MEDICINE AS A SCIENCE AND AN ART-ITS PHILOSOPHY, IN- FLUENCES, PURPOSES AND RESULTS, ITS PAST AND PRE- SENT CONDITION AND FUTURE PROSPECTS. ' BEING AN ADDRESS BEFORE THE MEDICAL SOCIETY OF THE w DISTRICT OF COLUMBIA, DELIVERED BY APPOINTMENT ] AT THE HALL OF THE SWTHSOMAN xNSTOTnON, January, 1852, By GRAFTON TYLER, M. D„ PROFESSOR OF PATHOLOGY AND PRACTICE OF MEDICINE AND OF CLINICAL MEDICINE IN THE NATIONAL MEDICAL COLLEGE, WASHINGTON- MEMBER, &C. Non sibi, sed omnibus. WASHINGTON: PRINTED AND PUBLISHED BY R. A. WATERS. 1852. PUBLISHED BY REQUEST- ADDRESS. MR. PRESIDENT AND GENTLEMEN: In imposing upon me the duty of addressing you, an honor is conferred, the highest within the gift of those whose good will I esteem above that of every other class of men. A responsibility is also placed upon me which excites a diffidence I desire not to conceal. But I cannot now contemplate the fearful delicacy of my position, lest, by absorbing every fa- culty of my soul, it thwart the honorable purpose to which your generous confidence has invited me. As the orators of antiquity were accustomed to supplicate the gods before addressing their fellow countrymen upon interests most dear and vital to them, lest they prove unworthy to be heard or fail to promote the good they desire, so the mind, in- stinctively recoiling before the vastness of the theme presented to me, is encouraged only by a reliance on Him who has brought our frail barques, after another year's voyage upon the stream of life, to- gether again to-day in-safety. Gentlemen, I tremble, yet I rejoice to meet you; it gladdens my heart to know, that amidst the dangers of the way, the whirlpool, the shoals and quicksands, the tempest and the thunderbolt, we have not made shipwreck of a all that sparkles in the eye of hope or pants in the bosom of ambition." Let this be a moment of ac- 4 knowledgment of providential care, and in our daily purposes hereafter, let us not forget that our barques are still afloat upon an ocean whose winds cease not to blow under the control of Him who commands our destiny. At the last annual meeting of this society it was resolved to appoint an orator each year, who should deliver an address upon such subjects as might suit his choice and the occasion. This movement has resulted, no doubt, from our increasing numbers ma- king it incumbent on us, not only to be faithful indi- vidually, as members of our honored profession, but also to act collectively and to organize more efficiently in the discharge of the duties devolving upon us. The humblest among you, gentlemen, has by your suffrages been selected first to this office, and I have thought it fit and proper to endeavor to entertain you with considerations upon medicine as a science and as a practical art-comprehending something of its past history, present condition, and future pros- pects. In traversing such a field of research, as the intellectual vision strikes over the grand panorama, objects of rapturous interest, beauty of arrangement, order, adaptation, utility, unceasing novelty and end- less variety, excite ideas of wonder and amazement which confound utterance, and even though thoughts burn eloquently on the lips, they are as unequal to reflect the scene as " With taper light " To seek the beauteous eye of Heaven to garnish." I fear, that to all who may behold this world of ob- 5 jects through the feeble illuminations of your orator Tis a day- ''Just such a day as when the sun is hid.'1 Gentlemen, the locality of this society is a rare one. The sun which rose this morning, will shed its rays in its diurnal round upon no portion of our globe where is presented a more faithful exhibit of this great age of improvement. Here is centered a government such as history tells not of. The republics of old compare not with it for practical good. Its gran- deur, its power, its efficiency, claim and command the admiration of the world. The noble river which washes the base of our capi- tol, flows gently but resistlessly, till it mingles with the waters of the ocean, thence is exhaled the va- pory clouds, which, borne upon the winds, descend in dew drops and showers to freshen and vivify the earth. Thus its waters having served our uses assist to nourish and support other nations. Not surer does that mighty river thus reach other men and other climes, than does the moral power of this people, through the government concentrated here. Here is a mighty stream laden with the hopes of mankind. From every quarter of these United States its tribu- taries come, commingling they roll with swelling current to the mighty sea, whose waves lash the shores of every country, and from whose surface arise the vapory clouds on which sits already the bow of promise to a hoping world. Let the sun of science shed its rays to brighten the colors of that arch, so that the vapor whose dew drops fall to cher- ish everywhere the budding tree of liberty shall bear 6 in its beautiful adornment the sign and seal of the ever brightening and enduring light of knowledge. I have said our locality is a rare one. Here sci- ence and art are rearing durable monuments of this progressive age, and every where is seen and felt and heard the influences of the master minds these monu- ments are to perpetuate as actors at the capitol of this great nation ; and the majestic mountains that pour out the waters of our Potomac are fit emblems in duration and stability of the mighty power here which is pouring its vast influences over the intellec- tual world. In consideration of this locality our professional responsibilities increase. We are connected with the highest glory of our republic and the most exalted interests of our race. Man cannot act wisely unless he feels a just estimate of the business of his life. It is proper then on this occasion, that these things should come up to our view, that our profession may be exalted or humbled as it may be equal or other- wise to the standard and requirements of the age. I am proud to declare it needs no special advocacy. As intellectual effort has improved the condition of man in all things else, in government, social and do- mestic relations, in politics, morality and religion, the science we profess has occupied no humble place and exercised no small proportion in the great work of progress. We are too apt, in the busy exercise of every day duties, to forget how intimately and largely medicine is now, and always has been, asso- ciated with the progress not only of individual but also of social comfort and national greatness and hap- piness. Tending in its study and practice to call forth 7 the fullest exercise of all the best and most useful qualities of the mind, it stands pre-eminent among the pursuits which have contributed to elevate man to his present state; and as its great object is not only to prolong life, but preserve in its fullest vigor, man's mental and physical capabilities, it is associated with all the discoveries of every age, and plants the stan- dard of its power wherever man has attained the highest destiny of his race. The province of medicine extends from imme- diate attendance on the sick for the alleviation and removal of individual suffering, to an important par- ticipation in promoting the general health and hap- piness, social and political, of the community at large; and this sphere is limited to no city or province, but compasses the whole world. The purposes of our profession, are not the least important of those which operate near the central power of a great nation which is governed upon the principle of the greatest good to the greatest number. In the administration of every department of the civil government, her aid is no less necessary than in the military, where her power was so supremely exercised even in the days of the great poet of Greece as to become of classic renown in immortal verse ; at the siege of Troy, the wounded Physician is among his country's first in- terests ; at the command of Idomeneus, he is guarded with care and supported in safety to her fleets. Ascend thy chariot, haste with speed away, And great Machaon to the ships convey. A wise physician skilled our wounds to heal, Is more than armies to the public weal." Thus writes the master of the Grecian epic, and 8 wherever this tribute is read in all subsequent time, the public defence at home and military enterprize abroad, acknowledge and confirm its truth. From the recruiting service to the catastrophe of the battle field, medicine is a necessary and efficient aid. The memoiis of military medicine show that more armies have fallen by disease than by the sword. How is government then to be secure in its enterprises or confident in its measures of defence, except through a proper system of hygiene and a sure reliance upon our profession for both prophylactic and curative agents and their means of application. This consid- eration might be illustrated with many facts con- nected with military medicine which would greatly enhance its necessity and usefulness. Not in con- nection with military establishments and operations only, but in all legislation in any way appertaining to the public health, government asks information in re- gard to the causes of disease and also the most neces- sary and expedient preventive or curative measures. Hence her practice of supporting medical bureaus for special governmental purposes-some of whose members honor their country and adorn their pro- fession. We are proud to have such names upon the roll of our society. A nation's wealth and all the benefits which com- merce gives, owe us an unending tribute. Marine hospitals, lazarettos and quarantine regulations, must ever command the attention of the most enlightened legislation. And just at this period of international commingling, and particularly to our government, offering as it does, a refuge and a home to the op- 9 pressed and starving millions of the earth. Who can estimate the value of that experience, which alone can guide their deliberations to practical re- sults of wisdom and security ? Methinks I see commerce, with its diffusive influ- ences, stationary and perishing, while medicine pleads her interests in the Senate house. She tells of con- flicts amidst the lurid atmosphere of pestilence ; she presents her experience, bought with the price of her philanthropic sons. Thus securing an audience which it is her right to command, she pleads the cause of humanity; she points to the comfort and security and usefulness of all voyagers jeoparded; to the man of science arrested in his tour of observation; to the pub- lic spirited merchant defeated in his calculations; to the philanthropist every where turned from his be- nevolent work. Senates listen and are wise, so that science, literature and art, mercantile enterprise, even the progress of civilization and the extension of Chris- tianity, all! all! are estimates of the great interests of the world resting upon the knowledge of the medi- cal philosopher. Government, too, is to be enlightened upon the uni- form and diversified effects of climate and soil upon the human economy and the no less important effects of the habits, occupations and diet of a people, to- gether with subtle subsidiary agencies which give efficiency to causes of disease that otherwise would be inoperative. The physical condition of a country is even more susceptible of improvement for sanatary purposes than for the enterprises of commerce. And I would here 10 suggest, that there are' two departments of research which especially demand the attention of the medi- cal mind of the United States. These are, medical topography and meteorology. The relative salubrity of every city and county of any magnitude should be investigated in connection with its physical as- pects and meteorological influences. The application of meteorological science to the explanation of the operations of climate upon the healthy and diseased condition in conjunction with vegetable and animal geography, can alone unfold to us the causes of the geographical limits, and the spe- cial endemial character of certain diseases. Were all the meteorological and celestial influences thoroughly understood, and the natural and complicated attraction of the whole material universe fully appreciated, we should be better able to comprehend the nature of pestilential and epidemic diseases. This subject seems to grow in interest with the profession, and will, I trust, more and more engage the exercise of its most gifted intellect.* Government looks, too, to medicine in the impor- tant department of the administration of justice. Moral accountability is to be judged of only by the enlightened medical mind. Under this judgment, the • I commend to general perusal, a Report to the Louisiana- Slate Medical Society, on the Meteorology, &c., of the State of Louisiana, by E. A. Barton, A. M , M. D., New Orleans, 1851'. Also Observations on Planetary and Celestial Influences in the production of Epidemics, &c., by John O. Bowron, M. D.r New York, 1850. 11 guilty may escape punishment or the innocent be consigned to ignominy or death. Courts and juries await instruction, and the law is inoperative, till science directs its application. Always humane in her purposes, she not only de- termines the guilt or innocence, but also regulates the reformation of criminals. The principals of public hygiene to which we have alluded acquire a more important and grander aspect when we reflect, that in allaying physical, it also ar- rests moral evils. Experience teaches, that poverty and pestilence are accompanied with intellectual degradation and hopeless moral abasement. The practitioner of medicine is, every where, a social re- former, and who, in consideration of this, can doubt that medical science is a mighty moral agent in its application to the social and political economy of the nations of the earth, promoting not only their greatness, but the happiness of their people ? It was the opinion of the illustrious Rush, that physical causes influenced not only morality, but reli- gious principles and opinions, and this accords with enlightened observation. In the social and moral condition of all civilized communities, our profession is as diffusive in its in- fluences as the atmosphere, and quite as essential to the present state of man as the air he breathes is to his vitality. Those who enjoy this universal good may, at first, be startled at my statement, but it only requires a moment's thought in regard to the source from which so many of their necessities are supplied, to satisfy them of its truth. 12 Important results of medical research, embracing much scientific knowledge, have so interpenetra- ted the social condition of the masses, that much prophylactic and practical information is in daily use- ful application without the personal assistance of the physician or a thought in regard to its authors. Did men consider well these facts, a more proper estimate would be formed of the utility of medicine in all the varied channels through which it operates. The industry of our profession securing greater numbers of enlightened practitioners leads, at this day, to a lower estimate of individual skill. When medical men were thought to possess superhuman knowledge; when their views and opinions were mys- terious sand unintelligible, the masses bowed down in awful and adoring reverence; but since the mantle of pretended superior wisdom has given place to the garb of humility, which always invests the philoso- pher; since the medical mind has risen superior to the tolerance of superstitious veneration and scorned to assume dictatorial and oracular wisdom; since it disdains to be satisfied with present advances and presses forward to new discoveries, giving rise to doubts and controversies, where traditionary igno- rance has rested in indolent satisfaction; the gene- ral mind mistaking this hope of progress for retro- gradation and an abandonment of fixed principles, distrusts and decries the profession ; the multitude having advanced just far enough to take hold of and cherish rejected dogmas, begin to prize their own wisdom and vaunt themselves over what they esteem a contentious and unsettled profession. Aristotle 13 teaches that " those who wish to learn must first know how to doubt, for science is nothing else than a solu- tion of antecedent doubts; but he who knows not of the knot cannot untie it." Does not a constant antagonism of forces existing in the beautiful order of creation, preserve, amidst ceaseless motion, integral stability and repose ? So from jarring elements, from the confluence and con- flict of facts and opinions, truth emerges, and, amidst apparent discord, establishes its dominion. Medicine is distrusted, even derided. Now, so far as popular expectation in times past, and even now, have measured its capabilities, it should be distrusted, it should be derided-an over estimate of its purposes may well bring it into disrepute. Man looks for an antidote to all his physical maladies, he expects worn out organs to be renewed, old age to be rejuve- nised, and life to be indefinitely prolonged. Science recognises no such perversion of the laws of nature, no such impious disregard of the fiat of Him whose minister she is. Ignorant, reckless empiricism, alone vaunts such pretensions, and whether through Para- celsus, with his boasted elixir of life, or Mesmer, promising freedom from pain and the undisturbed possession of ceaseless pleasure, or Hahneman, with his specific application of potential infinitismalism, or Priesnitz or Thompson, with their hot and cold ablu- tions, or Dickson, with his chronothermal vagaries, all! all! belong to the category of those, who have over- leaped the wisdom of experience, gone back to the temple of the ancient Asclepiadae, stolen from it one of its misguiding tablets, and, worshipping the hiero- 14 glyphic inscription, have become apostles of divine re- vealings to enlighten a benighted world. The expectation of the multitude has sometimes been the hope of the more enlightened, to remedy all the physical ills of our race, so that death will only take place at the period which limits human lon- gevity. That this is unphilosophic and vain, is de- monstrated by all observation and experience. Con- genital structural defects, in completeness of function and innate tendency to decay, are too obvious and too frequently observed to permit such a thought. The causes warring against life from without are too nu- merous and varied not to evade human ingenuity, too subtle not to escape the perception of our senses, and too intimately blended with the essential ele- ments of unerring development, of uniform function or even vital operation, not to point the mind to the omniscient fiat, a that man is born to die," and that he never can be certain of more than the sunbeam of the moment. It becomes us then, as philosophers, to surrender to empiricism all such giddy day dreams and enter- tain a consciousness of what is really our province. " Non fingendum aut excogitandum quid natura feret et faciat; sed inveniendum est," is the pre- cept and spirit of our philosophy, the material uni- verse is our workhouse, the immensity of revolving worlds and the relation of atoms, alike, the subjects of our observation. We scorn the appellation of Al- lopathists, which would imply, that we are the mere antagonists of an opposing system or the special ad- vocates and supporters of some mean, narrow, selfish, 15 senseless abstraction. Medicine recognises nothing exclusive. If she is ever arrogant, it is not without meekness, for if there is one glory among her attri- butes brighter than another, it is, that her experience is ever chastened while her spirit is submissive. Her desire is to learn, and, without investigation, to reject the experience of none. She has no systems to uphold or perfect. These are the boast of empiricism. She has no hypotheses to prefer. They belong not to a sound philosophy. She has no prejudices to indulge ; without predelection she is the true votary of science, assuming nothing for herself, but guided by observa- tion and experience, a childlike simplicity, bowed before the majesty of truth in humble docility, is the emblem alike of her humility and her power. The medical philosopher has studied too well the weaknesses of mankind to be disturbed by them. Men are impatient under the restraint of the civil law, im- patient under the sure penalties of the moral law, and discontented with every thing which does not flatter their pride, exalt their self-sufficiency, or promise something never yet attained. It is this spirit which fosters unnatural pretension and encourages self- delusion or knavery. There is also a certain crav- ing for the marvellous which must be fed. The enter- tainment of hypotheses will not suffice, but only the positive conclusions of dogmatism. So in retrospec- tion, we see system after system rise and fall, delusion follow delusion, and each expiring folly breathes its spirit into a successor- *' They in turns appear to make the vulgar stare Till the swollen bubbles burst, and all is air." To eradicate the evil which encourages and begets 16 these impostures, would be to place man far in ad- vance of his present enlightenment. This evil always did and always will exist while three-fourths of civi- lized man have no appreciation of medical science or of professional capacity. The progressive tendency of the present age is destroying reliance on prescrip- tion and authority. Improvements are looked for in all things, and those to whom science is entrusted, should be careful that its foundations are laid deep and broad, that an enlightened scrutiny may be satis- fied. The sciences which relate to inorganic matter, do not interest the whole race as does our science. Every man the subject of disease has crude notions of medicine without any idea of vital phenomena, mor- bid processes, or therapeutics. Hence the whole is mysterious and unintelligible, and the artful seduc- tions of quackery find ready listeners and easy dupes. Nor is this confined to the really ignorant. Many of in- telligence in other things, and of a proper judgment in most of the affairs of life, exercise none in regard to this absurdity. They have observed, that it re- quires years of apprenticeship and daily attention for a long subsequent period, to become a master work- man in any of the mechanic arts, and they seek only such to reconstruct a broken steam engine or any other complicated mechanism. Did the same just principle direct their appreciation of medicine they would avoid fatal error to themselves and rid society of ignorant and indolent pretenders, who, without study or ap- plication, have no difficulty in disposing of questions, which remain without final adjustment among those 17 who, with all the aids of science, have spent long lives in the study of disease. Medicine as a science, and consequently as an art, is far from being perfected. It is in each year be- coming more exact as general science advances. Science is the great aid of art. Certain things, when learned, assist us in doing safely and effectually cer- tain other things. Science, to the physician, is useful only as it aids and promotes practical art; to this end it is indispensable; for, without it, art can advance but little. And, at this stage of scientific progression, it is well to have this fact in our minds. Studied ab- stractly, it conveys no positive good, but becomes rather an evil. Food which does not nourish the body, is useless, and generally hurtful; so science or know- ledge received into the mind without entering into combinations there w'hich transforms it to mental sus- tenance, is dead and worthless, and most destructive of mental vitality and intellectual growth. It must be not only received, but appropriated, adopted, and combined into a sustaining influence, such as the separate and indigestible elements of truth can never give. Isolated facts and speculative truths are brought, by a proper digestion, to a a tertium quid," which, like the chyle to the physical man, is the pa- bulum vitae, supports reason in determining rules of action and useful adaptation in practice. Medicine is to be cultivated in the spirit and pur- poses of a positive science instead of a conjectural art. Looked at superficially, its phenomena appear unstable, irregular, and complex, subject to change from endless accidents. But a close observation of 18 the laws which govern them, will show that they ad- mit of order and connection, and are subject to rules of arrangement and classification. Here masses of phenomena must be brought under observation. When a few only are examined, individual discrepan- cies obscure the existence of positive law, which is easily discerned in the general concordance of a lar- ger number. There is much complication to con- fuse observation and embarrass induction, but the ad- vance of general knowledge at this day, enables infe- rior minds to comprehend what was formerly beyond the understanding of the most gifted. The vastness of the subjects embraced may well demand the efforts of many ages to compass them. The progress of all science shows, that mankind are much more generally endowed with speculative facul- ties than with the capacity for accurate observation. The discovery of new phenomena and their relation- ships, which alone adds to the amount of knowledge, results from intellectual endowments which few pos- sess. In medicine, the great variety and extent of the phenomena to be observed, and their multiform re- lationships, make it difficult rightly to estimate evi- dence. Hence experience is often fallacious. The dissimilarity of the proofs, and the greater difficulty of their certain attainment, must ever keep practical medicine behind that of the other sciences. Cumula- tive observation implies progress and consequently defects. By it, mechanics, astronomy, and natural philosophy have been made sciences, and discoveries have been continually made in the laws of matter. 19 The developments here strike the mind with wonder and admiration. But the intricacies of living matter, who can unravel? This too, must be the work of cumulative observation, and the want of exactness and the existence of errors in medicine, arise from the same causes as elsewhere, with the greater proba- bility of their existence from the greater difficulty of observation. To unravel all the intricacies of living matter would, alone, ensure perfection of skill. A due acquaintance with the physical phenomena of living beings is necessary to the practitioner who aims at the skill- ful application of the therapeutic art. As a physiolo- gist, he must, in the application of physics to unravel- ing the bodily motions, recognise and profoundly re- spect the higher laws of life. These laws or motions are the positive agents of cure. These are the life- giving and life-continuing forces, and all other means are, through them, the instruments of good. This curative quality is only the operation of nature's laws; something of like influence governs the universal creation. It preserves the integrity of the physical world, and, however much it may be and is the pro- vince of the philosopher to contemplate and endeav- or to trace out the series of phenomena by which results are arrived at, there is no probability that he can ever fathom all its mysteries, but must refer its immutable truth to the omniscient fiat. There is to be observed in the living body three classes of phenomena. The purely physical; the vital, altogether distinct from physics; and those in which physical laws, under the peculiar condition of a living organism, effect results essential to its con- 20 tinuance. A knowledge of physics, then, is essential to a consideration of the phenomena of living beings, and physics and chemistry are essentially productive of those processes over which the practitioner would desire to exert an influence. This combination of phenomena must forever prevent the formation of a system of medical philosophy, so complete, defi- nite, and universal in its relations, as exists in regard to mere material substance. And as a knowledge of physics is pre-existent to a consideration of vital phenomena and the results of a combination of these, it follows, distinctly, why practical medicine, based upon such knowledge, must follow in progress. When we consider the difficulty of understanding living motions, their nature and effects, we have no cause for humiliation in our approach to the exact sciences in improvement. We have not found out the secret springs of life, but we have discovered many of its modifying influences, and when we find our research unsatisfactory, we have not left the field of legitimate observation for the delusions of hypothe- sis and the blindness of superstition, but have looked from the feebleness of our own minds to that source from which all science comes to us, and by which many things are hidden from intellects so feeble. God has strewed the seeds of knowledge around us, and he has given us capacities for research and intelligences to make research profitable. But many things are reserved to his own wisdom. The human mind cannot comprehend its own essence. The pe- culiar field of enquiry is the physical world, where alone exactness is to be obtained. Though there are limits to human research, we 21 are, as yet, so far from those limits, that we have no reason to presume that, even in the future, man can ever assign their bounds. Though present attainments are so far in advance of former periods, coming genera- tions will, in all probability, be equally as much in ad- vance of us, and still leave the unexplored to exercise the ingenuity of those who may come after them. " The intellectual hero will never need to sit down and weep because he has conquered the world of science and exhausted the fields of discovery." From the conclusions at which we have arrived, it does not detract from the dignity of our profession, that it has not been perfected to a degree to relieve all the ills that physical man is heir to. The time will come, I doubt not, when it will equal the highest wishes of a rational being. The laws of nature are the laws of God, and when medicine is improved to a degree that will alleviate suffering and prolong life to the utmost, in accordance with her laws, it will have attained its highest perfection. Whatever un- certainty attaches to medicine arises from ignorance of the operations of nature to which all her doings are subservient; and as this ignorance is removed, in the same proportion will this imperfection or un- certainty be removed also. There can be no imper- fection in nature, and consequently there can be no imperfection in science, except so far as it implies ig- norance of her laws. The planetary motions were once considered un- certain, irregular, and lawless,but with what wonder- ful precision do they move in the light of modern science. 22 The progress of medicine as a science and as a practical art, is influenced by peculiarities which at- tach to each. They both require the gift and habit of sagacious, diligent, continuous, and honest observa- tion; but it is easier to investigate the one as a science to be taught, than the other as an art to be exercised in practice. The results of the one invention, can be shown to any, who have no knowledge of the means or processes of intellect by which they are discovered; the other can, in most particulars, be sufficiently un- derstood for practical application, only by those who rely upon their native sagacity, exercised in repeated personal trials, till, by successive steps, advance is made to the establishment of a proper and suitable method of practice. The results of the one, are positive, fixed in physics, with laws and doctrines which, once un- derstood, are easily conveyed by language. The other reached only by mental processes, which are forgotten in the eagerness to arrive at the end in view, or, for the most part, only to be learned in the same usage of exercise by all who would be so skilled. Our senses are more instructive to us in discerning things and acquainting us with them, than the lan- guage of others can be who have observed the same. There is a degree of observation which is the isolated wrork of each individual. Language cannot convey its minute impressions upon our minds and memo- ries, though they become quite familiarized to us ; and this constitutes the experience of those who ex- cel in any practical art. No amount of book learn- ing or oral instruction can supply its place ; and hence it is, that those men who have most excelled in prac- 23 practical medicine, possessing a kind of knowledge not possibly communicable to others, have failed to advance those who were taught by them, to that de- gree of practical skill which they found easy of appli- cation. The great fact which Harvey discovered, is readily transmitted to posterity, taught in its entire- ness. This grand discovery is common to all who choose to enter the domain of science, and is fully understood by those who have no knowledge of the successive steps of investigation which led to it. But the invaluable experience of Hippocrates, enriched by the industrious exercise of his senses to the pos- session of gifts seemingly inborn, cannot be explained in its fullness to others. The senses, by cultivation, may acquire a minute- ness and delicacy of exercise, for the observation of things, that gives an appreciation of them beyond the capabilities of intelligent communication; conse- quently the great experiential gifts of men are buried with them, and only acquired by others of peculiar sa- gacity, by personal trial and effort. We find these gifts common to Hippocrates and Sydenham ; but we do not find, that in leaving behind them for imitation their method and their rules, other men can so profitably use the same instruments. Medicine as a healing art is more difficult than as a science of diseases and of drugs. Hence, fsays Sydenham,) "our art is not to be better learned than by its exercise and use, and that it is likely in every case to prove true, that those who have direct- ed their eyes and their minds the most accurately and diligently to the natural phenomena of disease, 24 will excel in eliciting and fulfilling the true indications of cure". While the remote causes of disease must be sought after, they are incomparably less influential and intelligible in a special case than immediate and conjunct causes. There are to be studied compound and opposing forces, acting upon an organism so modified by contingencies, as often to have as much that is different from, as common to, like organic structures. So that a method, with exactness of re- sults, cannot be constructed. Governing principles may be established which are intelligible as founded in reason, and admit of being explained and taught; but their useful application in most cases, must be left to each man's skill, his perception of peculiar signs, symptoms, and contingencies, the fixedness of his at- tention, and the accuracy of his judgment. And here it is suggested, that as there are wider views of prin- ciples, directer, ampler methods of discovery now than at any former time, the office of physician becomes more difficult than before, requiring more compass and energy of mind, more disciplined exercise of the senses, that the number of objects to be considered, now so infinitely increased, may each receive its pro- per and proportionate estimate, so that, amidst the mixture of dangerous and obscure symptoms, where exact rules cannot govern the necessary action, it may be decided by what is, most probably, the true combination constituting a number of the elements of judgment. There is one more consideration which, I think, it is proper should be mentioned on this occasion : The present state of medicine as regards its utility. How 25 does the present compare with former times in this particular ? We have already shown how' medicine is more enlightened, freer from error, less conjectural, and more exact; consequently, we find that its influence upon society, and upon the moral and religious views of mankind, have progressed with the spirit of the present time. Would you require the proofs of its beneficence in the past, a retrospection of more than two thou- sand years in the world's history presents them. Through this long period, from the Hippocratic foun- tain they come as a mighty stream, the healing waters of which have refreshened in every clime the droop- ing spirits of a suffering race; and on every soil where man has trod, are erected monuments that tell her good deeds and perpetuate her blessed memory. Medical science, as I have already said, has interpene- trated the minds of the masses, producing there incal- culable effects. And need we do more in comparing modern with ancient medicine, than to direct atten- tion to the physic of JEsculapius, lauded by Plato the wise in that day, because it offered nothing of hope or help to a valetudinarian, giving him over to cer- tain death, (C and will not soothe and cannot save," failing where it is now most exercised and most needed. And learn there, one lesson of what the true philosophy has accomplished. 'Tis not the philo- sophy of Plato, but the truly divine philosophy, which teaches man his relations both to nature and to God. Well might Hippocrates desire to separate medicine and religion, and have them studied as distinct depart- 26 merits of learning. Ancient philosophical religion and ancient medicine needed separation, because it was necessary to separate facts from hypothesis. Medicine, now intimately connected with natural sci- ence, becomes the handmaid of Christianity. Phi- losophy and a false religion had no connecting link. But the philosophy which assists the mind in a know- ledge of the wisdom and goodness of God, which dispels superstition, and lays deep and broad the foun- dation of natural religion, is linked too with the Chris- tian's faith. Its experience limits the mind's capabili- ties, shows its want of comprehensiveness for what the soul craves, teaches its necessities, from which spring burning thoughts of immortality, of Heaven, a ready acceptance of revealed truth, and a hopeful confiding faith, strengthened by the daily revelation of physical truths by God to man. Who does not see that science must have a large share in bringing about human progress towards that period when Christianity will be vindicated by that second advent which is the hope of all christendom ? And as the medical philosopher offers up the daily prayer, "Thy kingdom come, thy will be done on earth as it is in heaven," he feels, that in revealing to the minds of men through the illuminations of science, the more perfect wisdom and goodness of God, he is, by God's help, bringing to pass its blessed fulfillment. In Ecclesiastes it is said, that " God created physic and the physician, and that 'tis He that giveth science to man, and that 'tis He that healeth man." This is all true in our philosophy, but not in the sense that the ancient pagans held their Gods to be its authors. 27 <c Deorum immortalium inventioni consecrata est ars medica," says Cicero. With them, disease being alto- gether incomprehensible, was readily supposed to be of supernatural agency, and considered the infliction of an offended deity, from whom the prevention and cure were alone to be obtained. But in the sense of our philosophy, how beautifully does the fact of God's giving physic to man, present the arrangement and beneficence of his providence; that with physical in- firmities and disease, he has placed within his reach and at his disposal, medicaments for their relief, and endowed him with the capacity for observation, which his necessities stimulate him to exercise, thus investigating the uses of things and their adaptation to his comfort and requirements; and this, too, not with any prejudice or evil to himself, but in accordance with a principle of his nature, both physical and intel- lectual, which requires that his capacities be exercised for their development and support. It is in this sense, that modern science teaches that God made physic and physicians. How plainly does this reject all hypothe- sis, dispel all superstition, and invite to the study of nature. And it is worthy of remark, that the divine writings mention no superstitious means of cure, but the instruments of nature are resorted to even under the direction of God himself. When he who had touched Isaiah's hallowed lips with fire would have him raise King Hezekiah from a bed of sickness, he tells him not, with sweet melo- dy, to enchant his weary spirit, but orders physical appliances for his restoration. And when he would enlighten the mind of Solomon, it was not illumined 28 with mysterious and unfathomable thoughts, but the beauty and order of natural phenomena were reveal- ed to inspire his genius, for we are told, that he knew from the cedar of Lebanon to the hyssop that grew upon the wall. The science of medicine is a necessary means to an important end ; its ultimate aim is practical good; its grand prerogative, to cure disease and to alleviate human suffering in all its varieties and degrees. Let us recur again to the comparison of its present with its past condition, in answer to the question not unfrequently asked, whether physicians cure more diseases than they used to do, and whether this prac- tical result is now progressing among us ? I shall not attempt fully to answer this question, that is, to answer it by a recital of all the improvements of this day, but will notice only the most prominent, which are altogether sufficient for our pupose. As the physical sciences have advanced wfith such wonderful rapidity, it is true, (as we might infer,) that every department of medicine has been enriched with discoveries. Even in anatomy, a new field of investigation has been explored and microscopic re- searches are a part of the daily teachings of the schools. Organic chemistry has also assumed an importance unknown at the beginning of this century. Every department, too, of practical medicine, is so much improved, that we look back with w'onder at the practice of our predecessors without the advantages we possess. The treatment of febrile diseases, gener- ally, has been prominent in this change. Their patho- logy has been so much more fully developed, that the 29 Isedentia and juvantia are much more readily chosen. The malarious fevers have been so put under the con- trol of a powerful therapeutic antagonism as to be al- most stricken out from the catalogue of fearful diseases. Within my own experience, cases of autumnal fever, which lasted for weeks, are now arrested in as many days, under the proper use of antiperiodics. In the materia medica, not only the uses of medicines which have long been known, are more properly understood, but additions have been made whose importance seems to render them indispensable. What practi- tioner at this day, could be satisfied without the pre- parations of iodine, not to mention other important additions? Diseases, too, have been more thoroughly investigated, their nature more fully understood, and the adaptation of therapeutic agents rendered easier and more effective. When symptomatology alone was studied by the physician, and through this, his diagnosis was formed, his knowledge was much less exact than with the aid which morbid anatomy efieets. The phenomena which constitute disease in the aggregate being examined, through morbid anatomy, the physical condition giving rise to these phenomena is ascertained ; one such observation is compared with many others, and from their aggregate results, a knowledge of the nature of disease is ob- tained. Next, similar processes of observation and induction are made' in other departments of our science, and the result of all is combined in the sum of our estimate of the indication and means of cure. A drug is exhibited or a remedy applied; the effects produced are noted. This is practiced both on the 30 healthy and diseased subject, and by comparing one observation with many others, the effect of the re- medy in health and disease is ascertained. In this way, by numberless experiments in succeeding ages, the investigation of disease has been progressing, and at the same time and by a like process, their means of cure have been discovered. There are some diseases which still baffle the skill of the profession, but who can doubt, that an intelligence which has discovered the application of antiperiodics to the neuropathic element of fever, may also achieve a vic- tory over the deadliness of hydrophobia and tetanus. In this latter disease, art is already often successful. In tuberculosis, much has certainly been discovered, and though the fatality of this disease is still an op- probrium to science, the more accurate diagnosis fur- nished by physical exploration and a more thorough knowledge of its exciting causes, have led to pro- phylactic and regimenal means, which seem to con- stitute the more necessary part of its management. The diseases of infants have been more fully explored. The study of specialities have greatly eludicated the peculiar diseases of particular organs, and vital statis- tics show that the mean longevity of man has con- siderably increased. Were all the sanative and pro- phylactic measures put in practice, and scientific medi- cine more generally and timely sought, who does not see that this would be still more prolonged ? How many in infancy die from accident, or neglect, or im- proper management ? How many poor perish for the want of proper aid? How many, even intelligent and opulent adults, sink to a premature grave from 31 the use of patent nostrums and a disregard of those rules which scientific medicine recognises as essen- tially requisite to their condition. Such are some of the evidences of the improved and improving state of medicine. But it does not stop here. Who has not heard of the far famed Letheon ? Surgery, the great boon to sufferers, so venerated by man for its health-giving influences, as- to cause him to submit to the torture of the knife, and the infliction of the severest agony of pain, rather than lose its benefits, now presents inviting pleasures and sweet dreams of bliss, where groaning and wailing from manly bosoms attested the agony of its endur- ance. Within the experience of even the youngest amongst us, has Heaven sent this blessing. On the wings of the wind and by lightening speed, it has traversed already the four quarters of the earth. The soldier upon the battle field, has bared his breast to the enemy's bayonet, and uplifted his country's standard, dyed with the blood of his many wounds. But, when the battle is over, and the friendly surgeon tells of the only hope to life from wounds he would inflict in kindness, an instinctive dread causes him to shrink and shudder. But now, even the tenderly nurtured and timid maiden, the victim of some grie- vous malady, who courted death through fear of suf fering, invites the welcome knife which extirpates the seeds of disease, while her mind wanders in elysean fields, where, in wrapt joy, she dreams of health, long life, the sweet communion of anxious friends, and awakens, only to thank heaven, that what seemed too joyous to be true, was, indeed, only the passage from 32 hopeless misery to comfort and security, from death to life, through the painless operations of surgery. Who is there among us that has not witnessed such a scene, the triumph of modern art? Were there no other experience, the history of anesthetic agents in this city alone, is sufficient to establish this estimate of their value. Not only do they relieve the patient of suffering, but they also lessen the danger; thus en- larging the field of surgery by rendering operations practicable, which, otherwise, could not be safely attempted. Nor is the benefit alone to the patient. The surgeon is not under the necessity of that haste which had become an important feature in modern practice ; he has not to contend with the writhings of his patient; and, therefore, his more steady hand enables him to effect more exactly and skilfully his purposes. When we consider this great discovery, and others which have appeared in our time, and then look back half a century, and see what the observation of a single individual accomplished for the good of man- kind in the present and all coming generations- when we see the dreadful ravages of smallpox ar- rested by means so simple and easy of application, what may we not expect in the future ? How it gladdens the hearts of us all to know, that we have been instrumental in saving from death even a single fellow being ! But when millions are ran- somed-arrows poisoned and death-bringing, in number beyond computation falling harmless at the feet of heretofore helpless victims-old age encour- aged for a few more years-middle age saved from 33 its loathsome doom-youth and beauty and helpless infancy rescued from a disease which, when it spares the life of its victim, disfigures him with the indelible marks of its malignity. I see domestic ties weakened, families scattered from their homes, in vain seeking shelter elsewhere- every man dreading his neighbor as a pestilence- society disrupted-government palsied and unequal to their purposes-commerce destroyed-all the ele- ments of civil progress broken up, and the vials of Heaven's wrath poured with relentless fury over a distracted people. Prevention is defied--skill is baffled ; but science ever hopes, and her true votaries neither sicken at defeat, nor forget the pathway of discovery. In the midst of so much to unsettle the purposes of man, strike down his efforts and stifle his energies, an humble student of medicine, by observation, enquiry, and reflection, evolved the im- portant doctrine of vaccination. "With that inductive sagacity which seizes upon the analogies between dissimilar things that are the clues by which the labyrinths of nature's secrets are to be explored, he conceived the idea of introducing the disease of a beast into the human frame, as a means of preventing a worse disease natural to man." * With what success, let the security we enjoy when exposed to this fatal influence, answer. This terror of mankind is so mitigated, as almost to be for- * Discourse on the Baconian philosophy, by Samuel Tyler, Esq. Frederick, Maryland. 34 gotten in its awfulness, when this prophylactic is used. And who can estimate the value of this discovery to the interests of the world ? An effort is now mak- ing to secure contributions from medical men every- where, for the purpose of erecting in London a mon- ument to the memory of its author. Let it rise as an honorable testimony of the gratitude of this age. Rather let all men of all nations contribute to it, but let it not be considered as necessary to preserve his memory. We pronounce this discovery the greatest triumph of science over human woe, and did medicine ever institute comparisons of its beneficence with others, we would ask this acknowledgment of its supremacy, while we give it the homage of our hearts. What ' perpetuate the name of Jenner by earthly monuments-perishable matter ! The sculptured bust, the colossal statue, the towering pyramid, aye, all works of art must perish 1 '' The deep foundations that we lay " Time ploughs them up and not a trace remains." but his greatness dies not amidst the waste of ages. A more lasting monument is already erected to this greatest benefaction the sun ever looked upon. Let our hearts cluster around it. No blood stained ban- ner floats from its summit. No shrieks or wailing echoe from its recesses. No widow's cries or or- phans tears are there. It rests not upon immolated victims. Its base is too broad and solid, to stand upon the collected bones, in all time, of the world's battle 35 fields. 'Tis not reared in triumph over the dead. The whole living human heart sustains it. Towering over all things thought of for temporal good, there it stands, and there it will stand, till the last lingering grateful spirit wings its flight to Heaven.