And again, the cool way in which everything favorable in a case is set down by these people entirely to their treatment, may be seen in a case of croup reported in the "Homoeopathic Gazette" of Leipsic, in which leeches, blistering, inhalation of hot vapor, and powerful internal medicine had been employed, and yet the merit was all attributed to one drop of some Homoeopathic fluid.
I need not multiply these quotations, which illustrate the grounds of an opinion which the time does not allow me to justify more at length; other such cases are lying open before me; there is no end to them if more were wanted; for nothing is necessary but to look into any of the numerous broken-down Journals of Homoeopathy, the volumes of which may be found on the shelves of those curious in such matters.
A number of public trials of Homoeopathy have been made in different parts of the world. Six of these are mentioned in the Manifesto of the "Homoeopathic Examiner." Now to suppose that any trial can absolutely silence people, would be to forget the whole experience of the past. Dr. Haygarth and Dr. Alderson could not stop the sale of the five-guinea Tractors, although they proved that they could work the same miracles with pieces of wood and tobacco-pipe. It takes time for truth to operate as well as Homoeopathic globules. Many persons thought the results of these trials were decisive enough of the nullity of the treatment; those who wish to see the kind of special pleading and evasion by which it is attempted to cover results which, stated by the "Homoeopathic Examiner" itself, look exceedingly like a miserable failure, may consult the opening flourish of that Journal. I had not the intention to speak of these public trials at all, having abundant other evidence on the point. But I think it best, on the whole, to mention two of them in a few words,—that instituted at Naples and that of Andral.
There have been few names in the medical profession, for the last half century, so widely known throughout the world of science as that of M. Esquirol, whose life was devoted to the treatment of insanity, and who was without a rival in that department of practical medicine. It is from an analysis communicated by him to the "Gazette Medicale de Paris" that I derive my acquaintance with the account of the trial at Naples by Dr. Panvini, physician to the Hospital della Pace. This account seems to be entirely deserving of credit. Ten patients were set apart, and not allowed to take any medicine at all,—much against the wish of the Homoeopathic physician. All of them got well, and of course all of them would have been claimed as triumphs if they had been submitted to the treatment. Six other slight cases (each of which is specified) got well under the Homoeopathic treatment, none of its asserted specific effects being manifested.
All the rest were cases of grave disease; and so far as the trial, which was interrupted about the fortieth day, extended, the patients grew worse, or received no benefit. A case is reported on the page before me of a soldier affected with acute inflammation in the chest, who took successively aconite, bryonia, nux vomica, and pulsatilla, and after thirty-eight days of treatment remained without any important change in his disease. The Homoeopathic physician who treated these patients was M. de Horatiis, who had the previous year been announcing his wonderful cures. And M. Esquirol asserted to the Academy of Medicine in 1835, that this M. de Horatiis, who is one of the prominent personages in the "Examiner's" Manifesto published in 1840, had subsequently renounced Homoeopathy. I may remark, by the way, that this same periodical, which is so very easy in explaining away the results of these trials, makes a mistake of only six years or a little more as to the time when this at Naples was instituted.
M. Andral, the "eminent and very enlightened allopathist" of the "Homoeopathic Examiner," made the following statement in March, 1835, to the Academy of Medicine: "I have submitted this doctrine to experiment; I can reckon at this time from one hundred and thirty to one hundred and forty cases, recorded with perfect fairness, in a great hospital, under the eye of numerous witnesses; to avoid every objection—I obtained my remedies of M. Guibourt, who keeps a Homoeopathic pharmacy, and whose strict exactness is well known; the regimen has been scrupulously observed, and I obtained from the sisters attached to the hospital a special regimen, such as Hahnemann orders. I was told, however, some months since, that I had not been faithful to all the rules of the doctrine. I therefore took the trouble to begin again; I have studied the practice of the Parisian Homoeopathists, as I had studied their books, and I became convinced that they treated their patients as I had treated mine, and I affirm that I have been as rigorously exact in the treatment as any other person."
And he expressly asserts the entire nullity of the influence of all the Homoeopathic remedies tried by him in modifying, so far as he could observe, the progress or termination of diseases. It deserves notice that he experimented with the most boasted substances,—cinchona, aconite, mercury, bryonia, belladonna. Aconite, for instance, he says he administered in more than forty cases of that collection of feverish symptoms in which it exerts so much power, according to Hahnemann, and in not one of them did it have the slightest influence, the pulse and heat remaining as before.
These statements look pretty honest, and would seem hard to be explained away, but it is calmly said that he "did not know enough of the method to select the remedies with any tolerable precision." ["Homoeopathic Examiner, vol. i. p. 22.]
"Nothing is left to the caprice of the physician." (In a word, instead of being dependent upon blind chance, that there is an infallible law, guided by which; the physician MUST select the proper remedies.') ['Ibid.,' in a notice of Menzel's paper.] Who are they that practice Homoeopathy, and say this of a man with the Materia Medica of Hahnemann lying before him? Who are they that send these same globules, on which he experimented, accompanied by a little book, into families, whose members are thought competent to employ them, when they deny any such capacity to a man whose life has been passed at the bedside of patients, the most prominent teacher in the first Medical Faculty in the world, the consulting physician of the King of France, and one of the most renowned practical writers, not merely of his nation, but of his age? I leave the quibbles by which such persons would try to creep out from under the crushing weight of these conclusions to the unfortunates who suppose that a reply is equivalent to an answer.
Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris, invited two Homoeopathic practitioners to experiment in his wards. One of these was Curie, now of London, whose works are on the counters of some of our bookstores, and probably in the hands of some of my audience. This gentleman, whom Dr. Baillie declares to be an enlightened man, and perfectly sincere in his convictions, brought his own medicines from the pharmacy which furnished Hahnemann himself, and employed them for four or five months upon patients in his ward, and with results equally unsatisfactory, as appears from Dr. Baillie's statement at a meeting of the Academy of Medicine. And a similar experiment was permitted by the Clinical Professor of the Hotel Dieu of Lyons, with the same complete failure.
But these are old and prejudiced practitioners. Very well, then take the statement of Dr. Fleury, a most intelligent young physician, who treated homoeopathically more than fifty patients, suffering from diseases which it was not dangerous to treat in this way, taking every kind of precaution as to regimen, removal of disturbing influences, and the state of the atmosphere, insisted upon by the most vigorous partisans of the doctrine, and found not the slightest effect produced by the medicines. And more than this, read nine of these cases, which he has published, as I have just done, and observe the absolute nullity of aconite, belladonna, and bryonia, against the symptoms over which they are pretended to exert such palpable, such obvious, such astonishing influences. In the view of these statements, it is impossible not to realize the entire futility of attempting to silence this asserted science by the flattest and most peremptory results of experiment. Were all the hospital physicians of Europe and America to devote themselves, for the requisite period, to this sole pursuit, and were their results to be unanimous as to the total worthlessness of the whole system in practice, this slippery delusion would slide through their fingers without the slightest discomposure, when, as they supposed, they had crushed every joint in its tortuous and trailing body.
3. I have said, that to show the truth of the Homoeopathic doctrine, as announced by Hahnemann, it would be necessary to show, in the third place, that remedies never cure diseases when they are not capable of producing similar symptoms! The burden of this somewhat comprehensive demonstration lying entirely upon the advocates of this doctrine, it may be left to their mature reflections.
It entered into my original plan to treat of the doctrine relating to Psora, or itch,—an almost insane conception, which I am glad to get rid of, for this is a subject one does not care to handle without gloves. I am saved this trouble, however, by finding that many of the disciples of Hahnemann, those disciples the very gospel of whose faith stands upon his word, make very light of his authority on this point, although he himself says, "It has cost me twelve years of study and research to trace out the source of this incredible number of chronic affections, to discover this great truth, which remained concealed from all my predecessors and contemporaries, to establish the basis of its demonstration, and find out, at the same time, the curative medicines that were fit to combat this hydra in all its different forms."
But, in the face of all this, the following remarks are made by Wolff, of
Dresden, whose essays, according to the editor of the "Homoeopathic
Examiner," "represent the opinions of a large majority of Homoeopathists
in Europe."
"It cannot be unknown to any one at all familiar with Homoeopathic literature, that Hahnemann's idea of tracing the large majority of chronic diseases to actual itch has met with the greatest opposition from Homoeopathic physicians themselves." And again, "If the Psoric theory has led to no proper schism, the reason is to be found in the fact that it is almost without any influence in practice."
We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Duke of Baden," and a "distinguished" Homoeopathist, actually asked Hahnemann for the proof that chronic diseases, such as dropsy, for instance, never arise from any other cause than itch; and that, according to common report, the venerable sage was highly incensed (fort courrouce) with Dr. Hartmann, of Leipsic, another "distinguished" Homoeopathist, for maintaining that they certainly did arise from other causes.
And Dr. Fielitz, in the "Homoeopathic Gazette" of Leipsic, after saying, in a good-natured way, that Psora is the Devil in medicine, and that physicians are divided on this point into diabolists and exorcists, declares that, according to a remark of Hahnemann, the whole civilized world is affected with Psora. I must therefore disappoint any advocate of Hahnemann who may honor me with his presence, by not attacking a doctrine on which some of the disciples of his creed would be very happy to have its adversaries waste their time and strength. I will not meddle with this excrescence, which, though often used in time of peace, would be dropped, like the limb of a shell-fish, the moment it was assailed; time is too precious, and the harvest of living extravagances nods too heavily to my sickle, that I should blunt it upon straw and stubble.
I will close the subject with a brief examination of some of the statements made in Homoeopathic works, and more particularly in the brilliant Manifesto of the "Examiner," before referred to. And first, it is there stated under the head of "Homoeopathic Literature," that "SEVEN HUNDRED volumes have been issued from the press developing the peculiarities of the system, and many of them possessed of a scientific character that savans know well how to respect." If my assertion were proper evidence in the case, I should declare, that, having seen a good many of these publications, from the year 1834, when I bought the work of the Rev. Thomas Everest, [Dr. Curie speaks of this silly pamphlet as having been published in 1835.] to within a few weeks, when I received my last importation of Homaeopathic literature, I have found that all, with a very few exceptions, were stitched pamphlets varying from twenty or thirty pages to somewhat less than a hundred, and generally resembling each other as much as so many spelling-books.
But not being evidence in the case, I will give you the testimony of Dr.
Trinks, of Dresden, who flourishes on the fifteenth page of the same
Manifesto as one of the most distinguished among the Homoeopathists of
Europe. I translate the sentence literally from the "Archives de la
Medecine Homoeopathique."
"The literature of Homoeopathy, if that honorable name must be applied to all kinds of book-making, has been degraded to the condition of the humblest servitude. Productions without talent, without spirit, without discrimination, flat and pitiful eulogies, exaggerations surpassing the limits of the most robust faith, invectives against such as dared to doubt the dogmas which had been proclaimed, or catalogues of remedies; of such materials is it composed! From distance to distance only, have appeared some memoirs useful to science or practice, which appear as so many green oases in the midst of this literary desert."
It is a very natural as well as a curious question to ask, What has been the success of Homoeopathy in the different countries of Europe, and what is its present condition?
The greatest reliance of the advocates of Homoeopathy is of course on Germany. We know very little of its medical schools, its medical doctrines, or its medical men, compared with those of England and France. And, therefore, when an intelligent traveller gives a direct account from personal inspection of the miserable condition of the Homoeopathic hospital at Leipsic, the first established in Europe, and the first on the list of the ever-memorable Manifesto, it is easy enough answer or elude the fact by citing various hard names of "distinguished" practitioners, which sound just as well to the uninformed public as if they were Meckel, or Tiedemann, or Langenbeck. Dr. Leo-Wolf, who, to be sure, is opposed to Homoeopathy, but who is a scholar, and ought to know something of his own countrymen, assures us that "Dr. Kopp is the only German Homoeopathist, if we can call him so, who has been distinguished as an author and practitioner before he examined this method." And Dr. Lee, the same gentleman in whose travels the paragraph relating to the Leipsic Hospital is to be found, says the same thing. And I will cheerfully expose myself to any impertinent remark which it might suggest, to assure my audience that I never heard or saw one authentic Homoeopathic name of any country in Europe, which I had ever heard mentioned before as connected with medical science by a single word or deed sufficient to make it in any degree familiar to my ears, unless Arnold of Heidelberg is the anatomist who discovered a little nervous centre, called the otic ganglion. But you need ask no better proof of who and what the German adherents of this doctrine must be, than the testimony of a German Homoeopathist as to the wretched character of the works they manufacture to enforce its claims.
As for the act of this or that government tolerating or encouraging Homoeopathy, every person of common intelligence knows that it is a mere form granted or denied according to the general principles of policy adopted in different states, or the degree of influence which some few persons who have adopted it may happen to have at court. What may be the value of certain pompous titles with which many of the advocates of Homoeopathy are honored, it might be disrespectful to question. But in the mean time the judicious inquirer may ponder over an extract which I translate from a paper relating to a personage well known to the community as Williams the Oculist, with whom I had the honor of crossing the Atlantic some years since, and who himself handed me two copies of the paper in question.
"To say that he was oculist of Louis XVIII. and of Charles X., and that he now enjoys the same title with respect to His Majesty, Louis Philippe, and the King of the Belgians, is unquestionably to say a great deal; and yet it is one of the least of his titles to public confidence. His reputation rests upon a basis more substantial even than the numerous diplomas with which he is provided, than the membership of the different medical societies which have chosen him as their associate," etc., etc.
And as to one more point, it is time that the public should fully understand that the common method of supporting barefaced imposture at the present day, both in Europe and in this country, consists in trumping up "Dispensaries," "Colleges of Health," and other advertising charitable clap-traps, which use the poor as decoy-ducks for the rich, and the proprietors of which have a strong predilection for the title of "Professor." These names, therefore, have come to be of little or no value as evidence of the good character, still less of the high pretensions of those who invoke their authority. Nor does it follow, even when a chair is founded in connection with a well-known institution, that it has either a salary or an occupant; so that it may be, and probably is, a mere harmless piece of toleration on the part of the government if a Professorship of Homoeopathy is really in existence at Jena or Heidelberg. And finally, in order to correct the error of any who might suppose that the whole Medical Profession of Germany has long since fallen into the delusions of Hahnemann, I will quote two lines which a celebrated anatomist and surgeon (whose name will occur again in this lecture in connection with a very pleasing letter) addressed to the French Academy of Medicine in 1835. "I happened to be in Germany some months since, at a meeting of nearly six hundred physicians; one of them wished to bring up the question of Homoeopathy; they would not even listen to him." This may have been very impolite and bigoted, but that is not precisely the point in reference to which I mention the circumstance.
But if we cannot easily get at Germany, we can very easily obtain exact information from France and England. I took the trouble to write some months ago to two friends in Paris, in whom I could place confidence, for information upon the subject. One of them answered briefly to the effect that nothing was said about it. When the late Curator of the Lowell Institute, at his request, asked about the works upon the subject, he was told that they had remained a long time on the shelves quite unsalable, and never spoken of.
The other gentleman, [Dr. Henry T. Bigelow, now Professor of Surgery in Harvard University] whose name is well known to my audience, and who needs no commendation of mine, had the kindness to procure for me many publications upon the subject, and some information which sets the whole matter at rest, so far as Paris is concerned. He went directly to the Baillieres, the principal and almost the only publishers of all the Homoeopathic books and journals in that city. The following facts were taken by him from the account-books of this publishing firm. Four Homoeopathic Journals have been published in Paris; three of them by the Baillieres.
The reception they met with may be judged of by showing the number of subscribers to each on the books of the publishing firm.
A Review published by some other house, which lasted one year, and had about fifty subscribers, appeared in 1834, 1835.
There were only four Journals of Homoeopathy ever published in Paris. The Baillieres informed my correspondent that the sale of Homoeopathic books was much less than formerly, and that consequently they should undertake to publish no new books upon the subject, except those of Jahr or Hahnemann. "This man," says my correspondent,—referring to one of the brothers,—"the publisher and headquarters of Homoeopathy in Paris, informs me that it is going down in England and Germany as well as in Paris." For all the facts he had stated he pledged himself as responsible.
Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and since then has been going down.
Louis told my correspondent that no person of distinction in Paris had embraced Homoeopathy, and that it was declining. If you ask who Louis is, I refer you to the well-known Homoeopathist, Peschier of Geneva, who says, addressing him, "I respect no one more than yourself; the feeling which guides your researches, your labors, and your pen, is so honorable and rare, that I could not but bow down before it; and I own, if there were any allopathist who inspired me with higher veneration, it would be him and not yourself whom I should address."
Among the names of "Distinguished Homoeopathists," however, displayed in imposing columns, in the index of the "Homoeopathic Examiner," are those of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the world of science, and the last of them identified with some of the most valuable contributions which anatomical knowledge has received since the commencement of the present century. One Dr. Chrysaora, who stands sponsor for many facts in that Journal, makes the following statement among the rest: "Professors, who are esteemed among the most distinguished of the Faculty (Faculty de Medicine), both as to knowledge and reputation, have openly confessed the power of Homoeopathia in forms of disease where the ordinary method of practice proved totally insufficient. It affords me the highest pleasure to select from among these gentlemen, Marjolin, Amussat, and Breschet."
Here is a literal translation of an original letter, now in my possession, from one of these Homoeopathists to my correspondent:—
"DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER:
"You have had the kindness to inform me in your letter that a new American Journal, the 'New World,' has made use of my name in support of the pretended Homoeopathic doctrines, and that I am represented as one of the warmest partisans of Homoeopathy in France.
"I am vastly surprised at the reputation manufactured for me upon the new continent; but I am obliged, in deference to truth, to reject it with my whole energy. I spurn far from me everything which relates to that charlatanism called Homoeopathy, for these pretended doctrines cannot endure the scrutiny of wise and enlightened persons, who are guided by honorable sentiments in the practice of the noblest of arts.
"PARIS, 3d November, 1841
"I am, etc., etc.,
"G. BRESCHET,
"Professor in the Faculty of Medicine, Member of the Institute, Surgeon of Hotel Dieu, and Consulting Surgeon to the King, etc." [I first saw M. Breschet's name mentioned in that Journal]
Concerning Amussat, my correspondent writes, that he was informed by Madame Hahnemann, who converses in French more readily than her husband, and therefore often speaks for him, that "he was not a physician, neither Homoeopathist nor Allopathist, but that he was the surgeon of their own establishment; that is, performed as a surgeon all the operations they had occasion for in their practice."
I regret not having made any inquiries as to Marjolin, who, I doubt not, would strike his ponderous snuff-box until it resounded like the Grecian horse, at hearing such a doctrine associated with his respectable name. I was not aware, when writing to Paris, that this worthy Professor, whose lectures I long attended, was included in these audacious claims; but after the specimens I have given of the accuracy of the foreign correspondence of the "Homoeopathic Examiner," any further information I might obtain would seem so superfluous as hardly to be worth the postage.
Homoeopathy may be said, then, to be in a sufficiently miserable condition in Paris. Yet there lives, and there has lived for years, the illustrious Samuel Hahnemann, who himself assured my correspondent that no place offered the advantages of Paris in its investigation, by reason of the attention there paid to it.
In England, it appears by the statement of Dr. Curie in October, 1839, about eight years after its introduction into the country, that there were eighteen Homoeopathic physicians in the United Kingdom, of whom only three were to be found out of London, and that many of these practised Homoeopathy in secret.
It will be seen, therefore, that, according to the recent statement of one of its leading English advocates, Homoeopathy had obtained not quite half as many practical disciples in England as Perkinism could show for itself in a somewhat less period from the time of its first promulgation in that country.
Dr. Curie's letter, dated London, October 30, 1839, says there is "one in Dublin, Dr. Luther; at Glasgow, Dr. Scott." The "distinguished" Chrysaora writes from Paris, dating October 20, 1839, "On the other hand, Homoeopathy is commencing to make an inroad into England by the way of Ireland. At Dublin, distinguished physicians have already embraced the new system, and a great part of the nobility and gentry of that city have emancipated themselves from the English fashion and professional authority."
But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize
Homoeopathy; the Queen Dowager Adelaide has been treated by a
Homoeopathic physician. "Jarley is the delight of the nobility and
gentry." "The Royal Family are the patrons of Jarley."
Let me ask if a Marquis and a Knight are better than two Lords, and if the Dowager of Royalty is better than Royalty itself, all of which illustrious dignities were claimed in behalf of Benjamin Douglass Perkins?
But if the balance is thought too evenly suspended in this case, another instance can be given in which the evidence of British noblemen and their ladies is shown to be as valuable in establishing the character of a medical man or doctrine, as would be the testimony of the Marquis of Waterford concerning the present condition and prospects of missionary enterprise. I have before me an octavo volume of more than four hundred pages, in which, among much similar matter, I find highly commendatory letters from the Marchioness of Ormond, Lady Harriet Kavanagh, the Countess of Buckinghamshire, the Right Hon. Viscount Ingestre, M. P., and the Most Noble, the Marquis of Sligo,—all addressed to "John St. John Long, Esq," a wretched charlatan, twice tried for, and once convicted of, manslaughter at the Old Bailey.
This poor creature, too, like all of his tribe, speaks of the medical profession as a great confederation of bigoted monopolists. He, too, says that "If an innovator should appear, holding out hope to those in despair, and curing disorders which the faculty have recorded as irremediable, he is at once, and without inquiry, denounced as an empiric and an impostor." He, too, cites the inevitable names of Galileo and Harvey, and refers to the feelings excited by the great discovery of Jenner. From the treatment of the great astronomer who was visited with the punishment of other heretics by the ecclesiastical authorities of a Catholic country some centuries since, there is no very direct inference to be drawn to the medical profession of the present time. His name should be babbled no longer, after having been placarded for the hundredth time in the pages of St. John Long. But if we are doomed to see constant reference to the names of Harvey and Jenner in every worthless pamphlet containing the prospectus of some new trick upon the public, let us, once for all, stare the facts in the face, and see how the discoveries of these great men were actually received by the medical profession.
In 1628, Harvey published his first work upon the circulation. His doctrines were a complete revolution of the prevailing opinions of all antiquity. They immediately found both champions and opponents; of which last, one only, Riolanus, seemed to Harvey worthy of an answer, on account of his "rank, fame, and learning." Controversy in science, as in religion, was not, in those days, carried on with all the courtesy which our present habits demand, and it is possible that some hard words may have been applied to Harvey, as it is very certain that he used the most contemptuous expressions towards others.
Harvey declares in his second letter to Riolanus, "Since the first discovery of the circulation, hardly a day, or a moment, has passed without my hearing it both well and ill spoken of; some attack it with great hostility, others defend it with high encomiums; one party believe that I have abundantly proved the truth of the doctrine against all the weight of opposing arguments, by experiments, observations, and dissections; others think it not yet sufficiently cleared up, and free from objections." Two really eminent Professors, Plempius of Louvain, and Walaeus of Leyden, were among its early advocates.
The opinions sanctioned by the authority of long ages, and the names of Hippocrates and Galen, dissolved away, gradually, but certainly, before the demonstrations of Harvey. Twenty-four years after the publication of his first work, and six years before his death, his bust in marble was placed in the Hall of the College of Physicians, with a suitable inscription recording his discoveries.
Two years after this he was unanimously invited to accept the Presidency of that body; and he lived to see his doctrine established, and all reputable opposition withdrawn.
There were many circumstances connected with the discovery of Dr. Jenner which were of a nature to excite repugnance and opposition. The practice of inoculation for the small-pox had already disarmed that disease of many of its terrors. The introduction of a contagious disease from a brute creature into the human system naturally struck the public mind with a sensation of disgust and apprehension, and a part of the medical public may have shared these feelings. I find that Jenner's discovery of vaccination was made public in June, 1798. In July of the same year the celebrated surgeon, Mr. Cline, vaccinated a child with virus received from Dr. Jenner, and in communicating the success of this experiment, he mentions that Dr. Lister, formerly of the Small-Pox Hospital, and himself, are convinced of the efficacy of the cow-pox. In November of the same year, Dr. Pearson published his "Inquiry," containing the testimony of numerous practitioners in different parts of the kingdom, to the efficacy of the practice. Dr. HAYGARTH, who was so conspicuous in exposing the follies of Perkinism, was among the very earliest to express his opinion in favor of vaccination. In 1801, Dr. Lettsom mentions the circumstance "as being to the honor of the medical professors, that they have very generally encouraged this salutary practice, although it is certainly calculated to lessen their pecuniary advantages by its tendency to extirpate a fertile source of professional practice."
In the same year the Medical Committee of Paris spoke of vaccination in a public letter, as "the most brilliant and most important discovery of the eighteenth century." The Directors of a Society for the Extermination of the Small-Pox, in a Report dated October 1st, 1807, "congratulate the public on the very favorable opinion which the Royal College of Physicians of London, after a most minute and laborious investigation made by the command of his Majesty, have a second time expressed on the subject of vaccination, in their Report laid before the House of Commons, in the last session of Parliament; in consequence of which the sum of twenty thousand pounds was voted to Dr. Jenner, as a remuneration for his discovery, in addition to ten thousand pounds before granted." (In June, 1802.)
These and similar accusations, so often brought up against the Medical Profession, are only one mode in which is manifested a spirit of opposition not merely to medical science, but to all science, and to all sound knowledge. It is a spirit which neither understands itself nor the object at which it is aiming. It gropes among the loose records of the past, and the floating fables of the moment, to glean a few truths or falsehoods tending to prove, if they prove anything, that the persons who have passed their lives in the study of a branch of knowledge the very essence of which must always consist in long and accurate observation, are less competent to judge of new doctrines in their own department than the rest of the community. It belongs to the clown in society, the destructive in politics, and the rogue in practice.
The name of Harvey, whose great discovery was the legitimate result of his severe training and patient study, should be mentioned only to check the pretensions of presumptuous ignorance. The example of Jenner, who gave his inestimable secret, the result of twenty-two years of experiment and researches, unpurchased, to the public,—when, as was said in Parliament, he might have made a hundred thousand pounds by it as well as any smaller sum,—should be referred to only to rebuke the selfish venders of secret remedies, among whom his early history obliges us reluctantly to record Samuel Hahnemann. Those who speak of the great body of physicians as if they were united in a league to support the superannuated notions of the past against the progress of improvement, have read the history of medicine to little purpose. The prevalent failing of this profession has been, on the contrary, to lend a too credulous ear to ambitious and plausible innovators. If at the present time ten years of public notoriety have passed over any doctrine professing to be of importance in medical science, and if it has not succeeded in raising up a powerful body of able, learned, and ingenious advocates for its claims, the fault must be in the doctrine and not in the medical profession.
Homoeopathy has had a still more extended period of trial than this, and we have seen with what results. It only remains to throw out a few conjectures as to the particular manner in which it is to break up and disappear.
1. The confidence of the few believers in this delusion will never survive the loss of friends who may die of any acute disease, under a treatment such as that prescribed by Homoeopathy. It is doubtful how far cases of this kind will be trusted to its tender mercies, but wherever it acquires any considerable foothold, such cases must come, and with them the ruin of those who practise it, should any highly valued life be thus sacrificed.
2. After its novelty has worn out, the ardent and capricious individuals who constitute the most prominent class of its patrons will return to visible doses, were it only for the sake of a change.
3. The Semi-Homoeopathic practitioner will gradually withdraw from the rotten half of his business and try to make the public forget his connection with it.
4. The ultra Homoeopathist will either recant and try to rejoin the medical profession; or he will embrace some newer and if possible equally extravagant doctrine; or he will stick to his colors and go down with his sinking doctrine. Very few will pursue the course last mentioned.
A single fact may serve to point out in what direction there will probably be a movement of the dissolving atoms of Homoeopathy. On the 13th page of the too frequently cited Manifesto of the "Examiner" I read the following stately paragraph:
"Bigelius, M. D., physician to the Emperor of Russia, whose elevated reputation is well known in Europe, has been an acknowledged advocate of Hahnemann's doctrines for several years. He abandoned Allopathia for Homoeopathia." The date of this statement is January, 1840. I find on looking at the booksellers' catalogues that one Bigel, or Bigelius, to speak more classically, has been at various times publishing Homoeopathic books for some years.
Again, on looking into the "Encyclographie des Sciences Medicales" for April, 1840, I find a work entitled "Manual of HYDROSUDOPATHY, or the Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel, Physician of the School of Strasburg, Member of the Medico-Chirurgical Institute of Naples, of the Academy of St. Petersburg,—Assessor of the College of the Empire of Russia, Physician of his late Imperial Highness the Grand Duke Constantine, Chevalier of the Legion of Honor, etc." Hydrosudopathy or Hydropathy, as it is sometimes called, is a new medical doctrine or practice which has sprung up in Germany since Homoeopathy, which it bids fair to drive out of the market, if, as Dr. Bigel says, fourteen physicians afflicted with diseases which defied themselves and their colleagues came to Graefenberg, in the year 1836 alone, and were cured. Now Dr. Bigel, "whose elevated reputation is well known in Europe," writes as follows: "The reader will not fail to see in this defence of the curative method of Graefenberg a profession of medical faith, and he will be correct in so doing." And his work closes with the following sentence, worthy of so distinguished an individual: "We believe, with religion, that the water of baptism purifies the soul from its original sin; let us believe also, with experience, that it is for our corporeal sins the redeemer of the human body." If Bigel, Physician to the late Grand Duke Constantine, is identical with Bigel whom the "Examiner" calls Physician to the Emperor of Russia, it appears that he is now actively engaged in throwing cold water at once upon his patients and the future prospects of Homoeopathy.
If, as must be admitted, no one of Hahnemann's doctrines is received with tolerable unanimity among his disciples, except the central axiom, Similia similibus curantur; if this axiom itself relies mainly for its support upon the folly and trickery of Hahnemann, what can we think of those who announce themselves ready to relinquish all the accumulated treasures of our art, to trifle with life upon the strength of these fantastic theories? What shall we think of professed practitioners of medicine, if, in the words of Jahr, "from ignorance, for their personal convenience, or through charlatanism, they treat their patients one day Homoeopathically and the next Allopathically;" if they parade their pretended new science before the unguarded portion of the community; if they suffer their names to be coupled with it wherever it may gain a credulous patient; and deny all responsibility for its character, refuse all argument for its doctrines, allege no palliation for the ignorance and deception interwoven with every thread of its flimsy tissue, when they are questioned by those competent to judge and entitled to an answer?
Such is the pretended science of Homoeopathy, to which you are asked to trust your lives and the lives of those dearest to you. A mingled mass of perverse ingenuity, of tinsel erudition, of imbecile credulity, and of artful misrepresentation, too often mingled in practice, if we may trust the authority of its founder, with heartless and shameless imposition. Because it is suffered so often to appeal unanswered to the public, because it has its journals, its patrons, its apostles, some are weak enough to suppose it can escape the inevitable doom of utter disgrace and oblivion. Not many years can pass away before the same curiosity excited by one of Perkins's Tractors will be awakened at the sight of one of the Infinitesimal Globules. If it should claim a longer existence, it can only be by falling into the hands of the sordid wretches who wring their bread from the cold grasp of disease and death in the hovels of ignorant poverty.
As one humble member of a profession which for more than two thousand years has devoted itself to the pursuit of the best earthly interests of mankind, always assailed and insulted from without by such as are ignorant of its infinite perplexities and labors, always striving in unequal contest with the hundred-armed giant who walks in the noonday, and sleeps not in the midnight, yet still toiling, not merely for itself and the present moment, but for the race and the future, I have lifted my voice against this lifeless delusion, rolling its shapeless bulk into the path of a noble science it is too weak to strike, or to injure.
THE CONTAGIOUSNESS OF PUERPERAL FEVER
Printed in 1843; reprinted with additions, 1855.
THE POINT AT ISSUE.
THE AFFIRMATIVE.
"The disease known as Puerperal Fever is so far contagious as to be frequently carried from patient to patient by physicians and nurses." O. W. Holmes, 1843.
THE NEGATIVE.
"The result of the whole discussion will, I trust, serve, not only to exalt your views of the value and dignity of our profession, but to divest your minds of the overpowering dread that you can ever become, especially to woman, under the extremely interesting circumstances of gestation and parturition, the minister of evil; that you can ever convey, in any possible manner, a horrible virus, so destructive in its effects, and so mysterious in its operations as that attributed to puerperal fever."—Professor Hodge, 1852.
"I prefer to attribute them to accident, or Providence, of which I can form a conception, rather than to a contagion of which I cannot form any clear idea, at least as to this particular malady."—Professor Meigs, 1852.
" . . . in the propagation of which they have no more to do, than with the propagation of cholera from Jessore to San Francisco, and from Mauritius to St. Petersburg."—Professor Meigs, 1854.
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"I arrived at that certainty in the matter, that I could venture to foretell what women would be affected with the disease, upon hearing by what midwife they were to be delivered, or by what nurse they were to be attended, during their lying-in; and, almost in every instance, my prediction was verified."—Gordon, 1795.
"A certain number of deaths is caused every year by the contagion of puerperal fever, communicated by the nurses and medical attendants." Farr, in Fifth Annual Report of Registrar-General of England, 1843.
". . . boards of health, if such exist, or, without them, the medical institutions of a country, should have the power of coercing, or of inflicting some kind of punishment on those who recklessly go from cases of puerperal fevers to parturient or puerperal females, without using due precaution; and who, having been shown the risk, criminally encounter it, and convey pestilence and death to the persons they are employed to aid in the most interesting and suffering period of female existence." —Copland's Medical Dictionary, Art. Puerperal States and Diseases, 1852.
"We conceive it unnecessary to go into detail to prove the contagious nature of this disease, as there are few, if any, American practitioners who do not believe in this doctrine."—Dr. Lee, in Additions to Article last cited.
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[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion arose in a Medical Society of which I was a member, involving the subject of a certain supposed cause of disease, about which something was known, a good deal suspected, and not a little feared. The discussion was suggested by a case, reported at the preceding meeting, of a physician who made an examination of the body of a patient who had died with puerperal fever, and who himself died in less than a week, apparently in consequence of a wound received at the examination, having attended several women in confinement in the mean time, all of whom, as it was alleged, were attacked with puerperal fever.
Whatever apprehensions and beliefs were entertained, it was plain that a fuller knowledge of the facts relating to the subject would be acceptable to all present. I therefore felt that it would be doing a good service to look into the best records I could find, and inquire of the most trustworthy practitioners I knew, to learn what experience had to teach in the matter, and arrived at the results contained in the following pages.
The Essay was read before the Boston Society for Medical Improvement, and, at the request of the Society, printed in the "New England Quarterly Journal of Medicine and Surgery" for April, 1843. As this Journal never obtained a large circulation, and ceased to be published after a year's existence, and as the few copies I had struck off separately were soon lost sight of among the friends to whom they were sent, the Essay can hardly be said to have been fully brought before the Profession.
The subject of this Paper has the same profound interest for me at the present moment as it had when I was first collecting the terrible evidence out of which, as it seems to me, the commonest exercise of reason could not help shaping the truth it involved. It is not merely on account of the bearing of the question,—if there is a question,—on all that is most sacred in human life and happiness, that the subject cannot lose its interest. It is because it seems evident that a fair statement of the facts must produce its proper influence on a very large proportion of well-constituted and unprejudiced minds. Individuals may, here and there, resist the practical bearing of the evidence on their own feelings or interests; some may fail to see its meaning, as some persons may be found who cannot tell red from green; but I cannot doubt that most readers will be satisfied and convinced, to loathing, long before they have finished the dark obituary calendar laid before them.
I do not know that I shall ever again have so good an opportunity of being useful as was granted me by the raising of the question which produced this Essay. For I have abundant evidence that it has made many practitioners more cautious in their relations with puerperal females, and I have no doubt it will do so still, if it has a chance of being read, though it should call out a hundred counterblasts, proving to the satisfaction of their authors that it proved nothing. And for my part, I had rather rescue one mother from being poisoned by her attendant, than claim to have saved forty out of fifty patients to whom I had carried the disease. Thus, I am willing to avail myself of any hint coming from without to offer this paper once more to the press. The occasion has presented itself, as will be seen, in a convenient if not in a flattering form.
I send this Essay again to the MEDICAL PROFESSION, without the change of a word or syllable. I find, on reviewing it, that it anticipates and eliminates those secondary questions which cannot be entertained for a moment until the one great point of fact is peremptorily settled. In its very statement of the doctrine maintained it avoids all discussion of the nature of the disease "known as puerperal fever," and all the somewhat stale philology of the word contagion. It mentions, fairly enough, the names of sceptics, or unbelievers as to the reality of personal transmission; of Dewees, of Tonnelle, of Duges, of Baudelocque, and others; of course, not including those whose works were then unwritten or unpublished; nor enumerating all the Continental writers who, in ignorance of the great mass of evidence accumulated by British practitioners, could hardly be called well informed on this subject. It meets all the array of negative cases,—those in which disease did not follow exposure,—by the striking example of small-pox, which, although one of the most contagious of diseases, is subject to the most remarkable irregularities and seeming caprices in its transmission. It makes full allowance for other causes besides personal transmission, especially for epidemic influences. It allows for the possibility of different modes of conveyance of the destructive principle. It recognizes and supports the belief that a series of cases may originate from a single primitive source which affects each new patient in turn; and especially from cases of Erysipelas. It does not undertake to discuss the theoretical aspect of the subject; that is a secondary matter of consideration. Where facts are numerous, and unquestionable, and unequivocal in their significance, theory must follow them as it best may, keeping time with their step, and not go before them, marching to the sound of its own drum and trumpet. Having thus narrowed its area to a limited practical platform of discussion, a matter of life and death, and not of phrases or theories, it covers every inch of it with a mass of evidence which I conceive a Committee of Husbands, who can count coincidences and draw conclusions as well as a Synod of Accoucheurs, would justly consider as affording ample reasons for an unceremonious dismissal of a practitioner (if it is conceivable that such a step could be waited for), after five or six funerals had marked the path of his daily visits, while other practitioners were not thus escorted. To the Profession, therefore, I submit the paper in its original form, and leave it to take care of itself.
To the MEDICAL STUDENTS, into whose hands this Essay may fall, some words of introduction may be appropriate, and perhaps, to a small number of them, necessary. There are some among them who, from youth, or want of training, are easily bewildered and confused in any conflict of opinions into which their studies lead them. They are liable to lose sight of the main question in collateral issues, and to be run away with by suggestive speculations. They confound belief with evidence, often trusting the first because it is expressed with energy, and slighting the latter because it is calm and unimpassioned. They are not satisfied with proof; they cannot believe a point is settled so long as everybody is not silenced. They have not learned that error is got out of the minds that cherish it, as the taenia is removed from the body, one joint, or a few joints at a time, for the most part, rarely the whole evil at once. They naturally have faith in their instructors, turning to them for truth, and taking what they may choose to give them; babes in knowledge, not yet able to tell the breast from the bottle, pumping away for the milk of truth at all that offers, were it nothing better than a Professor's shrivelled forefinger.
In the earliest and embryonic stage of professional development, any violent impression on the instructor's mind is apt to be followed by some lasting effect on that of the pupil. No mother's mark is more permanent than the mental naevi and moles, and excrescences, and mutilations, that students carry with them out of the lecture-room, if once the teeming intellect which nourishes theirs has been scared from its propriety by any misshapen fantasy. Even an impatient or petulant expression, which to a philosopher would be a mere index of the low state of amiability of the speaker at the moment of its utterance, may pass into the young mind as an element of its future constitution, to injure its temper or corrupt its judgment. It is a duty, therefore, which we owe to this younger class of students, to clear any important truth which may have been rendered questionable in their minds by such language, or any truth-teller against whom they may have been prejudiced by hasty epithets, from the impressions such words have left. Until this is done, they are not ready for the question, where there is a question, for them to decide. Even if we ourselves are the subjects of the prejudice, there seems to be no impropriety in showing that this prejudice is local or personal, and not an acknowledged conviction with the public at large. It may be necessary to break through our usual habits of reserve to do this, but this is the fault of the position in which others have placed us.
Two widely-known and highly-esteemed practitioners, Professors in two of the largest Medical Schools of the Union, teaching the branch of art which includes the Diseases of Women, and therefore speaking with authority; addressing in their lectures and printed publications large numbers of young men, many of them in the tenderest immaturity of knowledge, have recently taken ground in a formal way against the doctrine maintained in this paper:
On the Non-Contagious Character of Puerperal Fever: An Introductory
Lecture. By Hugh L. Hodge, M. D., Professor of Obstetrics in the
University of Pennsylvania. Delivered Monday, October 11, 1852.
Philadelphia, 1852.
On the Nature, Signs, and Treatment of Childbed Fevers: in a Series of
Letters addressed to the Students of his Class. By Charles D. Meigs, M.
D., Professor of Midwifery and the Diseases of Women and Children in
Jefferson Medical College, Philadelphia, etc., etc. Philadelphia, 1854.
Letter VI.
The first of the two publications, Dr. Hodge's Lecture, while its theoretical considerations and negative experiences do not seem to me to require any further notice than such as lay ready for them in my Essay written long before, is, I am pleased to say, unobjectionable in tone and language, and may be read without offence.
This can hardly be said of the chapter of Dr. Meigs's volume which treats of Contagion in Childbed Fever. There are expressions used in it which might well put a stop to all scientific discussions, were they to form the current coin in our exchange of opinions. I leave the "very young gentlemen," whose careful expositions of the results of practice in more than six thousand cases are characterized as "the jejune and fizenless dreamings of sophomore writers," to the sympathies of those "dear young friends," and "dear young gentlemen," who will judge how much to value their instructor's counsel to think for themselves, knowing what they are to expect if they happen not to think as he does.
One unpalatable expression I suppose the laws of construction oblige me to appropriate to myself, as my reward for a certain amount of labor bestowed on the investigation of a very important question of evidence, and a statement of my own practical conclusions. I take no offence, and attempt no retort. No man makes a quarrel with me over the counterpane that covers a mother, with her new-born infant at her breast. There is no epithet in the vocabulary of slight and sarcasm that can reach my personal sensibilities in such a controversy. Only just so far as a disrespectful phrase may turn the student aside from the examination of the evidence, by discrediting or dishonoring the witness, does it call for any word of notice.
I appeal from the disparaging language by which the Professor in the Jefferson School of Philadelphia world dispose of my claims to be listened to. I appeal, not to the vote of the Society for Medical Improvement, although this was an unusual evidence of interest in the paper in question, for it was a vote passed among my own townsmen; nor to the opinion of any American, for none know better than the Professors in the great Schools of Philadelphia how cheaply the praise of native contemporary criticism is obtained. I appeal to the recorded opinions of those whom I do not know, and who do not know me, nor care for me, except for the truth that I may have uttered; to Copland, in his "Medical Dictionary," who has spoken of my Essay in phrases to which the pamphlets of American "scribblers" are seldom used from European authorities; to Ramsbotham, whose compendious eulogy is all that self-love could ask; to the "Fifth Annual Report" of the Registrar-General of England, in which the second-hand abstract of my Essay figures largely, and not without favorable comment, in an important appended paper. These testimonies, half forgotten until this circumstance recalled them, are dragged into the light, not in a paroxysm of vanity, but to show that there may be food for thought in the small pamphlet which the Philadelphia Teacher treats so lightly. They were at least unsought for, and would never have been proclaimed but for the sake of securing the privilege of a decent and unprejudiced hearing.
I will take it for granted that they have so far counterpoised the depreciating language of my fellow-countryman and fellow-teacher as to gain me a reader here and there among the youthful class of students I am now addressing. It is only for their sake that I think it necessary to analyze, or explain, or illustrate, or corroborate any portion of the following Essay. But I know that nothing can be made too plain for beginners; and as I do not expect the practitioner, or even the more mature student, to take the trouble to follow me through an Introduction which I consider wholly unnecessary and superfluous for them, I shall not hesitate to stoop to the most elementary simplicity for the benefit of the younger student. I do this more willingly because it affords a good opportunity, as it seems to me, of exercising the untrained mind in that medical logic which does not seem to have been either taught or practised in our schools of late, to the extent that might be desired.
I will now exhibit, in a series of propositions reduced to their simplest expression, the same essential statements and conclusions as are contained in the Essay, with such commentaries and explanations as may be profitable to the inexperienced class of readers addressed.
I. It has been long believed, by many competent observers, that Puerperal Fever (so called) is sometimes carried from patient to patient by medical assistants.
II. The express object of this Essay is to prove that it is so carried.
III. In order to prove this point, it is not necessary to consult any medical theorist as to whether or not it is consistent with his preconceived notions that such a mode of transfer should exist.
IV. If the medical theorist insists on being consulted, and we see fit to indulge him, he cannot be allowed to assume that the alleged laws of contagion, deduced from observation in other diseases, shall be cited to disprove the alleged laws deduced from observation in this. Science would never make progress under such conditions. Neither the long incubation of hydrophobia, nor the protecting power of vaccination, would ever have been admitted, if the results of observation in these affections had been rejected as contradictory to the previously ascertained laws of contagion.
V. The disease in question is not a common one; producing, on the average, about three deaths in a thousand births, according to the English Registration returns which I have examined.
VI. When an unusually large number of cases of this disease occur about the same time, it is inferred, therefore, that there exists some special cause for this increased frequency. If the disease prevails extensively over a wide region of country, it is attributed without dispute to an epidemic influence. If it prevails in a single locality, as in a hospital, and not elsewhere, this is considered proof that some local cause is there active in its production.
VII. When a large number of cases of this disease occur in rapid succession, in one individual's ordinary practice, and few or none elsewhere, these cases appearing in scattered localities, in patients of the same average condition as those who escape under the care of others, there is the same reason for connecting the cause of the disease with the person in this instance, as with the place in that last mentioned.
VIII. Many series of cases, answering to these conditions, are given in this Essay, and many others will be referred to which have occurred since it was written.
IX. The alleged results of observation may be set aside; first, because the so-called facts are in their own nature equivocal; secondly, because they stand on insufficient authority; thirdly, because they are not sufficiently numerous. But, in this case, the disease is one of striking and well-marked character; the witnesses are experts, interested in denying and disbelieving the facts; the number of consecutive cases in many instances frightful, and the number of series of cases such that I have no room for many of them except by mere reference.
X. These results of observation, being admitted, may, we will suppose, be interpreted in different methods. Thus the coincidences may be considered the effect of chance. I have had the chances calculated by a competent person, that a given practitioner, A., shall have sixteen fatal cases in a month, on the following data: A. to average attendance upon two hundred and fifty births in a year; three deaths in one thousand births to be assumed as the average from puerperal fever; no epidemic to be at the time prevailing. It follows, from the answer given me, that if we suppose every one of the five hundred thousand annual births of England to have been recorded during the last half-century, there would not be one chance in a million million million millions that one such series should be noted. No possible fractional error in this calculation can render the chance a working probability. Applied to dozens of series of various lengths, it is obviously an absurdity. Chance, therefore, is out of the question as an explanation of the admitted coincidences.
XI. There is, therefore, some relation of cause and effect between the physician's presence and the patient's disease.
XII. Until it is proved to what removable condition attaching to the attendant the disease is owing, he is bound to stay away from his patients so soon as he finds himself singled out to be tracked by the disease. How long, and with what other precautions, I have suggested, without dictating, at the close of my Essay. If the physician does not at once act on any reasonable suspicion of his being the medium of transfer, the families where he is engaged, if they are allowed to know the facts, should decline his services for the time. His feelings on the occasion, however interesting to himself, should not be even named in this connection. A physician who talks about ceremony and gratitude, and services rendered, and the treatment he got, surely forgets himself; it is impossible that he should seriously think of these small matters where there is even a question whether he may not carry disease, and death, and bereavement into any one of "his families," as they are sometimes called.
I will now point out to the young student the mode in which he may relieve his mind of any confusion, or possibly, if very young, any doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised in his mind.
The most prominent ideas of the Letter are, first, that the transmissible nature of puerperal fever appears improbable, and, secondly, that it would be very inconvenient to the writer. Dr. Woodville, Physician to the Small-Pox and Inoculation Hospital in London, found it improbable, and exceedingly inconvenient to himself, that cow pox should prevent small-pox; but Dr. Jenner took the liberty to prove the fact, notwithstanding.
I will first call the young student's attention to the show of negative facts (exposure without subsequent disease), of which much seems to be thought. And I may at the same time refer him to Dr. Hodge's Lecture, where he will find the same kind of facts and reasoning. Let him now take up Watson's Lectures, the good sense and spirit of which have made his book a universal favorite, and open to the chapter on Continued Fever. He will find a paragraph containing the following sentence: "A man might say, 'I was in the battle of Waterloo, and saw many men around me fall down and die, and it was said that they were struck down by musket-balls; but I know better than that, for I was there all the time, and so were many of my friends, and we were never hit by any musket-balls. Musket-balls, therefore, could not have been the cause of the deaths we witnessed.' And if, like contagion, they were not palpable to the senses, such a person might go on to affirm that no proof existed of there being any such thing as musket-balls." Now let the student turn back to the chapter on Hydrophobia in the same volume. He will find that John Hunter knew a case in which, of twenty-one persons bitten, only one died of the disease. He will find that one dog at Charenton was bitten at different times by thirty different mad dogs, and outlived it all. Is there no such thing, then, as hydrophobia? Would one take no especial precautions if his wife, about to become a mother, had been bitten by a rabid animal, because so many escape? Or let him look at "Underwood on Diseases of Children," [Philadelphia, 1842, p. 244, note.] and he will find the case of a young woman who was inoculated eight times in thirty days, at the same time attending several children with smallpox, and yet was not infected. But seven weeks afterwards she took the disease and died.
It would seem as if the force of this argument could hardly fail to be seen, if it were granted that every one of these series of cases were so reported as to prove that there could have been no transfer of disease. There is not one of them so reported, in the Lecture or the Letter, as to prove that the disease may not have been carried by the practitioner. I strongly suspect that it was so carried in some of these cases, but from the character of the very imperfect evidence the question can never be settled without further disclosures.
Although the Letter is, as I have implied, principally taken up with secondary and collateral questions, and might therefore be set aside as in the main irrelevant, I am willing, for the student's sake, to touch some of these questions briefly, as an illustration of its logical character.
The first thing to be done, as I thought when I wrote my Essay, was to throw out all discussions of the word contagion, and this I did effectually by the careful wording of my statement of the subject to be discussed. My object was not to settle the etymology or definition of a word, but to show that women had often died in childbed, poisoned in some way by their medical attendants. On the other point, I, at least, have no controversy with anybody, and I think the student will do well to avoid it in this connection. If I must define my position, however, as well as the term in question, I am contented with Worcester's definition; provided always this avowal do not open another side controversy on the merits of his Dictionary, which Dr. Meigs has not cited, as compared with Webster's, which he has.
I cannot see the propriety of insisting that all the laws of the eruptive fevers must necessarily hold true of this peculiar disease of puerperal women. If there were any such propriety, the laws of the eruptive fevers must at least be stated correctly. It is not true, for instance, as Dr. Meigs states, that contagion is "no respecter of persons;" that "it attacks all individuals alike." To give one example: Dr. Gregory, of the Small-Pox Hospital, who ought to know, says that persons pass through life apparently insensible to or unsusceptible of the small-pox virus, and that the same persons do not take the vaccine disease.
As to the short time of incubation, of which so much is made, we have no right to decide beforehand whether it shall be long or short, in the cases we are considering. A dissection wound may produce symptoms of poisoning in six hours; the bite of a rabid animal may take as many months.
After the student has read the case in Dr. Meigs's 136th paragraph, and the following one, in which he exclaims against the idea of contagion, because the patient, delivered on the 26th of December, was attacked in twenty-four hours, and died on the third day, let him read what happened at the "Black Assizes" of 1577 and 1750. In the first case, six hundred persons sickened the same night of the exposure, and three hundred more in three days. [Elliotson's Practice, p. 298.] Of those attacked in the latter year, the exposure being on the 11th of May, Alderman Lambert died on the 13th, Under-Sheriff Cox on the 14th, and many of note before the 20th. But these are old stories. Let the student listen then to Dr. Gerhard, whose reputation as a cautious observer he may be supposed to know. "The nurse was shaving a man, who died in a few hours after his entrance; he inhaled his breath, which had a nauseous taste, and in an hour afterwards was taken with nausea, cephalalgia, and singing of the ears. From that moment the attack began, and assumed a severe character. The assistant was supporting another patient, who died soon afterwards; he felt the pungent heat upon his skin, and was taken immediately with the symptoms of typhus." [Am. Jour. Med. Sciences, Feb. 1837, p. 299.] It is by notes of cases, rather than notes of admiration, that we must be guided, when we study the Revised Statutes of Nature, as laid down from the curule chairs of Medicine.
Let the student read Dr. Meigs's 140th paragraph soberly, and then remember, that not only does he infer, suspect, and surmise, but he actually asserts (page 154), "there was poison in the house," because three out of five patients admitted into a ward had puerperal fever and died. Have I not as much right to draw a positive inference from "Dr. A.'s" seventy exclusive cases as he from the three cases in the ward of the Dublin Hospital? All practical medicine, and all action in common affairs, is founded on inferences. How does Dr. Meigs know that the patients he bled in puerperal fever would not have all got well if he had not bled them?
"You see a man discharge a gun at another; you see the flash, you hear the report, you see the person fall a lifeless corpse; and you infer, from all these circumstances, that there was a ball discharged from the gun, which entered his body and caused his death, because such is the usual and natural cause of such an effect. But you did not see the ball leave the gun, pass through the air, and enter the body of the slain; and your testimony to the fact of killing is, therefore, only inferential,—in other words, circumstantial. It is possible that no ball was in the gun; and we infer that there was, only because we cannot account for death on any other supposition." [Chief Justice Gibson, in Am. Law Journal, vol. vi. p. 123.]
"The question always comes to this: Is the circumstance of intercourse with the sick followed by the appearance of the disease in a proportion of cases so much greater than any other circumstance common to any portion of the inhabitants of the place under observation, as to make it inconceivable that the succession of cases occurring in persons having that intercourse should have been the result of chance? If so, the inference is unavoidable, that that intercourse must have acted as a cause of the disease. All observations which do not bear strictly on that point are irrelevant, and, in the case of an epidemic first appearing in a town or district, a succession of two cases is sometimes sufficient to furnish evidence which, on the principle I have stated, is nearly irresistible."
Possibly an inexperienced youth may be awe-struck by the quotation from Cuvier. These words, or their equivalent, are certainly to be found in his Introduction. So are the words "top not come down"! to be found in the Bible, and they were as much meant for the ladies' head-dresses as the words of Cuvier were meant to make clinical observation wait for a permit from anybody to look with its eyes and count on its fingers. Let the inquiring youth read the whole Introduction, and he will see what they mean.
I intend no breach of courtesy, but this is a proper place to warn the student against skimming the prefaces and introductions of works for mottoes and embellishments to his thesis. He cannot learn anatomy by thrusting an exploring needle into the body. He will be very liable to misquote his author's meaning while he is picking off his outside sentences. He may make as great a blunder as that simple prince who praised the conductor of his orchestra for the piece just before the overture; the musician was too good a courtier to tell him that it was only the tuning of the instruments.
To the six propositions in the 142d paragraph, and the remarks about "specific" diseases, the answer, if any is necessary, seems very simple. An inflammation of a serous membrane may give rise to secretions which act as a poison, whether that be a "specific" poison or not, as Dr. Homer has told his young readers, and as dissectors know too well; and that poison may produce its symptoms in a few hours after the system has received it, as any may see in Druitt's "Surgery," if they care to look. Puerperal peritonitis may produce such a poison, and puerperal women may be very sensible to its influences, conveyed by contact or exhalation. Whether this is so or not, facts alone can determine, and to facts we have had recourse to settle it.
The following statement is made by Dr. Meigs in his 142d paragraph, and developed more at length, with rhetorical amplifications, in the 134th. "No human being, save a pregnant or parturient woman, is susceptible to the poison." This statement is wholly incorrect, as I am sorry to have to point out to a Teacher in Dr. Meigs's position. I do not object to the erudition which quotes Willis and Fernelius, the last of whom was pleasantly said to have "preserved the dregs of the Arabs in the honey of his Latinity." But I could wish that more modern authorities had not been overlooked. On this point, for instance, among the numerous facts disproving the statement, the "American Journal of Medical Sciences," published not far from his lecture-room, would have presented him with a respectable catalog of such cases. Thus he might refer to Mr. Storrs's paper "On the Contagious Effects of Puerperal Fever on the Male Subject; or on Persons not Childbearing" (Jan. 1846), or to Dr. Reid's case (April, 1846), or to Dr. Barron's statement of the children's dying of peritonitis in an epidemic of puerperal fever at the Philadelphia Hospital (Oct. 1842), or to various instances cited in Dr. Kneeland's article (April, 186). Or, if he would have referred to the "New York Journal," he might have seen Prof. Austin Flint's cases. Or, if he had honored my Essay so far, he might have found striking instances of the same kind in the first of the new series of cases there reported and elsewhere. I do not see the bearing of his proposition, if it were true. But it is one of those assertions that fall in a moment before a slight examination of the facts; and I confess my surprise, that a professor who lectures on the Diseases of Women should have ventured to make it.