1847.]

Recent Medical Heresies.

395

heeded. Surely these are contingencies not to be hazarded with a view to follow laws of disease which lead to structural disturbance. The laws and history of ague have been most attentively and wisely studied for many ages; not in order that our practice might be in unison with those laws, but that it might interrupt and break the sequence of phenomena which would take place under them. If the disease be permitted to exhaust itself under this sequence, the patient is probably exhausted pari passu."-P. 183.

A little farther on, Dr. Mayo makes the following very just observations:

"There is something very attractive at first sight in the prostration of scientific interference before natural laws. But it is not justified by the history of the laws of disease, in the extent to which it is recommended. That history and those laws must in fact be attentively perused and excogitated, as the plans of an enemy are studied, and with the same intention; namely, with a view to obviate them or prevent their development. The doctrines of non-interference may gain a temporary sway through the talents of their supporters, but this truth, habitually familiar to the English mind, will afterwards recur in full force, and Young Physic * will rise from a temporary suspension of active measures to a more heroic use than ever of calomel and the lancet."-P. 188.

No sooner, however, has our author given expression to these remarks, than straightway he speaks of a report of cases treated on Homoeopathic principles as "a very valuable contribution," an "excellent detail!" As a specimen, he relates from the said report a case of Pneumonia, where the patient's life was evidently sacrificed to the plan of treatment by infinitesmal doses of Aconite and Phosphorus! Yet such is the system, by the adoption of which we have been told of late, by some who have put themselves forward as would-be regenerators of the science of Medicine, "homoeopathists cure nearly as many patients as the regular practitioners." On the strength of the very mischievously mismanaged case just alluded to, Dr. Mayo screws himself up to declare homoeopathy a "heresy ;" but the tenderness of his spirit seems at once to rebuke him for the harshness of such an expression, "which may seem inappropriate to the labours of the very respectable practitioners, by whom it has occasionally been carried out!" and he closes his remarks by predicting "that the theory of Hahnemann, and his school, is destined to melt away and disappear, or to be consolidated in a fragmentary state with the general mass of medical knowledge, so far as any portions of it can survive the test of time and experience."

Now we must frankly tell him, that it is not by such weak and washy means as he employs that the progress of rank empiricism is to be resisted, and the scientific character of our profession is to be defended against either the open assaults of mendacious quacks, or the covert underminings of false or ignorant friends within the camp. We want bolder and stouter men than him to expose and denounce the "heresy" that he alludes to Dr. Mayo, indeed, is not likely to apostatise from the true faith; but it would not do to rely upon his strenuous assistance in defence of it. He is one of those who are neither hot nor cold; but his lukewarmness seems to proceed rather from distrust of his own judgment than from any vacillation of principle. He evidently perceives the folly of the attempt that has lately been made to bring the niassaries of a do-nothing practice into favour, and yet he lacks courage to condemn it with energy and decision.

He gently taps the delinquents upon the back, expressing his regret that they have gone so far. He will not join with them; but he is not quite prepared to set himself against them. It is this weak and uncertain conduct, this half halting between two opinions, this vain seeking to reconcile the claims of science with the pretensions of quackery, that we cannot abide. It is high time for men to speak out their minds with unmistakeable decision. For any one, who has had the opportunity of studying diseases not in the closet or from books alone, but by the bedside of the sick, to try and make us believe that recovery from an acute malady like Pneumonia is quite as likely to take place in the hands of an Homœopathic doctor as in those of a regular Physician, is a piece of effrontery that we were certainly not prepared to expect in the present day. But the foolish attempt will not do. There may be much to correct alike in the science and in the art of medicine in the present day, both in this country and abroad. But it is assuredly not by preaching down either the over-active practice of some physicians, or by preaching up the do-nothing silliness of empirics; it is not either by denouncing polypharmacy on the one hand, or by eulogising homoeopathy on the other; it is not by suggesting the trial of every new remedy,* or by giving currency to the assertions of such men as Fleischmann or Henderson-alas! the disgrace to that uni

two

*The last suggestion, that has been made by one of the disciples of the "Young Physic" school, is the use of the cold-water sheet in the treatment of Fever! Some of the cases, treated according to the Preisnitzian plan, were cured within forty-eight hours! Morrison's Pills, we doubt not, could do the same. At least, an Hygeist would tell you so. But a much more offensive communication, than even that of the surgeon of the Leicester Dispensary, is the account given by a medical officer of one of H. M. ships of the practice which he has been pursuing, of late years, in the treatment of the crew that were committed to his professional care. This person-he wisely withholds his name, and that of the vessel to which he is attached-informs us that, upon a recent outbreak of Fever (the remittent of the Mediterranean, we believe) on board his vessel, he selected twelve cases for experiment. Of these, four were treated by him with Blood-letting and the use of vigorous antiphlogistic remedies; two with large doses (a scruple) of Quinine, from the very commencement of the attack; with liberal doses of Mercurials; two with a draught-containing 90 drops (!) of Laudanum, as many of tincture of Digitalis, and of antimonial and ipecacuan wines to be given at once, and to be repeated in six hours; and two with mere sponging of the surface with vinegar, and the unrestrained use of water to drink. Of the first four, two died; of the next two, one died; and of the following two, one died the others recovered. "Need I add," says this reckless promulgator of his own shame, "that, since that period, the patient labouring under Fever, who has been solely under my charge [his colleagues, we suppose, would never go along with him], has never been bled, or that but very little medicine, in the treatment of either the Mediterranean or the W. Indian Fever, has been expended in my practice." This wiseacre goes on to tell us that, for some years past, he has never used the lancet but once, on board his ship; and he closes his communication with cases of Gastrodynia, obstinate Constipation, and of Dysentery accompanied with Tape-worm, in which a cure was effected with bread-pills, after the ordinary remedies had failed! All this is certainly very creditable to the naval medical service, in the present day; and not less so to the character of professional journalism, in the 19th century!

1847.]

How to improve the Art of Medicine.

397

versity which has had a Cullen and a Gregory among its teachers, and is still graced by the names of an Alison and a Christison;-it is not by such means as these, that the errors of the healing art in the present day are to be corrected. No. It is by the inculcation of a more sedulous observation of diseases and of their symptoms, by a more minute enquiry into their predisposing and exciting causes, by a more exact scrutiny of the condition of every part of the body, fluid as well as solid, internal as well as external, and by a more diligent examination of all the excretions, but not an exclusive attention to any one of them; it is by carefully observing what things do harm and what do good, and by remembering how much may often be effected by regulation of the food and drink which a patient takes —a wide field of therapeutic research-of the air which he breathes, the locality where he resides; it is by studying the operation of Mind and its thousand feelings upon the health of the body, and of the influence of evil habits, unrestrained indulgences, vicious practices on the physical constitution of our nature;-it is in this way, and in this way alone, that the practice of Medicine can be improved, and our profession made to maintain that place in the estimation of the wise and the good, which it was designed to occupy. The natural, and indeed inevitable, result of following such a plan will be, that medical men will be simpler in their treatment of most diseases, more scientific and less mechanical and routinist in the selection of their remedies.

Many maladies, we all know, will cease quite as well and almost as quickly without medicines-but not without medical treatment-as with them. The numerous cases of catarrhs, rheumatic pains, &c. which are so rife just now (February), will generally subside under the use of the most simple means, provided due attention be paid to diet, clothing, exercise, &c. He who doctors such cases by mere physic, may unquestionably consult the interest of the chemist or the business-like appearance of his own daybook, but assuredly the patient will have no cause to thank him. Lower the diet, forbid strong meats and drinks, give diluents, enjoin warm clothing, and all will speedily be well;-more speedily perhaps, if some mild diuretic febrifuge be given at the same time. We have daily occasion to regret the too frequent neglect of hygienic, and the undue attention that is paid to medicinal, therapeutics. The physician who does not give exact instructions as to the former, in almost every case that he is consulted upon, has done but one half-and that often the least important-of his duty. In the treatment of some maladies, indeed, the direction of the regimen is almost every thing. Scrofula, in its hundred forms, bears witness of this. There is therefore quite as much skill required in the management of the diet, &c. as in the selection of the appropriate medicinal remedies to be employed. Nor are we to suppose that the treatment of diseases more by hygienic, and less by pharmaceutic, prescriptions affords any argument in favour of the extravagant notion that, because Nature is the agent in the cure of diseases, and as she acts in accordance with fixed and invariable laws, therefore "the aim of the physician ought always to be to facilitate her efforts by acting in harmony with, and not in opposition to, these laws." There is just about as weak and pernicious folly in ascribing all, or nearly all, to the "vis medicatrix naturæ," as there is in neglecting its operations altogether. In some cases, there is no curative effort at all No. 108

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made by the system. What, pray, would become of the Chlorotic girl, if the cure of her malady was left to-nay, were it even influenced bythe suggestions of her own feelings, and the cravings of her appetite? Or, is the patient, we may ask, affected with Diabetes, led by the instinctive promptings of Nature to avoid the use of those very articles of food which will inevitably exacerbate his malady, and aggravate all his sufferings? Again, in other cases, Nature may indeed effect a cure, or rather a termination, of an exciting disease; but it will be at the inevitable induction of a most serious lesion, or perhaps at the cost of life itself. Where is the homoeopathist who, if he was labouring under an attack of Iritis, threatening the loss of sight, would be satisfied with any thing short of the very active remedies which every enlightened physician would at once employ? And if inflammation is seen to produce such grave effects in the case of the Iris, its consequences are not less so in other parts which are hidden from our immediate inspection. That the subjective symptoms-those, we mean, independent of auscultatory investigationof Endocarditis, for example, will often cease under the employment of the most simple remedies, cannot be denied; but is there not more than sufficient warrant to believe that, under such circumstances, the liability to incipient organic mischief of the Heart will be tenfold greater than if the patient had been treated according to the principles which have been explained in a preceding article of our present Number?

We should like to have pursued these remarks, and to have endeavoured to point out what are the classes or families of diseases wherein the inexperienced practitioner is apt, on the one hand, to do too much, and, on the other, to ascribe undue importance to the medicinal agents which he may have employed in their treatment. But this we cannot do just now. Suffice it therefore merely to say, that it is more especially in the management of idiopathic Fevers of all sorts, that the operations of nature ought to be watched with most sedulous and patient attention, with the view of determining the line of practice that should be adopted. Infinite mischief has been done of late years by laying down dogmatic and peremptory rules for the treatment of diseases which change with every season, and almost vary in every individual. Had the indications of Nature, derived from a most diligent observation of all the symptoms of disease, been more faithfully followed out, and had the bold pretensions of pathological anatomy and physiology been more cautiously received, we should not now have been exposed to the taunts of the empiric, nor to the still more humiliating conviction within our own minds, that the boasted discoveries of modern medical science have not taught us how to treat a large proportion of diseases a whit more ably or successfully than did many of our predecessors in the old time before us.

1847.]

Renouard's History of Medicine.

399

I.

HISTOIRE DE LA MEDECINE DEPUIS SON ORIGINE JUSQU'AU XIX. SIECLE. Par le Dr. P. V. Renouard. Tom. II. pp. 980. 8vo. Paris, 1846.

II. ESSAI SUR L'HISTOIRE ET LA PHILOSOPHIE DE LA CHIRURGIE. Par M. Malgaigne.

[Concluded from page 316.]

Medical Organization in Europe during the Arabic Period.-In Europe amidst the chaotic confusion consequent upon the barbaric invasions, the ecclesiastical schools placed under the protection of the bishops, alone retained a slight image of literary and scientific instruction. The exercise of all the liberal professions, and especially of medicine, thus fell into the hands of the clergy; and we read of priests, abbots, and bishops officiating as the physicians of kings and popes. Several of the female religious orders likewise meddled with the practice of physic. Between the 9th and 13th centuries, the Jews, in spite of the canons of the Church which forbade them, divided this monopoly with the clergy. Several of them learned in Arabic were enabled to peruse the medical works in that language, and acquired a degree of skill in their treatment which caused their services to be sought in the courts of princes and even in the palaces of pontiffs. The acquirements of these practitioners, however, whether Jewish or Christian, were usually of the most meagre character; medical education, by reason of the rarity of books and the want of teachers, being an impossibility. No restriction on, or examination for, practice being in existence, crowds of low ignorant persons, barbers, bathmen, and women assumed the titles of curers of disease. Although the law provided no security against ignorant persons assuming these functions, it visited accidents which resulted from their ministration with fine or imprisonment. M. Malgaigne suggests that such severity was especially employed in surgical cases, the practice in which was abandoned to persons of the lowest condition, internal medicine only being in the hands of the Clergy. It is probably from about the 7th century that medicine became disunited from surgery. This separation, so little rational in itself, was in violation of the traditions of the great masters, and was gradually brought about by the ecclesiastical prohibitions against the clergy spilling blood, prohibitions which, from their frequent iteration by popes and councils, accompanied by the severest menaces, seem to have been constantly violated. However, in the course of the 12th century, the secular authority commenced endeavouring to remedy the abuses produced by this pernicious exercise of medicine. Roger of Sicily seems to have been the first sovereign who (1140) published an ordinance compelling those who would practise physic to obtain an authorization, and other monarchs gradually followed his example; while the institution of university grades and faculties completed medical organization.

5. The School of Salerno.-The origin of this celebrated school is some