CHAPTER XIII.

"I can scarcely credit my memory when I recall the first impressions produced upon me by sights afterwards become so familiar that they could no more disturb a pulse-beat than the commonest of every-day experiences. The skeleton, hung aloft like a gibbeted criminal, looked grimly at me as I entered the room devoted to the students of the school I had joined, just as the fleshless figure of Time, with the hour-glass and scythe, used to glare upon me in my childhood from the New England Primer. The white faces in the beds at the Hospital found their reflection in my own cheeks which lost their color as I looked upon them. All this had to pass away in a little time; I had chosen my profession, and must meet all its aspects until they lost their power over my sensibility....

"After attending two courses of lectures in the School of the University, I went to Europe to continue my studies. I can hardly believe my own memory when I recall the old practitioners and professors who were still going round the hospitals when I mingled with the train of students in the École de Médicine."

Of the famous Baron Boyer, author of a nine-volumed book on surgery, Doctor Holmes says, "I never saw him do more than look as if he wanted to cut a good collop out of a patient he was examining." Baron Larrey, the favorite surgeon of Napoleon, he describes as a short, square, substantial man, with iron-gray hair, red face, and white apron. To go round the Hotel des Invalides with Larrey was to live over the campaign of Napoleon, to look on the sun of Austerlitz, to hear the cannon of Marengo, to struggle through the icy waters of the Beresina, to shiver in the snows of the Russian retreat, and to gaze through the battle smoke upon the last charge of the red lancers on the redder field of Waterloo.

Then there was Baron Dupuytren, "ce grand homme de lautre côté de la rivièrè,—with his high, full-doomed head and oracular utterances; Lisfrance, the great drawer of blood and hewer of members; Velpeau, who, coming to Paris in wooden shoes, and starving, almost, at first, raised himself to great eminence as surgeon and author; Broussais, the knotty-featured, savage old man who reminded one of a volcano, which had well-nigh used up its fire and brimstone, and Gabriel Audral, the rapid, fluent, fervid and imaginative speaker.

"The object of our reverence, however, I might almost say idolatry," adds Doctor Holmes, "was Pierre Charles Alexandre Louis, a tall, rather spare, dignified personage, of serene and grave aspect, but with a pleasant smile and kindly voice for the student with whom he came into personal relations.

"If I summed up the lessons of Louis in two expressions, they would be these: First, always make sure that you form a distinct and clear idea of the matter you are considering. Second, always avoid vague approximations where exact estimates are possible....

"Yes, as I say, I look back on the long hours of the many days I spent in the wards and in the autopsy room of La Pitié, where Louis was one of the attending physicians—yes, Louis did a great work for practical medicine. Modest in the presence of nature, fearless in the face of authority, unwearying in the pursuit of truth, he was a man whom any student might be happy and proud to claim as his teacher and his friend. And yet, as I look back on the days when I followed his teachings, I feel that I gave myself up too exclusively to his methods of thought and study. There is one part of their business that certain medical practitioners are too apt to forget; namely, that what they should most of all try to do is to ward off disease, to alleviate suffering, to preserve life, or at least to prolong it if possible. It is not of the slightest interest to the patient to know whether three or three and a quarter inches of his lungs are hepatized. His mind is not occupied with thinking of the curious problems which are to be solved by his own autopsy, whether this or that strand of the spinal marrow is the seat of this or that form of degeneration. He wants something to relieve his pain, to mitigate the anguish of dyspnæa, to bring back motion and sensibility to the dead limb, to still the tortures of neuralgia. What is it to him that you can localize and name by some uncouth term, the disease which you could not prevent and which you can not cure? an old woman who knows how to make a poultice and how to put it on, and does it tuto, cito, jucunde, just when and where it is wanted, is better—a thousand times better in many cases—than a staring pathologist who explores and thumps and doubts and guesses and tells his patient he will be better to-morrow, and so goes home to tumble his books over and make out a diagnosis.

"But in those days I, like most of my fellow students, was thinking much more of 'science' than of practical medicine, and I believe if we had not clung so closely to the skirts of Louis, and had followed some of the courses of men like Rousseau,—therapeutists, who gave special attention to curative methods, and not chiefly to diagnosis—it would have been better for me and others. One thing, at any rate, we did learn in the wards of Louis. We learned that a very large proportion of diseases get well of themselves, without any special medication—the great fact formulated, enforced and popularized by Doctor Jacob Bigelow."

It is well known that Doctor Holmes detests the habit of drugging practised by so many physicians of the "old school," and in his address before the Massachusetts Medical Society, entitled Currents and Counter Currents in Medical Science, he makes a severe attack upon the inordinate use of medicines.

"What is the honest truth," he says at another time, "about the medical art? By far the largest number of diseases which physicians are called to treat will get well at any rate, even in spite of reasonably bad treatment. Of the other fraction, a certain number will inevitably die, whatever is done: there remains a small margin of cases where the life of the patient depends on the skill of the physician. Drugs now and then save life; they often shorten disease and remove symptoms; but they are second in importance to food, air, temperature, and the other hygienic influences. That was a shrewd trick of Alexander's physician on the occasion of his attack after bathing. He asked three days to prepare his medicine. Time is the great physician as well as the great consoler. Sensible men in all ages have trusted most to nature."

Of quacks and other humbugs, Doctor Holmes had an undisguised, wholesome contempt.

"Shall we try," he says, "the medicines advertised with the certificates of justices of the peace, of clergymen, or even members of Congress? Certainly, it may be answered, any one of them which makes a good case for itself. But the difficulty is, that the whole class of commercial remedies are shown by long experience, with the rarest exceptions, to be very sovereign cures for empty pockets, and of no peculiar efficacy for anything else. You may be well assured that if any really convincing evidence was brought forward in behalf of the most vulgar nostrum, the chemists would go at once to work to analyze it, the physiologists to experiment with it, and the young doctors would all be trying it on their own bodies, if not on their patients. But we do not think it worth while, as a general rule, to send a Cheap Jack's gilt chains and lockets to be tested for gold. We know they are made to sell, and so with the pills and potions.... Think how rapidly any real discovery is appropriated and comes into universal use. Take anæsthetics, take the use of bromide of potassium, and see how easily they obtained acceptance. If you are disposed to think any of the fancy systems has brought forward any new remedy of value which the medical profession has been slow to accept, ask any fancy practitioner to name it. Let him name one,—the best his system claims,—not a hundred, but one. A single new, efficient, trustworthy remedy which the medical profession can test as they are ready to test before any scientific tribunal, opium, quinine, ether, the bromide of potassium. There is no such remedy on which any of the fancy practitioners dare stake his reputation. If there were, it would long ago have been accepted, though it had been flowers of brimstone from the borders of Styx or Cocytus."

Homœopathy is classed by Doctor Holmes among such "Kindred Delusions" as the Royal Cure for the King's Evil, the Weapon Ointment, the Sympathetic Powder, the Tar-water mania of Bishop Berkeley, and the Metallic Tractors, or Perkinsism.

In making a direct attack upon the pretentions of Homœopathy, Doctor Holmes declares at the outset that he shall treat it not by ridicule, but by argument; with great freedom, but with good temper and in peaceable language.

Similia similibus curantur. Like cures like, is one of the fundamental principles of Homœopathy, and "improbable though it may seem to some," says Doctor Holmes with his usual impartial fairness, "there is no essential absurdity involved in the proposition that diseases yield to remedies capable of producing like symptoms. There are, on the other hand, some analogies which lend a degree of plausibility to the statement. There are well-ascertained facts, known from the earliest periods of medicine, showing that under certain circumstances, the very medicine which from its known effects, one would expect to aggravate the disease, may contribute to its relief. I may be permitted to allude, in the most general way, to the case in which the spontaneous efforts of an over-tasked stomach are quieted by the agency of a drug which that organ refuses to entertain upon any terms. But that every cure ever performed by medicine should have been founded upon this principle, although without the knowledge of a physician, that the Homœopathy axiom is, as Hahnemann asserts, "the sole law of nature in therapeutics," a law of which nothing more than a transient glimpse ever presented itself to the innumerable host of medical observers, is a dogma of such sweeping extent and pregnant novelty, that it demands a corresponding breath and depth of unquestionable facts to cover its vast pretensions."

Among the many facts of which great use has been made by the Homœopathists, is that found in the precept given for the treatment of parts which have been frozen, by friction with snow, etc.

"But," says Doctor Holmes, "we deceive ourselves by names, if we suppose the frozen part to be treated by cold, and not by heat. The snow may even be actually warmer than the part to which it is applied. But even if it were at the same temperature when applied, it never did and never could do the least good to a frozen part, except as a mode of regulating the application of what? of heat. But the heat must be applied gradually, just as food must be given a little at a time to those perishing with hunger. If the patient were brought into a warm room, heat would be applied very rapidly, were not something interposed to prevent this, and allow its gradual admission. Snow or iced water is exactly what is wanted; it is not cold to the part; it is very possibly warm, on the contrary, for these terms are relative, and if it does not melt and let the heat in, or is not taken away, the part will remain frozen up until doomsday. Now the treatment of a frozen limb by heat, in large or small quantities, is not Homœopathy."

Another supposed illustration of the Homœopathic law is the alleged successful management of burns, by holding them to the fire. "This is a popular mode of treating those burns which are of too little consequence to require any more efficacious remedy, and would inevitably get well of themselves, without any trouble being bestowed upon them. It produces a most acute pain in the part, which is followed by some loss of sensibility, as happens with the eye after exposure to strong light, and the ear after being subjected to very intense sounds. This is all it is capable of doing, and all further notions of its efficacy must be attributed merely to the vulgar love of paradox. If this example affords any comfort to the Homœopathist, it seems as cruel to deprive him of it as it would be to convince the mistress of the smoke-jack or the flatiron that the fire does not literally draw the fire out, which is her hypothesis.

"But if it were true that frost-bites were cured by cold and burns by heat, it would be subversive, so far as it went, of the great principle of Homœopathy. For you will remember that this principle is that Like cures Like, and not that Same cures Same; that there is resemblance and not identity between the symptoms of the disease and those produced by the drug which cures it, and none have been readier to insist upon this distinction than the Homœopathists themselves. For if Same cures Same, then every poison must be its own antidote,—which is neither a part of their theory nor their so-called experience. They have been asked often enough, why it was that arsenic could not cure the mischief which arsenic had caused, and why the infectious cause of small-pox did not remedy the disease it had produced, and then they were ready enough to see the distinction I have pointed out. "O no! it was not the hair of the same dog, but only of one very much like him!"

The belief in and employment of the "Infinitesimal doses," Doctor Holmes handles with the same fairness and acumen; but the absurd idea affirmed by Hahnemann that Psora is the cause of the great majority of chronic diseases, he treats as it deserves, with unqualified contempt.

In conclusion, he says, "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 giants who walk in the noonday and sleep 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 up 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."

Upon the contagiousness of Puerperal Fever, Doctor Holmes wrote an able treatise some forty years ago. This was reprinted with some additions, in 1855, and in an introductory note which accompanies the still later addition (1883), Doctor Holmes says, "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 proportion of well-constituted and unprejudiced minds."

The essay, a most valuable one, is republished without the change of a word or syllable, as the author upon reviewing finds that it anticipates and eliminates those secondary questions which cannot be for a moment entertained until the one great point of fact is peremptorily settled.

There are but very few subjects, indeed, in medical science, that Doctor Holmes has not investigated, and investigated, too, most thoroughly....

In his article on "Reflex Vision," published in Volume IV. of the Proceedings of the American Academy, will be found a very interesting account of his experiments in optics. One, indeed, that will both interest and instruct.

To him, as is well known, we are indebted for numerous improvements in the stereoscope; and in microscopes also, he has done some original and important work.

Said an admirer of Doctor Holmes in referring to his career as a medical professor:

"He always makes people attentive, and I have been told that there is no professor whom the students so much like to listen to. In one of his books he says that every one of us is three persons, and I think that if the statement is true in regard to ordinary men and women, Doctor Holmes himself is at least half a dozen persons. He lectures so well on anatomy that his students never suspect him to be a poet, and he writes verses so well that most people do not suspect him of being an authority among scientific men. Though he illustrates his medical lectures by quotations of the most appropriate and interesting sort, from a wonderful variety of authors, he has never been known to refer to his own writings in that way."

In celebrating the silver anniversary year of his wedding with the Muse of the monthlies—meaning his reappearance in the Atlantic—he observed that during the larger part of his absence, his time had been in a great measure occupied with other duties. "I never forgot the advice of Coleridge," he said, "that a literary man should have a regular calling. I may say, in passing, that I have often given the advice to others, and too often wished that I could supplement it with the words, "And confine himself to it.'"