5155. MEDICINE, Views on Science of.—
We know from what we see and feel, that the animal body is, in its organs and functions,
subject to derangement, inducing pain,
and tending to its destruction. In this disordered
state, we observe nature providing for
the reestablishment of order, by exciting some
salutary evacuation of the morbific matter, or
by some other operation which escapes our
imperfect senses and researches. She brings on
a crisis, by stools, vomiting, sweat, urine, expectoration,
bleeding, &c., which, for the most
part, ends in the restoration of healthy action.
Experience has taught us, also, that there are
certain substances, by which, applied to the living
body, internally or externally, we can at will
produce these small evacuations, and thus do,
in a short time, what nature would do but
slowly, and do effectually, what perhaps she
would not have strength to accomplish. * * *
So far, I bow to the utility of medicine. It
goes to the well-defined forms of disease, and
happily, to those the most frequent. But the
disorders of the animal body, and the symptoms
indicating them, are as various as the
elements of which the body is composed. The
combinations, too, of these symptoms are so
infinitely diversified, that many associations of
them appear too rarely to establish a definite
disease: and to an unknown disease, there
cannot be a known remedy. Here, then, the
judicious, the moral, the humane physician
should stop. Having been so often a witness
to the salutary efforts which nature makes to
reestablish the disordered functions, he should
rather trust to their action, than hazard the interruption
of that, and a greater derangement
of the system, by conjectural experiments on a
machine so complicated and so unknown as the
human body, and a subject so sacred as human
life. Or, if the appearance of doing something
be necessary to keep alive the hope and spirits
of the patient, it should be of the most innocent
character. One of the most successful physicians
I have ever known, has assured me, that
he used more bread pills, drops of colored
water, and powders of hickory ashes, than of all
other medicines put together. It was certainly
a pious fraud. But the adventurous physician
goes on, and substitutes presumption for
knowledge. From the scanty field of what is
known, he launches into the boundless region
of what is unknown. He establishes for his
guide some fanciful theory of corpuscular attraction,
of chemical agency, of mechanical
powers, of stimuli, of irritability accumulated
or exhausted, of depletion by the lancet and
repletion by mercury, or some other ingenious
dream, which lets him into all nature's secrets
at short hand. On the principle which he thus
assumes, he forms his table of nosology, arrays
his diseases into families, and extends his curative
treatment, by analogy, to all the cases he
has thus arbitrarily marshalled together. I
have lived myself to see the disciples of Hoffman,
Boerhaave, Stalh, Cullen, Brown, succeed
one another like the shifting figures of a magic
lantern, and their fancies, like the dresses of
the annual doll-babies from Paris, becoming
from their novelty, the vogue of the day, and
yielding to the next novelty their ephemeral
favor. The patient, treated on the fashionable
theory, sometimes gets well in spite of the
medicine. The medicine, therefore, restored
him, and the young doctor receives new courage
to proceed in his bold experiments on the
lives of his fellow creatures. I believe we May
safely affirm, that the inexperienced and presumptuous
band of medical tyros let loose upon
the world, destroys more of human life in one
year, than all the Robinhoods, Cartouches, and
Macheaths do in a century. It is in this part
of medicine that I wish to see a reform, an
abandonment of hypothesis for sober facts, the
first degree of value set on clinical observation,
and the lowest on visionary theories. I
would wish the young practitioner, especially,
to have deeply impressed on his mind, the real
limits of his art, and that when the state of his
patient gets beyond these, his office is to be
a watchful, but quiet spectator of the operations
of nature, giving them fair play by a well-regulated
regimen, and by all the aid they can
derive from the excitement of good spirits and
hope in the patient. I have no doubt, that
some diseases not yet understood may in time
be transferred to the table of those known.
But, were I a physician, I would rather leave
the transfer to the slow hand of accident, than
hasten it by guilty experiments on those who
put their lives into my hands. The only sure
foundations of medicine are, an intimate knowledge
of the human body, and observation on the
effects of medicinal substances on that. The
anatomical and clinical schools, therefore, are
those in which the young physician should be
formed. If he enters with innocence that of
the theory of medicine, it is scarcely possible
he should come out untainted with error. His
mind must be strong indeed, if, rising above
juvenile credulity, it can maintain a wise infidelity
against the authority of his instructors.
and the bewitching delusions of their theories.
You see that I estimate justly that portion of
instruction which our medical students derive
from your labors; and, associating with it one
of the chairs which my old and able friend,
Dr. Rush, so honorably fills, I consider them
as the two fundamental pillars of the edifice.
Indeed, I have such an opinion of the talents
of the professors in the other branches which
constitute the school of medicine with you, as
to hope and believe, that it is from this side of
the Atlantic, that Europe, which has taught us
so many other things, will at length be led into
sound principles in this branch of science, the
most important of all others, being that to
which we commit the care of health and life.
I dare say, that by this time, you are sufficiently
sensible that old heads as well as
young, may sometimes be charged with ignorance
and presumption. The natural course of
the human mind is certainly from credulity to
skepticism; and this is perhaps the most favorable
apology I can make for venturing so far out
of my depth, and to one, too, to whom the strong
as well as the weak points of this science are so
familiar. But having stumbled on the subject
in my way, I wished to give a confession of my
faith to a friend; and the rather, as I had perhaps,
at times, to him as well as others, expressed
my skepticism in medicine, without defining
its extent or foundation. At any rate, it
has permitted me, for a moment, to abstract
myself from the dry and dreary waste of politics,
into which I have been impressed by the
times on which I happened, and to indulge in
the rich fields of nature, where alone I should
have served as a volunteer, if left to my natural
inclinations and partialities.—
To Dr. Caspar Wistar. Washington ed. v, 105.
Ford ed., ix, 81.
(W.
June. 1807)
