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dence in their system, it is attributable to the intervention of what they call allopathic practice; and when by proper kygienic measures they prevent disease, they are entitled to credit for it, but not on sectarian grounds, for hygiene is neither of homeopathy nor of allopathy. Indeed the chief credit of homeopathy springs from its careful system of prophylaxis, and those who practice it deserve recommendation just as the physicians among the Chinese, who are paid while people are well, but are promptly dismissed on the advent of sickness. The success of homeopathy was a signal for a thousand other fallacies springing up in its wake, each succeeding one more monstrous than the former, till the following formidable array is exhibited by the New York Medical Register for 1864: “The whole number of persons professing to practice medicine in some form or other in the city of New York, at the present time, is 1,234: Males.
46 Regular practitioners
98 T'he remainder designate themselves “Analytical,” “Botanic,” “Magnetic,
Magnetic,' “Hygeio-Electropathists," “ ElectroChemical," " Metaphysical,” “Eclectic," "Hydropathic,” “Indian,” “Pantological,” “Clairvoyants," "Physopaths," ,,
“ “Medical Astrologists,” &c. &c. Yet most of those impostors make money and drive fast horses; while many well-educated and industrious physicians eke out but a mere competence.
Although so long as ignorance will give countenance and support to heterodox systems of medicine we cannot hope to see the evil of quackery entirely extirpated, yet much that could have been done to render it abhorrent in the eyes of sensible persons has been left undone, owing to the supineness and apathy of the profession. The most effective weapon against ignorance and imposture would be the establishment of a higher standard of requirements ir candidates for medical degrees, a more elevated tone in our medical schools, and a careful exclusion from them of persons who have disgraced their previous lives by unjustifiable practices. Raw country boys, smelling of the hoe and the rake,
or those who have done nothing but jump counters since they were as high as one, are not such as a few years spent in a medical college can fit to be care-takers of the public
a health. We have but to glance at a few of the theses which are annually handed in by aspirants for medical degrees to witness an exhibition of the profoundest ignorance of the principles of spelling and syntax, not to mention the higher requisites of rhetoric. Then we sonetimes see colleges bestow diplomas on those who advertise or in some manner deceive the public. We have this moment before our minds the case of a man thoroughly ignorant both in speech and manner, who obtained a diploma from one of our first colleges, although before he began to study medicine he used to fill the daily prints with shameless lies, professing to cure the worst cases of consumption. Now that he has received a license to practice he riots in the most extravagant Munchausenisms, and invites the public to see a boy who had eaten nothing for a fabulous length of time, and whom he has rescued from the grave. While such things continue we cannot but expect to find unmedical people fall into serious errors concerning the true character of the medical profession. There has been some talk among a few eminent physicians about remedying those evils; but whatever their intentions may be, their action is decidedly null.
Although ignorance and quackery thus beset the progress of legitimate medicine, yet enough has been accomplished to prove that its tendency is undoubtedly progressive. Observation, unaided by the results of collateral sciences, the same species of observation which has been practised from Hippocrates down, has brought to light within the last fifty years many important facts which entirely escaped the attention of the ancients. Physical examination may be considered the most valuable help to diagnosis which pure observation has bestowed on modern medicine, and all the more important, as it leads to the detection of disease in those regions of the body where disease most frequently, has its seat. The older physicians, having been unable to penetrate the arcana of the system, confined their observations almost entirely to superficial changes. Their works, therefore, teem with labored descriptions of the changes of skin, countenance, color, and configuration, which supervene on diseased.conditions, but are entirely silent on the more significant changes taking place within. The cultivation of anatomy both morbid and healthy first suggested the possibility of estab
lishing a connection between the state of an internal organ and the character of the sound it gave forth. The French physician Laennec, therefore, gave auscultation as the result of enquiries thus suggested. By means of this diagnostic aid a skilful physician is now enabled to determine the exact aberration from the normal standard of those important organs the heart and the lungs. Unhappily, too many people know with what unerring accuracy an experiencd doctor can tell them how far and in what way they are affected; what their chances are of longevity; what feelings, agreeable or disagreeable, they will experience in the course of their ailment, and tbis after a few moments' careful examination. Since Laennec's time auscultation has been successfully practised in diseases of the brain, and promises soon to reach such a degree of perfection that through it incipient deviations from the normal state of things in that organ will be readily detected. Midwifery also has profited by this improvement, for auscultation of the foetal heart is looked on as an important means of determining the position of the fætus in utero. Chemical tests rank next to physical examination, and may be considered an off-shoot of organic chemistry. By chemical tests the first inroads of that formidable disease, Bright's disease of the kidney,'are detected, and if the progress of the disease can be at all arrested, it is when chemical reaction first discloses its presence. In medical jurisprudence, also, chemical tests are of exceeding value, for by their means traces of poison may be detected in the system, even a year after death, and a late celebrated poisoning case proves how infallible are their revelations. Lehmann and Liebig in Germany, and Regnault in France, have especially rendered organic chemistry available to medicine by having carefully noted the action of chemical agents on animal and vegetable tissues. But chemistry has contributed in another efficacious way to the advancement of medicine, by extracting the active principles of drugs from the crude material, thus giving compact and reliable remedies instead of dilute and uncertain ones. The termination ine suffixed to most of the drugs in use indicates the result of chemical extraction.
Organic chemistry lies at the root of the commonly received physiological doctrines of the present day. Before the habit of close analysis and a strict adherence to the inductive method had rejected mere names as insufficient to explain the phenomena of nature, the terms vitalism and vital force were greatly in vogue, and every event in the system was at
once explained by an appeal to the intervention of this mysterious agent. When, however, the question arose as to what was this vital force, the difficulties all returned, and it was found that a mere name had been received for an explanation. Thus, as when Toricelli discovered that nature did not abhor a vacuum, and that the maxim had been adopted as a cloak to ignorance, many rejected vital force as a mere figment and strove to find an explanation of the facts of physiology. The discoveries made in organic chemistry, and the analogy between chemical processes and the operations of nature in the animal economy, suggested a chemical theory of digestion and secretion. Facts were found in entire accordance with surmises, and every step of the digestive process can now be satisfactorily explained by chemistry. Yet there can be no doubt that life is more than a chemical process, and that growth and assimilation take place in contravention of the principles of organic chemistry. But the vitalist, from Paracelsus and Van Helmont down to Paine, cannot tell us how those mysterious processes of life are accomplished. If the chemical doctrine of physiology has
. failed to give an explanation of every function, at least credit is due to it for what it has done; nor is the attempt fair which has been made to depreciate chemicalism because it. has failed to explain everything. At least it possesses the undoubted advantage of having given an explanation which facts have confirmed, which is more than the vox et preterea nihil of vitalism. According to the vitalists, the same mysterious agency which keeps together the chemically antagouistic elements of the animal fabric, presides over every function and process of life. This view would be in accordance with analogy if there existed any means of discovering what this vital force is in se, whether it be a direct intervention of supernatural power or some unknown agent of the natural order. But so long as nothing of this sort can be definitely known, it is only proper to accept what experience teaches, and when we find in chemistry an adequate means of explaining certain physiological functions, we should not reject it because of its inadequacy to explain all.
These services bestowed on medical science by chemistry have been the occasion of a more energetic prosecution of chemical labors.
That which, however, gives character to modern medicine is the attention it has bestowed on measures preventive of disease. It has been almost a proverb among the people
that doctors thrive on epidemics and circumstances pernicious to public health ; and indeed, history teaches us that it has always been considered the proper mission of physicians to cure and not to prevent disease. Nor is this to be wondered at when we reflect that in past social conditions the influence of the physician was very limited, the exercise of his profession being confined to personal interviews with his patients. And physicians themselves gave color to this opinion by completely disregarding prevention as a thing that did not pay; and by looking on health as a lawyer would look on universal love, something exceedingly damaging to their business. We have the earliest testimony exhibiting this view of a physician's duties. Thus Xenophon represents Cambyses addressing his son Cyrus: “But, child, these men that you speak of are like menders of torn clothes, so when people are sick physicians cure them ; but your care of health is to be of a nobler kind—to prevent the army's being sick is what you ought to take care of."*
No doubt, to one looking at the condition of the streets of New York and certain other large cities, it would occur that no thought was further from our legislators and prominent physicians than the adoption of proper sanitary measures for the prevention of disease. But on enquiry it will be found that the fault entirely lies with the politicians, whose nature inclines them to filth and corruption. When aided by the authorities, enlightened and philanthropic practice will accomplish incalculable good in this field, and the worth of a physician will be rated by his success in preventing diseases, rather than by his skill in curing them. Were all the drugs in the world destroyed, the loss would be but little felt if proper sanitary measures were adopted for preserving the health of the people, as then the indications for the use of drugs would be infinitely fewer. What is needed especially is, not the establishment of chemical laboratories where new extracts and drugs may be manufactured, but the infusion of a more enlightened sentiment into the lower classes of the population, that they may take precautionary measures, which would prevent more disease than all the drugs could ever cure. The plan of prevention, as synonymous with hygiene, is carried into the field of disease itself; and to-day many diseases are treated by fresh air, tonics, and stimulants, where a few years ago the most active medica