"qu? res neque consilium neque modum habet ullum
eam consilio regere non potes."
ter. eun. act i, sc. i.
"master, the thing which hath not in itself
or measure or advice—advice can't rule."
colman.
position, progress, and prospects of the profession—of
hydropathy—of hom?opathy—of quackery—of public
ignorance.
a writer84, of no ordinary judgment and discrimination, has observed, that "it often happens in human affairs that the evil and the remedy grow up at the same time: the remedy unnoticed, and at a distance scarcely visible perhaps above the earth; whilst the evil may shoot rapidly into strength, and alone catch the eye of the observer by the immensity of its shadow; and yet," he adds, "a future age may be able to mark how the one declined and the other advanced, and how returning spring seemed no longer to renew the honours of the one, while it summoned into maturity and progress the perfection of the other."
we know not how it may appear to the reader, but we cannot help thinking that, in the foregoing sentence, there is a far-seeing341 perception of a very leading character in human affairs. there is no evil but which is charged with a certain degree of good. at first, it is indeed "scarcely visible"—nay, it escapes alike the most penetrative perception and faithful confidence, in the surpassing working-to-good of all things around us; but so soon as the evil begins to tell—so soon as the full flood of mischief becomes obtrusive or remarkable,—the small ripple of some corrective principle rises into view.
it would be easy to illustrate the foregoing proposition from general history, from the progress of nations, or even from the contracted area of individual experience. but we will confine ourselves to an illustration more directly in relation to our immediate object—namely, the present condition and prospects of medical science.
there are, no doubt, many persons who view the present state of medical science as little better than the triumphant domination of a conjectural art, which has long obscured, and is still very imperfectly representing, a beautiful science; and that the perception of the true relations which it bears to such science has been veiled by the impression that it involved some mystery from which the general public, who were most interested in its development, were necessarily excluded.
there have been at all times individuals, perhaps, sufficiently astute to see the real truth of the matter; but still they were rare exceptions, and did not prevent mystery from conferring, on a very considerable section of people, the social advantage of a gainful profession; that property being enhanced, of course, in that it ministered to an ignorant public. but, even in an early stage, correctives to an equivocally-earned advantage began to appear; for a thing which had no character but its indefiniteness, and its apparent facility of acquisition, obtained many followers: the supply, such as it was, was thus so close in relation to the demand, that what in theory seemed necessarily very gainful, in practice, on the whole, proved anything but a lucrative profession. as contrasted with any other, or a variety of commercial pursuits, medical men were neither so affluent, nor always so secure of their342 position. retiring competency in well-conducted callings has, in a rich country, been rather the rule. we fear, in the medical profession it is the exception; which, we are apprehensive (in its bereaved dependents), contributes more applicants for eleemosynary relief than any other.
this surely is not a state of things which can be well made worse. public ignorance, the real mischief, has, in the meantime, been left uninformed; and any attempt to enlighten it has too often been branded with some kind or other of corrupt motive. public positions have been conferred without competition—the surest test of fitness or excellence; and the public have been further doubly barred out, in that the chance of eliciting men of spirit and enthusiasm has been diminished, by the first positions having been often rendered contingent on the payment of money in the right quarter.
but all this time corrections were slowly springing up. hundreds were beginning, under the light of a more liberal diffusion of general knowledge, to feel that the so-called science of medicine and surgery was very different from science usually so termed; and, whilst other sciences were affording that which was definite and positive, the juxtaposition only seemed to bring out in higher relief the prevailing character of conjecture and uncertainty in medicine.
people began to see that, in mere human occupation, mystery is but mystery, to whatever it is applied; and that one man can see in the dark about as well as another; that, where all is obscure, any one may scramble with a chance of success. accordingly, we observe that a state of things has gradually been rising up, which, if it do not justify the expression of quot medici tot empirici, at least leads us to deplore that, of all callings in life, no one had ever such a legion of parasites as are represented by the hydra-headed quackeries which infest the medical profession. naturally enough, too, quackery attacked chiefly those disorders in regard to which mystery avowed its incapacity, or declared to be incurable; and thus, while the regular profession made their own limited knowledge the measures of the powers of343 nature, the quacks unconsciously proceeded, de facto, more philosophically, when they neither avowed nor acknowledged any other limits than those of observation and experience.
amongst, no doubt, innumerable failures, and, as we know, a multiplicity of fictions, they would now and then, in acting violently on the various organs, blunder on the last link in the chain—the immediate cause of the disorder; and perhaps effect the removal of a so-called incurable malady. thus, whilst the regular profession were making their own knowledge the measure of remedial possibility, and were reposing contentedly on the rule, they were every now and then undermined, or tripped up, by unexplained exceptions.
it is difficult to conceive any state of things, when once observed, more calculated to drive men to the obvious remedy that a definite science would alone afford; nor should it be forgotten that multiform quackeries, with mesmerism to boot, are coincident with a system which allows not one single appointment, which the public are requested to regard as implying authority, to be open to scientific competition. of late, many persons have begun to examine for themselves questions which they had been wont to leave entirely to their medical adviser.
the sanitary movement has shown that more people die every year from avoidable causes than would satisfy the yawning gulf of a severe epidemic, or the most destructive battle. in a crowded community, many events are daily impressing on the heads of families, besides the expedience of avoiding unnecessary expenses, that long illnesses are long evils; that their dearest connections are sometimes prematurely broken; and that parts are not unfrequently found diseased which are not suspected to be so during life. the thought will sometimes occur whether this may have been always consequent on the difficulty of the subject, or whether it may not have been sometimes the result of too hasty or too restricted an inquiry; that not only (as the spanish tutor told his royal pupil of kings) do patients die "sometimes," but very frequently.
these and other circumstances have induced many of the public to inquire into the reason of their faith in us; and to ask344 how it happens that, whilst all other sciences are popularized and progressing, there should be any thing so recondite in the laws governing our own bodies as to be accessible only to comparatively few; especially as they have begun to perceive that their interests, in knowing such laws, is of the greatest possible importance.
amongst various attempts to better this condition of things, the imagination of men has been very active. too proud to obey the guidance, or too impatient to await the fruition, of those cautious rules which the intellect has imposed on the one hand, and which have been so signally rewarded (whenever observed) on the other, imagination has set forth on airy wing, and brought home curiosities which she called science, and observations which, because they contained some of that truth of which even fancies are seldom entirely deprived, blinded her to the perception of a much larger portion of error.
two of these curiosities have made considerable noise, have been not a little damaging to the pecuniary interests of the medical profession, and have been proportionately species of el dorados to the followers of them. we allude to the so-called hom?opathy and hydropathy.
hom?opathy proceeds on an axiom that diseases are cured by remedies which excite an action similar to that of the disease itself; "similia similibus curantur."
our objection to this dogma is twofold, and, in the few hints we are giving, we wish them not to be confounded.
1st. it is not proven.
2nd. it is not true.
take the so-called fever. the immediate and most frequent causes of fever are bad air, unwholesome food, mental inquietude, derangement of the digestive organs, severe injuries. now it is notorious that very important agents in the cure of all fevers are good air, carefully exact diet or temporary abstinence, and correction of disordered functions, with utmost repose of mind and body, and so forth.
so of small-pox, one of the most instructive of all diseases. all the things favourable to small-pox are entirely opposite to345 those which conduct the patient safely through this alarming disease; and so clearly is this the case, that, if known beforehand, its virulence can be indefinitely moderated, so as to become a comparatively innoxious malady.
we might go on multiplying these illustrations to almost any extent. what, then, is the meaning of the similia similibus curantur? this we will endeavour, so far as there is any truth in it, to explain. the truth is, that nature has but one mode, principle, or law, in dealing with injurious influences on the body. before we offer the few hints we propose to do on these subjects (and we can here do no more), we entirely repudiate that sort of abusive tone which is too generally adopted. that never can do anybody any good. we believe both systems to be dangerous fallacies; but, like all other things, not allowed to be entirely uncharged with good. we shall state, as popularly as possible, in what respect we deem them to be dangerous fallacies, and in what we deem them to be capable of effecting some good; because it is our object to show, in respect to both, that the good they do is because they accidentally, as it were, chip off a small corner of the principles of abernethy.
hom?opathy is one of those hypotheses which show the power that a minute portion of truth has to give currency to a large quantity of error; and how much more powerful in the uninformed are appeals to the imagination than to the intellect. the times are favourable to hom?opathy. to some persons, who had accustomed themselves to associate medical attendance with short visits, long bills,—a gentleman in black, all smiles,—and a numerous array of red bottles, hom?opathy must have addressed itself very acceptably. it could not but be welcome to hear that all the above not very pleasing impressions could be at once dismissed by simply swallowing the decillionth part of a grain of some efficacious drug. then there was the prepossession so common in favour of mystery. how wonderful! so small a quantity! what a powerful medicine it must be! it was as good as the fortune-telling of the gipsies. there! take that, and then you will see what will happen next! then, to get released from red bottles tied over with blue or red paper, which,346 if they were not infinitesimal in dose, had appeared infinite in number, to say nothing of the wholesome repulsion of the palate.
besides, after the bottles, came the bill, having no doubt the abominable character of all bills, which, by some law analogous to gravitation, appear to enlarge in a terrifically accelerating ratio, in proportion to their longevity; so that they fall at last with an unexpected and a very unwelcome gravity. then hom?opathy did not restrict itself to infinitesimal doses of medicine, but recommended people to live plainly, to relinquish strong drinks, and, in short, to adopt what at least seemed an approximation to a simple mode of living. to be serious—what, then, are the objections to hom?pathy?
is there no truth, then, in the dogma, "similia similibus curantur?" we will explain. the laws governing the human body have an established mode of dealing with all injurious influences, which is identical in principle, but infinitely varied and obscured in its manifestations, in consequence of multifarious interferences; in that respect, just like the laws of light or of gravitation. as we have no opportunity of going into the subject at length, we will give a hint or two which will enable the observing, with a moderate degree of painstaking, to see the fallacy. you can demonstrate no fallacy in a mathematical process even, without some work; neither can you do so in any science; so let that absence of complete demonstration be no bar to the investigation of the hints we give. all medicines are more or less poisons; that is, they have no nutritive properties, or these are so overbalanced by those which are injurious, that the economy immediately institutes endeavours for their expulsion, or for the relief of the disturbance they excite. all organs have a special function of their own, but all can on occasions execute those of some other organ. so, in carrying out injurious influences, organs have peculiar relations to different forms of matter; that is, ordinarily. thus, the stomach is impatient of ipecacuanha, and substances which we call emetics; the liver, of mercury, alcohol, fat, and saccharine matters; and so forth. in the same way we might excite examples of other organs which ordinarily deal with particular natural substances. but then, by347 the compensating power they have, they can deal with any substance on special occasions.
now the natural mode in which all organs deal with injurious substances, or substances which tend to disturb them, is by pouring forth their respective secretions; but if, when stimulated, they have not the power to do that, then they evince, as the case may be, disorder or disease. thus, for example: if we desire to influence the secretion from the liver, mercury is one of the many things which will do it. but if mercury cease to do this, it will produce disease; and, if carried to a certain extent, of no organ more certainly than the liver. thus, again, alcohol, in certain forms, is a very useful medicine for the liver; yet nothing, in continuance, more notoriously produces disease of that organ. so that it happens that all things, which in one form disorder an organ, may, in another form, in greater or more continued doses, tend to correct that disorder, by inducing there a greater, and thus exciting stimulation of its secretions.
this is the old dogma, long before hom?opathy was heard of, of one poison driving out another. this is the way in which fat bacon, at one period, or in one case, may be a temporary or a good stimulant of a liver which it equally disorders in another; for as the liver is a decarbonizing agent, as well as the lungs, so articles rich in carbon are all stimulants of that organ; useful, exceptionally; invariably disordering, if habitual or excessive.
but if this be so, what becomes of the "curantur?" to that, we say it is far from proven. medicine hardly ever—perhaps never, strictly speaking—cures; but it often materially assists in putting people in a curable condition, proper for the agencies of more natural influences. true. well, then, may not hom?opathy be good here? we doubt it; and for this reason: medicine, to do good, should act on the organ to which it is directed; it is itself essentially a poison, and does well to relieve organs by which it is expelled; but if you give medicine in very small doses, or so as to institute an artificial condition of those sentinels, the nerves, you may accumulate a fearful amount of injurious influence in the system before you are at all aware of it. and it is the more necessary to be aware of this in respect to hom?opathy;348 because many of the medicines which hom?opathists employ are active poisons; as belladonna, aconite, and so on. we have seen disturbed states of nerves, bordering on paralysis, which were completely unintelligible, until we found that the patient had been taking small doses of narcotic poisons. we have no desire whatever to forestall the cool decisions of experience; but we earnestly request the attention of the hom?opathist to the foregoing remarks; and, if he thinks there is anything in them, to peruse the arguments on which we found the law of which we have formerly spoken85.
we must in candour admit that, as far as the inquiry into all the facts of the case go, as laid down by hahnemann, we think the profession may take a hint with advantage. we have long pleaded for more accuracy in this respect; but we fear, as yet, pleaded in vain. hom?opathic influences may be perhaps more successful. practically, the good that results from hom?opathy, as it appears to us, may be thus stated: that if people will leave off drinking alcohol, live plainly, and take very little medicine, they will find that many disorders will be relieved by this treatment alone.
for the rest, we fear that the so-called small doses are either inert, or, if persisted in so as to produce effect, that they incur the risk of accumulating in the system influences injurious to the economy; which the histories of mercury, arsenic, and other poisons, show to be nothing uncommon: and, further, that this tends to keep out of sight the real uses and the measured influences of medicine, which, in the ordinary practice, their usual effects serve, as the case may be, to suggest or demonstrate.
practically, therefore, the effects of hom?opathy resolve themselves, so far as they are good, into a more or less careful diet, and small doses of medicine; which, as we have said, is a chipping off of the views of abernethy.
we regret we have no space to consider the relation of hom?opathy to serious and acute diseases. we can therefore only say349 that the facts which have come before us have left no doubts on our minds of its being alike dangerous and inapplicable.
one morning, a nobleman asked his surgeon (who was representing to him the uselessness of consulting a medical man without obeying his injunctions) what he thought would be the effect of his going into a hydropathic establishment? "that you would get perfectly well," was the reply; "for there your lordship would get plain diet and good air, and, as i am informed, good hours; in short, the very things i recommend to you, but which you will not adopt with any regularity."
hydropathy sets out, indeed, with water as its staple, and the skin as the organ to which it chiefly addresses itself; but we imagine that the hydropathic physician, if he sees nothing in philosophical medicine, discovers sufficient in human nature, to prevent him from trading on so slender a capital. there was, no doubt, in the imperfection of medical science, a fine opening left for a scheme which proposed to rest its merits chiefly on an organ so much neglected.
there has never been anything bordering on a proper attention to the skin, until recently; and even now, any care commensurate with the importance of the organ, is the exception rather than the rule. thirty years ago, abernethy, when asked by a gentleman as to the probable success of a bathing establishment, said that the profession would not be persuaded to attend to the subject; and that, in respect to the capital which the gentleman proposed to invest in it, he had better keep the money in his pocket. this was said in relation to the general importance of attention to the skin, and also in connection with making it the portal for the introduction of medical agents generally. abernethy was, in fact, the first who introduced into this country lalonette's method of affecting the system by mercury applied to the skin in vapour.
hydropathy deals with a very potent agent, and applies it to a very powerful and important organ, the skin; and it employs in combination the energetic influences, temperature and moisture;350 so that we may be assured there will be very little that is equivocal or infinitesimal in its results; that in almost every case it must do good or harm.
but it does not limit itself to these agencies. it has "establishments;" that is to say, pleasant rural retreats, tastefully laid-out gardens; plain diet; often, no doubt, agreeable society; rational amusements; and, as we understand, good hours, with abstinence from alcohol. these are, indeed, powerful agencies in a vast variety of diseases. so that, if hydropathy be not very scientific, it is certainly a clever scheme; and as there are very many people who require nothing but good air, plain living, rest from their anxious occupations, with agreeable society,—it is very possible that many hydropathic patients get well, by just doing that which they could not be induced to do before.
but here comes the objection: the skin is, in the first place, only one of the organs of the body, and it is in very different conditions in different people, and in the same people at different periods.
it has, like other organs, its mode of dealing with powerful or with injurious influences; and if it deal with them in the full force of the natural law, it affects (and, in disease, almost uniformly) favourably the internal organs; but, on the other hand, if there be interfering influences opposed to the healthy exhibition of the natural law, so that the skin do not deal with the cold, or other agencies, to which it is subjected, as it naturally should do, then the cold, moisture, or other agent, increases the determination of the blood to the internal organs, and does mischief. this it may do in one of two ways: we have seen both. 1st. the blood driven from the surface, increases, pro tanto, the quantity in the internal organs: it must go somewhere; it can go nowhere else. or, if cold and moisture produce not this effect, nor be attended with a reactive determination to the surface, there may be an imperfect reaction; that is, short of the surface of the body. in the first case, you dangerously increase the disorder of any materially affected organ; in the latter, you incur the risk of diseased depositions; as, for example, tumours. we here speak from our own experience, having seen tumours of the most351 malignant and cancerous character developed under circumstances in which it appeared impossible to ascribe the immediate cause to anything but the violently depressing influence of hydropathic treatment on the skin, with a co-existing disordered condition of internal organs.
in one very frightful case indeed, the patient was told, when he first stated his alarm, that the tumour was a "crisis" or reaction; as sure enough it was; but it was the reaction of a cancerous disease, which destroyed the patient. but, as we have said, hydropathy has many features which obviously minister very agreeably and advantageously to various conditions of indisposition, whilst they favour the bona fide observance of something like a rational diet—a point of immense consequence, and too much neglected in regular practice. here again we speak from actual observation. one man allows his patient to eat what he pleases. an eminent physician replied to a patient who, as he was leaving the room, asked what he should do about his diet, "oh, i leave that to yourself;" showing, as we think, a better knowledge of human nature than of his profession. another restricts his patient to "anything light." others see no harm in patients eating three or four things at dinner, "provided they are wholesome;" thus rendering the solution of many a question in serious cases three or four times, of course, as difficult. now we do not require the elaborate apparatus of a hydropathic establishment to cure disorders, after such loose practice as this; and we do protest against the assertion that any such treatment can be called, as we have sometimes heard it, "abernethy's plan, attention to diet," and so forth.
so far from anything less than the beautifully simple views held out by abernethy being necessary, we trust that we have, some of us, arrived, as we ought to do, at several improvements. but people will confound a plain diet, or a select diet, with a starving diet, and, hating restrictions altogether, naturally prefer a physician who is good-natured and assenting; still this assentation is being visited, we think, with a justly retributive reaction.
hydropathy, in many points, no doubt, tends to excite attention to the real desiderata; but it is nevertheless imperfect and352 dangerous, because evidently charged with a capital error. it entirely fails in that comprehensive view of the relations which exists in all animals between the various organs; and on a sustained recollection and examination of which, rests the safe treatment of any one of them. it is, therefore, unsafe and unscientific. again, it is illogical, because it proceeds, as regard the skin, on the suppressed premise, that it will obtain a natural reaction; a thing, in a very large number of cases, and those of the most serious kind, seldom to be calculated on.
it is quite clear, therefore, that, so far as hydropathy does good, it effects it by the institution of diet, abstinence from alcohol, country air, exercise, agreeable society, and, we will suppose, in some cases, appropriate care of the surface; all of which are, in a general sense, beneficial to the nervous system and the digestive organs—the points insisted on by abernethy.
so long as the public are not better informed, and until medicine is more strictly cultivated as a science, they will necessarily be governed by the first impression on their feelings; and so long as this is the case, fallacies can never be exposed, except by the severe lessons of experience. to hope to reason successfully with those whose feelings induce them to adopt that which they decline to examine with their intellect, is madness, and is just what terence says of some other feelings:
"nihilo plus agas
quam si des operam ut cum ratione insanias."
but, although, therefore, we are neither hydropathists nor hom?opathists, we begin to see, in the very success of these things, some good; and that the "great shadow of the evil" of a conjectural science will one day be replaced by another example of the triumph of an inductive philosophy; that the retiring confidence of the public will induce in us a more earnest and successful effort to give them a more definite science; and that, as professor smythe says, the "returning spring will no longer renew the honours of the one," whilst it will gradually evolve the development of the other.
the efforts, too, which the profession are already making,353 though, as we humbly consider, not in the right direction, will certainly arrive in time at a path that is more auspicious. when we see the hydropathist looking so much to the skin, hom?opathy leading people to think of quantities of medicine; when, in the regular profession, we see one man restricting his views to one organ, another to another, a third thinking that everything can be learnt only by examination of the dead, thus confounding morbid anatomy with pathology—a fourth restricting his labours to the microscope, as if the discovery of laws depended rather on the enlargement of sensual objects than on the improvement of intellectual vision; still we cannot but perceive that these isolated labours, if once concentrated by unity of purpose and combined action, would be shadowing forth the outline of a really inductive inquiry.
hydropathy and hom?opathy are making powerful uses, too, of the argumenta ad crumenam. their professors are amassing very large sums of money, and that is an influence which will in time probably generate exertions in favour of a more definite science. still, medicine and surgery cannot be formed into a science so long as men consider it impossible; nor can there be any material advance, if they will persist in measuring the remedial processes of nature by their present power of educing them—a presumption obviously infinitely greater than any in which the veriest quack ever dared to indulge. well did lord bacon see the real difficulties of establishing the dominion of an inductive philosophy, when he laboured so much in the first place to destroy the influence of preconceived opinions—idols, as he justly called them.
you cannot, of course, write truth on a page already filled with conjecture. nevertheless, mankind seem gradually exhausting the resources of error: many of her paths have been trodden, and their misleading lures discovered; and by and by that of truth will be well-nigh the only one left untried. in the meantime, we fear the science is nearly good enough for the age. the difficulty of advance is founded deeply in the principles of human nature. people know that there are physical laws as well as moral laws, and they may rely on it that disobedience and disease, sin354 and death, are as indissolubly bound up with infractions of the one as well as the other.
it is true there are many who have (however unconsciously) discovered that the pleasures procured by the abuses of our appetites, are a cheat; and that permanent good is only attained by obeying those laws which were clearly made for our happiness.
error has, indeed, long darkened the horizon of medical science; and, albeit, there have been lightning—like coruscations of genius—from time to time; still they have passed away, and left the atmosphere as dark as before. at length, however, there has arisen, we hope, a small, but steady, light, which is gradually diffusing itself through the mists of error; and which, when it shall have gained a very little more power, it will succeed in dispelling.
then, we trust, medicine will be seen in the graceful form in which she exists in nature; as a science which will enable us to administer the physical laws in harmony with that moral code over which her elder sister presides; but, whenever this shall happen, surgery will recognize, as the earliest gleams of light shed on her paths of inquiry, in aid of the progress of science and the welfare of mankind, the honoured contributions of john hunter and john abernethy.
