NEW-YORK 
MEDICAL AND PHYSICAL 
APRIL, MAY, AND JUNE, 1828. 
Art. I. A Lecture on Medical Philosophy, delivered in the Col- 
lege of Physicians and Surgeons, on Monday the sixth of No- 
vember, 1827. By J. Augustine Smith, M.D. Professor of 
Anatomy and Physiology in the University of the State of New- 
York. 
[The following Discourse is published partly to correct 
erroneous impressions of its scope and objects, and partly in 
the hope that a wider diffusion of the principles which it in- 
culcates will tend to the permanent improvement of Medical 
Science.--J. A. S.] 
GENTLEMEN, 
My name standing first in the numerical order of 
my colleagues, it has, in consequence, devolved upon me to 
open the present session of the College. To discharge this 
duty with propriety, anatomy and physiology, the subjects 
especially committed to my charge, must be for the time in 
abeyance. A wider field is to be ranged, and some topic 
must be selected not less interesting but more comprehensive. 
Accordingly, I propose to engage you in a discussion suffi- 
ciently general and sufficiently important. It is my design 
to examine into the philosophy which has prevailed, and still 168 
J. A. Smith on Medical Philosophy. 
prevails, in medicine-an investigation which, in my opinion, 
is greatly required. For look first at the records of our 
science, and see how theory, as these whimsies have been 
termed, has succeeded theory, each rising and glittering, yet 
bursting in its turn. Observe, then, the actual condition of 
the profession, and what a scene does it exhibit to those, who 
feel what their vocation ought to be-who are aware what it 
is-and who reflect how large a portion of human happiness 
depends upon the soundness of medical principles and the 
correctness of medical practice ! Every where are we mor- 
tified by frivolous disputes and idle conjectures, assertions 
which are apocryphal and systems which are false; the 
whole rendered more humiliating and disgusting by a copi- 
ous admixture of bad feelings and angry passions. But 
this never can be right-we must have gone astray-we must 
have failed to observe those dictates of right reason which, as 
rules of philosophizing, have conducted other inquirers, with 
serene tempers and kindly dispositions, to certainty and truth. 
Here then must be the fault; here must be the source of all 
our errors, our broils, and our contests. Our philosophy 
IS WRONG AND REQUIRES TO BE CORRECTED. 
To induce and to enable you to make this correction, are the 
objects of the ensuing discourse. In their pursuit, I shall 
first give you some idea what philosophy really is; I shall 
next point out the mistakes with regard to it which have been 
committed; I shall then show you the evils resulting from 
those mistakes; and lastly, I shall endeavour to deduce from 
the principles which shall have been established, the means 
of permanent improvement to the healing art. 
To begin then with our philosophy. 
When any occurrence attracts our attention, our curiosity 
is excited, and we wish to understand it. Now an expla- 
nation must be sought in one of three several ways. We 
must simply generalize the fact, or we must resolve it into 
another fact of a more comprehensive character, or lastly, 
we must enumerate in the regular order of succession, the 
circumstances which precede the event under consideration. 
In the two first cases, our solutions are complete when we ar- J. A. Smith on Medical Philosophy. 
169 
rive at what are called the Laws of Nature, or more properly 
ultimate facts ; in the last, our analysis is perfected when we 
ascertain the entire series of phenomena which can alone 
usher in the one which we are investigating. 
Such, gentlemen, is philosophy when reduced to its bare 
elements, and the propositions which express it in this very 
abstracted form, would admit of much curious illustration. 
To indulge in this, however, would be too foreign to our pre- 
sent purpose, and a single example under each head must 
suffice. 
Suppose, then, we wish to know why a stone falls to the 
ground ? The reply is, that all bodies mutually attract, and 
consequently the earth and the stone acting in this manner 
on each other, are brought into contact. Here you per- 
ceive that a fact which is general has been substituted for one 
that is particular. 
But it may be occasionally observed that bodies, instead 
of approaching the earth, move in an opposite direction, and 
we may be desirous of knowing whence this proceeds. To 
satisfy our curiosity, Natural Philosophy demonstrates that 
the ascent of bodies which are light, is as much the effect of 
the attraction of which I have spoken, as the descent of those 
which are heavy. In this case, then, we have two particular 
and apparently opposite facts resolved into the more general 
one of gravitation. 
Lastiy, we sometimes hear it thunder, and the cause of this 
may be an object of inquiry. In that event, the same science 
shows us that there is a fluid called electricity; that this fluid 
is liable to have its equilibrium disturbed ; that when this hap- 
pens, there is a strong tendency in it topass from those bodies 
having an excess, to those in which there is a deficiency, &c. 
In other words, to account for the noise called thunder, we 
have to enumerate, in the order in which they occur, all the 
circumstances which of necessity precede the perception of 
such a sound by the ear. 
Now these various modes of explaining the phenomena of 
the physical or moral world, and the method of investiga- 
tion with regard to both is the same, agree in some respects. 170 
J. A. Smith on Medical Philosophy. 
though they differ in others. They all agree in proceeding 
upon facts and nothing but facts; and they further concur in 
terminating in facts, of which no other account can be given 
than that such is the will of the Creator. 
But there is a marked distinction in the conclusions to 
which these different processes lead. If we adopt either of 
the two first, our results are general. If we employ the last, 
our inquiries, however far they may be pushed, must always 
end in particulars. By the first two methods, when carried 
to their utmost limits, we establish, as I have already observed, 
the Laws of Nature, and to one of these laws it follows as 
corollary, there can be no exception. For whoever under- 
takes to announce such a law, does in reality aver that some 
fact is universally and invariably true. But if it can be 
shown, in any one instance, that the supposed fact is not uni- 
versally and invariably true, the statement of course is false, 
and the law does not exist. Take the law of gravity to which 
I have before referred as an example. It is expressed in the 
following words : " that bodies attract each other directly as 
their masses and inversely as the square of their distances." 
Now if it can be proved that there is any one body in the 
universe, with regard to which this rule does not obtain, there 
is no such thing as the law of gravity. 
To apply this to medicine. Suppose a theorist to lay 
it down as a law of the system, that the cause of fever is 
ah inflammation of the stomach and bowels,* (the gastro- 
enterite of the French schools) and any one patient can 
be produced labouring under this disease, in whom no inflam- 
mation of the kind exists, there is an end of the proposition 
as a law. For independently of what I have already stated, 
* It is alleged by the friends of Mons. Broussais, that he does not inva- 
riably locate his inflammation in the stomach and duodenum. Exceptions 
to his general proposition are, I suspect, extremely rare in the mind of 
Mons. B.; but it will be seen that my argument applies to his rule, how- 
ever modified, and is equally valid, whatever view of his doctrine may 
be taken. J. A. Smith on Medical Philosophy. 
171 
it must be for ever borne in mind, what seems never to have 
occurred to some speculators in medicine, that one breach in 
the succession of events, provided it be sufficiently establish- 
ed, is as fatal to our notion of cause and effect, as a thousand 
such failures. What may be the connexion between pheno- 
mena, in virtue of which one follows another, it is not neces- 
sary for me to inquire, since it is admitted on all bands that 
invariability of antecedence is absolutely indispensable to the 
idea of causation. Mere coincidence, therefore, as regards 
time and place, however frequent, if not perfectly uniform, is to 
be held fortuitous and not essential. Now that multitudes of 
cases of fever have occurred where there was no trace of in- 
flammation of the stomach or intestines,orindeed of any other 
organ, is as certain as dissection, to say nothing of other 
proof's, can render any negative fact in the world. What then 
becomes of Mons. Broussais' law ? 
But to return. The different methods of philosophizing 
which I have mentioned,have their respective advantages, but 
they cannot be used indiscriminately. The tendency of the 
mind is strongly in favour of the second, that is, to refer less 
general to more general facts. And this, where it can be done 
with propriety, is commonly the most useful and by far the 
most gratifying. The discovery, indeed, of a reference of 
this ki d, where the facts are numerous and imposing, and to 
common observers remote and contradictory, is the most ex- 
quisite of all intellectual enjoyments.* No wonder then 
there should be such a propensity to attempt them. Where 
however we know and can command all the circumstances 
upon which any event depends, the event itself is of course 
under our control, and for practical purposes nothing further 
can be required. The objection is, that where these aniece- 
* The " 'Eypixa! !" of Archimedes will at once occur to the reader; 
and I have heard that Dr. Rittenhouse, on one occasion, almost fainted 
with pleasure at the verification of an astronomical prediction. Every 
cultivator of science, however, must have felt something of the intense de- 
light which the discovery of truth imparts to the human mind. 172 
J. A. Smith on Medical Philosophy. 
dent circumstances are very numerous the mind is unable to 
retain them, whereas a happy generalization will embrace a 
whole science in a single theorem. But such generalizations 
I fear are little to be expected in medicine, and as the effort to 
introduce them is the besetting sin of the profession, and the 
daily source of incalculable mischief to the public, I must, if 
possible, guard you against the error. To do this was, in- 
deed, the primary object which I proposed to myself when I 
determined to engage in the present inquiry. I shall there- 
fore expatiate upon it somewhat at large, explaining first the 
difficulties attending all grand and comprehensive doctrines 
in medicine, showing secondly the aboitiveness of all the at- 
tempts which have hitherto been made to introduce such doc- 
trines into the profession, and lastly exhibiting the pernicious 
consequences which these attempts have produced, both to us 
and to others. 
In the first place then, in all cases of general disease the 
nerves are more or less implicated, and wherever these mys- 
terious agents are brought into action, our philosophy is ex- 
ceedingly apt to be foiled. So long as we confine our atten- 
tion to the bones, muscles, and blood-vessels, we seem to com- 
prehend something of what is going forward ; but the mo- 
ment the nerves become involved, all our a priori reasoning 
is overthrown, and I have sometimes thought that the rule of 
contrary afforded the best approximation to the truth. 
Secondly. The most efficient agents in the production of 
disorders, are not cognizable by our senses. Miasmata and 
atmospheric poisons give us no notice of their presence. We 
see nothing but effects, and these effects undergo the most ex- 
traordinary mutations without previous warning in the first 
instance, or assignable cause in the second. 
Thus the general character of the maladies which infest 
our country is inflammatory, but in 1813-14, this type was, 
without the slightest premonitory intimation, suddenly re- 
versed, insomuch that bark and wine became in my hands the 
remedies for ordinary pleurisy. We talk, indeed, under such 
circumstances, as Sydenham did, "of the constitution of the 
atmosphere." But this amounts to very little, since in what J. A. Smith on Medical Philosophy. 
173 
that " constitution" consists we have not the slightest con- 
ception. 
In the third place, the various influences to which we are 
subjected, are nearly innumerable. Heat, cold, moisture, 
drought, different kinds of food and of drink, modes of life, 
places of abode, feelings, passions, &,c. &c. All these are con- 
stantly operating upon us, and affecting us to a greater or less 
degree. Hence the inhabitants of cold countries are unlike those 
of warm. Those who live upon hard and scanty fare, differ 
from those who are pampered with delicacies. Persons who 
are secluded and sedentary, are not affected in the same man- 
ner with those who are active and exposed, and those who 
breathe the atmosphere of a crowded city, do not resemble 
such as inhale the air of the country. In London conse- 
quently, and probably in New-York also, stimuli can be used 
with a freedom which in less populous places would be alto- 
gether inadmissible. 
Fourthly. There is a principle in all animated beings mo- 
difying in a way entirely unknown to us, the action of every 
agent to which they are exposed, whether remedial or mor- 
bific. The existence of such a principle has, indeed, been 
denied; for in our happy profession, no proposition can be 
supposed too plain to be contested, (the circulation of the 
blood has been recently controverted) or too absurd to be 
maintained. I shall assume, however, that our disorders are 
sometimes relieved without the intervention of medicine, and 
as every effect pre-supposes a cause, the power operating in 
such cases may, I think, be well designated by the phrase, vis 
medicatrix natures.* 
Lastly, every person has a certain individuality about him, 
physical as well as moral, which constitutes him what he is, 
and distinguishes him from all others of his race. These 
idiosyncrasies are what a patient means when he talks of his 
* The term re-action is, indeed, frequently substituted; but this is spe- 
cific, while the former is generic; they cannot, therefore, be used indiffe- 
rentlv. 174 
J. A. Smith on Medical Philosophy. 
" constitution"-an expression covering an infinitude of 
quackery and imposition undoubtedly, but still having a real 
foundation. 
To recapitulate We have causes then innumerable, im- 
perceptible, and ever varying, operating in the dark, through 
the instrumentality of agents of whose modus operandi we are 
ignorant-these agents themselves not acting precisely alike 
in any two individuals, and the whole modified by a power of 
which little more is known than the name. And yet these 
multifarious elements sometimes concurring, sometimes con- 
flicting, occasionally one of them enjoying the supremacy 
and occasionally another, are all to be reduced to one solitary 
principle. Why, in comparison to simplification like this, the 
dreams of the alchymists were most hopeful philosophy. 
The fate of these fantastic schemes, the second head of 
our inquiry, will not detain us long. Who hears now of 
the humoral pathology, or the error loci of one school, the 
spasm of a second, or the excitement, excitability, &,c of a 
third ? But for our books, it would not be known that such 
notions had ever existed, although they convulsed, in succes- 
sion, the medical world. Their oblivion, however, is in per- 
fect accordance with the law which ordains that the prompt- 
ness and certainty of dissolution are always in proportion to 
the facility and rapidity of production. For nothing is so 
easy as to construct what is dignified with the appellation of 
a Medical Theory. The folk wing is the recipe. Take a 
fact true in one case at least, if it will hold in half a dozen, so 
much the better. Extend it to all times, places, seasons, per- 
sons, and circumstances. Let it embrace every malady that 
flesh is heir to ; let it comprehend the whole human family, 
including men, women, and children, of every age, sex, co- 
lour, condition, and profession, and you have a theory pos- 
sessing all the usefulness, truth, and stability which so very 
wise a proceeding can be supposed to confer. 
But perhaps you think I have borne rather hard upon the 
theorists. It is not so, however, as a slight retrospect will 
show. J. A. Smith on Medical Philosophy. 
175 
Thus it having been ascertained that our fluids are some- 
times contam'nated, the humoral pathology sprang into exist- 
ence, and every thing was to be explained by a depraved state 
of our juices. 
This being soon found insufficient, and it being observed 
that a constriction of the surface frequently takes place in 
fever, the spasm of Cullen became the cause of all mischief. 
This has equally passed away, and, not to be tedious, it has 
been finally succeeded by inflammation of tissues and sur- 
faces, particularly of the stomach and bowels. Gastro-enter- 
itis is accordingly the hobby of the day, destined, I have na 
doubt, to run the usual course of brief popularity and final 
oblivion. 
But our countryman, Dr. Rush, the warmth of whose tem- 
perament carried him at once to the "ultima thule" of simpli- 
fication, affords, perhaps, the best exemplification of what I 
have stated. He convinced himself of having attained, what 
he denominated, that the felicity of the expression might equal 
the magnitude of the discovery, The Unity of Disease. 
In the fulness of his heart he communicated the sublime idea 
to one of his old medical friends and correspondents, who 
shrewd, sensible, and satirical, observed in reply as he in- 
formed me, " that one slight difficulty still remained, one 
little step was yet to be taken, and if Dr. Rush would only 
add the unity of remedy, the grand consummation would be 
complete." Unfortunately this was beyond the Doctor's 
power ; and we have now, as formerly, to select as we can, 
from an abundant materia medica, which the chemists, thanks 
to their labours, are daily rendering more extensive and more 
efficient. 
We come now to the evils which result from these excessive 
generalizations. 
Of these evils the first and undoubtedly the greatest is, the 
sacrifice of human comfort and human life which they occa- 
sion. This I am aware has been controverted, and it has 
been contended that our practice has been more consistent 
and sound than our reasoning. This I believe to be true in 
part, but in part only. For it was observed of Dr. Cullen 176 
J. A. Smith on Medical Philosophy. 
that in the latter stages of fever, he was endeavouring to re- 
ax the spasm of his patients instead of supporting their 
strength. But this is the merest trifle, in my opinion, com- 
pared to the mischief inflicted upon mankind by Brunonianism 
and its opposite, the sytem of depletion. I know it was said 
by the friends of the great patron of the latter, that with him 
the doctrine was innoxious, his good sense correcting, at the 
bed-side of his patients, the folly of his notions, and that in 
practice Dr. Rush did not push blood-letting beyond other 
judicious prescribers. That this may have been true of him, 
I shall not deny. But how did the case stand with the mul- 
titude of young and ardent tempers who were annually turned 
loose upon the public, with imaginations inflamed by the un- 
merited and extravagant eulogiums of this favourite remedy ? 
What was the price which the community had to pay, before 
their experience and tact could neutralize so dangerous an 
error ? 
2ndly. The promulgation of these fanciful speculations 
is particularly injurious to the junior part of the profession, 
who eagerly catch at them, and are thus diverted from the real 
business of their lives. To talk fluently of membranes, sur- 
faces, tissues, and contra-stimulants, the cant phrases of the 
day, and the legitimate successors of excitement, excitabi- 
lity, state of the system, &c. is very easy, very captiva- 
ting, very imposing-and very useless. Whereas to collect 
dry details, to arrange them methodically, and then deduce 
by patient and continued thought those inferences upon which 
the lives of their patients are hereafter to depend, have, in 
the first instance, nothing to allure the buoyant and impa- 
tient temperament of youth, always ready to spurn the earth 
and wing their way in the clouds, but sadly averse to delve 
where alone I fear the truth is to be found. 
A third ill consequence resulting from these whimsies is the 
effect which they produce, not only upon the intellect, but 
upon the very senses of those who pursue them. The au- 
thors, and too frequently the supporters of a system, not only 
believe as they wish, but what is really wonderful, perceive J. A. Smith on Medical Philosophy. 
177 
after the same manner-their minds and their perceptive or- 
gans being equally perverted. Accordingly, while such per- 
sons see, hear, and credit with the most extraordinary quick- 
ness and facility, whatever tends to support their favourite 
scheme, they have neither eyes, nor ears, nor faith for facts 
of a contrary description. And hence it is that so many un- 
founded and conflicting statements get abroad, both in and 
out of the profession-the multitude seeing, every man 
through his own glass. Distrust therefore, not the integrity, 
but the accuracy of all who have peculiar doctrines to main- 
tain : for be assured, that it is by no means unusual for pro- 
jectors to put forth, with perfect honesty, the most confident 
assertions which are entirely destitute of truth. Sometimes, 
however, it is impossible to predicate either truth or false- 
hood of their propositions-there being no evidence one way 
or the other. Take Mr. Broussais as an example, and I 
quote him, not because I think him more culpable than 
other speculators, but because he happens to be the lead- 
ing theorist of the day. In the 29th and following sec- 
tions of his physiology, of which alone I speak, he writes 
thus : " The ganglionick nerves preside over the interior 
movements or functions of the viscera which are independent 
of the brain, they are the grand agents therefore of the living 
chemistry." " The ganglionick nerves receive and collect 
the stimulant influence of the cerebral nerves." "The gan- 
glionick nerves avail themselves of »he vital force of the ani- 
mal, for the purposes of this living chemistry." And much 
more to the same effect, which I need not quote. Now from 
the calm, serious, and positive tone with which all this is sta- 
ted, a suspicion of its fallacy would never enter the mind of 
an ordinary reader. He would take it for granted that every 
thing was as sound as it is fair, and that Monsieur Brous- 
sais was merely applying acknowledged truths to his particu- 
lar purposes. Yet so far is this from being the case, that in 
the present state of our knowledge, what Mons. Broussais af- 
firms of the ganglionic nerves, would be equally authentic if 
asserted of any other of the internal and intangible parts of J. A. Smith on Medical Philosophy. 
178 
the body-so entirely ignorant are we of the real uses of the 
ganglionic system.* 
Before 1 take my leave of Monsieur Broussais, I may re- 
mark, that I do not believe he w 11 ever acquire tae distinc- 
tion and influence which some of his predecessors have en- 
joyed. I think so for two reasons. In the first place, there 
is, I am persuaded, less proneness in the profession than there 
was to be notional. But secondly and principally, the apho- 
ristic form in which this gentleman has thought proper to 
clothe his opinions, though very sinking at first, is on the 
whole disadvantageous. Th re is an unjo. tunate perspicuity 
about it ivhich is fatal.\ Mysticism, or at least a certain 
vagueness of expression, is indispensable to error. Where 
our vision is perfect there can be no deception, whereas a du- 
bious twilight gives ample scope for supposed knowledge and 
real delusion. Moreover, in the midst of uncertainty every 
man will interpret to please himself. Proselytes are thus 
readily obtained, and when once engaged, having to contend 
at least as much for themselves as their masters, their self-love 
effectually guarantees their adhesion. And lastly, a disputant 
intrenched in a mbiguity, is invincible ; for if driven from 
one Covert, he immediately takes shelter in another, saying, 
" O (hat is not what we contend fo!r." And this sort of bush- 
fighting is interminable-no proposition being ever admitted 
which is sufficiently definite to be battered down. Now the 
ideas and phraseology of Mr. Broussais wanting this conve- 
nient degree of obscurity and confusion, his system as an ex- 
clusive one, for doubtless the stomach and bowels are some- 
times inflamed, will never, I apprehend, acquire any very 
great vogue. 
* Majendie has torn out all the accessible ganglia without pain or other 
perceptible consequence to the animal ; the physiology consequently of 
these bodies is as unknown as the composition of the moon. 
f Vide the curious discussion in Campbell's Philosophy of Rhetoric, 
" Why nonsense so often escapes being detected, both by the writer and 
the reader."-Philosophy of Rhetoric, Vol. II. p. 112. J. A. Smith on Medical Philosophy. 
179 
Let us revert, however, to the evils of such systems. A 
fourth is this. Facts which are at onetime to account for 
every thing, are soon found to have been magnified beyond 
their'deserts ; they are then neglected and ultimately denied. 
The spasm of Cullen is too recent to be controverted ; it is 
simply unnoticed, whereas the vitiation oi our humours is 
stoutly contested, although the birth of children covered with 
the pustules of small-pox demonstrates the fact of our fluids 
being sometimes contaminated.* 
There is one and but one more of the mischievous conse- 
quences of these wild speculations with which I shall trouble 
you. It is of a different character from those which I have 
already mentioned, and in some respects more injurious. 
From the long continuance and almost universal pievalence 
of loose reasoning and rash generalization in the profession, 
every thing in medicine is yet unsettled. We have no ele- 
mentary principles in which all are agreed, and we have conse- 
sequently no conclusions to which all will assent. Whatever 
approaches to system,is in a state of perpetual change and re- 
volution. In matters of detail, indeed, it is otherwise. New facts 
are observed, and new remedies are added,so that our practice un- 
doubtedly improves, and improvesgreatly; but beyond this,asto 
any thing which in legitimate language can be called tAcory,Iam 
not aware there is any material amendment. Those who will 
theorize, as they term it, tread the same ceaseless round of 
premises which, if not false, are narrow, and of deductions 
which, if not altogether unwarranted, are pushed far beyond 
the truth. But this cycle of error alone proves there is 
something radically wrong. The toil of thousands, if well 
directed, must have made some advances. Yet in upwards 
of twenty centuries, in spite of every thing which numbers, 
zeal, learning, and talents could effect, how little, how very 
* Mr. Abernethy says, that this does not happen earlier than the sixth 
month of foetal life. From this it would appear that at this period the 
communication between mother and offspring becomes more free. 180 
./. A. Smith on Medical Philosophy. 
little has been gained from the terra incognita of systematic 
medicine ? A similar result in the labours of those most in- 
genious personages the schoolmen, is well known to have con- 
vinced Lord Bacon that their philosophy was false. Would 
that another Bacon might arise, from the same premises deduce 
the same conclusion, and then regenerate the science of medi- 
cine, giving us certainty in our principles, uniformity in our 
practice, and permanence in our systems ! 
Upon the effects of so delightful a change, could it be ac- 
complished, it is not my object to descant. But there is one 
benefit that would ensue upon which, as being less obvious, 
I will offer a few remarks. 
The irritability and querulousness of the profession are 
proverbial and most lamentable. At all times and in all 
places has it been rent by discord, and divided into parties, 
sects, and schools. Let half a dozen medical men be re- 
quired to give their professional opinions to the public, and 
they certainly disagree about their facts, and almost as cer- 
tainly fall to calling each other hard names. But assertions, 
contradictions, and criminations, however well calculated to 
excite derision and contempt for the parties concerned, do 
nothing towards the elucidation of the truth. The Doctors 
are therefore very properly set aside, and the matter is dis- 
posed of as common sense seems to dictate. That my pic- 
ture is not overcharged, every one conversant with medical 
history knows, and those who wish for further information, 
that I may not come too near home for examples, are refer- 
red to the discussions which took place in England on 
the quarantine laws, and the testimony in what is called the 
Gardner peerage case. 
Now this irritability of the profession proceeds in a very 
great degree, if not exclusively, from the vacillating and du- 
bious state of its principles. Accordingly among those who 
cultivate the exact sciences, little or nothing of the kind is 
observable. Among them the certainty which attends every 
step produces calmness and equanimity, or should a diffe- 
rence of opinion arise, it is settled at once without difficulty 
or animosity by an appeal to data universally admitted to be J. A. Smith on Medical Philosophy. 
181 
true. In medicine all this is reversed. Nothing being de- 
termined or fixed, every one is at liberty to construct a sys- 
tem according to his own fancy ; and as no employment is 
more delectable to minds of a certain, and by no means un- 
common description than castle-butiding in all its varieties, 
these aerial structures of course abound.* Unfortunately, 
however, exclusiveness is the very essence of such schemes, 
and projectors, like other potentates, " can bear no rival near 
the throne." Contests and collisions therefore between the 
parties are unavoidable; and all being equally ready for de- 
fence or attack,and alike unprovided with authenticated facts to 
support themselves or confute their opponents, they are com- 
pelled to dismiss reason and logic, and then of course have 
to rely upon the poor weapons which petulance and passion 
can supply. The consequences may be readily imagined, 
and have indeed already been detailed. Let us endeavour 
then to correct our philosophy, that our manners as well as 
our minds may be benefited by the reformation. 
I have thus, gentlemen, laid before you the deplorable ef- 
fects of this rash spirit of generalization which has so greatly 
infested the profession, and which with its consequences, con- 
stitutes the true and only opprobrium medicorum.f But be- 
* These day-dreams, while they tickle most agreeably the imagination, 
constitute no tax upon the mind in the way of labour or thought. Were 
they only as harmless to others as they are pleasant to the individual, the 
philosopher would smile, but never think of awakening the dreamer. 
f Notwithstanding the blot mentioned in the text, the medical escut- 
cheon is one of which any member of the profession may justly be proud. 
Engaged in the discovery of truth, and in its application to the relief of 
human suffering, constantly associated with females who constitute much 
the better portion of the community, and who are then in the situation best 
calculated for the display and exercise of their virtues, the intellect and 
the feelings of the physician are equally exposed to the most benign influ- 
ences. And hence, I presume, it has happened that of those who mingle 
much with the world, a species of contact extremely apt to leave a soil be- 
hind it, the best moral exemplars whom I have ever seen have been me- 
dical men. 182 
J. A. Smith on Medical Philosophy. 
fore I take my leave of this part of my subject, there are 
two remarks which I have to make. In the first place I 
must caution you against supposing that I wish to condemn 
in the gross the eminent men whose names I have had occa- 
sion to mention. So tar from this. I willingly acknowledge 
that they were endowed with great talents, and I further con- 
cede, that they were the authors of much good. But with 
this good was mingled no small portion of evil; and it is to 
guard you against the one, while you take advantage of the 
other that I now address you. 
My second observation is this. The opinions which I have 
now expressed are by no means the hasty conceptions of the 
moment, dressed up for the occasion. On the contrary, they 
were my settled convictions long before I could trace and 
methodisethem as I have now done. They arose, indeed, while 
1 was yet a student; and as facts,which produced so deep and 
permanent an impression upon me, may not be without their 
influence upon you, I will state the occurrences to which I 
allude. 
When I began the study of medicine, the doctrines of Dr. 
Rush were all the fashion, and like other young men, 1 im- 
bibed them fully. Thus impressed I went to London, and 
walking through the wards of St. Thomas' Hospital not long 
after my arrival, I saw a patient with a full bounding pulse in 
a high state of erysipelatous inflammation. Here then was 
a case requiring, according to my theory, copious blood-let- 
ting and other depletions. Yet when I asked the nurse what 
the man was taking, " Bark," was the reply : Bark, said I, 
and how often ? " Every three hours." And in what form ? 
" Powder, tincture, and infusion, the mode in which we use 
it." You may easily imagine my astonishment. In forty- 
eight hours I observed to myself, this poor man will be dead. 
Next day 1 stopped to see how he was, found to my astonish- 
ment that his pulse had subsided under the use of these sti- 
mulants, and that he was better. In a few days he was dis- 
charged cured. Fact and hypothesis, you thus perceive, were 
brought fairly to issue, and with a sigh I have no doubt, al though I 
do not now' recollect it, the latter was obliged to yield. Had the J. A. Smith on Medical Philosophy. 
183 
bantling been my own, instead of having been adopted, the 
result might have been different. As it was, however, I aban- 
doned my much cherished notions. But I soon found that I 
was not alone in error-the medical officers of the institution 
pushing their doctrine as far into one extreme as I had gone 
in the other. A man broke his leg, and was attacked in con- 
sequence with erysipelas : they gave him bark, and in two 
days he was a corpse. 
Conversing on this subject a few years ago with the most emi- 
nent member of the profession in our country, I stated the cir- 
cumstances which I have just mentioned. " Why," said he, 
" something of the same kind occurred to myself while a stu- 
dent. Going w'arm from my books with my head filled with 
Cullen's fine description of a paroxysm of fever, I found a 
man labouring under a severe attack of it. ' So, my friend,' 
said I to him, ' you first began to feel sluggish, then cold, and 
so on.' ' No indeed,' replied the man, ' I felt no such thing. 
Iwas never better in my life, when all at once I began to burn, 
and have been as hot as fire ever since.' I was," he con- 
tinued, " as much disconcerted as yourself, and became im- 
mediately aware that all was not right." That all is not 
right is certain, and it only remains to render that so which 
has heretofore been wrong. But on this point I shall be ex- 
ceedingly brief, as nothing could be more absurd than an at- 
tempt to point out new modes of arriving at truth. They are 
already sufficiently well known ; the difficulty being here, as 
in cases of more importance, not to see, but to follow the 
straight and narrow path. 
Facts, as I have before stated, are the basis of all philoso- 
phy; and to ascertain these, is of course the first great object. 
Now there* are four methods by which this can be done-ob- 
servation, experiment, calculation, and deduction. Of these, 
calculation is excluded from medicine: we must content our- 
selves, therefore, with the other three. Of these, the first and 
second are by far the most important. But experiments, from 
the peculiar circumstances of the profession, should be at- 
tempted with more reserve and caution than I fear are fre- 
quently practised. In hydrophobia, tetanus, hydrocephalus, 
and other equally intractable disorders, the administration of 184 
J. A. Smith on Medical Philosophy. 
novel and hazardous remedies, provided they hold out a 
glimpse of hope, is both justifiable and commendable. But 
as a disease becomes controllable, whether we consider the 
time in which it can be cured or the ease and certainty with 
which this can be effected, we are to abstain from tampering 
with the life or comfort of a patient. 
With regard to inferring conclusions, whether general or 
particular, if what I have said do not teach you prudence 
and circumspection, it were useless to add any thing further. 
Let me remind you, however, that the reverse of error does 
not constitute truth. The golden rule of Aristotle, and a 
most golden one it is, enjoins upon us that virtue is equally 
removed from all extremes. Do not, therefore, in your 
anxiety to avoid vain and pernicious speculations, become 
downright empirics-a mistake infinitely less dangerous no 
doubt and unfrequent than the other, but still a mistake, and 
therefore to be avoided. I must add, however, that when 
we observe the manner in which medical investigations have 
been conducted, and the evils which have thence ensued to the 
profession and the public, a little extra horror of hypothetical 
reasoning is, in my opinion, by no means to be censured. 
Reasoning of this description, be it remembered, even when 
well founded, and according to Dr. Fordyce it is in every 
case a million to one that it is false,* is by no means indis- 
pensable to the melioration of the hfealing art. He who 
should discover a remedy for tubercular consumption, would 
be quite as great a benefactor to humanity as he who should 
generalize, with success, the phenomena of fever. Simplifi- 
cation is doubtless desirable, but extension is more so, and 
these two improvements by no means and of necessity go on 
pari passu. In astronomy, indeed, this has been remarkably 
the case. For supposing the heavenly bodies once put into 
motion, every thing can be traced to the single fact of 
mutual attraction. But this is a peculiarity in the sublimest of 
the physical sciences, and admits of no parallel. In che- 
mistry, on the other hand,the most progressive of philosophi- 
* He argued thus. On every subject a million of hypotheses may be 
formed-therefore, it is a million to one against any one hypothesis. J. A. Smith on Medical Philosophy. 
185 
cal pursuits, the reverse has been the fact-the complexity of 
the science having increased in a full ratio with its utility 
and importance. The ancients were contented with four ele- 
ments. These have been discarded altogether, and in place 
of them we have now fifty, and may hereafter have fifty more. 
Now a living body may be esteemed a chemical apparatus, 
exceedingly curious and complicated, and possessed, more- 
over, of a power to which in mere chemistry there is nothing 
analogous. Common sense, therefore, seems to me to teach 
us, that the operations of such a machine must be proportion- 
ally involved, and that consequently, any violent simplification 
of them is necessarily false. 
What can be alleged then under this head, may be sum- 
med up in a single sentence. It is our business " to observe 
well, to observe long, and to observe all;" to experiment when 
allowable with care and accuracy, and from facts thus ascer- 
tained, deduce the principles which they warrant. 
I have thus I hope, gentlemen, satisfied you of the truth of 
the propositions which I undertook to establish, " that our 
philosophy is wrong, and that it requires to be corrected." 
And I hope you are further convinced, that all attempts at 
extensive generalizations in medicine are premature, and at 
this time injurious, and consequently, that for the present at 
least, we must content ourselves with the third mode of phi- 
losophizing which I have mentioned. In other words, that it 
is for us to detect the special causes of disease and to control 
them and their effects, so far as it may be in our power. 
And as to the general laws which regulate the operations of 
the human system, whether morbid or healthy, since no intel- 
lect on earth can now detect them, they are to be reserved for 
one of those superior geniuses, who, born at a lucky moment, 
are destined to shed light and lustre upon the world. 
Such, gentlemen, are the conclusions to which we have ar- 
rived, and on which I wish your minds finally to rest. But 
clear as I trust our results are in the abstract, how far they are 
likely to be adopted in practice, is a question which I almost 
fear to ask myself. Our very nature is against them. Useless 
silly conjectures, therefore, and vain aspirations after splendid 
theories, although they degrade the profession, and what is 186 
Beck on the Lunatic Asylums 
immeasurably worse, although they sacrifice our patients at 
the altar of our follies, are still too deeply rooted in our dis- 
positions to be readily abandoned. For thus it ever is with 
the sons of Adam. Prone to evil and averse to improvement, 
the effort to reform them is of all human undertakings the 
most forlorn. With the old and the bigoted, the task is ab- 
solutely hopeless. But with you, whose minds have yet re- 
received no particular taint, and whose only object is advance- 
ment in the cause in which you are engaged, the prospect is 
better. Upon you some effect may be produced, and from 
you, consequently, my colleagues and myself may derive the 
highest reward which teachers of medicine can ever attain- 
that their pupils at the close of a long and successful profes- 
sional career, should look back with pride and satisfaction 
upon THE LESSONS WHICH THEY IMBIBED FROM THE PRECEP- 
TORS OF THEIR YOUTH.