedies upon disease, their modes of action, and the best methods of administering them. Without stopping to inquire how far some of the propounders of strange doctrines do actually and honestly believe in the wild and irrational notions which they profess to hold, it is notorious, that a great diversity of opinion upon many points relating to the cure of disease prevails among the most sincere, zealous, and able cultivators of medical science.

It can scarcely, I think, be doubted, that many of the conflicting opinions which exist with regard to the treatment of certain diseases, and the value of particular means of cure, have their origin in an insufficient regard to what has been called the natural history of disease,-by which I mean, the origin, the nature, and the consequences of morbid processes. Within the last few years, the importance and the intimacy of the relationship between therapeutics and pathology have been much more insisted upon than formerly; but it is very apparent, that the subject has not yet received all the attention to which it has a claim; and that to the neglect of it may be attributed many of the opposing theories and the diverse modes of practice which are found to prevail.

There are certain propositions with reference to this subject which are so self-evident as to receive immediate and universal assent. It is obvious, for instance, that no one is fully competent to cure a disease, unless he have the power to detect the particular malady which he professes to heal. cure for ague ; It is not sufficient to know, that quinine is but there must also be the ability to distinguish ague from other diseases with which it may be confounded. Without this power of diagnosis, the remedy would sometimes be withheld when it might have been given with success; while, in other cases, supposed to be ague, but not really such, the administration of quinine might be useless, or even mischievous. We sometimes receive from our patients, in reply to the question, "What ails you ?" not a detail of symptoms, but a ready-formed diagnosis; and among those who have

(a) The course of lectures which I was appointed to deliver is nominally on Materia Medica. I had the express permission of the President of the College to give the term a wide interpretation.

[No. 718.-NEW SERIES, No. 157.]

[JULY 2, 1853.

had chills or rigors, the belief is common, that they are
suffering from ague. It scarcely need be said, that we cannot
act upon such a diagnosis without further inquiry, and that,
if we were to do so, we should often fail to cure our patients,
while, at length, our frequent failures would naturally lead
us to the conviction, that the value of quinine as a remedy
for ague has been greatly over-estimated.

The importance of scientific pathology, and of an accurate
diagnosis, would be far less than it is, if, for every disease
which we can recognise, we had one or more specific
remedies, such as quinine for ague. Unhappily, however,
it is far otherwise; and, in a large proportion of cases,
we are reduced to the necessity of treating disease upon
what are called general principles. In other words, we
study the phenomena of disease with a view to ascertain
their nature and tendency; we learn what we can of the
natural curative efforts which are continually manifesting
themselves during the progress of various diseases; and
we thence deduce rules for our guidance in the manage-
ment of these diseases; one of the most important rules
being, to avoid all mischievous interference, and to do
nothing, if we have not a reasonable hope of doing good.
will ever be found for many of the diseases with which we
It is, I think, extremely improbable, that specific remedies
are acquainted. The contrary doctrine, we know, is main-
tained by some claimants for public favour, who proclaim
the virtues of one unfailing remedy for impure blood, the
source, as they assert, of all diseases, while others boast
with equal confidence of specifics as numerous as the multi-
tudinous forms of disease. A short time since I was told by
a friend, who has acquired a well-deserved reputation by
investigating a particular class of diseases, that a certain
practitioner is in the habit of sending to him patients, in
order that he may form a diagnosis and name the disease;
this being done, the patients return to the aforesaid prac-
titioner, who supplies them with the cure for the disease
which he could not himself detect, and which he still knows
only by name! It would be a waste of time to insist upon
the absurdity of such pretensions as these.

It is not difficult to perceive, that there is an almost daily increasing difference between true and false medical science of the present day; and, inasmuch as their methods of procedure are essentially opposite, the breach between them will soon become so wide, as to be apparent to all who are not wilfully blind. One great and important distinction between true and false philosophy is this, that the one, while it pays due regard to the wisdom and experience of past ages, and obtains from them all the assistance which they are capable of yielding, does not hesitate to examine, by the aid of such light as modern researches afford, all the dogmas which have been handed down to it; and, finding some to be inconsistent with facts and with analogies, it abandons them as untenable, and as unsafe guides in practice. It scarcely need be said, that this is the truly scientific method of inquiry, and that a very prevalent false method is, in many respects, the direct opposite of this,-a method which has a tendency to dogmatise with reckless boldness, and which, starting from certain ill-grounded and false data, arrives at conclusions which are not more opposed to the doctrines of former ages than they are to the experience and common-sense of the present. The disciples of Hahnemann are conspicuous examples of this pseudo-scientific method. The difference between the two methods, as I have before intimated, is daily becoming more apparent. We are gradually banishing both from our theories and from our practice, much of that mystery-in an evil sense of the word -for which practitioners of the healing art were formerly quite proverbial; and we are becoming more accustomed to appeal to the common-sense of each other, and of our patients, in confirmation of our doctrines and our practice.

There is, probably, no better test of the truth or soundness of any doctrine, when applied to practice, than the fact of its being consistent with the dictates of well-informed common sense; and, perhaps, I could give no better illustration of the beneficial influence which has been exerted by this kind of appeal, than is to be afforded by the modified views now prevalent with regard to the nature and the treatment of inflammation. It certainly does appear contrary to common sense to suppose, that a disease, whatever may be its name or its nature, which has been induced by exhausting and depressing influences,-by excessive labour, by loss of rest, by abstinence, by hæmorrhage, or by some other drain upon the bodily strength,—that a disease so originating can