Abbildungen der Seite
PDF
EPUB

other art, than to spin any amount of nice , chronic, it must be owned there is an inscruhypotheses, or build any number of “castella table s, Osov, a specific property which eludes in aere," as Sydenham calls them. The ob- the keenest anatomy.” server's object is, and it is no mean one, - He then goes on to say, that as Hippo

crates censured the abuse of anatomy, so “ To know what's what, and that's as high in his own day there were many who, in like As Metaphysic wit can fly.”

manner, raised hopes for Physic from discov

eries in Chemistry, which, in the nature of Sydenham adds, “Nor will the publica- things, never could be realized, and which tion of such observations diminish, but rather only served to distract from the true Hippoincrease the reputation of our art, which, be- cratic method of induction; "for the chief ing rendered more difficult

, as well as more deficiency of medicine is not a want of efficauseful, only men of sagacity and keen sound cious medicine. Whoever considers the matjudgment would be admitled as physicians."

ter thoroughly, will find that the principal How true to the spirit of his great master in defect on the part of physic proceeds, not his Novum Organum, “Nature is only sub- from a scarcity of medicines 10 answer pardued by submission!” “The subtilty of na- | 'ticular intentions, but from the want of knowture is far beyond that of sense, or of the ing the intentions to be answered, for an apothunderstanding, and the specious meditations ecary's apprentice can tell me what medicine and theories of mankind are but a kind of will purge, vomit, or sweat, or cool; but a insanity, only there is no one to stand by and

man must be conversant with practice who observe it.' There is a very remarkable is able to tell me when is the properest time passage in Sydenham's." Treatise of the for administering any of them.” Dropsy,” in which, after quoting this curious

He is constantly inculcating the necessity passage from Hippocrates, “certain physi- of getting our diagnostic knowledge at first cians and philosophers say that it is impossi- hand, ridiculing those descriptions of disble for

any

man to understand medicine with ease which the manufacturers of “ Bodies out knowing the internal structure of man; of Medicine” make up in their studies, and for my part, I think that what they have which are oftener compositions than portraits, written or said of nature pertains less to the or at the best bad copies, and which the medical than the pictorial art,” be asserts young student will find it hard enough to not only his own strong conviction of the identify in real life. There is too much of importance of a knowledge of minute anato- this we fear still; and Montaigne, who remy to the practitioner, but also his opinion joices in giving a sly hit to his cronies, the that what Hippocrates meant was to caution doctors, might still say with some reason, against depending too much on, and expect-like him who paints the sea, rocks, and ing too much help from anatomical research- havens, and draws the model of a ship as he es, to the superseding of the scrupulous ob- sits safe at his table ; but send him to sea servation of living phenomena, of successive and he knows not how or where to steer : so actions. * “For in all diseases, acute and doctors oftentimes make such a description

of our maladies as a town-crier does of a * As far as the cure of diseases is concerned, lost dog or donkey, of such a color and Medicine has more to do with human Dynamics height, such ears, &c.; but bring the very than Statics, for whatever be the essence of life- animal before him, and he knows it not for all and as yet this so delov, this nescio quid divinum, that.bas defied all scrutiny-it is made known to us Everywhere our author acknowledges the chiefly by certain activities or changes. It is the vis medicatrix natura, by which alone so tendency at the present time of medical research to reverse this order. Morbid anatomy, microscopical many diseases are cured, and without or investigations, though not confined to states or con against which none, and by directing and ditions of parts, must regard them fully more than helping which medicine best fulfills its end. actions and functions. This is probably what Stahl means when he says, "ubi Physicus desinit

, Medicus incipit ;" and in the following passage of his rough magis in materiam energia, tempora ejus, gradus, Tudesque Latin, he plainly alludes to the tendency, vices, maxime autem omnium, fines obiter in aniin his day, to dwell too much upon the materials of mum admittuntur.” The human machine has been the human body, without considering its actions “ut compared to a watch, and some hope that in due vivens.” The passage is full of the subtilty and time doctors will be as good at their craft as watchfire and depth of that wonderful man. “Undique makers are at theirs; but watchmakers have not to hinc materiæ advertitur animus, et quæ crassius in mend their work while it is going ; this makes all sensum impingit conformatio, et mutua proportio the difference. corporea consideratur; motuum ordo, vis, et absoluta

" For I do not think it below me or my art to he is always spoken of as the father of rational acknowledge, with respect to the cure of fevers medicine, as the first man who applied to and other distempers, that when no manifest indi; his profession the Baconian principles of cation pointed out to me what should be done, I have consulted my patient's safety and my own

interpreting and serving nature, and who reputation, most effectually, by doing nothing at never forgot the master's rule, “non fingenall

. But it is much to be lamented that abundance dum aut excogitandum, sed inveniendum, of patients are so ignorant as not to know, that quid natura aut faciat aut ferat.”

He was it is sometimes as much the part of a skillful what Plato would have called an “artsman,' physician to do nothing, as at others to apply the as distinguished from a doctor of abstract most energetic remedies, whence they not only science. But he was by no means deficient deprive themselves of fair and honorable treat- in either the capacity or the relish for specument, but impute it to ignorance or negligence.”

lative truth. Like all men of a large pracWe conclude these extracts with a pic-tical nature, he could not bave been what he turesque description. It is a case of the was, or done what he did, without possessing hysterics” in a man.

and often exercising the true philosophizing

faculty. He was a man of the same quality "I was called not long since to an ingenious of mind in this respect with Watt, Franklin, gentleman who had recovered from a fever, but a and John Hunter, in whom speculation was few days before he had employed another physi: not the less genuine that it was with them a cian, who blooded and purged him soundly, and

means rather than an end. forbade him the use of flesh. When I came I found him up, and heard him talking sensibly. I

This distinction between the science and asked why I was sent for, to which one of his the art or craft, or as it was often called the friends replied with a wink, wait and you'll see. cunning of medicine, is one we have already Accordingly, sitting down and entering into dis- insisted upon, and the importance of which course with the patient, I perceived his under lip was thrust outward, and in frequent motion, as dition of this department of knowledge and

we consider very great, in the present conhappens to peevish children, who pout before they cry, which was succeeded by the most violent fit practice. We are now-a-days in danger of of crying, with deep and convulsive sobs. I con- neglecting our art in mastering our science, ceived this was occasioned partly by his long ill- though medicine must always be more of an ness, partly by the previous evacuations, and art than of a science. It being the object of partly by emptiness; I therefore ordered him a

the student of physic to learn or know some roast chicken, and a pint of canary.”

thing or things, in order to be able safely,

effectually and at once, to do some other In making these selections we have done our thing; and inasmuch as human nature canauthor great injustice, partly from having to not contain more than its fill, a man may not give them either in Swan's translation or our only have much scientific truth in his head, own, and thereby losing much of the dignity which is useless, but it may shut out and and nerve—the flavor, or what artists would hinder

, and even altogether render ineffectual, call the crispness of the original; partly the active, practical, artistical faculties, for also from our being obliged to exclude strict whose use his knowledge was primarily got. ly professional discussions, in which, as might It is the remark of a profound thinker, that be expected, his chief value and strength lie. We know nothing in medical literature advantage in not being allowed to be ignorant

"all professional men labor under a great dismore exquisite than his letter to Dr. Cole on of what is useless ; every one fancies that he the hysterical passion, and his monograph of is bound to receive and transmit whatever is the gout. Well might Edward Hannes, the believed to have been known.” friend of Addison, in his verses on Syden

This subject of art and science is hinted ham, thus sing :

at, with his usual sagacity, by Plato, in a “ Sic te seientem non faciunt libri

very singular passage in his Theatetus :Et dogma pulchrum ; sed sapientia

Particulars," he says, “are infinite, and Enata rebus, mensque facti

the higher generalities gire no sufficient direcExperiens, animusque felix.”

tion in medicine; but ihe pith of all sciences, It would not be easy to over-estimate the that which makes the arisman differ from the permanent impression for good, which the inexpert, is in the middle propositions, which, writings, the character, and the practice of in every particular knowledge, are taken from Sydenham have made on the art of healing tradition and experience."* It would not be in England, and on the Continent generally. In the writings of Boerhaave, Stahl, Gau

* Being anxious to see what was the context of bius, Pinel, Bordeu, Haller, and many others, this remarkable passage, which Bacon quotes, as if

easy to convey in fewer words, more of have been appropriated, and vitally adopted, what deserves the name of the philoso- by the mind, and which, to use Bacon's strong phy of this entire subject, and few things words, have been “drenched in flesh and would be more for the advantage of the best blood,” have been turned in “ Succum et interests of all arts and sciences, and all true sanguinem ;" for man's mind, any more than progress in human knowledge and power, his body, cannot live on mere elementary than the taking this passage and treating it substances; he must have fat, albumen, and exegetically, as a divine would say, bring- sugar ; he can make nothing of their eleing out fully its meaning, and illustrating ments, bare carbon, azote, or hydrogen. And it by examples. Scientific truth is to the more than this, as we have said, he must mind of a physician what food is to his body; digest and disintegrate his food before it can but, in order to his mind being nourished and be of any use to him. In this view, as in growing by this food, it must be assimilated another and a higher, we may use the sacred -it must undergo a vital internal change- words,—“That which thou sowest is not must be transformed, transmuted, and lose quickened except it die : except a corn of its original form. This destruction of formal wheat fall into the ground and die, it abideth identity--this losing of itself in being received alone ; but if it die, it bringeth forth much into the general mass of truth—is necessary fruit ;" for as it is a law of vegetable life, to bring abstract truth into the condition of that a seed does not begin to pass into a new what Plato calls “the middle propositions," form, does not begin to grow into a plant, or, as Mr. J. S. Mill calls them, the generalia until its nature is changed, and its original of knowledge.* These are such truths as condition is broken up, until it “dies" in

giving birth to something better,—so is it verbatim, in his advancement of learning, we bunted the mind—it must die, else it abides alone

with scientific truth, taken into or planted in through the Theatetus, but in vain. We set two friends, thorough-bred Grecians, upon the scent, but it does not germinate. they could find no such passage. One of them then Had Plato lived now, he might justly have spoke to Sir William Hamilton, and he told him said, “particulars are infinite.” Facts, as literal translation of any sentence in Plato's writings such, are merely so many units, and are often He considered it a quotation from memory, and as

rather an encumbrance to the practical man giving the substance of a passage in the Philebus, than otherwise. These “middle proposiwhich occurs in the 6th and 7th of the forty-two tions” stand midway between the facts in sections of that Dialogue. Perhaps the sentence their infinity and speculative truth in its abwhich comes nearest to the words of Bacon is the last in the 6th section, beginning with the words stract inertness; they take from both what οι δε νύν των ανθρώπων σοφοι. The τα δε μεσα | they need, and they form a tertium φuid, aurous expeuye, of which he speaks, seem to be upon which the mind can act practically, and equivalent to "the middle propositions.”

reason upon in practice, and form rules of * The following we give as a sort of abstract of

action. Sydenham, Hippocrates, Abernethy, an admirable chapter in Mill's Logic on “The Logic Pott, Hunter, Baillie, Abercrombie, and such of Art:"-An art, or a body of art

, consists of the like, among physicians, are great in the region rules, together with as much of the speculative pro- of the “middle propositions." They selectpositions as comprise the justification of those rules

. ed their particulars—their instances, and they Art selects and arranges the truths of science in the made their higher generalities come down, order most convenient for thought-science follow they appropriated them, and turned them ing one cause to its various effects, while art traces into blood, bone, and sinew. one effect to its multiplied and diversified causes The great problem in the education of and conditions. There is need of a set of intermediate scientific truths, derived from the higher generalities young men for medicine in our times, is to of science, and destined to serve as the generalia or

know

how to make the infinity of particulars, first principles of art. The art proposes for itself the prodigious treasures of mere science, an end to be gained, defines the end, and hands it available for practice—how the art may keep over to science. Science receives it, studies it as a phenomenon or effect, and, having investigated its pace with, and take the maximum

of good

out of the science. We have often thought causes and conditions, sends it back to Art, with a rationale of its cause or causes, but nothing more.

that the apprenticeship syslem is going too Art then examines their combinations, and accord much into disrepule. It had its manifest and ing as any of them are or are not in human power, great evils ; but there was much good got by or within the scope of its particular end, pronounces it that is not to be upon their utility, and forms a rule of action. The

way. rules of art do not attempt to comprise more cond, The personal authority, the imitation of their tions than require to be attended to in ordinary cases i master—the watching his doings, and picking and therefore are always imperfect.

up his practical odds and ends--the coming

got in

any other

[ocr errors]

under the influence of his mind, following in lowed, to show how much they had eaten, in-
his steps, looking with his eyes, accumulating stead of concocting it into wool and milk.
a stock of knowledge, multifarious it might Men of the “middle propositions" are not
be, the good of which was not fully known clever, glib expounders of their reasons,
till after-years explained and confirmed its they prefer doing a thing to speaking about
worth. There were other practical things how it may be done. We remember hear-
besides jokes learned and executed in the ing a young doctor relate how, on one oc-
apprentices' room, and there were the friend casion when a student, he met with the late
ships for life, on which so much, not merely Dr. Abercrombie, when visiting a man who
of the comfort, but the progress of a phy- was laboring under what was considered
sician depends. Now everything, at least malignant disease of the stomach. He was
most, is done in public, in classes; and it is present when that excellent man first saw
necessarily with the names of things rather the patient along with his regular attendant.
than the things themselves, or their manage. The doctor sauntered into the room in his
ment, that the young men have chiefly to do. odd, indifferent way, which many must rec-
The memory* is exercised more than the ollect; scrutinized all the curiosities on the
senses or the judgment; and when the exami- mantelpiece; and then, as if by chance, found
nation comes, as a matter of course the student himself at his patient's bedside ; but when
returns back to his teacher as much as pos- there his eye settled upon him intensely ;
sible of what he has received from him, and his whole mind was busily at work. He
as much as possible in his very words. He asked a few plain questions ; spoke with
goes over innumerable names. There is lit- great kindness, but very briefly; and, com-
tle opportunity even in anatomy for testing ing back to consult, he said, to the astonish-
his power or his skill as a workman, as an ment of the surgeon and the

young student, independent observer and judge, under what the mischief is all in the brain, the stomach Sir James Clark justly calls "the demoralizing is affected merely through it. The case will system of cramming. He repeats what is do no good; he will get blind and convulsed, already known; he is not able to say how and die.” He then in his considerate, simple all or any of this knowledge may be turned way, went over what might be done to palto practical account. Epictetus cleverly il- liate suffering and prolong life.

He was lustrates this very system and its fruits right. The man died as he said, and on ex“ As if sheep, after they have been feeding, amination the brain was found softened, the should present their shepherds with the very stomach sound. The young student, who grass itself which they had cropped and swal- was intimate with Dr. Abercrombie, ventured

to ask him what it was in the look of the * Professor Syme, in his Letter to Sir James Gra- man that made him know at once. “I can't ham on the Medical Bill, in which, in twelve pages, tell you, I can hardly tell myself ; but I rest he puts the whole of this vexed question on its true frooting, makes these weighty observations :—“As

with confidence upon the exactness and a teacher of nearly twenty-five years' standing, and honesty of my past observations. I rememwell acquainted with the dispositions, babits, and ber the result, and act upon it; but I can't powers of medical students, I beg to remark, that put you, or, without infinite trouble, myself, subject by different Boards, especially if protracted in possession of all the steps.” “But would beyond the age of twenty-two, is greatly opposed

you tell to the acquisition of sound and useful knowledge. others ?" said the young doctor.

It would Medicine, throughout all its departments, is a science be no such thing ; il would be the worst thing of observation; memory alone, however retentive, that could happen to you; you would not or diligently assisted by teaching, is unable to afford know how to use it. You must follow in the the qualifications for practice, and it is only by digest- same road, and you will get as far, and much ing the facts learned, through reflection, comparison, and personal research, that they can be appropriated farther. You must miss often before you with improving effect; but when the mind is loaded bit. You can't tell a man how to hit ; you with the minutiæ of elementary medical and collateral may tell him what to aim at.” “Was it study, it is incapable of the intense and devoted at something in the eye !” said his inveterate cellence in practical medicine and surgery. It has querist. "Perhaps it was,” he said goodaccordingly always appeared to me, that the charac-naturedly ; “but don't you go and blister ter of medical men depends less upon what passes every man's occiput, whose eyes are, as you during the period even of studentship than upon the think, like his."* mode in which they spend the next years, when their trials and examinations being over, the whole strength of a young and disciplined intellect may be pre- * This is very clearly stated by Dr. Mandeville, paring itself for the business of life.”

the acute but notorious author of the Fable of the

[ocr errors]

It would be well for the community, and pouring in from without, keep our senses for the real good of the profession, if the ripe and our understandings well exercised on experience, the occasional observations of immediate work. Let us look with our own such men aś Sydenham and Abercrombie, eyes, feel with our own fingers. formed the main amount of medical books, One natural consequence of the predomiinstead of Vade Mecums, Compendiums, nance in our days of scientific element, is, Systems, Handbooks, on the one hand, and that the elder too much serves the younger. the ardent but unripe lucubrations of very The young man teaches, and the old man young men.

It is said that facts are what learns. This is excellent, when it is confined we want, and every periodical is filled with to the statement of discovery, or the laws of papers by very young physicians made up knowledge or of matter.

But the young of practical facts. What is fact? we would men have now almost the whole field to ask; and are not many—most of the new themselves. Chemistry and Physiology facts, little else than the opinions of the have become, to all men above forty, imposwriters about certain phenomena, the reality, sible sciences; they dare not meddle with and assuredly the importance of which, is them; and they keep back from giving to by no means made out so strongly as the the profession their own personal experience opinions about them are stated.* In this in- in matters of practice, from the feeling that tensely scientific age, we need some wise much of their science is out of date; and the heads to tell us what not to learn, fully as consequence is, that, even in matters of pracmuch as what to learn. Let us by all means tice, the young men are in possession of the avail ourselves of the unmatched advantages field. of science, and of the discoveries which every Let it not be supposed that we despair of day is multiplying with a rapidity which con- Medicine gaining the full benefit of the genefounds ; let us convey into and carry in our ral advance in knowledge and usefulness. heads as much as we safely can, of new Far from it. We believe there is more of knowledge from Chemistry, Statistics, the exact diagnosis, of intelligent, effectual Microscope, the Stethoscope, and all new treatment of disease, that there are wider helps and methods; but lei us go on with the views of principles--directer, ampler methods old serious diligence, the experientia as well of discovery, at this moment in Britain than as the experimenta--the forging, and direct at any former time, and we have no doubt ing, and qualifying the mind as well as the that the augmentation is still proceeding, and furnishing it, and what is called accomplish- will defy all calculation. But we are likeing it. Let us, in the midst of all the wealth wise of opinion, that the office of a physician,

in the highest sense, will become fully more Bees, in his Dialogues on the Hypochondria, one of difficult than before, will require a greater his best works, as full of good sense and learning as compass and energy of mind, as working in a of wit. “If you please to consider that there are no wider field, and using finer weapons; and words in any language for a hundreth part of all that there never was more necessity for the minute differences that are obvious to the skillful, you will soon find that a man may know a thing making every effort to strengthen and clarify perfectly well, and at the same time not be able to the judgment and the senses by inward tell you why or how he knows it. The practical discipline, than when the importance and the knowledge of a physician, or at least the most con multitude of the objects of which they must siderable part of it, is the result of a large collection of observations that have been made on the minutiæ be cognizant, are so infinitely increased. of things in human bodies in health and sickness ; The middle propositions must be attended but likewise there are such changes and differences to, and filled up as the particulars and the in these minutiæ as no language can express; and higher generalities crowd in. when a man has no other reason for what he does

It would be out of place in a Journal than the judgment he has formed from such observations, it is impossible he can give you the one such as this, and a paper so desultory as the without the other,—that is, he can never explain his present, to enter at large upon the subjects reasons to you, unless he could communicate to you now hinted at—the education of a physician that collection of observations, of which his skill is the degree of certainty in medicine—its the product."

* Louis, in the preface to the first edition of his progress and prospects, and the beneficial Researches on Phthisis, says—“Few persons are effects it may reasonably expect from the free from delusive mental tendencies, especially in advance of the purer sciences. But we are youth, interfering with true observations, and I am not more firmly persuaded of any thing than of opinion that, generally speaking, we ought to of the importance of such an inquiry, made men; and, above all, not intrust the task of accu- largely, liberally, and strictly, by a man at mulating facts to them exclusively."

once deep, truthful, knowing, and clear. VOL. XIX. NO. II.

11

« ZurückWeiter »