PROF. YALERJ’S 
INTRODUCTORY LECTURE 
ON 
CLINICAL MEDICINE. AN 
INTRODUCTION 
TO THE STUDY OF 
CLINICAL MEDICINE; 
AN INTRODUCTORY LECTURE TO THE 
MEDICAL CLASS 
IN THE UNIVERSITY AT ROME, ITALY. 
JBy GAETANO VALERJ, M.D., 
Professor in the Mv&'stty 5 - 
Honorary Member of the Massachusetts Medical Society; 
&c. &c. 
TRANSLATED FROM THE ITALIAN BY THE AUTHOR. 
BOSTON, MASSACHUSETTS: 
DAVID CLAPP & SON. 
18 6 6 PRESS OP THE BOSTON MEDICAL AND SURGICAL JOURNAL: 
DAVID CLAPP AND SON, 
PRINTERS. LECTURE. 
My Dear Young Gentlemen,—Yon are here assembled for the 
very important purpose of examining with the utmost attention the 
manifold infirmities wherewith humanity is afflicted, of determining 
their various natures and degrees of intensity, of tracing them 
through their progress, and prescribing for them their proper reme- 
dies. In other words, you are here present to prosecute the study of 
the clinical department of the medical art, to put in practice the 
varied theoretical knowledge acquired during a course of four years 
in this University, and to learn how to convert it all into an agency 
suited to cure, or to relieve the patient. But if such be the intent 
which has urged you to frequent this School, most difficult, nay im- 
possible, would it be to carry it out without having previously formed 
a distinct idea of the extent of your acquirements, or, to express 
myself more clearly, without knowing most precisely the nature of 
the action of medicine on the patient’s frame, with what intent, and 
within what limits it is lawful for you to exercise it. Ignorant of all 
this, you will be acting with recklessness in a matter so delicate as 
is the health of mankind, acting like an artizan who would pretend 
to excel in his calling without knowing the use or efficacy of the in- 
struments essential to it, or like a pilot who would steer his ship into 
safe harbor unknowing, or making no account of, the force of the 
wind, the primary and indispensable agency in favoring his en. 
terprisc. 4 
PROFESSOR VALERj’S 
In order, then, to understand clearly the sphere of the healing 
action, to determine distinctly the true sense and nature of that prac- 
tical agency which you are to-day invited as so many artificers to 
exercise, let us, if you please, imagine ourselves to have been present 
at the cure of a long and grievous malady, executed with the utmost 
nicety of art, and to have beheld the patient at length completely 
restored to health. Let us, moreover, fancy ourselves, after this 
fortunate issue, to be called as umpires in deciding the following 
controversy, which might have arisen among those who witnessed 
the said recovery: “ To whom is due the honor of the cure? ” Some 
would pretend to attribute it to the highly-skilled physician, others 
to the all-potent vis medicatrix natures. 
Do not consider, young men, as futile the question proposed, nor 
so easy of solution as might appear to some at first sight. On the 
contrary, it is a question of the highest importance, including the 
hinge, the very turning point of the medical art, and daily brought 
forward by physicians themselves, by patients, and by the public. 
To be enabled to judge which of the two agents—nature or the 
physician—operates in the cure of diseases, or, to express myself 
more accurately, in what degree, and with what subordination, each 
of these two causes contributes to this effect, is tantamount to under- 
standing in what true and efficient medicine consists, and becoming 
initiated into the exercise of it through the requisite knowledge of 
the respective value of all the instrumentalities indispensable thereto. 
Who, then, cured the patient ? or rather—to generalize the ques- 
tion, as we have to discuss the argument not as it regards an indivi- 
dual case but the whole circle of infirmities—who cures diseases, Na- 
ture or the Physician ? 
Previous to pronouncing our sentence, according to the correctness 
or the falsity of which, correct or false must be the mode of curing, 
it is requisite first to examine what we should understand by this 
word nature, and in what manner it acts, and afterwards to define the 
scope and limits of medical action in the cure of diseases. 
By the term nature is meant that aggregate of natural causes and INTRODUCTORY LECTURE. 
5 
powers proper to the living man, which, though irrational and void of 
volition or discernment, favor and watch over his conservation in the state 
of health, and his cure in the state oj illness, and all tins with surpris- 
ing regularity. “ Uti solerter sanitatem tuetur, sic optime morbis 
medetur natura,” says Sydenham. u Quotics vero naturam nomino, 
toties causarum naturalium complexum quemdam significari volo; 
qua) quidem causa), brutm licet et omni consilio destituta), non tamcn 
sine summo consilio reguntnr, dum suas qua)quc operationes cdunt 
suosque cffectus exsequuntur.” 
This definition, as you will see, is used entirely in a practical sense; 
that is, conformably with the clinical and experimental view of the 
subject, and from which I do not mean to depart, and which consists 
essentially in admitting that man, upon whom we try our medical 
action, possesses those faculties and powers with which in reality we 
see him endowed, as likewise in being acquainted with the order 
and laws by which they act and move. As the word gravitation 
does not express an hypothesis, but signifies simply this general fact, 
that all bodies tend towards the centre of the earth, without em- 
bracing the question as to whether this depends on attraction, sympa- 
thy, impulsion or other causes ; so the term nature, in the sense we 
have attached to it, will not signify an abstract or hypothetical idea, 
but the existence of the actual powers, which we see acting in the 
vital organism, occasioning its various phenomena, and operating with 
incessant activity and wondrous regularity towards its conservation, 
as well in the physiological as the pathological state,—without regard- 
ing in what their essence consists. If, then, we contemplate with 
astonishment the efficacy of these powers, and the order and mode 
of their action; if the scope to which they unfailingly tend be that 
of man’s welfare both in health and illness, it is all to be attributed 
to the infinite wisdom of the omnipotent Artificer of Creation. “ Ni- 
mirum supremum illud Numcn,” continues Sydenham in the above- 
cited definition, “ cujus vi producta sunt omnia, et a cujus nutu depen- 
dent; infinita sua sapientia sic disponit omnia, ut ad opera destinata 
sc ccrto quodam ordine et incthodo accingant; ncc frustra quicquam 6 
PROFESSOR VALERJ’S 
molita, neque nisi quod optimum est, ac toti rerum fabricm suisquo 
privatis naturis maxime accommodum, exsequcntia.” Not otherwise 
writes Baglivi: “ Naturae nomine non intelligo sapiens quoddam Phan- 
tasma vagans et consilio singula dirigens, sed complexum quendam 
generalem causarum naturalium quae, licet consilio destituantur? 
effectus tamen suos pariunt juxta leges a summo conditore inditas, 
atque ita ordinate ut quasi a summo regis consilio videantur.” 
In order to prove that man receives and retains within him by 
means of his original organization and conformation an aggregate of 
special causes and powers suited to his existence and preservation, 
it will suffice to bestow a rapid glance on the functions which are in- 
cessantly at work within him; for function comprehends action, or 
movement, and movement the cause or force which produces it. 
The fluid blood, so complexly composed as not to be reproduced 
by the most accurate chemical synthesis, although by the process of 
analysis its component parts are well ascertained, impelled from the 
heart, circulates by means of the arteries through every part of the 
body. Containing in itself the anatomical elements of our tissues, 
during its course, and at its contact, not only all the organs absorb 
the materials of their manifold and respective secretions, but even 
every cell, every fibre selects and appropriates to itself the hystologic 
element from which it is formed, just as the beast of the field tastes 
and chooses in the flowery pasture such herbs as most please and 
quicken its appetite; while the molecules, already worn out and ren- 
dered useless to the economy, are secreted and absorbed, and by the 
current of blood are afterwards eliminated through their proper 
emunctories. Now this vital fluid, from having given to each organ 
the materials of so many secretions, from having nourished every 
part of the economy, that is, administered to each the unicuique 
suum, undergoes a diminution of its reparative substances. But re- 
turning through channels quite different from those by which it had 
departed, to the heart, the centre of its motion, it receives the product 
of the alimentary substances, wonderfully elaborated by an appara- 
tus of organs surprising and inimitable in their structure; thence INTRODUCTORY LECTURE. 
7 
passing into the vast superficies of the lungs, almost in contact with 
the atmospheric air, it becomes purified from the noxious gases with 
which it was intermixed during its passage, absorbs others of a 
requisite revivifying nature, and thus becomes, as before, the pabulum 
vita; that is to say, enriched again with all the various substances 
essential for the nutritive functions and manifold secretions, it continues 
its unfailing circulatory motion. In the mean time, as a result of all 
these - processes of composition and decomposition, of assimilation 
and disassimilation, is produced a constant development of caloric, 
by virtue of which the body maintains a temperature proper to it- 
self, and almost invariable, whatever be that of the atmosphere which 
surrounds it. But all this regards only the vegetable existence of 
man; or, in other words, those functions which affect directly, or I 
might say silently, his material preservation. Other functions are in 
activity within him, and of such a nature that, although as requisite as 
the purely vegetative to his existence, they are, notwithstanding, of a 
more elevated order, because distinguishing him from all other created 
beings, rendering him conscious of the vicissitudes enacted within him, 
placing him in close relationship with external objects, constituting 
him, in fine, nothing else than an intelligent, moral being. From the 
necessity under which he stands of receiving and selecting his alimen- 
tary food, he is provided with a locomotive apparatus, by means of 
which he moves wherever he pleases, and thus regulates his relation- 
ship with his kind, and with all surrounding objects; and whereas 
such objects are not indifferent to him, but on the contrary claim a 
necessary and indispensable connection with his being, he is endowed 
with a nervous system, by means of which he feels the different im. 
pressions derived therefrom, distinguishes their several natures, 
brings them near or removes them from him—in a word, subjects or 
withdraws himself from their influence. In truth, this nervous sys- 
tem, arranged in five different forms through the apparatus of five 
external senses, ramifying through every part of the tissues and vis- 
cera, terminating in the great encephalic mass, or rather, if you will, 
originating from it, is the truly marvellous organ of sensibility. By 8 
PROFESSOR YALERJ’S 
means of this, man perceives the various and distinct impressions of 
heat and cold, of sound, color, taste, and smell of different objects, 
experiences a sensation of well-being from the state of health, of in- 
disposition from that of illness; it is by it that the soul within the 
brain exercises its noble intellectual faculties; namely, it feels, thinks, 
reflects, compares, discerns, judges, wills or rejects, determines the 
body to motion or station, &c. &c. Finally, in the enumeration 
of its functions we should not omit that important and mysterious 
one, which is reproduction or generation. Performed by an appara- 
tus of special sexual organs, distinguished into male and female, it is 
the result of a series, more or less complicated, of acts by which the 
individual begets a new being like unto himself, and thus perpetuates 
his kind through the ages. 
Such are the functions of the human vital organism, which I merely 
mention with the sole view of giving you to understand that their 
continual and uninterrupted exercise necessarily proves the actual 
existence and simultaneous action of corresponding powers. But 
though we may all be convinced of this, there are some who might 
maintain that they are nothing beyond the common, or, in other 
words, are nothing more than those powers which at every moment 
we behold acting in the physical world. Now such an opinion would 
be lamentably erroneous, and in order to refute it we deem it requi- 
site to dwell at some length on this subject. 
You are all aware that physiologists, after having attentively ex- 
amined our tissues, and the various systems and organs derived from 
them, and finding them, as they really are, endowed with physico- 
chemical properties (some being, in fact, consistent and tenacious 
7 
others extensile, others elastic, hygrometric, &c. &c.), have therefore 
unanimously directed their studies with laudable and unwearied zeal 
towards explaining every act of the human economy by the powers 
and laws of physics, chemistry and mechanics. Numerous, indeed, 
are the useful results and positive notions with which these studies 
have supplied us for the elucidation of the many phenomena of our 
frame, and it would be foolishness to deny their importance, ignorance INTRODUCTORY LECTURE. 
9 
and serious loss to be unacquainted with their precise meaning. 
Who among you is not aware of the utility, the absolute necessity of 
the laws of optics and acoustics for the explaining of the senses of 
sight and hearing, those of mechanics for demonstrating the pheno- 
mena of locomotion and circulation, the influence that chemical laws 
exercise over digestion, respiration, absorption, secretions, &c. &c. ? 
The respective degree of action that these material forces exercise 
over the acts of our frame is a positive and undeniable fact, and con- 
stitutes a most valuable fund of knowledge, which we find every day 
increasing and becoming more complete; knowledge so necessary 
both to the physiologist and practitioner, and constituting one of the 
fundamental bases of our acquaintance with the human kind, both in 
health and illness. But is this aggregate of knowledge sufficient to 
demonstrate thoroughly any act whatsoever, even the simplest, of the 
vital organism ? No, certainly. Mechanics, with its laws of equili- 
brium and its three descriptions of levers, will never be able to ex- 
plain the sometimes incredible amount of muscular force, and much less 
will the anatomist succeed therein with the description of his succes- 
sive zig-zags and inflections of the muscular fibres. Chemistry, every 
day more and more enriched with accurate analyses of all the fluids 
which circulate within us, will never succeed in re-composing by syn- 
thesis a product equivalent either to blood or to any other humor, much 
less to form a substance that can compare with a bone, a muscle or a 
nerve. Neither with the theory of affinity, of catalysis, endosmosis, 
or exosmosis, will it succeed in demonstrating how that bread and 
onions, as the saying is, with which yon poor man is nourished, can 
be converted, equally with the fibrine of a succulent paste eaten by 
a gourmand, into blood so rich as afterwards to be transformed into 
the whole distinct and varied series of the hystologic elements of all 
his tissues. What law more fixed and general than that of the force 
of gravitation, which the whole universe obeys ? and yet man, at 
every step he takes, is being uplifted from the earth, and his humors 
incessantly ascend from the extremities of his feet to the thinnest tips 
of Iiis hair. But, you will say, do not the degrees of calibre of the 
2 10 
PROFESSOR VALERJ’S 
vessels, their valves, capillary attraction, atmospheric and muscular 
pressure explain this phenomenon? No, certainly; all these and 
such like causes doubtless contribute, each in its proper degree, to- 
wards producing it; but for its complete demonstration we must 
recur to the irritability the muscular fibre of the heart and arte- 
ries, to the stimulating force of the blood, and to that of the nervous 
system, which exercise their influence up through the whole ramifica- 
tions of the circulatory system. Now such powers, as you well 
know, are quite of a different nature from those called physico-che- 
mical. And what will the professors of physics and chemistry say 
respecting the recondite phenomenon of the nervous action? By 
which of the forces which regulate the materials of their experiments 
will they explain the transmission to the common sensorium of the 
impressions received by the senses, or the motive impulse communi- 
cated by the sensorium to the very nerves interspersed through the 
muscles ? Microscopic researches have succeeded admirably in dis- 
covering that the composition and structure of the nervous system 
results from the tubes and corpuscles, or cells, and moreover that the 
nervous motive fibres are distinct from the nervous sensitive fibres in 
the cerebro-spinal axis, and from the rachitic nerves; but notwith- 
standing all this, the cause of the nervous action is still a mystery 1 
The numerous electrical experiments have proved, that if nervous 
phenomena are not without an analogy with electric phenomena, they 
are nevertheless far from being an effect of electricity and magnetism. 
In fact, it has been ascertained that the nerves, contrary to the ex- 
pectation of so many experimentalists, are bad electric conductors, and 
that the velocity of the nervous currents of the nerves is much less 
than that of the electric currents up the conductors of our physical 
apparatus. Electricity travels nearly at the same rate as light—that 
is, more than 500 millions of metres in a second; the nervous cur- 
rents travel about 16 millions less in the same space of time. What 
must we conclude from these facts ? The deduction to be drawn 
from them is quite clear. Taking it to be proved and granted that 
thw physical powers, with their various properties and laws, do not INTRODUCTORY LECTURE. 
11 
explain completely, but only partially and to a certain extent, the 
functions of the human vital organism, since between them and the 
vital acts exists not that full and direct relationship which must ex- 
ist between cause and effect, we are forced, on logical grounds, to 
admit and acknowledge that there is within us another principle of 
activity, which concurs with the aforesaid powers in producing and 
explaining completely the phenomena of life. 
What, then, is this other indispensable element of activity ? this 
other singular force ? Mysterious in its essence, though most mani- 
fest in its effects, as are in this two-fold regard all the material 
forces which human knowledge has become acquainted with and 
made the subject of discussion, this ist the vital power, so called, 
conformably with the concurrent sanction of physiologists, from the 
universally acknowledged fact, that it exists and plays its part only 
during life-time, and ceases with it. Diffused through the entire 
organism, whether this consists of the first embryonic cell or of the 
body arrived at its complete development, it resides not in one part 
in preference to another, but pervades equally all tissues and organs, 
the blood-globule, the muscular fibril, the nervous duct, the cellular 
lamina, &c. <fcc. It is no wonder, then, that the physical powers, act- 
ing upon an organism endowed by the vital action with such special 
force, are modified in their effects, and incapable of themselves of 
producing the numerous phenomena above enumerated; whence it 
follows that if any philosophic physicians, by defining life as a con- 
tradiction, of physico-chemical forces, have exaggerated the importance 
of this fact, or rather interpreted it wrongly, it is true, on the other 
hand, that the physics and chemistry operating in our frames, are 
special physics and chemistry, varying essentially in their results, and 
exercising themselves not in the museum and laboratory of purely 
inanimate matter, but in the laboratory of the human organism com- 
posed of living matter; that is to say, endowed with a singular force 
which it receives from the act of existence. 
But it is not my purpose to expatiate at greater length in the 
field of physiology; what I have stated was requisite to prove the 12 
PROFESSOR VALERJ’S 
actual existence and specialty of those powers, whose simultaneous 
and united action constitute the conception of “ nature.” In order,how- 
ever, thoroughly to understand their signification, it is necessary that 
we should now briefly direct our attention to the spontaneous and 
wondrous effects, which result from these forces, which reside and 
operate in man, and which we have but just now demonstrated. 
The first fact which presents itself, is the perfect order and 
unison with which the different parts and functions of the organism 
are linked together. Although this results from a re-union of tissues, 
differing in form, structure and uses, notwithstanding the limits 
which the anatomical texture seems to fix between each of them, they 
are nevertheless intimately associated, and harmonize into a truly 
wondrous ensemble. Granted that the different pieces have peculiar 
actions, different sizes, and various distances, the influence of the 
elements of life penetrating into, and distributing itself through each 
of them, they are connected by manifold relations, and mutually 
communicate their sensations and influences in such a manner, that 
all converge, all conspire, and concur towards the same end: the 
tissues and organs, that is, constitute by their mutual action and 
symmetry the union, the great One of Hippocrates. The same may be 
said of the functions: could we conceive or demonstrate what nutri- 
tion is without digestion, this latter without circulation and absorp- 
tion, absorption without exhalation or secretion, and vice-versa ? 
And could these vegetative functions be effected and understood 
without the concurrence of those called animal or relative functions, 
namely innervation, motion, sensibility? Let a skilful anatomist 
or physiologist commence his description and explanation of our 
body with one tissue, viscus, or function, rather than with another, 
and he will succeed equally well. Tissues, organs and functions, all 
are so intimately connected with, and dependent on one another, that 
to commence or conclude this circle of activity with one point in 
preference to another is a task equally practicable and regular. 
11 Nullum mea quidem opinione,” writes Hippocrates, “ corporis est 
principium, sed omnes partes ex equo et principium et Jinis esse videntur. .INTRODUCTORY LECTURE. 
13 
Descripto enim circulo, principium non invenitur.” (Dc locis in liomine.) 
Engrave, I pray, my young friends, this fact on your memories; 
it is the origin, the efficient cause of a fundamental canon, indispen- 
sable for the study of the human organism, as well in health as in 
illness, and is as follows: That each part sympathizes with, partici- 
pates and contributes towards the well-being or indisposition of 
every other part. 
Another result of no less importance is, that our existence is lim- 
ited by a certain space of time: “ Constat,, aeterna positumquc lege est, 
constat ut aeternum nihil! ” exclaims Boezio. The duration of man’s 
life is fixed almost invariably, as in the case with all other kinds of 
animals, nor can the physician or philosopher explain the reason 
why the lives of some of them are ephemeral and transient, while 
others enjoy a very long one. We may infer from this, that medicine 
is not an art, to heal all diseases, but only such as are curable; 
“ Ncquc enim fieri potest, ut omnes cegroti sanitatem assequantur! ” 
Between your action and the disease you will find the alternative of 
life or death! 
On a like principle the organism lias also a determined time and 
measure (and this too almost invariable) for its complete development, 
and that of its parts. Dentition belongs to infancy, the development 
of the organs of generation to puberty, the maximum of muscular 
fibre and strength is observed in youth, the exuberance of the adipose 
cellular tissue in manhood; and to be brief, we will state, that the 
other organic systems, the very splanchnic cavities and the parts 
contained therein, complete the degree of their respective perfection 
with a fixed lapse of years, becoming, at their respective periods, 
centres of an exuberant nutrition and special activity. In the mean 
time at our twenty-first, or twenty second year, the skeleton attains 
its maximum height, and grows no higher after; so that if a certain 
latitude is still left for the further development of the body’s trans- 
verse dimensions, the non plus ultra of his longitudinal one is deter- 
mined. When all the parts have attained, at the prefixed time and 
established periods, their complete development, the economy seems PROFESSOR VALERJ’S 
to continue for several years in a state of equilibrium more apparent 
than real, until following an inverse and equally graduated order, it 
runs towards its fatal decline. “ Old age is a second childhood,” ac- 
cording to the vulgar adage; for when the intellectual faculties have 
relapsed into childish weakness, man’s physical structure and with 
it the harmonious degree and concurrence of the forces, which ani. 
mate him, have undergone the law of gradual debility, as they had 
previously passed through their gradual and periodical development. 
The knowledge of this law is of a most significant practical import- 
ance. Firstly, by observing that in the physiological state, the econ- 
omy increases, and develops itself cum ordine, tempore, el mensura, we 
may foresee and conclude that, even in the pathologic, the morbid 
processes must proceed, as in fact they really do, with order, time, 
and measure; secondly, we shall not be surprised by this other clini- 
cal fact, verified by all medical observers, that the physiological 
changes above mentioned, corresponding to the different epochs or 
periods of life, exert an influence over the production and frequency 
of the diseases peculiar to those splanchnic cavities in which such 
changes are effected. In other words, at the period in which the 
systems and organs become the centres of predominant development 
and action, they become subject simultaneously to certain morbid 
impressions and processes proper to themselves. For this reason it 
occurred to the celebrated Stahl, with exquisite clinical tact, to divide 
life into three medical periods; the first appertaining to diseases of 
the head, the second to diseases of the chest, the third distinguished 
by alterations in the abdominal viscera. 
Not last among the wondrous effects of nature are our instincts and 
habits. Instinct consists, as you well know, in certain sensations, 
passions, appetites, aversions, which, independently of the will, urge 
man to actions, some of which are necessary, others for the most 
part useful to his personal safety, to the conservation and propaga- 
tion of his kind. Habit is that faculty which he possesses of being 
enabled, by the frequent and continued* repetition of any act whatso. 
ever, to vary, moderate, augment, and even annul the impressions INTRODUCTORY LECTURE. 
15 
caused by the various stimulants acting upon his organs, to nourish 
himself with variable qualities and quantities of food, to live in dif- 
ferent kinds of climate, &c. &c. In life habit is everything, custom is 
a second nature ; this is a truth too well known to need an}' discussion. 
In physiological books you will find an ample store of facts upon 
this subject, as instructive as they are astounding. In the mean 
time bear well in mind the existence of these two faculties—instinct 
and habit—for in the cure of diseases you will find that they exer- 
cise a great, though inexplicable influence. How often must we not 
recur to the habitudes of the patient in regulating the diet, measur- 
ing the doses, and the effects of certain remedies ? How often must 
not our curative indications be guided by the mysterious physical or 
moral impulses of the patient ? u Inest aliquid sajnentice in aegro- 
tantibus instinctibus,” exclaimed Boerhaave. 
Nor is this the whole category of faculties resulting from the spe- 
cial forces, concordantly and harmoniously acting in our organism; 
but I have pointed out the principal, and deem them sufficient to 
make you understand how in the living man all the organs, with the 
functions, powers and laws derived therefrom, constitute him a per 
feet economy; that is, an aggregate of natural and special causes and 
effects, which, in perfect order, according to fixed methods, and with- 
in proper limits, incessantly tend towards its conservation, “ quae 
node atque die nostris rebus invigilat, contulitque." It is just to this 
aggregate, conformably with the definition quoted from Sydenham, 
that we have applied the term Nature, apprising you, at the same 
time, that we shall henceforth adopt it in a like sense; a sense una- 
nimously received by all those physicians who, following the doctrine 
of Hippocrates, cultivate the medical art with positive advantage to 
humanity. 
Having thus defined the word nature, explained its import, and 
enumerated the principal laws by which it operates in conserving the 
individual, let us now enter upon the field which more directly con- 
cerns us—that of pathology. 
Firstly, then, how does nature aet in treating with diseases ? It is 16 
PROFESSOR VALERj’S 
an axiom as ancient as medicine itself, as unanimously proclaimed by 
the most renowned physicians of all ages and countries as any obvi- 
ous and common truth can be, that nature cureth diseases. u Mor- 
bis natura medetur,” says Elippo'crates, and Sydenham emphatically 
expresses himself in a like sense as follows:—“Natura sibi permissa 
negotiant suurn in morbis suo tempore exequilur, materiamquc morbosam 
debito o'dine ac via turn sccernit, turn etiam cxpellit; nostra ope, nostris 
artificiis, atque auxiliis non indigeat, suis viribus instructa, suis operibus 
locuplcs, suo tandem ingenio satis cdocta.” In a similar tone, and in 
phraseology not less impressive, has this truth been proclaimed by 
Baglivi, and a host of other standard medical practitioners; nor can 
we peruse a single treatise on pathology or clinics of any account, 
without finding therein this truth beautifully expounded. This fact, 
so auspicious for humanity, that nature cureth diseases, might be 
demonstrated, a priori, as a consequence of the definition laid down; 
namely, that nature, being the cause of man’s conservation in his 
healthful state, must therefore also be amedicatrix in his after state of 
infirmity. But we should rather prefer carrying out our reasoning 
by actual proofs. 
It is an ever-occurring observation, numerous and striking exam- 
ples of which you will shortly witness, that out of ten maladies there 
are two thirds that cure of themselves, thus forming, by their natural 
course, the numerous class of those that terminate happily through 
the sole influence of the vital motions. Fevers, inflammations, drop- 
sies, bloody fluxes, exanthemata, neuropathies, sores, tumors, &c. Ac., 
not unfrequently heal spontaneously. And not only this, but we find 
that even pestilential maladies, epidemics, cholera, dysentery, and 
even the plague itself, are overcome by the sole aid of nature. Never 
shall be forgotten the fact related by Santorio, a professor of the 
seventeenth century in the University of Padua, namely, that, of the 
population affected with the plague, the nobility and wealthy who 
received medical aid succumbed, while a considerable number of the 
indigent who were left to themselves recovered. “ Nob ilium fere nemo 
cum remediis sauatur, qui pestc laburut, Vlebei vero sine iis places sanan- INTRODUCTORY LECTURE. 
17 
tur .” (Sect. I., affect. 139.) The same may be said of many other 
maladies, which terminate more happily without the aid of art than 
with it; the reason of which is most clear, for when nature suffices 
of herself to effect the cure, the intervention of the physician and 
his remedies only act as an obstruction to her perfect operations* 
Nature frequently resembleth some classic artist executing with in- 
comparable skill a perfect work. Even the slightest touch from 
another artist, however skilful, could only mar its beauty. When 
Raphael’s pencil, and the great hand that sculptured the Apollo Belvi- 
dcre, were working out their masterpieces, which we so highly admire, 
could other hands, even the most practised, have touched without 
spoiling them ? The similitude, though unhappy as to the subject, is 
perfectly apropos with regard to the result. And, alas! how often 
do we not only lack skill, but also, unmindful of the natural course 
of diseases, militate against, ruin and destroy by ill-timed indications 
and violent remedies the sublime workings of nature, entirely direct- 
ed towards curing them ? “ Natura omnia omnibus suffic'd," exclaims 
Hippocrates, and self-taught, “ nemine cdocta, saepc novum opus exordilur 
ubi conatus nostri desiere,” adds Bagiivi. As she is the efficient cause 
of health, it is quite natural that she protect it from those vicissitudes 
apt to disorder it; and this she does by means to us sometimes mys- 
terious, but generally most perceptible. 
And what are these means? You are already aware that I would 
allude to certain crises, or great perturbations, which occur in the 
course of maladies, accompanied or followed by excretions, or abun- 
dant deposits of morbose matter, as, for instance, perspiration, lur- 
morrhage, an abscess, diarrhoea, sedimentose urine, Ac. “ Crisis, nut 
judicium fit in morbis, quando cl magnae perturbationes accidunt,et nova 
apparent phomomena; subito, simulque haec apparent sequuntur vel cl 
comitantur insignes excretioncs, vel dispositioncs humorum in loco quodum 
corporis, id est abscessus," &jc. (Van Swieten, vol. v. p. 34.) You arc 
aware of the many dissensions which have arisen concerning the sub- 
ject of the crises, and that certain solidists have denied or considered 
doubtful their existence, holding them as a deceit, a mere effect of 18 
PROFESSOR VALERJ’S 
superstitiously deluded observation. To my mind the best confuta- 
tion that could be instituted against this class of physicians would 
be that of inviting them to visit some hospital, thus imitating Dioge- 
nes, whose sole reply to the sophism of Zeno against the possibility of 
motion was to invite him to take a walk through the portico. In that 
hospital, or in any other assemblage of patients, they might witness, 
/ \ 
for instance, an epistaxis which frees a plethoric subject from a con- 
gestion or cerebral haemorrhage, already on the point of bringing 
him to the grave; a profuse perspiration which dissolves a rheuma- 
tism; a fit of vomiting which puts a term to a colic of the stomach, 
occasioned by an indigested meal, or by the absorption of a poison; 
an abscess, an aposthema which arrests the danger of a malignant fe- 
ver ; a bilious diarrhoea which resolves the jaundice; an abundant 
expectoration which arrests a violent paroxysm of asthma, or voids a 
vomica which threatens life itself; purulent urine which in the 
course of one night does away with an abscess, which the surgeon’s 
hand was about to open on the following morning; a parotitis which 
brings to a favorable issue a maniacal delirium, or a violent nervous 
fever; a succession of boils which cure a quartan ague, that had for 
several months been the opprobrium of the physicians, or a convul- 
sive cough which had resisted manifold remedies; a profuse diuresis, 
vainly sought to be promoted by numerous diuretics, which, brought on 
by the supervention of a passing fever, voids a frightful ascites, re- 
solves an anasarca; and so on with analogous cases. I could, in 
fact, pass in review the whole lengthy series of the various kinds of 
diseases, and prove to you by similar facts, that these crises, or eva- 
cuations, constitute the sensible mode by which nature oftentimes 
effects their cure without the physician’s aid. I have enumerated to 
you such of them as occur most frequently, and have chosen those 
which, impressing more deeply the practitioner’s attention, do not 
easily pass unobserved. What though the crises are sometimes not 
very manifest, because effected without any exacerbation of the symp- 
toms which usually accompany them, and by the evacuation of mat- 
ters not copious nor profuse, but rare and thin, and escaping in an INTRODUCTORY LECTURE. 
19 
unaccountable manner; they nevertheless occur, nor escape the atten- 
tion of a mindful observer. In maladies of long duration, in which 
the patient slowly recovers, it is quite natural that we cannot notice 
great perturbations previous to, or simultaneous with, great crises; 
and it is logical to conclude that all the various secretions can and 
must eliminate the morbose matter through their respective emuncto- 
ries in the same manner as it is gradually matured by nature in the 
affected organism. In proof of this, we find that slow nervous fe- 
vers improve after some weeks on account of no other evacuation 
than a slight general mador, sustained for several days on a skin 
which at first had been arid and dry; ancient, deep congestions of 
the liver are insensibly improved by the intervention of alvine mat- 
ter somewhat dissimilar in quantity and quality to what it is natu- 
rally. How frequently occurs a particular odor of the perspiration or 
of the breath, a change, apparently indifferent, in the urine, all which 
relate to the degree of improvement observable in the course of the 
malady; and thus passing off unnoticed by the physician, so as to in- 
duce him to think that the disease terminated without any crisis. Criti- 
cal absorptions, too, followed by critical emissions of morbose mat- 
ter must, and really have several chronic affections which are also 
cured by the mere efficacy of nature, aided only by a simple change 
of air, food, system of life, by the organism entering into a different 
period of age, by the mere relinquishment of a false curative method, 
<fcc. Do Ave not, in fact, behold glandular tumors, hypertrophies of 
certain viscera, splsenie cysts, chronic rheumatisms, dermatoses, &c., 
spontaneously and gradually resolve themselves ? and whereas none 
of you can deny that all these are infirmities aim materia, morbosd, it 
follows that, once granted their natural recovery, they must also have 
gone through the process of maturation, absorption and elimination 
of the said matter. An instance drawn from a serious, and unlucki- 
ly in our country very frequent malady, will serve to illustrate our 
argument. A man becomes apoplectic from cerebral hsemorrhage, 
but fortunately recovers, finding himself, however, hemiplegic: after a 
few months, more fortunate still, without having had recourse to a 20 
PROFESSOR VALERj’S 
physician or medicine, he recovers even the use of his limbs. Now; 
in this case, there was an extravasation of blood in the brain, and to 
the end that the patient might recover, nature was forced to absorb 
it, but previously to the absorption, to transform its globules and 
other component parts by a metamorphosis not dissimilar to that by 
which we see large ecchymoses resolve themselves after external con- 
tusions. Now, once absorbed, we must necessarily conclude that it 
must be also eliminated from the economy by some of its emuncto- 
ries, or that this blood effused within our tissues (the same may be 
said of the humors that have degenerated and have lodged for a long 
time in the viscera) may, after having been re-absorbed, and as a 
necessary condition for the re-absorption previously transformed, 
may, I assert, be re-composed, and return once more to constitute an 
integral and reconstructive element in the mass of vital fluid. Now 
this second conclusion, although it seems not unreasonable when we 
consider the powerful resources of our economy, we are far from be- 
ing able to prove; while, on the other hand, the former fully tallies 
with the doctrine of the crises, and is daily attested by facts minute- 
ly observed. 
But not only the natural course of diseases teaches us that they are 
cured by the crises, but also that these crises do not act irregularly 
or confusedly, nor in a uniform manner in all kinds of maladies* 
This standard fact of the crises is comprehended within the direct- 
ing law of all created things, as I have already stated in speaking 
of the conservative nature of our economy in its healthy state; that 
is to say, even the. crises are accomplished cum online, tempore, et 
mensura. 
Orderly.—You do not find, for instance, that an indigestion is cured 
by perspiration, but by vomiting, and conversely a rheumatism is 
cured by perspiration, not by vomiting; an abundant flow of urine 
will prove critical for a dropsy, and a dropsy will not be cured by a 
puriform expectoration, as is the case with bronchitis or pneumonia. 
An epistaxis will decide favorably the issue of a congestion, an in- 
flammation or a fever, but not of smallpox, for instance, nor scarla- INTRODUCTORY LECTURE. 
21 
tina; this latter is arrested by a desquamation, and the Arabic exanthe- 
ma by suppuration. And for sake of briefness, I will state, that every 
morbose process has a particular crisis relative to the nature of its 
cause, the tissue and organ that it attacks, the course it pursues, the 
ago, constitution and temperament of the individual, epidemic influ- 
ence, &c. We may lay it down as a general rule, that the crises for 
haemorrhage ordinarily appertain to inflammations, those for mucous 
secretions to phlogosis of the mucous membranes, so widely extend- 
ed over such a number of apparatus; the crises through the skin to 
a great variety of pyrexiae of a nervous and humoral character; in 
line, that the critical fluxes of the glandular system belong rather to 
malignant and typhus fevers, the plague, &c. &c. 
Within due Limits.—The reason of this is so clear, so intimately 
connected with the very nature of the crises, that it requires but a 
brief explanation. If the critical perturbations were too violent or 
too gentle, if the salutary evacuations were too abundant or too 
scarce, in other words, if they were not commensurate with the na- 
ture and specialty of the manifold pathologic processes which they 
arc to resolve, they would be no longer beneficial, and, so far from 
effecting a perfect cure, would either prove useless or detrimental to 
the affected organism. Nil paucum criticum essentially comprehends 
the inverse aphorism of nil midtum criticum. Thus, for instance, a 
haemorrhage, a fit of vomiting, a perspiration, a diarrhoea, if irresis- 
tible and ungovernable, so far from being completely favorable to a 
congestion, a gastric obstruction or a fever, would reduce the patient 
to a state of deplorable inanition: on the other hand, we do not find 
that a slight purulent spitting empties a vomica, nor that a few drops 
of blood arc sufficient for a real plethora, nor does a diuresis of a 
few hours dissolve a general anasarca, and so on with regard to 
analogous cases. The crises, then, exercise themselves within suffi- 
ciently just limits to operate a perfectly favorable change in diseases, 
which is the scope of the salutary nature. If at times this does not 
occur, there are reasons for it, which I shall explain to you here- 
after. For the present you will permit me, for the due order of my 22 
PROFESSOR YALERJ’S 
discourse, to speak only of the healthful and benignant side of na- 
ture, or of the operations she perforins purely, and without any con- 
currence of ours, for the welfare of our affected organism. 
At proper periods.—Although by the simplest notions of physiolo- 
gy, which plainly teach us that the whole economy, as regards in- 
crease or decrease, action or repose, a3 well of itself as of all its 
tissues, organs and functions, is influenced by time’s silent sway; 
although by the simplest notions of pathology, which teach us that 
each peculiar malady takes its proper course almost invariably, phy- 
sicians should, even previous to their individual experience, have 
unanimously foreknown and concluded that even crises arc regulated 
by time, that is to say, by a law which appoints the periods of their 
first appearance and of their maturity; notwithstanding all this there 
has been no truth in medicine so much discussed, contested, and, I 
would also say, wrongly interpreted, as that of critical days. Syd- 
enham, who next to Hippocrates may be justly considered as the 
most experienced observer of diseases, surprised at the regularity of 
of their periods, the peculiar order and method with which they oc- 
cur, and considering the phenomenon neither more nor less surpris- 
ing and mysterious than so many other realities which occur in crea- 
tion at appointed periods, rather than confute the objections brought 
forward by the opponents of this doctrine, meets them with the fol- 
lowing query:—“ Tell me, explain to me, I pray you, if you make so 
great account of yourselves, why the horse attains to its perfect 
growth at the age of seven, man at the age of twenty-one; why this 
plant is wont to flower in May, that in June, another in a different 
month; and so on with so many like phenomena of Creation?” 
Libenter cnim a vobis queesierim cur cequus ad acmen saam pertingat 
VII. annorum spatio, homo XXi ? cur in plantarum regno haec mense 
Maio, ilia Junio, ista alio Jlorerc solcat ? ut innumcra alia nunc sileam. 
As for us, we shall deport ourselves in a like manner, preferring, 
like Sydenham, not to discuss the arguments brought forward against 
the existence of critical days; but simply noting the fact, we declare 
that, despite the opposition from so many quarters, the doctrine of the INTRODUCTORY LECTURE. 
23 
critical days has never fallen to nought, but still lives and prospers. 
Philosophers and physicians, even the very vulgar, and patients them- 
selves, all respect it. “ Savans et peuple, medecins ct malades touts ad- 
mitlent la doctrine dcs jours critiques dans les malades.”—Ballonius, 
Epid., lib. 1st. In fact, observation, the most faithful guide to our 
attainments, teaches us that as diseases have their regular periods of 
increase, acme and diminution, so their great and manifest changes, 
favorable or unfavorable (ad salutcm aut mortem, ad melius aut ad pejus 
inclinations), mostly take place on certain stated days, called there- 
fore decretory, while on certain others they are pre-announced, and 
these days are lienee called indicatory; and on certain others they 
occur but rarely, or in an irregular, imperfect, and often fatal man- 
ner, and these last are called intercalary days. I shall not here stop 
to specify the cyphers which represent these different days; you have 
certainly engraven them in your memories. However, there is one 
thing which I deem it not superfluous, but even useful to be remem- 
bered, and it is that Hippocrates was the first who established and 
noted their importance. Nor in doing this was his mind pre-occu- 
pied by any pre-conceived numerical law; but endowed with a sub- 
lime genius, which no law affecting the patient could escape, by 
merely observing with clear introspection the natural progress of the 
morbose processes, he distinctly perceived that their issue in recove- 
ry or death, and the critical phenomena which influenced them bene- 
ficially or otherwise, for the most part occurred on stated days, which, 
however, he does not lay down as unexceptional, but the most oft- 
recurring, not as regards the universality of diseases, but the great- 
est number of them, not as absolute, but dependent upon a multitude 
of circumstances; as, for instance, the diversity of age and strength 
of the patient, their surroundings, difference of seasons and climate, 
epidemic influences, Ac. It suffices to read the golden work by Testa, 
a celebrated physician of Ferrara, “ De vitalibus periodis aegrotan- 
tium ct sanorum," and Anthony de Staen, in his “ Ratio Mcdendi ” 
(wherein, with unmatched erudition, he analyses the course, crises, and 
critical days of more than two hundred cases of maladies and epi- PROPESSOE VALERJ’S 
demies recorded in the works of Hippocrates), to be convinced that 
this truth rests on unshakable evidence, connected with which it will 
be of some service to repeat the fact, that the father of medicine, in 
enumerating the critical days, had no other guide than mere observa- 
tion. The result, then, is that physicians of every age and country, 
independent of every system, and true to the maxim of observing 
and never tampering with the operations of nature, whenever she 
was self-sufficient to cure diseases, unanimously noticed not only 
the crises, but the regularity of the critical days. Foresto, for in- 
stance, gives the history of forty-eight cases of intense malignant 
fever, thirty-eight of which terminated on the critical days, declaring 
with rare minuteness, that among these patients five were favorably 
determined on the fourth day, twenty-two on the seventh, seven on 
the fourteenth, two on the eleventh, one on the seventeenth, and 
another on the 21st. Now, if out of forty-eight patients three fourths 
were determined favorably on the critical days, these days must be 
distinguished from the others; and if out of these critical days twen- 
ty-two were favorably decided on the seventh, and seven on the four- 
teenth, out of the sum total of thirty-eight cases, there is no doubt 
that these numbers seven and fourteen are to be preferred to the 
others. Jandie Bauvais, in his “ Siineiotique,” states as follows:— 
“ I can positively assert that, during my twenty years’ experience, I have 
always observed the crises occur at the periods noticed by Hippo- 
crates, in all cases wherein no disturbing medicine interfered with 
the regular course of the disease; and my pupils at the Salpitriere 
have frequently seen the crises occur on the critical days even among 
the aged.” Andral himself, in his medical clinique on acute diseases 
of the chest, has observed that out of ninety-three cases of recovery, 
three fourths of them coincided with the critical days. 
But the critical evacuations on critical days are not the sole means 
by which nature healeth: another mode of recovery, equally effica- 
cious, and confirmed by daily experience, is metastasis, that is the 
changing of the seat and form of the disease, by means of which the 
grave symptoms of an affection, in most cases internal and dangcr- INTRODUCTORY LECTURE. 
25 
ous; arc arrested, giving place to the manifestation of another affec- 
tion of much less importance, and often curable. This fact, notwith- 
standing the different interpretations which it has received, in con- 
formity with the various systems which have prevailed in medicine? 
is incontestable, and a few examples will suffice to convince you of 
its truth. 
Suppose that a certain person has suffered for many years, from a 
persistent dyspepsia, or if you will, from vertigo, or neuralgia in any 
region whatsoever, or from a violent intestinal colic; and suppose 
that (no matter which of these morbose forms) it attacks him with 
recurring paroxysms several times a year, and at each time with re- 
doubled intensity. All on a sudden he is fortunately attacked by a 
lit of gout, and from that instant the vertigo, the dyspepsia, the colic, 
or any other serious malady whatsoever that a shifting and visceral 
gout can engender, ceases, never more to return. A girl is affected 
from hemoptysis, which after recurring several times, is finally ac- 
companied by slow fever with cough, pain in the chest, puriform 
sputa, and a certain degree of general consumption. The case is 
adjudged to be most serious; but while the members of the family 
almost despair of her recovery, there appears on the skin of the pa- 
tient a herpes inherited from her parents; the pulmonary syndromes 
are checked, get better, and finally cease completely, and the poor 
girl recovers henceforth her strength and health. A man of bilious 
temperament, but of a robust constitution, in a few years becomes 
quite indisposed, at first by a fierce hepatitis, then by jaundice of 
long duration, and ultimately by repeated attacks of cerebral con- 
gestion. On a fine morning he ejects with his excrements a copious 
quantity of black venous blood, preceded for several days by more or 
less tenesmus, costiveness, and a sense of burning along the rectum: 
from that moment sets in a hemorrhoidal and periodical flux, from 
which a long series of years of perfect health compensates him for 
his by-gone dangers and sufferings. I should draw out this most 
important subject to a great length if I had to enumerate to you the 
many like instances, which are daily beheld in medical practice; 26 
PROFESSOR YALERJ’S 
the above cases, cited as an abstract, are the most common, and 
tested by my personal experience. It is not unfrequent, for example, 
to see a pleurisy, or pneumonitis, or a meningitis suddenly resolve 
itself by the appearance of an erysipelas; a persistent convulsive 
cough arrested by means of an eczema, a jluxus post aurcs, or by an 
acne appearing on the skin of children; an urticaria cure a cardial- 
gia, which for so many years baffled a number of remedies; the ap- 
pearance of a foetid perspiration on the feet cure a persistent laryn- 
geal cough in a boy threatened with pulmonary tubercles, and from 
being thin, and delicate, render him in a short time florid and robust. 
I myself have seen a spontaneous eruption of boils heal a mcloena, 
which threatened speedily to carry off a noble personage; and not 
long since I have witnessed a hemorrhoidal affection which perma- 
nently arrested a copious hematuria recurring at very brief intervals. 
In perusing the clinical histories by authors of sound practice, you 
will find an ample collection of such like recoveries from maladies 
reputed even incurable, and ultimately brought to a favorable issue 
by nature in this manner, namely, converting them into diseases of 
much less importance and danger, by transferring at once the mor- 
bose matter or process lodged in a viscus to an external, or less 
important part of the body. I cannot, in the meantime, too strongly 
impress upon you not to forget this salutary procedure—or the 
practical importance derived from it in effecting the diagnosis, prog- 
nosis and cure of many diseases we shall treat at the sick bed; 
suffice it for the present for you to know that so great is the benefit 
which nature designs to bestow on the patient by this means, that 
when, like the exclusive anatoino-pathologists you would suppress or 
inopportunely cure these metastatic manifestations, you inflict the 
forfeit of death on your poor patients. 
But nature, as if not content with curing diseases by means of the 
crises and metastasis, is wont, moreover, to excite, by a mysterious 
influence in the affected organism, certain appetites, and sensations, 
in being blindly obedient to which, the individual, by satisfying them, 
finds the only hope of his recovery. I have already addressed you INTRODUCTORY LECTURE. 
27 
on the subject of these internal spontaneous motions and stimulants, 
otherwise termed instinctive desires, and stated to you that they not 
only contribute towards the maintenance of health, but moreover, in 
several cases towards the cure of maladies. Let us take, for exam- 
ple, a person affected with dropsy, whom the copious variety of 
diuretic medicines has failed to cure: reduced to the last extremity, 
he feels a rabid yearning for a certain quality of wine; it is given to 
him, perhaps against the physician’s will; he drinks it, and is cured 
through the intermediation of a critical diuresis. A person threat- 
ened with consumption, whose diarrhoea is increased even by the 
most selected aliments, feels an unwonted craving for oysters, and by 
partaking of them the gastric flux becomes moderated, ceases, and he 
happily recovers his health. A patient affected with a severe dysen- 
tery recovers by eating to satiety and with voracity certain pickled 
meats. Some aged person, ill treated, with a quartan ague, is cured 
by plunging into a cold bath, to which he felt himself impelled in the 
height of his feverish paroxysm. How many chlorotic females, whom 
tonics and ferruginous remedies have failed to invigorate, by merely 
satisfying their extravagant appetites for hard food and indigestible 
substances have restored the crasis of their impoverished blood, and 
thus re-acquired the regularity of their catamenia, to the astonish- 
ment of themselves and their physicians ! Nor shall I dwell further 
on these facts, so strikingly curious, interesting and mysterious, for 
the history of medicine supplies us with them most abundantly; and 
you yourselves, at your leisure, may make an ample collection of 
them. 
We have, then, heretofore seen that nature curetli diseases, and 
passed in review the means and order which she adopts for this pur- 
pose. I would not, however, that any of you should deem yourselves 
adequate to solve, by these sole elements, the question expounded in 
the opening of our discourse, and which I characterized as not being 
very easily judged with impartiality and soundness of discernment. 
In fact, if astonished at the extraordinary power which nature dis- 
plays in the cure of diseases, you decide the cause by a simple and PROPESSOE VALERJ’S 
hasty sentence in her favor, and against the physician, you would 
expose yourself to two strong objections, which would not fail to 
present themselves to you, and would certainly prove very embarrass- 
ing. And these objections are, firstly, that nature by curing and 
operating so marvellously, seems to act with discernment and intelli- 
gence. Secondly, that for this reason she may be sufficient of herself 
alone to cure diseases, and, therefore, the ars mcdica and the physi- 
cian are superfluous, if not hurtful. 
The discussion of such difficulties, or the just solution of them, com- 
prehending, as a necessary consequence, both the necessity of medi- 
cine and the usefulness of the physician and his remedies, if it 
requires on my part a clear exposition of the subject, requires on 
yours the most serious attention. 
In order to perceive that nature docs not effect the cure of diseases 
with discernment or intelligence, it is requisite first to bear in mind, 
that we defined this term as being u an aggregate of forces, which, 
though special, efficient, and acting according to provident laws for 
the conservation of our economy, act, nevertheless, of necessity— 
that is, void of discernment or reflection with regard to the end in 
view; in other words, they operate fatally, physically, without know- 
ing, or being enabled to avoid or modify the scope for which they 
were destined by the infinite wisdom of the Creator, namely, the 
health of the individual. Now the same happens in the state of 
illness. Nature, the moment our organism enters into the abnormal 
condition of suffering, displays her salutary activity, but without 
volition or choice. Indifferent with regard to the consequences of 
her operations, she is forced to act of necessity, not as a being en- 
dowed with will, compos sui, but according to those immutable laws 
which her Author has imposed upon her. Just as a stone thrown 
into the air invariably falls towards the centre of the earth; just as 
an acid, when it comes in contact with certain alkalies, is invariably 
converted into a salt, so the vis mcdicatrix natures, invariably and un- 
failingly, unconscious why or how, effects the process of curing, of 
restoring health. It hence follows that when we physicians, observ- INTRODUCTORY LECTURE. 
29 
ing a crisis, 'which, far from saving a patient, occasions his death, ex- 
claim, that nature deceives herself, our declaration in this case should be 
received in a metaphorical, not positive sense; because error belongs 
only to him who possesses the faculty of choosing, and the conscious- 
ness of what he is transacting, and not to that which acts through physi- 
cal necessity, ignorant both of cause and effect, and operating accord- 
ing to determined laws and with appointed instruments. Let me give 
you here some actual proofs of the truth of my assertion. Let us sup- 
pose that several persons, in order to pursue their journey, are con- 
strained in a state of perspiration, to cross a current of cold water, 
and that arrested perspiration has been the cause of illness to 
them all. Nature, ever watchful and operating for their benefit, be- 
gets a fever, which on the morrow terminates in the case of one with 
a profuse diaphoresis; in that of another, far from ceasing, it pro- 
gresses to a pneumonia; in the case of a third, it results in a violent 
and acute rheumatism. Now can we interpret these three different 
maladies, all derived from one identical cause, as an operation of a 
rational intermediating nature, acting with discernment, with pre- 
science of the result, with well-pondered determination ? No, cer- 
tainly ; for, if it were so, she would have produced the perspiration in 
them all by means of the fever, and would have thus equally freed 
them from their malady by the shortest, safest and least painful pro- 
cess. Suppose, in like manner, that two individuals have swallowed 
an equal quantity of poison, and that nature, in order to effect their 
recovery, has immediately brought on a fit of vomiting (the shortest 
and most efficacious remedy), and suppose, moreover, that one of 
them it fortunately cured, leaving no other effects from the poison 
than a sense of burning in the stomach; while the other, notwith- 
standing the vomiting, is laid up with a painful and mortal gastritis. 
These and many other examples, which you may multiply at your 
pleasure, as numbers of them occur daily, evidently prove that nature 
acts not with intelligence, that she is not free in her operations, and 
therefore no wonder that various, and not invariably salutary, must 
be, and really are, the modes and effects of her action in benefiting 30 
PROFESSOR V ALERj’S 
our affected organism. Nor, indeed, can it be otherwise; for, taking 
it as proved and granted that nature is the re-union of the forces in 
herent in the living organism, as she cannot exist or act without this 
latter, so she is obliged to operate in as many different modes as arc the 
different physical conditions which this organism may assume. If 
we apply a motive power to a watch, or to any other mechanical 
apparatus, as long as the wheels and other parts of the mechanism 
retain their stated conditions as to form, size, relationship, <fcc., the 
motion will be such as was expected; but as soon as one, two, or all 
these conditions are modified, the motion must necessarily change, 
and the changes bo proportioned to the respective modifications that 
have taken place; never ceasing, however, to act uniformly (that is, 
in perfect relationship and harmony) with mechanical laws. Thus 
it happens with nature in her dealings with our affected organism. 
Her beneficent action is unceasing, ever guided with admirable order 
and by admirable laws, but always subordinate to the condition of 
our frame, as the motions of a watch arc to that of its wheels, and 
the works of an artizan to that of his implements and the substance 
which he handles. The better to understand one another, let us 
suppose that a legitimate inflammation has established itself in a 
sound lung of a robust person; nature will resolve it hastily by that 
process which pathological anatomy lias now well determined. But 
if, on the other hand, this pneumonitis attacks a lung granulated with 
tubercles, or congested with chronic bronchitis, or a person of seventy 
years, feeble and buffering from disease of the heart—nature, even 
under such circumstances, will proceed in the work of resolving the 
pulmonary exudation; but, operating on organs, and with an organic 
frame quite different, the absorption of the exuded matter will be 
either incomplete or tedious, or arrested by the complications of co- 
incident alterations; so that, far from being cured, a chronic pneu- 
monitis, or a phthisis, or even death itself, will be the result. Al- 
ways bear in mind, however, and I deem it useful to repeat it, that 
these last-mentioned effects, although they seem different from the 
former, do not cease to be, like this, not only physically necessary, INTRODUCTORY LECTURE. 
31 
but even regular, that is to say, comprised within the scale of those 
laws which regulate the economy in its pathological state. 
Let us now proceed to confute the second objection, which consists 
in considering medicine, and therefore also the physician, as super- 
fluous or hurtful. 
And, firstly, I will say that the very experience which teaches us 
that nature cures a considerable number of diseases without the con- 
currence of the physician, also daily teaches us that in various cases 
she remains impotent if not opportunely aided by him. We observe, 
in fact, as is easily to be conjectured, that her efforts, whether it be 
on account of the weakness or bad crasis of the organism, or on 
account of the virulence of the morbose causes, or the gravity of the 
pathological process, prove insufficient, sometimes excessive, or over- 
impetuous, and sometimes, too, wrongly directed. 
Perhaps it is not possible to establish the exact limits, or mark 
with precision the circumstances wherein the exclusive power of na- 
ture ends, and ■where it begins to need the aid of art. But it may, 
nevertheless, be retained as a general maxim (of the truth of which 
you will shortly be convinced in the very outset of your career), 1st, 
that nature exercises less activity in chronic maladies than in acute 
ones ; 2dly, that its predominant action, in acute maladies, may either 
be irregular or too violent, from which arises the necessity of an art 
capable of aiding, moderating and directing her. And here it will 
not be out of place to state precisely in what manner this art acts, 
and ought to act, in order to prove beneficial, and what instruments 
are to be used therefor. But to proceed aright in such a delicate 
and important matter we should consider what is meant by disease. 
You are all aware of the numerous causes which disturb, convulse, 
or ruin the human frame. Some of these are congenital with the 
primordial development of the germs in the very act of its fecunda- 
tion; others are engendered by the incessant exercise or motion to 
which all its parts are subject during life; others by the action of a 
number of agents which surround us, and act upon our organisms 
not only internally but even in the innermost recesses of our tissues. 32 
PROFESSOR VALERJ’S 
Cold, heat, light, electricity, air and the different substances it con- 
tains, our aliments and their contents, &c. &c., at the same time that 
they are the necessary and indispensable agents for the maintenance of 
our physical existence, create, moreover, to a great extent, the forces 
termed hurtful, or those that beget that state called disease. Now, 
however numerous may be the definitions that have been given of 
this state (definitions, all of which derived from a different system 
have variously and frequently, with deplorable consequences, influ- 
enced medical practice), the best, because most conforming to clini- 
cal reality, is that of considering disease as an alteration of the organ- 
ism, or a preternatural modification of the body ; a modification or alter- 
ation, which necessarily induces a corresponding disorder of its 
functional condition. What if, in some cases, we fail in discovering 
the existence of such a modification, or demonstrating in what it con- 
sists ? Our frame is composed of parts, and of parts with functions; 
when we find these impaired, we are forced to admit that the instru- 
ments that produce them have undergone corresponding damage. 
The surgical diseases, nay all those termed external, prove this con- 
clusion to be true; we find in each of them that with the functional 
element the anatomical element is also changed. If we are unable 
to do this in various cases of internal diseases, it should not be 
attributed to the want of a pathologic organic process, but to the cir- 
cumstance that this is not so obvious to our senses as in the external 
diseases, baffles every attempt at being explored, and, for the most 
part, operates in the innermost penetralia of our economy. More- 
over, if even in the physiological state the minute structure of some 
tissues, and the crasis of certain humors, are still far from being 
perfectly known, or from supplying us with a full explanation of the 
functions derived from them, can we be surprised if, in the pathologic 
state, many subtle alterations which these solids or fluids undergo 
should escape our notice ? 
But to penetrate somewhat deeper into the nature of disease, it is 
not sufficient to consider it a mere necessary organic alteration con- 
joined with a functional disorder, and produced by a morbific cause INTRODUCTORY LECTURE. 
33 
or agent. There is also another element equally indispensable and 
important, namely, the state of the forces, or the intermediatory ac- 
tion of nature. Let a piece of red hot iron, or any other injurious 
substance, be applied to a person who had died a moment previously. 
Here you see a hurtful cause, a material alteration; but let it, in- 
stead, be applied to a living man; what a difference do we not behold 
in the appearance and quality of the lesion inflicted! What a diver- 
sity in the process which ensues ! Now this difference, this diversity 
consists entirely in the presence and reaction of the ensemble of forces 
which we call nature, and whose existence lasts as long as life itself. 
In fact, whatever be the morbific causes, and the pathologic modifica- 
tions which result therefrom, experience teaches us that nature in- 
stantaneously reacts on them, effecting with that order, and according 
to those laws and method, of which we already treated, the elimina- 
tion of the morbose matter, the reparation of the damages inflicted, 
the recovery in fine of health, of which she is necessarily the pro- 
tcctrix. This stated, and wishing it to be understood that we in- 
clude all morbific causes in general, we shall say that by an attentive 
observation of them, we are taught that nature, in this solemn and 
beneficial task, if at one time she succeeds completely by herself, at 
another fails, unless we skilfully minister to her convenient aid. 
But what arc these aids, with what end in view are they given or 
prescribed? Are they more efficient than nature herself? That is; 
with regard to the cure, do they claim a principal part, a part supe- 
rior to that of nature, or otherwise ? This is what remains for us to 
determine in order to obtain the object of our lecture. 
These aids consist of all those means which in medicine are called 
remedies, inasmuch as they are proper to effect a salutary modifica- 
tion during a state of illness, and to remedy the damages which it has 
occasioned the affected organism. Hygiene, pharmacology, surgery, 
physic, the air, our food, the different exercises of the body, mineral 
waters, &c., supply such a plentiful quantity of them that we may 
assert, without danger of contradiction, that there is nothing that 
encompasseth man in this earth which has not been, and which can- 34 
PROFESSOR VALERJ’S 
not be administered as a remedy. However, although each of these 
substances produces a change, an impression on the organism, this 
change or impression is not absolute, that is, dependent solely on their 
chemical or physical properties, but relative and subject to the proper- 
ties of the organism itself to which they are applied. As between 
our partaking of food and its being transformed into blood there occur 
a series of vital acts, to which we must refer in order to explain this 
truly wonderful and sublime phenomenon, so between the application 
of any medicament whatever and its effect there intervenes the action 
of our economy, and determines its real character. Hence it fol- 
lows that, not a priori, but from experience alone, do we come to 
know the different properties of the numerous means which we call 
remedies. We see that some of them purge the stomach or intes- 
tines ; others promote diuresis, diaphoresis, or expectoration; some 
temper the body’s heat and its fevered motions; some soothe the pain 
or dissolve the spasm; others revive, strengthen and bind the tissues, 
Ac., thus forming an array of practical and positive knowledge, not 
deduced from any preconceived notions of ours, but from observa- 
tion and experience. Now, when we prescribe such substances it is 
clear that we do so with the view of producing such effects; but to 
the end that they may prove beneficial (for otherwise the substances 
prescribed would be no longer remedies), it is requisite that they 
should conform with those which nature herself, as sole curer of dis- 
eases, would adopt if she were (as happily she often is) self-sufficient 
under such circumstances. Nor could it be otherwise, inasmuch as 
the physician, being ignorant of the intimate nature or essence of the 
disease, being acquainted only with the manifestations pervious to 
his senses, cannot at his pleasure and choice imagine or produce 
solutions and crises, but only imitate, promote and regulate, by his 
previous knowledge of the effects of the remedies, those which arc 
applicable to each morbose case, and which observation and clinical 
experience have taught him to be the best suited. Thus, as we ob- 
serve that nature is wont to cure an indigestion by a fit of vomit- 
ing, a gastric obstruction by purging, a plethora or inflammation by INTRODUCTORY LECTURE. 
35 
a haemorrhage, a tumor either by resolution or suppuration, and so 
on, when we perceive by a variety of signs with which experience 
has also made us acquainted, that she is incapable of administering 
such resources, we assist her by such means as are adapted to pro- 
duce the said effects, taking heed that they be justly suited to each 
special case; for we should expect no good, nay, should harm the pa- 
tient, if we sought to cure, as in the cases above mentioned, an indiges- 
tion with sudorifics instead of emetics, a gastric embarrassment with 
expectorants rather than with purgatives, plethora with cordials in- 
stead of bloodletting, and so forth. Now, to come to a conclusion, 
as we have all the elements at hand to do so properly, if nature, unas- 
sisted, cures the greatest part of maladies, acts with the same object, 
order and method, even in those that prove superior to her power 
and resources; if the remedies prescribed in her aid arc, in these 
cases, nothing more than new instruments placed in her hands, and 
by her directed towards promoting, moderating and regulating her 
operations, it follows that true medicine consists in nothing else than 
in the art of imitating nature, of interpreting and ascertaining her 
wants, to the end that the physician may opportunely administer to 
her the aid required. But if medicine be simply the imitation of 
nature’s operations, if the physician be nothing more than her inter- 
2>rcs et minister, and the remedies simple instruments in her hands, 
we arc bound to agree that nature, not medicine, not the physician 
nor his remedies, is the curer of diseases, although medicine, by 
teaching the physician the art of assisting her, and the physician 
himself by administering to her his remedies have, by their salutary 
effects, contributed their share in the task. On the other hand, 
whereas nature would sometimes be inefficient to effect the cure 
without the intervention of remedies, and whereas these cannot be 
obtained without the physician, and whereas, again, the physician 
cannot prescribe them to any useful purpose without being acquaint- 
ed with his art, so it would be equally just and proper to assert 
that maladies are cured by remedies, or that they are so by the in- 
tervention of the physician, or of medicine. The difficulty, as you 36 
PROFESSOR VALERJ’S 
may well perceive, consists entirely in assigning, in this operation, 
to each agent its proper place and relative degree of influence; and 
I flatter myself that, from all I have hitherto stated concerning na- 
ture, you will not hesitate to assign to her the first rank, considering 
her as the first and efficient cause, the physician and his remedies 
as second and subordinate causes. 
And to the end that you may thoroughly understand the value 
and meaning of this argument, so important as to contain within it 
the pivot of sound doctrine and medical practice, you will allow me 
here to quote for you a somewhat lengthy passage from Galenus, 
who, in commenting on the cver-memorable words of Hippocrates, 
“ natura morbis medetur,” explains this subordination of causes all 
operating towards one and the same end, namely, the cure of dis- 
eases, in a manner and with a lucidness worthy an interpreter of 
such singular genius and ability. 
He, Galenus (in Hippoc. Epid., L. iv., Com. v.), after having ob- 
served that Hippocrates asserted, with reason, that nature cureth 
diseases, thus continues :—“ Certain persons will perhaps imagine 
that this opinion does away with medicine, and converts it into a 
superfluous and useless art. The words of Hippocrates contain a 
hidden sense, and require an ampler explanation; and as this sub- 
ject has not yet been handled amongst us, I shall proceed to un- 
fold it. 
“ If, then, any one might say that he can-rid himself of his mala- 
dy by means of good aliments taken in time and in proper quanti- 
ties, by means of fomentations, clysters, bloodletting, or other similar 
measures, such an assertion would not be false, nay, it would be equi- 
valent only to saying, that physicians cure, and that medicine con- 
tributes to the recovery of health. But as it may be said, witli 
truth, that physicians cure diseases, so it is equally certain that na- 
ture contributes something towards the conservation of the creature, 
and that she is more particularly instrumental in curing when she 
effects some critical evacuation of noxious humors, as, for example, 
by means of urine, perspiration, Ac. Thus, whereas nature, the INTRODUCTORY LECTURE. 
37 
physician and medicine may be equally said to be instrumental in 
curing diseases, so the question may be simply reduced to that of 
ascertaining which of them should be placed in the first rank, which 
in the second, and which in the third; and this especially, because, 
as many other circumstances concur in effecting the cure, we cannot 
easily assign to each of the said agents that place which actually 
belongs to it. 
“ Thus, therefore, nature, properly speaking, cures maladies of 
herself; but it may be likewise said, with equal propriety, that medi- 
cine, the physician, and even the very instruments that are adopted, 
cure them also. We may add, moreover, that the cook who sup- 
plies the aliments, the artificer who has made the instruments, and 
the pharmaceutist who has prepared the drugs, all contribute some- 
thing to this end, since we avail ourselves of these individuals in the 
preparation and compounding of the remedies. However, though 
we say that they prepare the remedies, it is not just or accurate to 
say that they prepare the materials of which these remedies are 
composed, for there is nothing which can really become a remedy 
if it be not administered under proper circumstances. Thus wine, 
opportunely administered, becomes a remedy; whereas if given to a 
patient wrongfully it may prove the efficient cause of phrenitis, de- 
lirium, &c., and hence merits not to be called a remedy, but should 
be considered as a hurtful cause. Who, then, is properly the cause 
why wine acts as a remedy? Is it not he who finds out the method 
of applying it under proper combinations ? But who is this person, 
if it be not the physician? and it is precisely for this reason that 
he should acquire the requisite knowledge respecting the subordi- 
nation of the causes concurring to maintain or restore health; for 
the physician is much more necessary for the patient’s health than 
the wine which ho prescribes, whereas wine is not and cannot be 
a remedy unless it bo given at the time indicated by a number of 
circumstances, and in such quantities as these circumstances re- 
quire.” 
“ It is, therefore, the physician alone who knows the time and 38 
PROFESSOR VALERJ’S 
manner of using medicaments, not from the fact of his being an ani- 
mal endowed with reason, but on account of his having learned the 
art of distinguishing what is salutary from what is quite the con- 
trary. Indeed, if he possessed this knowledge simply on account 
of his being a rational animal, certainly all men would be physi- 
cians. Hence it follows that the art of medicine is superior in 
character and dignity to the physician, this latter not finding it in 
his power to subdue diseases save by the aid of art. Just in the 
same manner as the instruments he adopts arc serviceable to him 
and his art, so medicine and the physician are serviceable to nature, 
which disposes, governs, and directs all the operations of the hu- 
man body. Therefore, it is clear how superior is nature to all arts 
whatever, though they contribute in somewise towards the conser- 
vation and re-establishment of health; for it is their office simply 
to supply her with the materials to be used, just as the other subor- 
dinate arts supply materials to medicine and to the physician. 
However, though it may be properly said that nature is the prin- 
cipal art of all those that contribute to health, or, in other words, 
the primary and efficacious cause of health itself, nevertheless medi- 
cine, the physician, and the remedies he uses, may be considered as 
so many secondary and subordinate causes, all concurring to pro- 
duce this effect; and whereas if, in this chain of causes, one only 
were wanting, the others could not possibly accomplish it, so 
it must be most evident that medicine is not a superfluous or use- 
less art.” 
I now flatter myself to have addressed you at sufficient length to 
qualify you to sit as competent and impartial judges of the question 
which has formed the exordium of this, my first lecture; and I hope 
that you will not hesitate to give it as your verdict regarding the 
query in general, that nature curcth maladies, and on the particular 
'case of the patient, whom we suppose to be assisted and cured with 
the utmost nicety of art, that nature cured him also, availing herself, 
however, of the remedies seasonably supplied by an able and skilful 
physician. The honor, therefore, of the cure is divided, and no INTRODUCTORY LECTURE. 
39 
one better than Galcnus could indicate in such a masterly style the 
respective degree of praise and action to be assigned to each agent. 
Just to recapitulate in a few words what wre have hitherto ex- 
pounded, we say— 
1st, That by nature we should understand the aggregate of all 
the forces proper to man, unceasingly and necessarily operating 
with providential order and laws towards his conservation, both in 
health and illness. 
2d, That the existence of these forces, mysterious in their es- 
sence and their mode of operating, is not a gratuitous supposition, 
but a fact constantly tested by experience. 
3d, That it is this very experience which proves that nature lieal- 
eth diseases; many of them by herself, others with the physi- 
cian's aid. 
4th, That the physician is therefore useful and necessary, inas- 
much as he understands the art of aiding her. 
5th, That this art is medicine, modelled after the works of na- 
ture herself, that it possesses means fitted to aid her, and teaches 
the physician the time and mode of prescribing them. 
6th, That these means arc the so-called remedies, not because 
they directly remedy the evil, but indirectly, that is to say, acting as 
instruments whereof nature avails herself in producing those crises 
and processes with which she only can, and is wont to cure. 
But though matters thus stand, that is, medicine and the office of the 
physician being reduced to these general terms (namely, the former 
to the art of helping nature, the latter to the minister of the aid), I 
would not have you imagine that it is easy to practise the art at the 
sick bed. It is most arduous, my dear young friends, soon to be my 
distinguished colleagues; and the cure of patients undertaken in the 
sense, and within the limits above specified, is often a work of the 
greatest difficulty! I would hazard the assertion that our history 
contains few physicians who were able to succeed easily in this mat- 
ter. Ah ! how often have we been embarrassed in making out wheth- 
er that state of vigor or of languor in which nature appears to us, 40 
PROFESSOR VALERj’S 
be absolute or ephemeral, if that tumult or disorder of her motions 
be transient or permanent, deserving, therefore, to be, or not to be 
appeased and reduced to order, with the when and the how, &c. Most 
simple and clear is the classic aphorism of the Father of medicine, 
by which he reduces to three principal heads the action of medicine 
in aiding nature. “ Strengthen her," he says, “ if she be too weak 
or slow ; temper, moderate her, if loo strong and violent; direct and calm 
her, if she be perturbed in her action ; always, however, seconding her, 
never striving against." But in its simplicity, what great practical 
tact and difficulty does not this doctrine contain! And what discri- 
mination, what consummate experience are required to determine 
clearly those very numerous cases in which the healing powers being 
sufficient of themselves, render all intervention useless, nay hurtful! 
Nor do we encounter less embarrassment in applying such a great 
number of medicines: even a nurse, a pharmaceutist’s lad, can tell 
us that such a substance causes vomiting, another induces sleep, pro- 
motes perspiration, expectoration, &c. &c.; but sometimes quite dif- 
ferent is the effect of them on such an individual, for it is a difficult 
matter, even for an expert practitioner, to determine the choice of 
the remedy and the time it should be administered, and to assure 
himself with certainty that such shall be the effect produced; “ Est 
enim liaec ars conjecturalis,” writes Celsus, u neque respondet ei plcrum- 
que conjectura, sed etiam experientia. * Et interdum non febris, non cibus, 
non somnus, non purgatio, fyc. 1\c. subsequitur, sicut assuevit." I will 
but mention to you the obscurity which the diagnosis of various 
maladies presents, the occasio prceccps of coming to nature’s aid in 
various others, the idiosyncrasies of the patients, &c., and numerous 
other obstacles; all which increase the difficulty of our ministry, and 
render it in point of fact, when we consider the shortness of life, too 
difficult and extensive to be known thoroughly. “ Ars longa, vita 
brevis." 
But I should fear that I had not fully exhausted the subject of this 
inaugural lecture to clinical practice, were I not to state what you 
must have known already, namely, that the principles which I have INTEODUCTORY LECTURE. 
41 
expounded as lucidly and regularly as my weak ability would per- 
mit, are identical with those which constitute the doctrine of Hip- 
pocrates. This celebrated physician, medicorum Romulus, cui nec cetas 
prisca vidit parem in re medica nec videbit futura, was the first who 
based medicine on the unshakable foundation of the healing power 
of nature. Endowed with a genius born for this art, with an ability 
and mind the most exquisite that ever any man possessed for obser- 
vation, it was not long before he perceived, from following the natu- 
ral course of diseases, that nature is their genuine and efficacious 
curer, and pronounced the ever memorable and classic words, “ Na- 
tura morbis medetur.” Astonished, too, by the surprising order and 
means wherewith she operates towards that end, he adds, “ Natura 
ipsa sibi per sc, non ex consilio motiones ad actiones obeundas invenit, a 
nullo quidem edocla, extraque disciplinam ea qua, conveniunt ejficit." But 
notwithstanding such high praise, he did not make of her a reasonable 
and intelligent being, but recognized her to be a necessary force, 
subject to the wondrous laws which the All-wise Maker of the universe 
imposed upon every created being specially; hence the organism, says 
he, knows not, sees not what is doing, knows not what wills, acts by 
divine necessity, and its operations tend towards the object predeter- 
mined. “ Corpora, quae faciunt non sciunt, quae vero faciunt scire sibi 
videntur, et quae vident non cognosunt; attamen omnia in ipsis jiunt per 
divinam necessitatem et quae volunt, et quae non volunt; unum quodque 
destinatum falum explent.” The body and each of its parts fulfil this 
destiny, being so intimately connected that one cannot be said more 
properly to be the beginning than another, while they form a real 
economy where everything conspires and concurs towards the com- 
mon weal. u Corporis nullum est principium, sed omnes partes acque 
principium et finis ; confiuxio una, conspiratio una, consentientia omnia.” 
Hippocrates, ever an acute observer, and schooled by positive expe- 
rience, perceived that nature does not always suffice of herself, but that 
medicine discovers and possesses certain aids capable of stimulating 
her in discharging whatever is hurtful and morbose, as likewise to 
force her to manifest to the physician what she stands in need of 42 
PROFESSOR VALERJ’S 
and what she requires of him. u Quando natura non sponte cxcerncnda 
dimittit, mcdicina necessitates ac vires invenit, quibns natura coacta indem- 
nis dimittat, sive excernat, nam stimulata monstrat medentibus, quae sint 
facienda.” And not to lengthen our discourse with other passages, with 
which this Romulus of physicians has called this art into existence, and 
that too quite on a sudden (with a privilege denied by Providence to 
the other arts and sciences, which, formed by degrees, were gradually 
developed and perfected), all in a moment, rendered it most conspicu- 
ous and useful, ever inquiring and scrutinizing, with impartial vision, 
and mind intent on clearly seeing, conceiving and judging of the 
course and phenomena of diseases; observed the rapid or gradual 
crises with which they terminate, the days on which they are more 
likely to occur, whether as harbingers of health or death; expound- 
ed the doctrine of these crises, and of the critical days, augment- 
ing it with a treatise on Semeiotics as practical as is requisite for 
the prognosis and cure of diseases; described a great number of 
maladies with matchless precision, deducing therefrom a most valua- 
ble collection of practical aphorisms; and after all, as a conse- 
quence of so many observations and studies, concluded, with a practi- 
cal knowledge which never can be too highly admired, that the medical 
art includes definitely these three things—the disease, the nature or 
strength of the patient, and the physician. The physician is the min- 
ister of this art; on him it devolves to direct against the malady the 
powers of the patient and his own. “ Artcm tria ista circumscribunt, 
morbus, aeger et medicus, qui artis est administer, aegrumque oportet una 
cum morbo reluctari.”, 
I have thus explained to you what medicine is, as I intend teach- 
ing it you at the patient’s bed, and may God grant that, for their 
happiness and yours, I may succeed in this very arduous task. 
Henry Cope wrote to Prince Lionel, that he would never have 
wished to be a physician save by following the doctrine of Hippo- 
crates : “ Nollem esse medicus nisi Hippocraticus.” Such should be the 
resolution of us all, being sure, in doing so, to follow that doctrine 
which, during the long period of more than twenty-four centuries, INTRODUCTORY LECTURE. 
43 
when forgotten or neglected eclipsed the science and caused the art 
to be pernicious rather than beneficial to patients, whilst, when at- 
tended and followed, was and will always be their safeguard and the 
true light which illumines the physician in the mysterious labyrinth 
of life, and our diseased organism. Do not fancy that the medicine 
of Hippocrates is ancient and circumscribed; on the contrary, it is 
ever recent like truth, which never grows old, and so comprehensive 
as to embrace every progress that must daily and necessarily enlarge 
our knowledge. If Hippocrates, as was natural, could not perceive 
everything, he has ably taught others to see all and see clearly. His 
doctrine is as a pyramid which, with the result of our studies and 
discoveries, we may build higher and still more high, on condition, 
however, of not touching the smallest stone of its foundation, for 
otherwise all would fall to ruin, and our medical system would 
become (as history proves) than an unwieldy mass of 
conjectures, an application of erroneous maxims, fatal to diseased 
humanity. 
I am fully convinced, that by practising now-a-days this art ac- 
cording to the dictates of Hippocrates, dictates which, as they were 
lawfully deduced from the observation of a great genius, have been 
followed and consecrated by the experience of the best physicians 
of every age and country, you will not succeed in contenting all your 
patients, nor in winning the gratitude and esteem of a considerable 
number among them. And what of that ? Shall we desert the truth 
in such an important matter as the curing of diseases, to embrace 
the error of this or that system, which best suits the genius of the 
multitude, or the taste of the age ? Let us ever remember, as a moral 
balm in the afflictions to which our sound method of curing might 
expose us, that our masters, even Hippocrates, Galenus, Sydenham, 
and so many other noted practitioners, had also to suffer on this 
score. A proof of this may be found in several biographical anec- 
dotes and utterances of lamentation, to be met in their works. “ Ce 
n'est pas la medicine, mats le medecin, qui fait le succes a la cour ! ” 
exclaims one subtle historian, alluding to the incapacity of a court- 44 
PROFESSOR VALERJ’S 
physician of his time; and Zimmerman, in his valuable treatise on 
“ Experience in Medicine,” relates, that in a large city where there 
was a host of physicians, the most stupid among them was the most 
highly esteemed, so much so that fifty or sixty patients presented 
themselves to him every morning; but that after having examined 
them all, he was wont to arrange them in four classes, to the first of 
which he prescribed a purge, to the second bloodletting, to the third 
a clyster, to the fourth a change of air. Now we too shall witness 
similar facts, and must bear the same painful consequences ; for now 
and then it happens, that a new and strange system of medicine is 
introduced and practised, and the most recent destroys the preced- 
ing, and becomes more glorified. Really, a few years ago, all dis- 
eases were cured, or rather ill-treated, by excessive purging and 
bloodletting; now-a-days people are endeavoring to do the same by 
means of hydrotherapy, homoeopathy, and by systematically abstaining 
from any bleeding in genuine inflammation of the lungs. But you, in 
the meantime, will say, that these errors triumph; that Priessnitz, 
Hahnemann, &c., have still their followers, and these latter their 
patients. Ah! let not that surprise, and much less entice you to 
follow any other path than that which I have proved to be the most 
conformable with experience, the most beneficial, nay, exclusively so, 
to humanity. The “ green ass,” in the fable of Gellert,* will always 
have a great number of followers; and if to-day, at this very hour, 
Cicero proceeded to the piazza of St. Peter’s to deliver one of his 
renowned orations, and Cagliostro to the “ Piazza del Popolo ” to 
display his impostures, you would see that Cicero would be honored 
with but a small audience and chary applause, Cagliostro by a con- 
course of people frantically bent on admiring him. And what, gen- 
tlemen, is the true reason of all this ? Here it is for you, in two words. 
The Jive senses are common to all, good sense the privilege only of a 
few; for which reason the great orator would have been understood 
* A person more knave than fool painted an ass all green except the legs, which he color- 
ed red. Indescribable was the astonishment of the people who flocked in crowds to behold 
the portentous animal. INTRODUCTORY LECTURE. 
and applauded but by a small number, the celebrated impostor by a 
large multitude. 
Solaced, therefore, by this truth, though hard it be, let us under- 
take, with alacrity, the study of this most difficult art, and approach- 
ing patients, let us ever bear in mind, that following in the steps of 
Hippocrates, we are not here, properly speaking, to cure them, but 
to aid their respective natures in restoring them to health. “ Medicus 
curat, nalura sanat.”