that many facts are explained by studying them in the wider range of related facts to which they belong. He will gratefully recognize that the anatomist has furnished him with indispensable data, that the physiologist has sometimes put him on the track of new modes of treatment, that the chemist has isolated the active principles of his medicines, has taught him how to combine them, has from time to time offered him new remedial agencies, and so of others of his allies. But he will also tell you, if I am not mistaken, that his own branch of knowledge is so extensive and so perplexing that he must accept most of his facts ready made at their hands. He will own to you that in the struggle for life which goes on day and night in our thoughts as in the outside world of nature, much that he learned under the name of science has died out, and that simple homely experience has largely taken the place of that scholastic knowledge to which he and perhaps some of his instructors once attached a paremount importance.
This, then, is my view of scientific training as conducted in courses such as you are entering on. Up to a certain point I believe in set Lectures as excellent adjuncts to what is far more important, practical instruction at the bedside, in the operating room, and under the eye of the Demonstrator. But I am so far from wishing these courses extended, that I think some of them–suppose I say my own–would almost bear curtailing. Do you want me to describe more branches of the sciatic and crural nerves? I can take Fischer’s plates, and lecturing on that scale fill up my whole course and not finish the nerves alone. We must stop somewhere, and for my own part I think the scholastic exercises of our colleges have already claimed their full share of the student’s time without our seeking to extend them.
I trust I have vindicated the apparent inconsequence of teaching young students a good deal that seems at first sight profitless, but which helps them to learn and retain what is profitable. But this is an inquisitive age, and if we insist on piling up beyond a certain height knowledge which is in itself mere trash and lumber to a man whose life is to be one long fight with death and disease, there will be some sharp questions asked by and by, and our quick-witted people will perhaps find they can get along as well without the professor’s cap as without the bishop’s mitre and the monarch’s crown.
I myself have nothing to do with clinical teaching. Yet I do not hesitate to say it is more essential than all the rest put together, so far as the ordinary practice of medicine is concerned; and this is by far the most important thing to be learned, because it deals with so many more lives than any other branch of the profession. So of personal instruction, such as we give and others give in the interval of lectures, much of it at the bedside, some of it in the laboratory, some in the microscope-room, some in the recitation-room, I think it has many advantages of its own over the winter course, and I do not wish to see it shortened for the sake of prolonging what seems to me long enough already.
If I am jealous of the tendency to expand the time given to the acquisition of curious knowledge, at the expense of the plain old- fashioned bedside teachings, I only share the feeling which Sydenham expressed two hundred years ago, using an image I have already borrowed. “He would be no honest and successful pilot who was to apply himself with less industry to avoid rocks and sands and bring his vessel safely home, than to search into the causes of the ebbing and flowing of the sea, which, though very well for a philosopher, is foreign to him whose business it is to secure the ship. So neither will a physician, whose province it is to cure diseases, be able to do so, though he be a person of great genius, who bestows less time on the hidden and intricate method of nature, and adapting his means thereto, than on curious and subtle speculation.”
“Medicine is my wife and Science is my mistress,” said Dr. Rush. I do not think that the breach of the seventh commandment can be shown to have been of advantage to the legitimate owner of his affections. Read what Dr. Elisha Bartlett says of him as a practitioner, or ask one of our own honored ex-professors, who studied under him, whether Dr. Rush had ever learned the meaning of that saying of Lord Bacon, that man is the minister and interpreter of Nature, or whether he did not speak habitually of Nature as an intruder in the sick room, from which his art was to expel her as an incompetent and a meddler.
All a man’s powers are not too much for such a profession as Medicine. “He is a learned man,” said old Parson Emmons of Franklin, “who understands one subject, and he is a very learned man who understands two subjects.” Schonbein says he has been studying oxygen for thirty years. Mitscherlich said it took fourteen years to establish a new fact in chemistry. Aubrey says of Harvey, the discoverer of the circulation, that “though all his profession would allow him to be an excellent anatomist, I have never heard of any who admired his therapeutic way.” My learned and excellent friend before referred to, Dr. Brown of Edinburgh, from whose very lively and sensible Essay, “Locke and Sydenham,” I have borrowed several of my citations, contrasts Sir Charles Bell, the discoverer, the man of science, with Dr. Abercrombie, the master in the diagnosis and treatment of disease. It is through one of the rarest of combinations that we have in our Faculty a teacher on whom the scientific mantle of Bell has fallen, and who yet stands preeminent in the practical treatment of the class of diseases which his inventive and ardent experimental genius has illustrated. M. Brown- Sequard’s example is as, eloquent as his teaching in proof of the advantages of well directed scientific investigation. But those who emulate his success at once as a discoverer and a practitioner must be content like him to limit their field of practice. The highest genius cannot afford in our time to forget the ancient precept, Divide et impera.
“I suppose I must go and earn this guinea,” said a medical man who was sent for while he was dissecting an animal. I should not have cared to be his patient. His dissection would do me no good, and his thoughts would be too much upon it. I want a whole man for my doctor, not a half one. I would have sent for a humbler practitioner, who would have given himself entirely to me, and told the other–who was no less a man than John Hunter–to go on and finish the dissection of his tiger.
Sydenham’s “Read Don Quixote” should be addressed not to the student, but to the Professor of today. Aimed at him it means, “Do not be too learned.”
Do not think you are going to lecture to picked young men who are training themselves to be scientific discoverers. They are of fair average capacity, and they are going to be working doctors.
These young men are to have some very serious vital facts to deal with. I will mention a few of them.
Every other resident adult you meet in these streets is or will be more or less tuberculous. This is not an extravagant estimate, as very nearly one third of the deaths of adults in Boston last year were from phthisis. If the relative number is less in our other northern cities, it is probably in a great measure because they are more unhealthy; that is, they have as much, or nearly as much, consumption, but they have more fevers or other fatal diseases.
These heavy-eyed men with the alcoholized brains, these pallid youths with the nicotized optic ganglia and thinking-marrows brown as their own meerschaums, of whom you meet too many,–will ask all your wisdom to deal with their poisoned nerves and their enfeebled wills.
Nearly seventeen hundred children under five years of age died last year in this city. A poor human article, no doubt, in many cases, still, worth an attempt to save them, especially when we remember the effect of Dr. Clarke’s suggestion at the Dublin Hospital, by which some twenty-five or thirty thousand children’s lives have probably been saved in a single city.
Again, the complaint is often heard that the native population is not increasing so rapidly as in former generations. The breeding and nursing period of American women is one of peculiar delicacy and frequent infirmity. Many of them must require a considerable interval between the reproductive efforts, to repair damages arid regain strength. This matter is not to be decided by an appeal to unschooled nature. It is the same question as that of the deformed pelvis,–one of degree. The facts of mal-vitalization are as much to be attended to as those of mal-formation. If the woman with a twisted pelvis is to be considered an exempt, the woman with a defective organization should be recognized as belonging to the invalid corps. We shudder to hear what is alleged as to the prevalence of criminal practices; if back of these there can be shown organic incapacity or overtaxing of too limited powers, the facts belong to the province of the practical physician, as well as of the moralist and the legislator, and require his gravest consideration.
Take the important question of bleeding. Is venesection done with forever? Six years ago it was said here in an introductory Lecture that it would doubtless come back again sooner or later. A fortnight ago I found myself in the cars with one of the most sensible and esteemed practitioners in New England. He took out his wallet and showed me two lancets, which he carried with him; he had never given up their use. This is a point you will have to consider.
Or, to mention one out of many questionable remedies, shall you give Veratrum Viride in fevers and inflammations? It makes the pulse slower in these affections. Then the presumption would naturally be that it does harm. The caution with reference to it on this ground was long ago recorded in the Lecture above referred to. See what Dr. John Hughes Bennett says of it in the recent edition of his work on Medicine. Nothing but the most careful clinical experience can settle this and such points of treatment.
These are all practical questions–questions of life and death, and every day will be full of just such questions. Take the problem of climate. A patient comes to you with asthma and wants to know where he can breathe; another comes to you with phthisis and wants to know where he can live. What boy’s play is nine tenths of all that is taught in many a pretentious course of lectures, compared with what an accurate and extensive knowledge of the advantages and disadvantages of different residences in these and other complaints would be to a practising physician
I saw the other day a gentleman living in Canada, who had spent seven successive winters in Egypt, with the entire relief of certain obscure thoracic symptoms which troubled him while at home. I saw, two months ago, another gentleman from Minnesota, an observer and a man of sense, who considered that State as the great sanatorium for all pulmonary complaints. If half our grown population are or will be more or less tuberculous, the question of colonizing Florida assumes a new aspect. Even within the borders of our own State, the very interesting researches of Dr. Bowditch show that there is a great variation in the amount of tuberculous disease in different towns, apparently connected with local conditions. The hygienic map of a State is quite as valuable as its geological map, and it is the business of every practising physician to know it thoroughly. They understand this in England, and send a patient with a dry irritating cough to Torquay or Penzance, while they send another with relaxed bronchial membranes to Clifton or Brighton. Here is another great field for practical study.
So as to the all-important question of diet. “Of all the means of cure at our command,” says Dr. Bennett, “a regulation of the quantity and quality of the diet is by far the most powerful.” Dr. MacCormac would perhaps except the air we breathe, for he thinks that impure air, especially in sleeping rooms, is the great cause of tubercle. It is sufficiently proved that the American,–the New Englander,–the Bostonian, can breed strong and sound children, generation after generation,–nay, I have shown by the record of a particular family that vital losses may be retrieved, and a feeble race grow to lusty vigor in this very climate and locality. Is not the question why our young men and women so often break down, and how they can be kept from breaking down, far more important for physicians to settle than whether there is one cranial vertebra, or whether there are four, or none?
–But I have a taste for the homologies, I want to go deeply into the subject of embryology, I want to analyze the protonihilates precipitated from pigeon’s milk by the action of the lunar spectrum,- shall I not follow my star,–shall I not obey my instinct,–shall I not give myself to the lofty pursuits of science for its own sake?
Certainly you may, if you like. But take down your sign, or never put it up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the difficulty. We all admire the achievements of this band of distinguished doctors who do not practise. But we say of their work and of all pure science, as the French officer said of the charge of the six hundred at Balaclava, “C’est magnifique, mais ce n’est pas la guerre,”–it is very splendid, but it is not a practising doctor’s business. His patient has a right to the cream of his life and not merely to the thin milk that is left after “science” has skimmed it off. The best a physician can give is never too good for the patient.
It is often a disadvantage to a young practitioner to be known for any accomplishment outside of his profession. Haller lost his election as Physician to the Hospital in his native city of Berne, principally on the ground that he was a poet. In his later years the physician may venture more boldly. Astruc was sixty-nine years old when he published his “Conjectures,” the first attempt, we are told, to decide the authorship of the Pentateuch showing anything like a discerning criticism. Sir Benjamin Brodie was seventy years old before he left his physiological and surgical studies to indulge in psychological speculations. The period of pupilage will be busy enough in acquiring the knowledge needed, and the season of active practice will leave little leisure for any but professional studies.
Dr. Graves of Dublin, one of the first clinical teachers of our time, always insisted on his students’ beginning at once to visit the hospital. At the bedside the student must learn to treat disease, and just as certainly as we spin out and multiply our academic prelections we shall work in more and more stuffing, more and more rubbish, more and more irrelevant, useless detail which the student will get rid of just as soon as he leaves us. Then the next thing will be a new organization, with an examining board of first-rate practical men, who will ask the candidate questions that mean business,–who will make him operate if he is to be a surgeon, and try him at the bedside if he is to be a physician,–and not puzzle him with scientific conundrums which not more than one of the questioners could answer himself or ever heard of since he graduated.
Or these women who are hammering at the gates on which is written “No admittance for the mothers of mankind,” will by and by organize an institution, which starting from that skilful kind of nursing which Florence Nightingale taught so well, will work backwards through anodynes, palliatives, curatives, preventives, until with little show of science it imparts most of what is most valuable in those branches of the healing art it professes to teach. When that time comes, the fitness of women for certain medical duties, which Hecquet advocated in 1708, which Douglas maintained in 1736, which Dr. John Ware, long the honored Professor of Theory and Practice in this Institution, upheld within our own recollection in the face of his own recorded opinion to the contrary, will very possibly be recognized.
My advice to every teacher less experienced than myself would be, therefore: Do not fret over the details you have to omit; you probably teach altogether too many as it is. Individuals may learn a thing with once hearing it, but the only way of teaching a whole class is by enormous repetition, representation, and illustration in all possible forms. Now and then you will have a young man on your benches like the late Waldo Burnett,–not very often, if you lecture half a century. You cannot pretend to lecture chiefly for men like that,–a Mississippi raft might as well take an ocean-steamer in tow. To meet his wants you would have to leave the rest of your class behind and that you must not do. President Allen of Jefferson College says that his instruction has been successful in proportion as it has been elementary. It may be a humiliating statement, but it is one which I have found true in my own experience.
To the student I would say, that however plain and simple may be our teaching, he must expect to forget much which he follows intelligently in the lecture-room. But it is not the same as if he had never learned it. A man must get a thing before he can forget it. There is a great world of ideas we cannot voluntarily recall,– they are outside the limits of the will. But they sway our conscious thought as the unseen planets influence the movements of those within the sphere of vision. No man knows how much he knows,–how many ideas he has,–any more than he knows how many blood-globules roll in his veins. Sometimes accident brings back here and there one, but the mind is full of irrevocable remembrances and unthinkable thoughts, which take a part in all its judgments as indestructible forces. Some of you must feel your scientific deficiencies painfully after your best efforts. But every one can acquire what is most essential. A man of very moderate ability may be a good physician, if he devotes himself faithfully to the work. More than this, a positively dull man, in the ordinary acceptation of the term, sometimes makes a safer practitioner than one who has, we will say, five per cent. more brains than his average neighbor, but who thinks it is fifty per cent. more. Skulls belonging to this last variety of the human race are more common, I may remark, than specimens like the Neanderthal cranium, a cast of which you will find on the table in the Museum.
Whether the average talent be high or low, the Colleges of the land must make the best commodity they can out of such material as the country and the cities furnish them. The community must have Doctors as it must have bread. It uses up its Doctors just as it wears out its shoes, and requires new ones. All the bread need not be French rolls, all the shoes need not be patent leather ones; but the bread must be something that can be eaten, and the shoes must be something that can be worn. Life must somehow find food for the two forces that rub everything to pieces, or burn it to ashes,–friction and oxygen. Doctors are oxydable products, and the schools must keep furnishing new ones as the old ones turn into oxyds; some of first- rate quality that burn with a great light, some of a lower grade of brilliancy, some honestly, unmistakably, by the grace of God, of moderate gifts, or in simpler phrase, dull.
The public will give every honest and reasonably competent worker in the healing art a hearty welcome. It is on the whole very loyal to the Medical Profession. Three successive years have borne witness to the feeling with which this Institution, representing it in its educational aspect, is regarded by those who are themselves most honored and esteemed. The great Master of Natural Science bade the last year’s class farewell in our behalf, in those accents which delight every audience. The Head of our ancient University honored us in the same way in the preceding season. And how can we forget that other occasion when the Chief Magistrate of the Commonwealth, that noble citizen whom we have just lost, large-souled, sweet- natured, always ready for every kind office, came among us at our bidding, and talked to us of our duties in words as full of wisdom as his heart was of goodness?
You have not much to fear, I think, from the fancy practitioners. The vulgar quackeries drop off, atrophied, one after another. Homoeopathy has long been encysted, and is carried on the body medical as quietly as an old wen. Every year gives you a more reasoning and reasonable people to deal with. See how it is in Literature. The dynasty of British dogmatists, after lasting a hundred years and more, is on its last legs. Thomas Carlyle, third in the line of descent, finds an audience very different from those which listened to the silver speech of Samuel Taylor Coleridge and the sonorous phrases of Samuel Johnson. We read him, we smile at his clotted English, his “swarmery” and other picturesque expressions, but we lay down his tirade as we do one of Dr. Cumming’s interpretations of prophecy, which tells us that the world is coming to an end next week or next month, if the weather permits,–not otherwise,–feeling very sure that the weather will be unfavorable.
It is the same common-sense public you will appeal to. The less pretension you make, the better they will like you in the long run. I hope we shall make everything as plain and as simple to you as we can. I would never use a long word, even, where a short one would answer the purpose. I know there are professors in this country who “ligate” arteries. Other surgeons only tie them, and it stops the bleeding just as well. It is the familiarity and simplicity of bedside instruction which makes it so pleasant as well as so profitable. A good clinical teacher is himself a Medical School. We need not wonder that our young men are beginning to announce themselves not only as graduates of this or that College, but also as pupils of some one distinguished master.
I wish to close this Lecture, if you will allow me a few moments longer, with a brief sketch of an instructor and practitioner whose character was as nearly a model one in both capacities as I can find anywhere recorded.
Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine in this University from 1812 to 1846, and whose name has been since retained on our rolls as Professor Emeritus, died on the 27th of August last, in the ninetieth year of his age. He studied his profession, as I have already mentioned, with Dr. Holyoke of Salem, one of the few physicians who have borne witness to their knowledge of the laws of life by living to complete their hundredth year. I think the student took his Old Master, as he always loved to call him, as his model; each was worthy of the other, and both were bright examples to all who come after them.
I remember that in the sermon preached by Dr. Grazer after Dr. Holyoke’s death, one of the points most insisted upon as characteristic of that wise and good old man was the perfect balance of all his faculties. The same harmonious adjustment of powers, the same symmetrical arrangement of life, the same complete fulfilment of every day’s duties, without haste and without needless delay, which characterized the master, equally distinguished the scholar. A glance at the life of our own Old Master, if I can do any justice at all to his excellences, will give you something to carry away from this hour’s meeting not unworthy to be remembered.
From December, 1797, to October, 1799, he remained with Dr. Holyoke as a student, a period which he has spoken of as a most interesting and most gratifying part of his life. After this he passed eight months in London, and on his return, in October, 1800, he began business in Boston.
He had followed Mr. Cline, as I have mentioned, and was competent to practise Surgery. But he found Dr. John Collins Warren had already occupied the ground which at that day hardly called for more than one leading practitioner, and wisely chose the Medical branch of the profession. He had only himself to rely upon, but he had confidence in his prospects, conscious, doubtless, of his own powers, knowing his own industry and determination, and being of an eminently cheerful and hopeful disposition. No better proof of his spirit can be given than that, just a year from the time when he began to practise as a physician, he took that eventful step which in such a man implies that he sees his way clear to a position; he married a lady blessed with many gifts, but not bringing him a fortune to paralyze his industry.
He had not miscalculated his chances in life. He very soon rose into a good practice, and began the founding of that reputation which grew with his years, until he stood by general consent at the head of his chosen branch of the profession, to say the least, in this city and in all this region of country. His skill and wisdom were the last tribunal to which the sick and suffering could appeal. The community trusted and loved him, the profession recognized him as the noblest type of the physician. The young men whom he had taught wandered through foreign hospitals; where they learned many things that were valuable, and many that were curious; but as they grew older and began to think more of their ability to help the sick than their power of talking about phenomena, they began to look back to the teaching of Dr. Jackson, as he, after his London experience, looked back to that of Dr. Holyoke. And so it came to be at last that the bare mention of his name in any of our medical assemblies would call forth such a tribute of affectionate regard as is only yielded to age when it brings with it the record of a life spent in well doing.
No accident ever carries a man to eminence such as his in the medical profession. He who looks for it must want it earnestly and work for it vigorously; Nature must have qualified him in many ways, and education must have equipped him with various knowledge, or his reputation will evaporate before it reaches the noon-day blaze of fame. How did Dr. Jackson gain the position which all conceded to him? In the answer to this question some among you may find a key that shall unlock the gate opening on that fair field of the future of which all dream but which not all will ever reach.
First of all, he truly loved his profession. He had no intellectual ambitions outside of it, literary, scientific or political. To him it was occupation enough to apply at the bedside the best of all that he knew for the good of his patient; to protect the community against the inroads of pestilence; to teach the young all that he himself had been taught, with all that his own experience had added; to leave on record some of the most important results of his long observation.
With his patients he was so perfect at all points that it is hard to overpraise him. I have seen many noted British and French and American practitioners, but I never saw the man so altogether admirable at the bedside of the sick as Dr. James Jackson. His smile was itself a remedy better than the potable gold and the dissolved pearls that comforted the praecordia of mediaeval monarchs. Did a patient, alarmed without cause, need encouragement, it carried the sunshine of hope into his heart and put all his whims to flight, as David’s harp cleared the haunted chamber of the sullen king. Had the hour come, not for encouragement, but for sympathy, his face, his voice, his manner all showed it, because his heart felt it. So gentle was he, so thoughtful, so calm, so absorbed in the case before him, not to turn round and look for a tribute to his sagacity, not to bolster himself in a favorite theory, but to find out all he could, and to weigh gravely and cautiously all that he found, that to follow him in his morning visit was not only to take a lesson in the healing art, it was learning how to learn, how to move, how to look, how to feel, if that can be learned. To visit with Dr. Jackson was a medical education.
He was very firm, with all his kindness. He would have the truth about his patients. The nurses found it out; and the shrewder ones never ventured to tell him anything but a straight story. A clinical dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse in the Massachusetts General Hospital, a mistress in her calling, was as good questioning and answering as one would be like to hear outside of the court-room.
Of his practice you can form an opinion from his book called “Letters to a Young Physician.” Like all sensible men from the days of Hippocrates to the present, he knew that diet and regimen were more important than any drug or than all drugs put together. Witness his treatment of phthisis and of epilepsy. He retained, however, more confidence in some remedial agents than most of the younger generation would concede to them. Yet his materia medica was a simple one.
“When I first went to live with Dr. Holyoke,” he says, “in 1797, showing me his shop, he said, ‘There seems to you to be a great variety of medicines here, and that it will take you long to get acquainted with them, but most of them are unimportant. There are four which are equal to all the rest, namely, Mercury, Antimony, Bark and Opium.'” And Dr. Jackson adds, “I can only say of his practice, the longer I have lived, I have thought better and better of it.” When he thought it necessary to give medicine, he gave it in earnest. He hated half-practice–giving a little of this or that, so as to be able to say that one had done something, in case a consultation was held, or a still more ominous event occurred. He would give opium, for instance, as boldly as the late Dr. Fisher of Beverly, but he followed the aphorism of the Father of Medicine, and kept extreme remedies for extreme cases.
When it came to the “non-naturals,” as he would sometimes call them, after the old physicians,–namely, air, meat and drink, sleep and watching, motion and rest, the retentions and excretions, and the affections of the mind,–he was, as I have said, of the school of sensible practitioners, in distinction from that vast community of quacks, with or without the diploma, who think the chief end of man is to support apothecaries, and are never easy until they can get every patient upon a regular course of something nasty or noxious. Nobody was so precise in his directions about diet, air, and exercise, as Dr. Jackson. He had the same dislike to the a peu pres, the about so much, about so often, about so long, which I afterwards found among the punctilious adherents of the numerical system at La Pitie.
He used to insist on one small point with a certain philological precision, namely, the true meaning of the word “cure.” He would have it that to cure a patient was simply to care for him. I refer to it as showing what his idea was of the relation of the physician to the patient. It was indeed to care for him, as if his life were bound up in him, to watch his incomings and outgoings, to stand guard at every avenue that disease might enter, to leave nothing to chance; not merely to throw a few pills and powders into one pan of the scales of Fate, while Death the skeleton was seated in the other, but to lean with his whole weight on the side of life, and shift the balance in its favor if it lay in human power to do it. Such devotion as this is only to be looked for in the man who gives himself wholly up to the business of healing, who considers Medicine itself a Science, or if not a science, is willing to follow it as an art,–the noblest of arts, which the gods and demigods of ancient religions did not disdain to practise and to teach.
The same zeal made him always ready to listen to any new suggestion which promised to be useful, at a period of life when many men find it hard to learn new methods and accept new doctrines. Few of his generation became so accomplished as he in the arts of direct exploration; coming straight from the Parisian experts, I have examined many patients with him, and have had frequent opportunities of observing his skill in percussion and auscultation.
One element in his success, a trivial one compared with others, but not to be despised, was his punctuality. He always carried two watches,–I doubt if he told why, any more than Dr. Johnson told what he did with the orange-peel,–but probably with reference to this virtue. He was as much to be depended upon at the appointed time as the solstice or the equinox. There was another point I have heard him speak of as an important rule with him; to come at the hour when he was expected; if he had made his visit for several days successively at ten o’clock, for instance, not to put it off, if be could possibly help it, until eleven, and so keep a nervous patient and an anxious family waiting for him through a long, weary hour.
If I should attempt to characterize his teaching, I should say that while it conveyed the best results of his sagacious and extended observation, it was singularly modest, cautious, simple, sincere. Nothing was for show, for self-love; there was no rhetoric, no declamation, no triumphant “I told you so,” but the plain statement of a clear-headed honest man, who knows that he is handling one of the gravest subjects that interest humanity. His positive instructions were full of value, but the spirit in which he taught inspired that loyal love of truth which lies at the bottom of all real excellence.
I will not say that, during his long career, Dr. Jackson never made an enemy. I have heard him tell how, in his very early days, old Dr. Danforth got into a towering passion with him about some professional consultation, and exploded a monosyllable or two of the more energetic kind on the occasion. I remember that that somewhat peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson succeeded to his place as Professor of Theory and Practice. A young man of Dr. Jackson’s talent and energy could hardly take the position that belonged to him without crowding somebody in a profession where three in a bed is the common rule of the household. But he was a peaceful man and a peace-maker all his days. No man ever did more, if so much, to produce and maintain the spirit of harmony for which we consider our medical community as somewhat exceptionally distinguished.
If this harmony should ever be threatened, I could wish that every impatient and irritable member of the profession would read that beautiful, that noble Preface to the “Letters,” addressed to John Collins Warren. I know nothing finer in the medical literature of all time than this Prefatory Introduction. It is a golden prelude, fit to go with the three great Prefaces which challenge the admiration of scholars,–Calvin’s to his Institutes, De Thou’s to his History, and Casaubon’s to his Polybius,–not because of any learning or rhetoric, though it is charmingly written, but for a spirit flowing through it to which learning and rhetoric are but as the breath that is wasted on the air to the Mood that warms the heart.
Of a similar character is this short extract which I am permitted to make from a private letter of his to a dear young friend. He was eighty-three years old at the time of writing it.
“I have not loved everybody whom I have known, but I have striven to see the good points in the characters of all men and women. At first I must have done this from something in my own nature, for I was not aware of it, and yet was doing it without any plan, when one day, sixty years ago, a friend whom I loved and respected said this to me, ‘Ah, James, I see that you are destined to succeed in the world, and to make friends, because you are so ready to see the good point in the characters of those you meet.'”
I close this imperfect notice of some features in the character of this most honored and beloved of physicians by applying to him the words which were written of William Heberden, whose career was not unlike his own, and who lived to the same patriarchal age.
“From his early youth he had always entertained a deep sense of religion, a consummate love of virtue, an ardent thirst after knowledge, and an earnest desire to promote the welfare and happiness of all mankind. By these qualities, accompanied with great sweetness of manners, he acquired the love and esteem of all good men, in a degree which perhaps very few have experienced; and after passing an active life with the uniform testimony of a good conscience, he became an eminent example of its influence, in the cheerfulness and serenity of his latest age.”
Such was the man whom I offer to you as a model, young gentlemen, at the outset of your medical career. I hope that many of you will recognize some traits of your own special teachers scattered through various parts of the land in the picture I have drawn. Let me assure you that whatever you may learn in this or any other course of public lectures,–and I trust you will learn a great deal,–the daily guidance, counsel, example, of your medical father, for such the Oath of Hippocrates tells you to consider your preceptor, will, if he is in any degree like him of whom I have spoken, be the foundation on which all that we teach is reared, and perhaps outlive most of our teachings, as in Dr. Jackson’s memory the last lessons that remained with him were those of his Old Master.
THE MEDICAL PROFESSION IN MASSACHUSETTS.
A Lecture of a Course by members of the Massachusetts Historical Society, delivered before the Lowell Institute, January 29, 1869.
The medical history of eight generations, told in an hour, must be in many parts a mere outline. The details I shall give will relate chiefly to the first century. I shall only indicate the leading occurrences, with the more prominent names of the two centuries which follow, and add some considerations suggested by the facts which have been passed in review.
A geographer who was asked to describe the tides of Massachusetts Bay, would have to recognize the circumstance that they are a limited manifestation of a great oceanic movement. To consider them apart from this, would be to localize a planetary phenomenon, and to provincialize a law of the universe. The art of healing in Massachusetts has shared more or less fully and readily the movement which, with its periods of ebb and flow, has been raising its level from age to age throughout the better part of Christendom. Its practitioners brought with them much of the knowledge and many of the errors of the Old World; they have always been in communication with its wisdom and its folly; it is not without interest to see how far the new conditions in which they found themselves have been favorable or unfavorable to the growth of sound medical knowledge and practice.
The state of medicine is an index of the civilization of an age and country,–one of the best, perhaps, by which it can be judged. Surgery invokes the aid of all the mechanical arts. From the rude violences of the age of stone,–a relic of which we may find in the practice of Zipporah, the wife of Moses,–to the delicate operations of to-day upon patients lulled into temporary insensibility, is a progress which presupposes a skill in metallurgy and in the labors of the workshop and the laboratory it has taken uncounted generations to accumulate. Before the morphia which deadens the pain of neuralgia, or the quinine which arrests the fit of an ague, can find their place in our pharmacies, commerce must have perfected its machinery, and science must have refined its processes, through periods only to be counted by the life of nations. Before the means which nature and art have put in the hands of the medical practitioner can be fairly brought into use, the prejudices of the vulgar must be overcome, the intrusions of false philosophy must be fenced out, and the partnership with the priesthood dissolved. All this implies that freedom and activity of thought which belong only to the most advanced conditions of society; and the progress towards this is by gradations as significant of wide-spread changes, as are the varying states of the barometer of far-extended conditions of the atmosphere.
Apart, then, from its special and technical interest, my subject has a meaning which gives a certain importance, and even dignity, to details in themselves trivial and almost unworthy of record. A medical entry in Governor Winthrop’s journal may seem at first sight a mere curiosity; but, rightly interpreted, it is a key to his whole system of belief as to the order of the universe and the relations between man and his Maker. Nothing sheds such light on the superstitions of an age as the prevailing interpretation and treatment of disease. When the touch of a profligate monarch was a cure for one of the most inveterate of maladies, when the common symptoms of hysteria were prayed over as marks of demoniacal possession, we might well expect the spiritual realms of thought to be peopled with still stranger delusions.
Let us go before the Pilgrims of the Mayflower, and look at the shores on which they were soon to land. A wasting pestilence had so thinned the savage tribes that it was sometimes piously interpreted as having providentially prepared the way for the feeble band of exiles. Cotton Mather, who, next to the witches, hated the “tawnies,” “wild beasts,” “blood-hounds,” “rattlesnakes,” “infidels,” as in different places he calls the unhappy Aborigines, describes the condition of things in his lively way, thus: “The Indians in these Parts had newly, even about a Year or Two before, been visited with such a prodigious Pestilence; as carried away not a Tenth, but Nine Parts of Ten (yea’t is said Nineteen of Twenty) among them so that the Woods were almost cleared of those pernicious Creatures to make Room for a better Growth.”
What this pestilence was has been much discussed. It is variously mentioned by different early writers as “the plague,” “a great and grievous plague,” “a sore consumption,” as attended with spots which left unhealed places on those who recovered, as making the “whole surface yellow as with a garment.” Perhaps no disease answers all these conditions so well as smallpox. We know from different sources what frightful havoc it made among the Indians in after years,–in 1631, for instance, when it swept away the aboriginal inhabitants of “whole towns,” and in 1633. We have seen a whole tribe, the Mandans, extirpated by it in our own day. The word “plague” was used very vaguely, as in the description of the “great sickness” found among the Indians by the expedition of 1622. This same great sickness could hardly have been yellow fever, as it occurred in the month of November. I cannot think, therefore, that either the scourge of the East or our Southern malarial pestilence was the disease that wasted the Indians. As for the yellowness like a garment, that is too familiar to the eyes of all who have ever looked on the hideous mask of confluent variola.
Without the presence or the fear of these exotic maladies, the forlorn voyagers of the Mayflower had sickness enough to contend with. At their first landing at Cape Cod, gaunt and hungry and longing for fresh food, they found upon the sandy shore “great mussel’s, and very fat and full of sea-pearl.” Sailors and passengers indulged in the treacherous delicacy; which seems to have been the sea-clam; and found that these mollusks, like the shell the poet tells of, remembered their august abode, and treated the way- worn adventurers to a gastric reminiscence of the heaving billows. In the mean time it blew and snowed and froze. The water turned to ice on their clothes, and made them many times like coats of iron. Edward Tilley had like to have “sounded” with cold. The gunner, too, was sick unto death, but “hope of trucking” kept him on his feet,–a Yankee, it should seem, when he first touched the shore of New England. Most, if not all, got colds and coughs, which afterwards turned to scurvy, whereof many died.
How can we wonder that the crowded and tempest-tossed voyagers, many of them already suffering, should have fallen before the trials of the first winter in Plymouth? Their imperfect shelter, their insufficient supply of bread, their salted food, now in unwholesome condition, account too well for the diseases and the mortality that marked this first dreadful season; weakness, swelling of the limbs, and other signs of scurvy, betrayed the want of proper nourishment and protection from the elements. In December six of their number died, in January eight, in February, seventeen, in March thirteen. With the advance of spring the mortality diminished, the sick and lame began to recover, and the colonists, saddened but not disheartened, applied themselves to the labors of the opening year.
One of the most pressing needs of the early colonists must have been that of physicians and surgeons. In Mr. Savage’s remarkable Genealogical Dictionary of the first settlers who came over before 1692 and their descendants to the third generation, I find scattered through the four crowded volumes the names of one hundred and thirty- four medical practitioners. Of these, twelve, and probably many more, practised surgery; three were barber-surgeons. A little incident throws a glimmer from the dark lantern of memory upon William Direly, one of these practitioners with the razor and the lancet. He was lost between Boston and Roxbury in a violent tempest of wind and snow; ten days afterwards a son was born to his widow, and with a touch of homely sentiment, I had almost said poetry, they called the little creature “Fathergone” Direly. Six or seven, probably a larger number, were ministers as well as physicians, one of whom, I am sorry to say, took to drink and tumbled into the Connecticut River, and so ended. One was not only doctor, but also schoolmaster and poet. One practised medicine and kept a tavern. One was a butcher, but calls himself a surgeon in his will, a union of callings which suggests an obvious pleasantry. One female practitioner, employed by her own sex,–Ann Moore,–was the precursor of that intrepid sisterhood whose cause it has long been my pleasure and privilege to advocate on all fitting occasions.
Outside of this list I must place the name of Thomas Wilkinson, who was complained of, is 1676, for practising contrary to law.
Many names in the catalogue of these early physicians have been associated, in later periods, with the practice of the profession,– among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge, Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams, Woodward. Touton was a Huguenot, Burchsted a German from Silesia, Lunerus a German or a Pole; “Pighogg Churrergeon,” I hope, for the honor of the profession, was only Peacock disguised under this alias, which would not, I fear, prove very attractive to patients.
What doctrines and practice were these colonists likely to bring, with them?
Two principal schools of medical practice prevailed in the Old World during the greater part of the seventeenth century. The first held to the old methods of Galen: its theory was that the body, the microcosm, like the macrocosm, was made up of the four elements– fire, air, water, earth; having respectively the qualities hot, dry, moist, cold. The body was to be preserved in health by keeping each of these qualities in its natural proportion; heat, by the proper temperature; moisture, by the due amount of fluid; and so as to the rest. Diseases which arose from excess of heat were to be attacked by cooling remedies; those from excess of cold, by heating ones; and so of the other derangements of balance. This was truly the principle of contraries contrariis, which ill-informed persons have attempted to make out to be the general doctrine of medicine, whereas there is no general dogma other than this: disease is to be treated by anything that is proved to cure it. The means the Galenist employed were chiefly diet and vegetable remedies, with the use of the lancet and other depleting agents. He attributed the four fundamental qualities to different vegetables, in four different degrees; thus chicory was cold in the fourth degree, pepper was hot in the fourth, endive was cold and dry in the second, and bitter almonds were hot in the first and dry in the second degree. When we say “cool as a cucumber,” we are talking Galenism. The seeds of that vegetable ranked as one of “the four greater cold seeds” of this system.
Galenism prevailed mostly in the south of Europe and France. The readers of Moliere will have no difficulty in recalling some of its favorite modes of treatment, and the abundant mirth he extracted from them.
These Galenists were what we should call “herb-doctors” to-day. Their insignificant infusions lost credit after a time; their absurdly complicated mixtures excited contempt, and their nauseous prescriptions provoked loathing and disgust. A simpler and bolder practice found welcome in Germany, depending chiefly on mineral remedies, mercury, antimony, sulphur, arsenic, and the use, sometimes the secret use, of opium. Whatever we think of Paracelsus, the chief agent in the introduction of these remedies, and whatever limits we may assign to the use of these long-trusted mineral drugs, there can be no doubt that the chemical school, as it was called, did a great deal towards the expurgation of the old, overloaded, and repulsive pharmacopoeia. We shall find evidence in the practice of our New- England physicians of the first century, that they often employed chemical remedies, and that, by the early part of the following century, their chief trust was in the few simple, potent drugs of Paracelsus.
We have seen that many of the practitioners of medicine, during the first century of New England, were clergymen. This relation between medicine and theology has existed from a very early period; from the Egyptian priest to the Indian medicine-man, the alliance has been maintained in one form or another. The partnership was very common among our British ancestors. Mr. Ward, the Vicar of Stratford-on- Avon, himself a notable example of the union of the two characters, writing about 1660, says,
“The Saxons had their blood-letters, but under the Normans physicke, begunne in England; 300 years agoe itt was not a distinct profession by itself, but practised by men in orders, witness Nicholas de Ternham, the chief English physician and Bishop of Durham; Hugh of Evesham, a physician and cardinal; Grysant, physician and pope; John Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul Bush, a bachelor of divinitie in Oxford, was a man well read in physick as well as divinitie, he was the first bishop of Bristol.”
“Again in King Richard the Second’s time physicians and divines were not distinct professions; for one Tydeman, Bishop of Landaph and Worcester, was physician to King Richard the Second.”
This alliance may have had its share in creating and keeping up the many superstitions which have figured so largely in the history of medicine. It is curious to see that a medical work left in manuscript by the Rev. Cotton Mather and hereafter to be referred to, is running over with follies and superstitious fancies; while his contemporary and fellow-townsman, William Douglass, relied on the same few simple remedies which, through Dr. Edward Holyoke and Dr. James Jackson, have come down to our own time, as the most important articles of the materia medica.
Let us now take a general glance at some of the conditions of the early settlers; and first, as to the healthfulness of the climate. The mortality of the season that followed the landing of the Pilgrims at Plymouth has been sufficiently accounted for. After this, the colonists seem to have found the new country agreeing very well with their English constitutions. Its clear air is the subject of eulogy. Its dainty springs of sweet water are praised not only by Higginson and Wood, but even the mischievous Morton says, that for its delicate waters Canaan came not near this country.” There is a tendency to dilate on these simple blessings, which reminds one a little of the Marchioness in Dickens’s story, with her orange-peel-and-water beverage. Still more does one feel the warmth of coloring,–such as we expect from converts to a new faith, and settlers who want to entice others over to their clearings, when Winslow speaks, in 1621, of “abundance of roses, white, red, and damask; single, but very sweet indeed;” a most of all, however, when, in the same connection, he says, “Here are grapes white and red, and very sweet and strong also.” This of our wild grape, a little vegetable Indian, which scalps a civilized man’s mouth, as his animal representative scalps his cranium. But there is something quite charming in Winslow’s picture of the luxury in which they are living. Lobsters, oysters, eels, mussels, fish and fowl, delicious fruit, including the grapes aforesaid,–if they only had “kine, horses, and sheep,” he makes no question but men would live as contented here as in any part of the world. We cannot help admiring the way in which they took their trials, and made the most of their blessings.
“And how Content they were,” says Cotton Mather, “when an Honest Man, as I have heard, inviting his Friends to a Dish of Clams, at the Table gave Thanks to Heaven, who had given them to suck the abundance of the Seas, and of the Treasures Aid in the Sands!”
Strangely enough, as it would seem, except for this buoyant determination to make the best of everything, they hardly appear to recognize the difference of the climate from that which they had left. After almost three years’ experience, Winslow says, he can scarce distinguish New England from Old England, in respect of heat and cold, frost, snow, rain, winds, etc. The winter, he thinks (if there is a difference), is sharper and longer; but yet he may be deceived by the want of the comforts he enjoyed at home. He cannot conceive any climate to agree better with the constitution of the English, not being oppressed with extremity of heats, nor nipped by biting cold:
“By which means, blessed be God, we enjoy our health, notwithstanding those difficulties we have undergone, in such a measure as would have been admired, if we had lived in England with the like means.”
Edward Johnson, after mentioning the shifts to which they were put for food, says,–
“And yet, methinks, our children are as cheerful, fat, and lusty, with feeding upon those mussels, clams, and other fish, as they were in England with their fill of bread.”
Higginson, himself a dyspeptic, “continually in physic,” as he says, and accustomed to dress in thick clothing, and to comfort his stomach with drink that was “both strong and stale,”–the “jolly good ale and old,” I suppose, of free and easy Bishop Still’s song,–found that he both could and did oftentimes drink New England water very well, –which he seems to look upon as a remarkable feat. He could go as lightclad as any, too, with only a light stuff cassock upon his shirt, and stuff breeches without linings. Two of his children were sickly: one,–little misshapen Mary,–died on the passage, and, in her father’s words, “was the first in our ship that was buried in the bowels of the great Atlantic sea;” the other, who had been “most lamentably handled” by disease, recovered almost entirely “by the very wholesomeness of the air, altering, digesting, and drying up the cold and crude humors of the body.” Wherefore, he thinks it a wise course for all cold complexions to come to take physic in New England, and ends with those often quoted words, that “a sup of New England’s air is better than a whole draught of Old England’s ale.” Mr. Higginson died, however, “of a hectic fever,” a little more than a year after his arrival.
The medical records which I shall cite show that the colonists were not exempt from the complaints of the Old World. Besides the common diseases to which their descendants are subject, there were two others, to say nothing of the dreaded small-pox, which later medical science has disarmed,–little known among us at the present day, but frequent among the first settlers. The first of these was the scurvy, already mentioned, of which Winthrop speaks in 1630, saying, that it proved fatal to those who fell into discontent, and lingered after their former conditions in England; the poor homesick creatures in fact, whom we so forget in our florid pictures of the early times of the little band in the wilderness. Many who were suffering from scurvy got well when the Lyon arrived from England, bringing store of juice of lemons. The Governor speaks of another case in 1644; and it seems probable that the disease was not of rare occurrence.
The other complaint from which they suffered, but which has nearly disappeared from among us, was intermittent fever, or fever and ague. I investigated the question as to the prevalence of this disease in New England, in a dissertation, which was published in a volume with other papers, in the year 1838. I can add little to the facts there recorded. One which escaped me was, that Joshua Scottow, in “Old Men’s Tears,” dated 1691, speaks of “shaking agues,” as among the trials to which they had been subjected. The outline map of New England, accompanying the dissertation above referred to, indicates all the places where I had evidence that the disease had originated. It was plain enough that it used to be known in many localities where it has long ceased to be feared. Still it was and is remarkable to see what a clean bill of health in this particular respect our barren soil inherited with its sterility. There are some malarious spots on the edge of Lake Champlain, arid there have been some temporary centres of malaria, within the memory of man, on one or more of our Massachusetts rivers, but these are harmless enough, for the most part, unless the millers dam them, when they are apt to retaliate with a whiff from their meadows, that sets the whole neighborhood shaking with fever and ague.
The Pilgrims of the Mayflower had with them a good physician, a man of standing, a deacon of their church, one whom they loved and trusted, Dr. Samuel Fuller. But no medical skill could keep cold and hunger and bad food, and, probably enough, desperate homesickness in some of the feebler sort, from doing their work. No detailed record remains of what they suffered or what was attempted for their relief during the first sad winter. The graves of those who died were levelled and sowed with grain that the losses of the little band might not be suspected by the savage tenants of the wilderness, and their story remains untold.
Of Dr. Fuller’s practice, at a later period, we have an account in a letter of his to Governor Bradford, dated June, 1630. “I have been to Matapan” (now Dorchester), he says, “and let some twenty of those people blood.” Such wholesale depletion as this, except with avowed homicidal intent, is quite unknown in these days; though I once saw the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy, order some ten or fifteen patients, taken almost indiscriminately, to be bled in a single morning.
Dr. Fuller’s two visits to Salem, at the request of Governor Endicott, seem to have been very satisfactory to that gentleman. Morton, the wild fellow of Merry Mount, gives a rather questionable reason for the Governor’s being so well pleased with the physician’s doings. The names under which he mentions the two personages, it will be seen, are not intended to be complimentary. “Dr. Noddy did a great cure for Captain Littleworth. He cured him of a disease called a wife.” William Gager, who came out with Winthrop, is spoken of as “a right godly man and skilful chyrurgeon, but died of a malignant fever not very long after his arrival.”
Two practitioners of the ancient town of Newbury are entitled to special notice, for different reasons. The first is Dr. John Clark, who is said by tradition to have been the first regularly educated physician who resided in New England. His portrait, in close-fitting skull-cap, with long locks and venerable flowing beard, is familiar to our eyes on the wall of our Society’s antechamber. His left hand rests upon a skull, his right hand holds an instrument which deserves a passing comment. It is a trephine, a surgical implement for cutting round pieces out of broken skulls, so as to get at the fragments which have been driven in, and lift them up. It has a handle like that of a gimlet, with a claw like a hammer, to lift with, I suppose, which last contrivance I do not see figured in my books. But the point I refer to is this: the old instrument, the trepan, had a handle like a wimble, what we call a brace or bit- stock. The trephine is not mentioned at all in Peter Lowe’s book, London, 1634; nor in Wiseman’s great work on Surgery, London, 1676; nor in the translation of Dionis, published by Jacob Tonson, in 1710. In fact it was only brought into more general use by Cheselden and Sharpe so late as the beginning of the last century. As John Clark died in 1661, it is remarkable to see the last fashion in the way of skull-sawing contrivances in his hands,–to say nothing of the claw on the handle, and a Hey’s saw, so called in England, lying on the table by him, and painted there more than a hundred years before Hey was born. This saw is an old invention, perhaps as old as Hippocrates, and may be seen figured in the “Armamentarium Chirurgicum” of Scultetus, or in the Works of Ambroise Pare.
Dr. Clark is said to have received a diploma before be came, for skill in lithotomy. He loved horses, as a good many doctors do, and left a good property, as they all ought to do. His grave and noble presence, with the few facts concerning him, told with more or less traditional authority, give us the feeling that the people of Newbury, and afterwards of Boston, had a wise and skilful medical adviser and surgeon in Dr. John Clark.
The venerable town of Newbury had another physician who was less fortunate. The following is a court record of 1652:
“This is to certify whom it may concern, that we the subscribers, being called upon to testify against doctor William Snelling for words by him uttered, affirm that being in way of merry discourse, a health being drank to all friends, he answered,
“I’ll pledge my friends,
And for my foes
A plague for their heels
And,’—
[a similar malediction on the other extremity of their feet.]
“Since when he hath affirmed that he only intended the proverb used in the west country, nor do we believe he intended otherwise.
“[Signed]
“WILLIAM THOMAS.
“THOMAS MILWARD.
“March 12th 1651, All which I acknowledge, and am sorry I did not expresse my intent, or that I was so weak as to use so foolish a proverb.
“[Signed]
“GULIELMUS SNELLING.”
Notwithstanding this confession and apology, the record tells us that “William Snelling in his presentment for cursing is fined ten shillings and the fees of court.”
I will mention one other name among those of the Fathers of the medical profession in New England. The “apostle” Eliot says, writing in 1647, “We never had but one anatomy in the country, which Mr. Giles Firman, now in England, did make and read upon very well.”
Giles Firmin, as the name is commonly spelled, practised physic in this country for a time. He seems to have found it a poor business; for, in a letter to Governor Winthrop, he says, “I am strongly sett upon to studye divinitie: my studyes else must be lost, for physick is but a meene helpe.”
Giles Firmin’s Lectures on Anatomy were the first scientific teachings of the New World. While the Fathers were enlightened enough to permit such instructions, they were severe in dealing with quackery; for, in 1631, our court records show that one Nicholas Knopp, or Knapp, was sentenced to be fined or whipped “for taking upon him to cure the scurvey by a water of noe worth nor value, which he solde att a very deare rate.” Empty purses or sore backs would be common with us to-day if such a rule were enforced.
Besides the few worthies spoken of, and others whose names I have not space to record, we must remember that there were many clergymen who took charge of the bodies as well as the souls of their patients, among them two Presidents of Harvard College, Charles Chauncy and Leonard Hoar,–and Thomas Thacher, first minister of the “Old South,” author of the earliest medical treatises printed in the country,[A Brief Rule to Guide the Common People in Small pox and Measles. 1674.] whose epitaph in Latin and Greek, said to have been written by Eleazer, an “Indian Youth” and a member of the Senior Class of Harvard College, may be found in the “Magnalia.” I miss this noble savage’s name in our triennial catalogue; and as there is many a slip between the cup and lip, one is tempted to guess that he may have lost his degree by some display of his native instinct,– possibly a flourish of the tomahawk or scalping-knife. However this may have been, the good man he celebrated was a notable instance of the Angelical Conjunction, as the author of the “Magnalia” calls it, of the offices of clergyman and medical practitioner.
Michael Wigglesworth, author of the “Day of Doom,” attended the sick, “not only as a Pastor, but as a Physician too, and this, not only in his own town, but also in all those of the vicinity.” Mather says of the sons of Charles Chauncy, “All of these did, while they had Opportunity, Preach the Gospel; and most, if not all of them, like their excellent Father before them, had an eminent skill in physick added unto their other accomplishments,” etc. Roger Williams is said to have saved many in a kind of pestilence which swept away many Indians.
To these names must be added, as sustaining a certain relation to the healing art, that of the first Governor Winthrop, who is said by John Cotton to have been “Help for our Bodies by Physick [and] for our Estates by Law,” and that of his son, the Governor of Connecticut, who, as we shall see, was as much physician as magistrate.
I had submitted to me for examination, in 1862, a manuscript found among the Winthrop Papers, marked with the superscription, “For my worthy friend Mr. Wintrop,” dated in 1643, London, signed Edward Stafford, and containing medical directions and prescriptions. It may be remembered by some present that I wrote a report on this paper, which was published in the “Proceedings” of this Society. Whether the paper was written for Governor John Winthrop of Massachusetts, or for his son, Governor John of Connecticut, there is no positive evidence that I have been able to obtain. It is very interesting, however, as giving short and simple practical directions, such as would be most like to be wanted and most useful, in the opinion of a physician in repute of that day.
The diseases prescribed for are plague, small-pox, fevers, king’s evil, insanity, falling-sickness, and the like; with such injuries as broken bones, dislocations, and burning with gunpowder. The remedies are of three kinds: simples, such as St. John’s wort, Clown’s all- heal, elder, parsley, maidenhair, mineral drugs, such as lime, saltpetre, Armenian bole, crocus metallorum, or sulphuret of antimony; and thaumaturgic or mystical, of which the chief is, “My black powder against the plague, small-pox; purples, all sorts of feavers; Poyson; either, by Way of Prevention or after Infection.” This marvellous remedy was made by putting live toads into an earthen pot so as to half fill it, and baking and burning them “in the open ayre, not in an house,”–concerning which latter possibility I suspect Madam Winthrop would have had something to say,–until they could be reduced by pounding, first into a brown, and then into a black, powder. Blood-letting in some inflammations, fasting in the early stage of fevers, and some of those peremptory drugs with which most of us have been well acquainted in our time, the infragrant memories of which I will not pursue beyond this slight allusion, are among his remedies.
The Winthrops, to one of whom Dr. Stafford’s directions were addressed, were the medical as well as the political advisers of their fellow-citizens for three or four successive generations. One of them, Governor John of Connecticut, practised so extensively, that, but for his more distinguished title in the State, he would have been remembered as the Doctor. The fact that he practised in another colony, for the most part, makes little difference in the value of the records we have of his medical experience, which have fortunately been preserved, and give a very fair idea, in all probability, of the way in which patients were treated in Massachusetts, when they fell into intelligent and somewhat educated hands, a little after the middle of the seventeenth century:
I have before me, while writing, a manuscript collection of the medical cases treated by him, and recorded at the time in his own hand, which has been intrusted to me by our President, his descendant.
They are generally marked Hartford, and extend from the year 1657 to 1669. From these, manuscripts, and from the letters printed in the Winthrop Papers published by our Society, I have endeavored to obtain some idea of the practice of Governor John Winthrop, Junior. The learned eye of Mr. Pulsifer would have helped me, no doubt, as it has done in other cases; but I have ventured this time to attempt finding my own way among the hieroglyphics of these old pages. By careful comparison of many prescriptions, and by the aid of Schroder, Salmon, Culpeper, and other old compilers, I have deciphered many of his difficult paragraphs with their mysterious recipes.
The Governor employed a number of the simples dear to ancient women, –elecampane and elder and wormwood and anise and the rest; but he also employed certain mineral remedies, which he almost always indicates by their ancient symbols, or by a name which should leave them a mystery to the vulgar. I am now prepared to reveal the mystic secrets of the Governor’s beneficent art, which rendered so many good and great as well as so many poor and dependent people his debtors,- at least, in their simple belief,–for their health and their lives.
His great remedy, which he gave oftener than any other, was nitre; which he ordered in doses of twenty or thirty grains to adults, and of three grains to infants. Measles, colics, sciatica, headache, giddiness, and many other ailments, all found themselves treated, and I trust bettered, by nitre; a pretty safe medicine in moderate doses, and one not likely to keep the good Governor awake at night, thinking whether it might not kill, if it did not cure. We may say as much for spermaceti, which he seems to have considered “the sovereign’st thing on earth” for inward bruises, and often prescribes after falls and similar injuries.
One of the next remedies, in point of frequency, which he was in the habit of giving, was (probably diaphoretic) antimony; a mild form of that very active metal, and which, mild as it was, left his patients very commonly with a pretty strong conviction that they had been taking something that did not exactly agree with them. Now and then he gave a little iron or sulphur or calomel, but very rarely; occasionally, a good, honest dose of rhubarb or jalap; a taste of stinging horseradish, oftener of warming guiacum; sometimes an anodyne, in the shape of mithridate,–the famous old farrago, which owed its virtue to poppy juice; [This is the remedy which a Boston divine tried to simplify. See Electuarium Novum Alexipharmacum, by Rev. Thomas Harward, lecturer at the Royal Chappell. Boston, 1732. This tract is in our Society’s library.] very often, a harmless powder of coral; less frequently, an inert prescription of pleasing amber; and (let me say it softly within possible hearing of his honored descendant), twice or oftener,–let us hope as a last resort,–an electuary of millipedes,–sowbugs, if we must give them their homely English name. One or two other prescriptions, of the many unmentionable ones which disgraced the pharmacopoeia of the seventeenth century, are to be found, but only in very rare instances, in the faded characters of the manuscript.
The excellent Governor’s accounts of diseases are so brief, that we get only a very general notion of the complaints for which he prescribed. Measles and their consequences are at first more prominent than any other one affection, but the common infirmities of both sexes and of all ages seem to have come under his healing hand. Fever and ague appears to have been of frequent occurrence.
His published correspondence shows that many noted people were in communication with him as his patients. Roger Williams wants a little of his medicine for Mrs. Weekes’s daughter; worshipful John Haynes is in receipt of his powders; troublesome Captain Underhill wants “a little white vitterall” for his wife, and something to cure his wife’s friend’s neuralgia, (I think his wife’s friend’s husband had a little rather have had it sent by the hands of Mrs. Underhill, than by those of the gallant and discursive captain); and pious John Davenport says, his wife “tooke but one halfe of one of the papers” (which probably contained the medicine he called rubila), “but could not beare the taste of it, and is discouraged from taking any more;” and honored William Leete asks for more powders for his “poore little daughter Graciana,” though he found it “hard to make her take it,” delicate, and of course sensitive, child as she was, languishing and dying before her time, in spite of all the bitter things she swallowed,–God help all little children in the hands of dosing doctors and howling dervishes! Restless Samuel Gorton, now tamed by the burden of fourscore and two years, writes so touching an account of his infirmities, and expresses such overflowing gratitude for the relief he has obtained from the Governor’s prescriptions, wondering how “a thing so little in quantity, so little in sent, so little in taste, and so little to sence in operation, should beget and bring forth such efects,” that we repent our hasty exclamation, and bless the memory of the good Governor, who gave relief to the worn-out frame of our long-departed brother, the sturdy old heretic of Rhode Island.
What was that medicine which so frequently occurs in the printed letters under the name of “rubila”? It is evidently a secret remedy, and, so far as I know, has not yet been made out. I had almost given it up in despair, when I found what appears to be a key to the mystery. In the vast multitude of prescriptions contained in the manuscripts, most of them written in symbols, I find one which I thus interpret:
“Four grains of (diaphoretic) antimony, with twenty grains of nitre, with a little salt of tin, making rubila.” Perhaps something was added to redden the powder, as he constantly speaks of “rubifying” or “viridating” his prescriptions; a very common practice of prescribers, when their powders look a little too much like plain salt or sugar.
Waitstill Winthrop, the Governor’s son, “was a skilful physician,” says Mr. Sewall, in his funeral sermon; “and generously gave, not only his advice, but also his Medicines, for the healing of the Sick, which, by the Blessing of God, were made successful for the recovery of many.” “His son John, a member of the Royal Society, speaks of himself as ‘Dr. Winthrop,’ and mentions one of his own prescriptions in a letter to Cotton Mather.” Our President tells me that there was an heirloom of the ancient skill in his family, within his own remembrance, in the form of a certain precious eye-water, to which the late President John Quincy Adams ascribed rare virtue, and which he used to obtain from the possessor of the ancient recipe.
These inherited prescriptions are often treasured in families, I do not doubt, for many generations. When I was yet of trivial age, and suffering occasionally, as many children do, from what one of my Cambridgeport schoolmates used to call the “ager,”–meaning thereby toothache or face-ache,–I used to get relief from a certain plaster which never went by any other name in the family than “Dr. Oliver.”
Dr. James Oliver was my great-great-grandfather, graduated in 1680, and died in 1703. This was, no doubt, one of his nostrums; for nostrum, as is well known, means nothing more than our own or my own particular medicine, or other possession or secret, and physicians in old times used to keep their choice recipes to themselves a good deal, as we have had occasion to see.
Some years ago I found among my old books a small manuscript marked “James Oliver. This Book Begun Aug. 12, 1685.” It is a rough sort of account-book, containing among other things prescriptions for patients, and charges for the same, with counter-charges for the purchase of medicines and other matters. Dr. Oliver practised in Cambridge, where may be seen his tomb with inscriptions, and with sculptured figures that look more like Diana of the Ephesians, as given in Calmet’s Dictionary, than like any angels admitted into good society here or elsewhere.
I do not find any particular record of what his patients suffered from, but I have carefully copied out the remedies he mentions, and find that they form a very respectable catalogue. Besides the usual simples, elder, parsley, fennel, saffron, snake-root, wormwood, I find the Elixir Proprietatis, with other elixire and cordials, as if he rather fancied warming medicines; but he called in the aid of some of the more energetic remedies, including iron, and probably mercury, as he bought two pounds of it at one time.
The most interesting item is his bill against the estate of Samuel Pason of Roxbury, for services during his last illness. He attended this gentleman,–for such he must have been, by the amount of physic which he took, and which his heirs paid for,–from June 4th, 1696, to September 3d of the same year, three months. I observe he charges for visits as well as for medicines, which is not the case in most of his bills. He opens the attack with a carminative appeal to the visceral conscience, and follows it up with good hard-hitting remedies for dropsy,–as I suppose the disease would have been called,–and finishes off with a rallying dose of hartshorn and iron.
It is a source of honest pride to his descendant that his bill, which was honestly paid, as it seems to have been honorably earned, amounted to the handsome total of seven pounds and two shillings. Let me add that he repeatedly prescribes plaster, one of which was very probably the “Dr. Oliver” that soothed my infant griefs, and for which I blush to say that my venerated ancestor received from Goodman Hancock the painfully exiguous sum of no pounds, no shillings, and sixpence.
I have illustrated the practice of the first century, from the two manuscripts I have examined, as giving an impartial idea of its every-day methods. The Governor, Johannes Secundus, it is fair to remember, was an amateur practitioner, while my ancestor was a professed physician. Comparing their modes of treatment with the many scientific follies still prevailing in the Old World, and still more with the extraordinary theological superstitions of the community in which they lived, we shall find reason, I think, to consider the art of healing as in a comparatively creditable state during the first century of New England.
In addition to the evidence as to methods of treatment furnished by the manuscripts I have cited, I subjoin the following document, to which my attention was called by Dr. Shurtleff, our present Mayor. This is a letter of which the original is to be found in vol. lxix. page 10 of the “Archives” preserved at the State House in Boston. It will be seen that what the surgeon wanted consisted chiefly of opiates, stimulants, cathartics, plasters, and materials for bandages. The complex and varied formulae have given place to simpler and often more effective forms of the same remedies; but the list and the manner in which it is made out are proofs of the good sense and schooling of the surgeon, who, it may be noted, was in such haste that he neglected all his stops. He might well be in a hurry, as on the very day upon which he wrote, a great body of Indians– supposed to be six or seven hundred–appeared before Hatfield; and twenty-five resolute young men of Hadley, from which town he wrote, crossed the river and drove them away.
HADLY May 30: 76
Mr RAWSON Sr
What we have recd by Tho: Houey the past month is not the cheifest of our wants as you have love for poor wounded I pray let us not want for these following medicines if you have not a speedy conveyance of them I pray send on purpose they are those things mentioned in my former letter but to prevent future mistakes I have wrote them att large wee have great want with the greatest halt and speed let us be supplyed.
Sr
Yr Sert
WILL LOCHS
(Endorsed)
Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye Council with it but could not obtaine any thing to be sent in answer thereto 13 June 1676
I have given some idea of the chief remedies used by our earlier physicians, which were both Galenic and chemical; that is, vegetable and mineral. They, of course, employed the usual perturbing medicines which Montaigne says are the chief reliance of their craft. There were, doubtless, individual practitioners who employed special remedies with exceptional boldness and perhaps success. Mr. Eliot is spoken of, in a letter of William Leete to Winthrop, Junior, as being under Mr. Greenland’s mercurial administrations. The latter was probably enough one of these specialists.
There is another class of remedies which appears to have been employed occasionally, but, on the whole, is so little prominent as to imply a good deal of common sense among the medical practitioners, as compared with the superstitions prevailing around them. I have said that I have caught the good Governor, now and then, prescribing the electuary of millipedes; but he is entirely excused by the almost incredible fact that they were retained in the materia medica so late as when Rees’s Cyclopaedia was published, and we there find the directions formerly given by the College of Edinburgh for their preparation. Once or twice we have found him admitting still more objectionable articles into his materia medica; in doing which, I am sorry to say that he could plead grave and learned authority. But these instances are very rare exceptions in a medical practice of many years, which is, on the whole, very respectable, considering the time and circumstances.
Some remedies of questionable though not odious character appear occasionally to have been employed by the early practitioners, but they were such as still had the support of the medical profession. Governor John Winthrop, the first, sends for East Indian bezoar, with other commodities he is writing for. Governor Endicott sends him one he had of Mr. Humfrey. I hope it was genuine, for they cheated infamously in the matter of this concretion, which ought to come out of an animal’s stomach, but the real history of which resembles what is sometimes told of modern sausages.
There is a famous law-case of James the First’s time, in which a goldsmith sold a hundred pounds’ worth of what he called bezoar, which was proved to be false, and the purchaser got a verdict against him. Governor Endicott also sends Winthrop a unicorn’s horn, which was the property of a certain Mrs. Beggarly, who, in spite of her name, seems to have been rich in medical knowledge and possessions. The famous Thomas Bartholinus wrote a treatise on the virtues of this fabulous-sounding remedy, which was published in 1641, and republished in 1678.
The “antimonial cup,” a drinking vessel made of that metal, which, like our quassia-wood cups, might be filled and emptied in saecula saeculorum without exhausting its virtues, is mentioned by Matthew Cradock, in a letter to the elder Winthrop, but in a doubtful way, as it was thought, he says, to have shortened the days of Sir Nathaniel Riche; and Winthrop himself, as I think, refers to its use, calling it simply “the cup.” An antimonial cup is included in the inventory of Samuel Seabury, who died 1680, and is valued at five shillings. There is a treatise entitled “The Universall Remedy, or the Vertues of the Antimoniall Cup, By John Evans, Minister and Preacher of God’s Word, London, 1634,” in our own Society’s library.
One other special remedy deserves notice, because of native growth. I do not know when Culver’s root, Leptandra Virginica of our National Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to John Winthrop of New London, speaks of it as famous for the cure of consumptions, and wishes to get some of it, through his mediation, for Katharine, his eldest daughter. He gets it, and gives it to the “poor damsel,” who is languishing, as he says, and who dies the next month,–all the sooner, I have little doubt, for this uncertain and violent drug, with which the meddlesome pedant tormented her in that spirit of well-meant but restless quackery, which could touch nothing without making mischief, not even a quotation, and yet proved at length the means of bringing a great blessing to our community, as we shall see by and by; so does Providence use our very vanities and infirmities for its wise purposes.
Externally, I find the practitioners on whom I have chiefly relied used the plasters of Paracelsus, of melilot, diachylon, and probably diaphoenicon, all well known to the old pharmacopoeias, and some of them to the modern ones,–to say nothing of “my yellow salve,” of Governor John, the second, for the composition of which we must apply to his respected descendant.
The authors I find quoted are Barbette’s Surgery, Camerarius on Gout, and Wecherus, of all whom notices may be found in the pages of Haller and Vanderlinden; also, Reed’s Surgery, and Nicholas Culpeper’s Practice of Physic and Anatomy, the last as belonging to Samuel Seabury, chirurgeon, before mentioned. Nicholas Culpeper was a shrewd charlatan, and as impudent a varlet as ever prescribed for a colic; but knew very well what he was about, and badgers the College with great vigor. A copy of Spigelius’s famous Anatomy, in the Boston Athenaeum, has the names of Increase and Samuel Mather written in it, and was doubtless early overhauled by the youthful Cotton, who refers to the great anatomist’s singular death, among his curious stories in the “Magnalia,” and quotes him among nearly a hundred authors whom he cites in his manuscript “The Angel of Bethesda.” Dr. John Clark’s “books and instruments, with several chirurgery materials in the closet,” a were valued in his inventory at sixty pounds; Dr. Matthew Fuller, who died in 1678, left a library valued at ten pounds; and a surgeon’s chest and drugs valued at sixteen pounds.’
Here we leave the first century and all attempts at any further detailed accounts of medicine and its practitioners. It is necessary to show in a brief glance what had been going on in Europe during the latter part of that century, the first quarter of which had been made illustrious in the history of medical science by the discovery of the circulation.
Charles Barbeyrac, a Protestant in his religion, was a practitioner and teacher of medicine at Montpellier. His creed was in the way of his obtaining office; but the young men followed his instructions with enthusiasm. Religious and scientific freedom breed in and in, until it becomes hard to tell the family of one from that of the other. Barbeyrac threw overboard the old complex medical farragos of the pharmacopoeias, as his church had disburdened itself of the popish ceremonies.
Among the students who followed his instructions were two Englishmen: one of them, John Locke, afterwards author of an “Essay on the Human Understanding,” three years younger than his teacher; the other, Thomas Sydenham, five years older. Both returned to England. Locke, whose medical knowledge is borne witness to by Sydenham, had the good fortune to form a correct opinion on a disease from which the Earl of Shaftesbury was suffering, which led to an operation that saved his life. Less felicitous was his experience with a certain ancilla culinaria virgo,–which I am afraid would in those days have been translated kitchen-wench, instead of lady of the culinary department,–who turned him off after she had got tired of him, and called in another practitioner. [Locke and Sydenham, p. 124. By John Brown, M. D. Edinburgh, 1866.] This helped, perhaps, to spoil a promising doctor, and make an immortal metaphysician. At any rate, Locke laid down the professional wig and cane, and took to other studies.
The name of Thomas Sydenham is as distinguished in the history of medicine as that of John Locke in philosophy. As Barbeyrac was found in opposition to the established religion, as Locke took the rational side against orthodox Bishop Stillingfleet, so Sydenham went with Parliament against Charles, and was never admitted a Fellow by the College of Physicians, which, after he was dead, placed his bust in their hall by the side of that of Harvey.
What Sydenham did for medicine was briefly this he studied the course of diseases carefully, and especially as affected by the particular season; to patients with fever he gave air and cooling drinks, instead of smothering and heating them, with the idea of sweating out their disease; he ordered horseback exercise to consumptives; he, like his teacher, used few and comparatively simple remedies; he did not give any drug at all, if he thought none was needed, but let well enough alone. He was a sensible man, in short, who applied his common sense to diseases which he had studied with the best light of science that he could obtain.
The influence of the reform he introduced must have been more or less felt in this country, but not much before the beginning of the eighteenth century, as his great work was not published until 1675, and then in Latin. I very strongly suspect that there was not so much to reform in the simple practice of the physicians of the new community, as there was in that of the learned big-wigs of the “College,” who valued their remedies too much in proportion to their complexity, and the extravagant and fantastic ingredients which went to their making.
During the memorable century which bred and bore the Revolution, the medical profession gave great names to our history. But John Brooks belonged to the State, and Joseph Warren belongs to the country and mankind, and to speak of them would lead me beyond my limited– subject. There would be little pleasure in dwelling on the name of Benjamin Church; and as for the medical politicians, like Elisha Cooke in the early part of the century, or Charles Jarvis, the bald eagle of Boston, in its later years, whether their practice was heroic or not, their patients were, for he is a bold man who trusts one that is making speeches and coaxing voters, to meddle with the internal politics of his corporeal republic.
One great event stands out in the medical history of this eighteenth century; namely, the introduction of the practice of inoculation for small-pox. Six epidemics of this complaint had visited Boston in the course of a hundred years. Prayers had been asked in the churches for more than a hundred sick in a single day, and this many times. About a thousand persons had died in a twelvemonth, we are told, and, as we may infer, chiefly from this cause.
In 1721, this disease, after a respite of nineteen years, again appeared as an epidemic. In that year it was that Cotton Mather, browsing, as was his wont, on all the printed fodder that came within reach of his ever-grinding mandibles, came upon an account of inoculation as practised in Turkey, contained in the “Philosophical Transactions.” He spoke of it to several physicians, who paid little heed to his story; for they knew his medical whims, and had probably been bored, as we say now-a-days, many of them, with listening to his “Angel of Bethesda,” and satiated with his speculations on the Nishmath Chajim.
The Reverend Mather,–I use a mode of expression he often employed when speaking of his honored brethren,–the Reverend Mather was right this time, and the irreverent doctors who laughed at him were wrong. One only of their number disputes his claim to giving the first impulse to the practice, in Boston. This is what that person says: “The Small-Pox spread in Boston, New England, A.1721, and the Reverend Dr. Cotton Mather, having had the use of these Communications from Dr. William Douglass (that is, the writer of these words); surreptitiously, without the knowledge of his Informer, that he might have the honour of a New fangled notion, sets an Undaunted Operator to work, and in this Country about 290 were inoculated.”
All this has not deprived Cotton Mather of the credit of suggesting, and a bold and intelligent physician of the honor of carrying out, the new practice. On the twenty-seventh day of June, 1721, Zabdiel Boylston of Boston inoculated his only son for smallpox,–the first person ever submitted to the operation in the New World. The story of the fierce resistance to the introduction of the practice; of how Boylston was mobbed, and Mather had a hand-grenade thrown in at his window; of how William Douglass, the Scotchman, “always positive, and sometimes accurate,” as was neatly said of him, at once depreciated the practice and tried to get the credit of suggesting it, and how Lawrence Dalhonde, the Frenchman, testified to its destructive consequences; of how Edmund Massey, lecturer at St. Albans, preached against sinfully endeavoring to alter the course of nature by presumptuous interposition, which he would leave to the atheist and the scoffer, the heathen and unbeliever, while in the face of his sermon, afterwards reprinted in Boston, many of our New England clergy stood up boldly in defence of the practice,–all this has been told so well and so often that I spare you its details. Set this good hint of Cotton Mather against that letter of his to John Richards, recommending the search after witch-marks, and the application of the water-ordeal, which means throw your grandmother into the water, if she has a mole on her arm;–if she swims, she is a witch and must be hanged; if she sinks, the Lord have mercy on her soul!
Thus did America receive this great discovery, destined to save thousands of lives, via Boston, from the hands of one of our own Massachusetts physicians.
The year 1735 was rendered sadly memorable by the epidemic of the terrible disease known as “throat distemper,” and regarded by many as the same as our “diphtheria.” Dr. Holyoke thinks the more general use of mercurials in inflammatory complaints dates from the time of their employment in this disease, in which they were thought to have proved specially useful.
At some time in the course of this century medical practice had settled down on four remedies as its chief reliance. I must repeat an incident which I have related in another of these Essays. When Dr. Holyoke, nearly seventy years ago, received young Mr. James Jackson as his student, he showed him the formidable array of bottles, jars, and drawers around his office, and then named the four remedies referred to as being of more importance than all the rest put together. These were “Mercury, Antimony, Opium, and Peruvian Bark.” I doubt if either of them remembered that, nearly seventy years before, in 1730, Dr. William Douglass, the disputatious Scotchman, mentioned those same four remedies, in the dedication of his quarrelsome essay on inoculation, as the most important ones in the hands of the physicians of his time.
In the “Proceedings” of this Society for the year 1863 is a very pleasant paper by the late Dr. Ephraim Eliot, giving an account of the leading physicians of Boston during the last quarter of the last century. The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch, Danforth, John Warren, Jeffries, are all famous in local history, and are commemorated in our medical biographies. One of them, at least, appears to have been more widely known, not only as one of the first aerial voyagers, but as an explorer in the almost equally hazardous realm of medical theory. Dr. John Jeffries, the first of that name, is considered by Broussais as a leader of medical opinion in America, and so referred to in his famous “Examen des Doctrines Medicales.”
Two great movements took place in this eighteenth century, the effect of which has been chiefly felt in our own time; namely, the establishment of the Massachusetts Medical Society, and the founding of the Medical School of Harvard University.
The third century of our medical history began with the introduction of the second great medical discovery of modern times,–of all time up to that date, I may say,–once more via Boston, if we count the University village as its suburb, and once more by one of our Massachusetts physicians. In the month of July, 1800, Dr. Benjamin Waterhouse of Cambridge submitted four of his own children to the new process of vaccination,–the first persons vaccinated, as Dr. Zabdiel Boylston’s son had been the first person inoculated in the New World.
A little before the first half of this century was completed, in the autumn of 1846, the great discovery went forth from the Massachusetts General Hospital, which repaid the debt of America to the science of the Old World, and gave immortality to the place of its origin in the memory and the heart of mankind. The production of temporary insensibility at will–tuto, cito, jucunde, safely, quickly, pleasantly–is one of those triumphs over the infirmities of our mortal condition which change the aspect of life ever afterwards. Rhetoric can add nothing to its glory; gratitude, and the pride permitted to human weakness, that our Bethlehem should have been chosen as the birthplace of this new embodiment of the divine mercy, are all we can yet find room for.
The present century has seen the establishment of all those great charitable institutions for the cure of diseases of the body and of the mind, which our State and our city have a right to consider as among the chief ornaments of their civilization.
The last century had very little to show, in our State, in the way of medical literature. The worthies who took care of our grandfathers and great-grandfathers, like the Revolutionary heroes, fought (with disease) and bled (their patients) and died (in spite of their own remedies); but their names, once familiar, are heard only at rare intervals. Honored in their day, not unremembered by a few solitary students of the past, their memories are going sweetly to sleep in the arms of the patient old dry-nurse, whose “blackdrop” is the never-failing anodyne of the restless generations of men. Except the lively controversy on inoculation, and floating papers in journals, we have not much of value for that long period, in the shape of medical records.
But while the trouble with the last century is to find authors to mention, the trouble of this would be to name all that we find. Of these, a very few claim unquestioned preeminence.
Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical School of our University, did a great work for the advancement of medicine and surgery in New England, by his labors as teacher and author, greater, it is claimed by some, than was ever done by any other man. The two Warrens, of our time, each left a large and permanent record of a most extended surgical practice. James Jackson not only educated a whole generation by his lessons of wisdom, but bequeathed some of the most valuable results of his experience to those who came after him, in a series of letters singularly pleasant and kindly as well as instructive. John Ware, keen and cautious, earnest and deliberate, wrote the two remarkable essays which have identified his name, for all time, with two important diseases, on which he has shed new light by his original observations.
I must do violence to the modesty of the living by referring to the many important contributions to medical science by Dr. Jacob Bigelow, and especially to his discourse on “Self-limited Diseases,” an address which can be read in a single hour, but the influence of which will be felt for a century.
Nor would the profession forgive me if I forgot to mention the admirable museum of pathological anatomy, created almost entirely by the hands of Dr. John Barnard Swett Jackson, and illustrated by his own printed descriptive catalogue, justly spoken of by a distinguished professor in the University of Pennsylvania as the most important contribution which had ever been made in this country to the branch to which it relates.
When we look at the literature of mental disease, as seen in hospital reports and special treatises, we can mention the names of Wyman, Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts or placed at the head of her institutions for the treatment of the insane.
We have a right to claim also one who is known all over the civilized world as a philanthropist, to us as a townsman and a graduate of our own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor of a great multitude who were born to a world of inward or of outward darkness.
I cannot pass over in silence the part taken by our own physicians in those sanitary movements which are assuming every year greater importance. Two diseases especially have attracted attention, above all others, with reference to their causes and prevention; cholera, the “black death” of the nineteenth century, and consumption, the white plague of the North, both of which have been faithfully studied and reported on by physicians of our own State and city. The cultivation of medical and surgical specialties, which is fast becoming prevalent, is beginning to show its effects in the literature of the profession, which is every year growing richer in original observations and investigations.
To these benefactors who have labored for us in their peaceful vocation, we must add the noble army of surgeons, who went with the soldiers who fought the battles of their country, sharing many of their dangers, not rarely falling victims to fatigue, disease, or the deadly volleys to which they often exposed themselves in the discharge of their duties.
The pleasant biographies of the venerable Dr. Thacher, and the worthy and kind-hearted gleaner, Dr. Stephen W. Williams, who came after him, are filled with the names of men who served their generation well, and rest from their labors, followed by the blessing of those for whom they endured the toils and fatigues inseparable from their calling. The hardworking, intelligent country physician more especially deserves the gratitude of his own generation, for he rarely leaves any permanent record in the literature of his profession. Books are hard to obtain; hospitals, which are always centres of intelligence, are remote; thoroughly educated and superior men are separated by wide intervals; and long rides, though favorable to reflection, take up much of the time which might otherwise be given to the labors of the study. So it is that men of ability and vast experience, like the late Dr. Twitchell, for instance, make a great and deserved reputation, become the oracles of large districts, and yet leave nothing, or next to nothing, by which their names shall be preserved from blank oblivion.
One or two other facts deserve mention, as showing the readiness of our medical community to receive and adopt any important idea or discovery. The new science of Histology, as it is now called, was first brought fully before the profession of this country by the translation of Bichat’s great work, “Anatomie Generale,” by the late Dr. George Hayward.
The first work printed in this country on Auscultation,–that wonderful art of discovering disease, which, as it were, puts a window in the breast, through which the vital organs can be seen, to all intents and purposes, was the manual published anonymously by “A Member of the Massachusetts Medical Society.”
We are now in some slight measure prepared to weigh the record of the medical profession in Massachusetts, and pass our judgment upon it. But in-order to do justice to the first generation of practitioners, we must compare what we know of their treatment of disease with the state of the art in England, and the superstitions which they saw all around them in other departments of knowledge or belief.
English medical literature must have been at a pretty low ebb when Sydenham recommended Don Quixote to Sir Richard Blackmore for professional reading. The College Pharmacopoeia was loaded with the most absurd compound mixtures, one of the most complex of which (the same which the Reverend Mr. Harward, “Lecturer at the Royal Chappel in Boston,” tried to simplify), was not dropped until the year 1801. Sir Kenelm Digby was playing his fantastic tricks with the Sympathetic powder, and teaching Governor Winthrop, the second, how to cure fever and ague, which some may like to know. “Pare the patient’s nails; put the parings in a little bag, and hang the bag round the neck of a live eel, and put him in a tub of water. The eel will die, and the patient will recover.”
Wiseman, the great surgeon, was discoursing eloquently on the efficacy of the royal touch in scrofula. The founder of the Ashmolean Museum at Oxford, consorting with alchemists and astrologers, was treasuring the manuscripts of the late pious Dr. Richard Napier, in which certain letters (Rx Ris) were understood to mean Responsum Raphaelis,–the answer of the angel Raphael to the good man’s medical questions. The illustrious Robert Boyle was making his collection of choice and safe remedies, including the sole of an old shoe, the thigh bone of a hanged man, and things far worse than these, as articles of his materia medica. Dr. Stafford, whose paper of directions to his “friend, Mr. Wintrop,” I cited, was probably a man of standing in London; yet toad-powder was his sovereign remedy.
See what was the state of belief in other matters among the most intelligent persons of the colonies, magistrates and clergymen. Jonathan Brewster, son of the church-elder, writes the wildest letters to John Winthrop about alchemy,–“mad for making gold as the Lynn rock-borers are for finding it.”
Remember the theology and the diabology of the time. Mr. Cotton’s Theocracy was a royal government, with the King of kings as its nominal head, but with an upper chamber of saints, and a tremendous opposition in the lower house; the leader of which may have been equalled, but cannot have been surpassed by any of our earth-born politicians. The demons were prowling round the houses every night, as the foxes were sneaking about the hen-roosts. The men of Gloucester fired whole flasks of gunpowder at devils disguised as Indians and Frenchmen.
How deeply the notion of miraculous interference with the course of nature was rooted, is shown by the tenacity of the superstition about earthquakes. We can hardly believe that our Professor Winthrop, father of the old judge and the “squire,” whom many of us Cambridge people remember so well, had to defend himself against the learned and excellent Dr. Prince, of the Old South Church, for discussing their phenomena as if they belonged to the province of natural science:
Not for the sake of degrading the aspect of the noble men who founded our State, do I refer to their idle beliefs and painful delusions, but to show against what influences the common sense of the medical profession had to assert itself.
Think, then, of the blazing stars, that shook their horrid hair in the sky; the phantom ship, that brought its message direct from the other world; the story of the mouse and the snake at Watertown; of the mice and the prayer-book; of the snake in church; of the calf with two heads; and of the cabbage in the perfect form of a cutlash, –all which innocent occurrences were accepted or feared as alarming portents.
We can smile at these: but we cannot smile at the account of unhappy Mary Dyer’s malformed offspring; or of Mrs. Hutchinson’s domestic misfortune of similar character, in the story of which the physician, Dr. John Clark of Rhode Island, alone appears to advantage; or as we read the Rev. Samuel Willard’s fifteen alarming pages about an unfortunate young woman suffering with hysteria. Or go a little deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia, first admonished, then whipped; at last, taking her own little daughter’s life; put on trial, and standing mute, threatened to be pressed to death, confessing, sentenced, praying to be beheaded; and none the less pitilessly swung from the fatal ladder.
The cooper’s crazy wife–crazy in the belief that she has committed the unpardonable sin–tries to drown her child, to save it from misery; and the poor lunatic, who would be tenderly cared for to-day in a quiet asylum, is judged to be acting under the instigation of Satan himself. Yet, after all, what can we say, who put Bunyan’s “Pilgrim’s Progress,” full of nightmare dreams of horror, into all our children’s hands; a story in which the awful image of the man in the cage might well turn the nursery where it is read into a madhouse?
The miserable delusion of witchcraft illustrates, in a still more impressive way, the false ideas which governed the supposed relation of men with the spiritual world. I have no doubt many physicians shared in these superstitions. Mr. Upham says they–that is, some of them–were in the habit of attributing their want of success to the fact, that an “evil hand” was on their patient. The temptation was strong, no doubt, when magistrates and ministers and all that followed their lead were contented with such an explanation. But how was it in Salem, according to Mr. Upham’s own statement? Dr. John Swinnerton was, he says, for many years the principal physician of Salem. And he says, also, “The Swinnerton family were all along opposed to Mr. Parris, and kept remarkably clear from the witchcraft delusion.” Dr. John Swinnerton–the same, by the way, whose memory is illuminated by a ray from the genius of Hawthorne–died the very year before the great witchcraft explosion took place. But who can doubt that it was from him that the family had learned to despise and to resist the base superstition; or that Bridget Bishop, whose house he rented, as Mr. Upham tells me, the first person hanged in the time of the delusion, would have found an efficient protector in her tenant, had he been living, to head the opposition of his family to the misguided clergymen and magistrates?
I cannot doubt that our early physicians brought with them many Old- World medical superstitions, and I have no question that they were more or less involved in the prevailing errors of the community in which they lived. But, on the whole, their record is a clean one, so far as we can get at it; and where it is questionable we must remember that there must have been many little-educated persons among them; and that all must have felt, to some extent, the influence of those sincere and devoted but unsafe men, the physic-practising clergymen, who often used spiritual means as a substitute for temporal ones, who looked upon a hysteric patient as possessed by the devil, and treated a fractured skull by prayers and plasters, following the advice of a ruling elder in opposition to the “unanimous opinion of seven surgeons.”
To what results the union of the two professions was liable to lead, may be seen by the example of a learned and famous person, who has left on record the product of his labors in the double capacity of clergyman and physician.
I have had the privilege of examining a manuscript of Cotton Mather’s relating to medicine, by the kindness of the librarian of the American Antiquarian Society, to which society it belongs. A brief notice of this curious document may prove not uninteresting.
It is entitled “The Angel of Bethesda: an Essay upon the Common Maladies of Mankind, offering, first, the sentiments of Piety,” etc., etc., and “a collection of plain but potent and Approved REMEDIES for the Maladies.” There are sixty-six “Capsula’s,” as he calls them, or chapters, in his table of contents; of which, five–from the fifteenth to the nineteenth, inclusive–are missing. This is a most unfortunate loss, as the eighteenth capsula treated of agues, and we could have learned from it something of their degree of frequency in this part of New England. There is no date to the manuscript; which, however, refers to a case observed Nov. 14, 1724.
The divine takes precedence of the physician in this extraordinary production. He begins by preaching a sermon at his unfortunate patient. Having thrown him into a cold sweat by his spiritual sudorific, he attacks him with his material remedies, which are often quite as unpalatable. The simple and cleanly practice of Sydenham, with whose works he was acquainted, seems to have been thrown away upon him. Everything he could find mentioned in the seventy or eighty authors he cites, all that the old women of both sexes had ever told him of, gets into his text, or squeezes itself into his margin.
Evolving disease out of sin, he hates it, one would say, as he hates its cause, and would drive it out of the body with all noisome appliances. “Sickness is in Fact Flagellum Dei pro peccatis mundi.” So saying, he encourages the young mother whose babe is wasting away upon her breast with these reflections: