Front Page Titles (by Subject) SECTION I. THE OATH OF HIPPOCRATES. - The Writings of Hippocrates and Galen
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SECTION I. THE OATH OF HIPPOCRATES. - Hippocrates, The Writings of Hippocrates and Galen 
The Writings of Hippocrates and Galen. Epitomised from the Original Latin translations, by John Redman Coxe (Philadelphia: Lindsay and Blakiston, 1846).
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THE OATH OF HIPPOCRATES.
SECTION I.—TREATISE I.
This treatise, constituting the celebrated Oath of Hippocrates, we are told by Haller, contains the rules or statutes of medicine, which the student was required to receive, and confirm by taking it. It points out the gratitude due to the preceptor; adverts to the treatment of the sick, and abjures the use of all dangerous remedies or measures. It leaves certain operations to the professed artists in that line;—and he adds, that it might be supposed to be written after the subdivision of medicine into distinct branches. Some of the ancients acknowledged this treatise, but Mercurialis considers it as spurious. It has been largely and learnedly commented on, by various writers, more particularly by Meibomius, who has pressed into his service the aid of not less than four hundred authors, in law, physic, and divinity.a
It is scarcely to be credited that Hippocrates was the author of this oath—many, besides Mercurialis, have ascribed it to other persons. A strong presumption of its not being his, may be derived from the oath itself, in which every means of inducing abortion is sedulously prohibited; and yet, in the treatise “De natura pueri,” we find a female made to abort under the author’s exclusive direction and prescription. Now, if Hippocrates was the author of this last named treatise, and was the pious character which his writings pretty generally indicate, it is inconceivable that he should thus have perjured himself. If not his, it has never been shown satisfactorily, whether it is anterior, or posterior to his time, though probably posterior.—Ed.
The first part of the oath is taken up by an adjuration to Apollo, Esculapius, Hygeia, Panacea, and all the deities, faithfully to fulfil all its requirements, to the best of his knowledge and power. Next follows the avowal of gratitude, and its scrupulous performance in the highest degree, towards his preceptor and all his family: regarding him as a parent, and his children as relations; engaging to teach the science to them without a fee, in its full extent, as he would do to his own, and that without a previous assumption of this oath, he would teach the science to no one. In the next clause of the oath, he promises to act faithfully towards the sick, prohibiting all that could harm them, and never prescribing (medicamentum lethale, Fœs.; φαρμαχον, Hip.) poisons, or remedies for procuring abortion.a Neither will he operate for the stone, but leave it to those who are devoted to it. He professes to live a chaste and pious life—to observe profound secrecy in his profession as to family transactions; will avoid all corrupt influence with either sex in the employment of aphrodisiacs, whether bond or free, and in case he should act in opposition to the above, he prays that he may neither live long, be successful in his pursuits, or become celebrated in his profession; but that if he scrupulously observes these rules, the reverse may be his destiny.
That part of the oath which has a reference to venery (αφροδιϛιων), might, without much difficulty, perhaps, be made to refer to a determination to give no attention to syphilis and its various complications; [“ab omni scelere voluntario et corruptila, tum alia, tum operum venereorum in corporibus mulierum ac virorum, liberorum, ac servorum procul remotus,” Haller.] Fœsius differs but little. Such were the libidinous and sodomitic propensities at that period in Greece, that it surely cannot be supposed that all venereal diseases were then unknown!—or, that, being known, their cure might not have been left to particular individuals. It is probable, however, that it is not the intrinsic intent of the text.—Ed.
Note.—“Ορχυς, item Jusjurandum. Medicis peculiare conscripsit Hippocrates non adeo ineptum. Prœstatio Juramenti non solum lingua, sed et corde, vel animo puro fieri debet.”—Castelli Lexicon Medicum.
THE LAW OF HIPPOCRATES.
SECTION I.—TREATISE II.
Haller tells us, that this treatise was every where accredited by the ancients, but was rejected by Mercurialis; and that it refers to the education, &c., of the physician. That medicine, although of the highest rank, had yet been extremely degraded, and points out the causes. The rules for its attainment are stated particularly, under six requisites, in order to become fully masters of the science.
As this treatise is short, I have judged it to be sufficiently interesting to give it nearly in detail. It has been, I believe, translated by M. Dacier—but I have never met with it. It has been illustrated by Zwingerus, Heurnius, Fonseca, and others.—Ed.
Of all the arts, medicine is the most illustrious; but the ignorance of its professors, and that of those who judge of their qualifications, is the cause of its having been considered as among the most contemptible. This, in my opinion, arises chiefly, from the circumstance, that medicine is the only profession, for which, in our cities, there is no penalty attached to such as ignorantly pursue it, beyond that of contempt. But ignominy scarcely wounds the ignorant. It is with them, as with the dumb performers of the theatre: they have the form, the dress, and mask of the real actors, but in nothing else do they resemble them. So we find many who are physicians in name and appearance,—but few who are such in reality. Six things are required to constitute a physician:—Natural talents—a good education—a competent instructer—early study—industry, and adequate time. The chief of these, is natural talent. In want of this, all is useless. But if this is possessed, the art may be acquired, by due attainments previously;—and by beginning to study it at an early age, and in a proper place. We must, moreover, be industrious, and continue long in study, by which means the science becomes, as it were, natural,—rapidly increases,—extends its researches, and brings forth mature fruit.
The study of medicine may be compared to the culture of plants. Our nature or disposition is the ground; the precepts of the teacher are the seed; commencing our studies early, resembles the sowing of the seed in a proper season; an appropriate location for the pursuits of study, resembles the surrounding atmosphere which affords nourishment and growth to the plant; diligence in study, is like the various means pursued to render the ground fertile; finally, the long continuance of our studies, resembles the period essential to full and perfect fructification.
Those who fully attend to the above precepts, will attain to a true knowledge of medicine, and should every where be considered as masters of their profession, and not merely nominal physicians. They may come forward with confidence; whilst ignorance proves but a poor foundation, and an empty treasury at all times; the enemy of all confidence and trust; a source of audacity as well as of timidity—since timidity is the offspring of weakness, as audacity is of ignorance. Science and opinion govern the world: the one points out our knowledge—the latter our deficiency. Things of a sacred character should be unveiled to the pure alone; for it is sacrilegious to communicate them to the profane, before they have been initiated into the mysteries of science.
Note.—“Lex, νομος, licet proprie non sit terminus medicus, Hippocrates tamen transsumsit e foro politico in medicum, &c.” De necessitate legum adversus pseudomedicos, vide C. Regies, Camp. Elys. Q. 21. n. 16.—Castelli Lexicon Medicum.
ON THE ART OF MEDICINE.
SECTION I.—TREATISE III.
In his prefatory remarks, Haller says that Mercurialis regarded it as spurious, and unnoticed by any of the ancients except the author of the Definitions. He says it is altogether a tissue of reasoning; it enters into a defence of physicians, and regards them as free from blame when death takes place, which he considers as rather dependent on the fault of the patient, or the impotence of medicine from the insufficiency of its means, when no suspicion of the intelligence or attention of the physician can be apparent. Neither is it considered as correct, that any one is restored to health without the employment of medicine, although unattended by a physician, since every thing that is beneficial or injurious, pertains to medicine. Nor is the physician blamable who refuses attention to desperate diseases. It proceeds then to the consideration of several particulars of an obscure nature in the human body, which are to be comprehended through a process of reasoning, depending on the manifest qualities of the excretions, &c. Some notice is taken of several of the cavities, the cellular tissue, &c.
The order of the treatise is a dissertation against the calumniators of medicine, whether sophists or the common people. It refers primarily to the arts in general, and then to medicine in particular, the certainty of which, as an art, it professes to demonstrate; this is followed by a variety of topics, appertaining to the physician, to the patient, and to the disease. We give a free translation of the whole.—Ed.
Note.—“Ars, τέχνη, verum est genus medicinæ, quicquid nonnulli Arabum secuti placita regerant. Denominatio a fine petenda est ultimo. Quæcunque igitur terminantur operatione, sunt artes: quorum terminus est sola cognitio, scientiarum nomine venire debent. Imo χατ εξοχην vocab. hoc Medicinam significat., 1. aph. 1,” &c.—Castelli Lexicon Medicum.
Many undertake to decry the arts, not from any expectation of destroying them, but merely to evince their genius.a The real intention of an enlightened mind, however, is that of attempting to discover something new that may be useful, or to perfect that which is already known. To pretend to tarnish the labours of others by idle remarks without improving them, for the sole purpose of lessening their merit in the eyes of ignorance, is a proof rather of malevolence than of a good disposition. As ignorant and wicked people are naturally envious, it is of course to be expected that they will attempt to overturn what is good, or to ridicule its deficiencies: but they cannot attain their end. It is incumbent on all to uphold their profession to the best of their abilities, against insolence and temerity; and here it is my intention to defend medicine against injustice and calumny. If, in this intention, there is any presumption, considering whom I am to attack, the art I profess to defend, will render my attempt easy,—the principles on which it is based will afford ample means.
It will be admitted at once, that there can be no art, in respect to things that have no existence; it would be absurd to treat of a non-entity in any way; for how can any conceive the mode of existence of what has no existence? and if it is impossible to see what does not exist, as we see that which does, by what means shall we know it, or whether it be good or bad! Were this possible, I cannot perceive how we could discriminate between non-entities and those things that are cognizable to our senses. Existing things may always be perceived—and by this alone that existence is appreciated. Those arts which exist, are known by our seeing them, for not one exists that is not manifest in some way. Now it is the particular species of art, that has given to each its especial title. It would be absurd to suppose the particular species is owing to its name,—that is impossible. Names are merely conventional terms, whereas species are the real products. If the reader does not comprehend this sufficiently, he must have recourse to other works.
As to medicine, our present subject, I undertake to demonstrate its existence, and what it actually is,—I commence therefore with its definition, according to my apprehension.
Medicine is an art that cures the sick, or lessens their pains, and which has nothing to do with incurable diseases: for that which is irremediable, medicine knows not how to attempt its cure. And I now proceed to prove, that it performs what it promises, and that it is always capable of doing so; and I will at the same time refute the reasons of those who attack it in those parts, wherein to them it seems most weak.
My first proposition no one can deny. It will be admitted that some of those who apply for medical assistance have been cured, but not all: and it is this which has given rise to the opposition against medicine. Its enemies assert, that the larger part of those attacked by the same disease, and who are restored to health, owe it to good luck, and not to the rules of art. Now, I have no desire to rob Fortune of her just rights, and therefore I must acknowledge that all who are well attended to, are very fortunate, whilst those who are neglected or illy treated, are extremely unlucky. But how happens it that those who are cured, should prefer ascribing it to any thing rather than to art, when their cure has been actually accomplished solely by their having employed and attended to its rules? They did not commit themselves to fortune, but called in the assistance of art. Hence, they are in this respect altogether absolved from all acknowledgment to the former, but not so with respect to art. They recognise art, insomuch as they pursued its rules, and cannot deny its existence, when evinced in the effects it has produced.
But it will be said, that many sick persons have been cured without the aid of a physician. Who doubts this? It is very possible, that without having called in a physician, they, nevertheless, have fallen into the arms of medicine. Not that they knew what medicine approved of, or disapproved; but they happily employed the very means which a good physician would have himself made use of, had he been called to their assistance; and, it is a strong evidence of art and its powers, when those, who have no belief in it, yet owe their safety to its rules: for it is certain, that those who have recovered, without the aid of a physician, must have been cured, either by doing certain things, or by doing nothing. In fact, they have been saved, by food or by abstinence; by drinking or abstaining from drinks; by bathing or not bathing; by labour or rest; by watching or sleeping; or by an alternation of all these. Now, since benefit was obtained, they must of necessity admit, that there was something done, by which that benefit was obtained. On the contrary, if injury was sustained, it must equally have arisen from something. It is indeed true, that few are qualified to distinguish between what was beneficial or hurtful to them. He, however, who is capable of such a discrimination, and of justly appreciating the measures he may have adopted, will equally discover, that what has saved him, is, in fact, a part of medicine. Even the faults he may have committed, are not less striking evidences of the existence of medicine: for, that which benefited, did so, only on account of its timely employment; as, on the contrary, what was injurious, was so, only on an opposite reason. Now, wherever the good, or the bad, has its own peculiar termination, how can it appear that art has no existence? For myself, I think, that art can alone be absent, when what was done, produced neither a good nor a bad effect; and that, when either appears, the existence of art, is fully substantiated.
I admit, that if medicine and physicians effected cures by purgatives or astringents alone, our arguments would be weak;—but we see the ablest physicians cure diseases by regimen, as well as by every other kind of remedies. Now, we must admit, unless we are ignorant, or deficient in understanding, that the employment of regimen, is a dependent on art. Nothing is useless in medicine in the hands of good physicians—we see various remedies, and cures in many instances, under the operation of nature, as well as through that of human industry; and such as have been restored without the aid of a physician, can in no respect attribute their recovery to chance, with any just foundation.
Chance, when we come to examine the phrase, means absolutely nothing. Every event has a certain cause, which is, itself, the effect of some preceding one. Chance, therefore, cannot be said to have existence. It is a term employed by ignorance for what it does not comprehend. But medicine is, and always will be, seen and demonstrated in its effects, induced by causes, which necessarily are incapable of producing any others,—and this is our answer to those who attribute their recovery to chance, rather than to the art of medicine.
As to those who allege the number of deaths under the employment of medicine, I wonder what reason so evident can be given, that complaint should be made of the ignorance of the physician, rather than of the irregularity of the patient; as if it was possible for the former, alone, to practice incorrectly, and impossible for the latter, to counteract his directions! It is much more credible, that the latter is the case. In fact, when an able physician undertakes a patient, and is sound in mind and body—is he not qualified to reason on the present state of the patient, and to compare his disease with such as he had previously seen, either the same, or approaching thereto, and which he has cured by the admission of the patient himself? Whilst the patient knows neither his disease, nor its causes, he knows not its termination, or what has taken place under similar circumstances. He receives his directions under present pain, and future dread. He thinks only of his disorder, and is weakened by want of food. He desires what is agreeable, rather than what may cure him;—not that he is desirous of dying, but that he detests physic. In such a case, which is most probable? That the patient duly obeys his physician, in all his directions, or, that the latter, with the qualities above stated, should practice erroneously? Is it not more likely that the physician performs his duty correctly, and that the patient (incapable sometimes of paying obedience) does disobey, and falls a victim to his own folly? Those who incorrectly judge of events, accuse the innocent, and exculpate the guilty.
Others there are who condemn medicine, under the pretext that physicians never undertake the care of those, who are already overpowered by disease. They say, that he cheerfully attends on such as would recover without him—but not a step will he take in behalf of those who are most in need of his assistance. If there was an art of medicine, they moreover say, it ought to cure these as well as the former. Those who speak thus, would have more reason to complain of a physician who would not treat them as fools, than they have, to accuse medicine in such manner. He who requires of an artist, what belongs not to his art, or what is beyond its power, is more knave than fool. We can effect every thing that is capable of being accomplished through the means of Nature, or of the instruments of our profession; but we possess no more. When the disease is more powerful than any of these means, it cannot be expected that medicine can overcome it. Thus, we have many caustics in medicine, of various powers, of which fire is the most so. We may reasonably doubt, in such cases as require the use of caustics, whether the highest degree of evil in such case, would not resist the fire, whilst we have no doubt of its utility in an inferior grade. Now, in such cases which fire cannot reach, nothing can be expected of an art that has no power stronger than fire. It is the same with all the instruments of medicine, and I apprehend, therefore, that when employed in extreme cases without advantage, the fault is in the violence of the disease and not in the art.
Some there are who reproach us for avoiding such as are already worn down by disease: this is like requiring of any art, to do that which does not belong to it. Nominal physicians will, it is true, undertake this from a desire of admiration; but they are looked on as ridiculous by real ones. Those who are masters of their profession, care neither for the praise nor reproof of such people—they esteem those only who know how to discriminate, and discern when and wherein the operations of art are perfect or imperfect, and whether the imperfection arises from the workman or his subject.—We may, perhaps, in a future treatise, take notice of what belongs to other arts. As to medicine, we have already shown what it is, and now proceed to point out how it is to be judged of.
All who are acquainted with it, will admit that there are two classes of diseases: one, affecting the external parts, and few in number; the other is in vast amount and attacks the parts that are internal and concealed, wherein they manifestly differ from the former. They are apparent both to sight and to the touch, by tumours, redness, &c.; and evince themselves by hardness, coldness, moisture, heat, &c.,—and thus enable us to recognise the presence or absence of such or such qualities as may or may not belong to them. There ought to be no mistake as to these,—not that they are easy to be comprehended, but because they are readily discovered, at least by those who are qualified to seek for them, by industry and natural attainments. Our art abounds in resources for visible diseases,—nor are they less abundant for those of a hidden character, or which attack the cavities or bones. The human body has many cavities: thus, two exist for the reception and discharge of food, with many others, known to those who have studied the subject. All those fleshy, rounded parts, called muscles, are cavernous; all parts, in fact, in which there is defect of continuity, are cavities, whether covered by flesh or skin,—and they are filled with air (spiritus) in health, but in disease with unhealthy humours. Such fleshy parts are seen in the arms, the thighs, and legs. Even those parts that are not fleshy, have a similar structure. For instance, the liver concealed in the abdomen, the brain in the skull, the lungs in the thorax, &c., all have cavities with subordinate divisions, or vessels, filled with humours of a healthy or injurious tendency. There are, moreover, nerves and vessels innumerable, passing to the bones;—and ligaments and cartilages belonging to the joints, wherein the bones move, and which are moistened by a glairy fluid (synovial) emitted from small cavities, which sometimes discharge much sanious matter when they are opened, accompanied with extreme pain. Now, none of all these parts are apparent to our sight,—and hence the above division of diseases into concealed and apparent. It must not, however, be supposed, that those thus latent are beyond the reach of medicine. The possibility of this depends very much, nevertheless, on the accuracy of the report by the patient of his complaint, and the tact of the physician in his interrogatories. Sometimes this seems to be attained as by intuition, although more time and labour are required than in the case of external diseases. The evil experienced by the sick from the delay of making known their disease, ought not to be attributed to medicine, but to the patient, or to the actual violence of the complaint. The physician who cannot by sight detect it, nor by the imperfect statement of the patient, is obliged to recur to reasoning; for it is certain, that when describing their internal complaints, they speak more from opinion than from any certain knowledge. Were they possessed of this, they would not require the aid of the physician, since the same science which enabled them to know their disease, would equally teach them the appropriate means of cure. Hence, since the physician cannot derive from the patient’s report a certain and absolute knowledge of his complaint, he is obliged to attain it in some other mode—which necessary delay, is not the fault of art, but arises from the nature of the case itself. Medicine requires only to know the disease, in order to proceed to its cure; yet, with prudence devoid of temerity, and depending more on patient attention than on violent efforts. It is requisite also, that the disease be curable, and that time be allowed for the purpose. If then the disease is known, and is found to be too powerful, either from its nature or from delay of calling in medical aid, the patient will die; for it rarely happens that it is too powerful, if soon attended to. Disease is rarely victorious, except from being permitted to gain too great advance, which arises from its concealed character, or from delayed assistance. It is, therefore, in my opinion, more correct to praise the art of medicine for the cure of such concealed diseases, than for undertaking, what it is impossible it can perform. Is there no parallel to be found in the other hitherto known arts? Those who employ fire in their operations, must remain inactive when their fire is extinguished, and must postpone their labour until it is again relighted. Most of the arts are exercised on subjects, where the work can be corrected; such as wood, leather, brass, iron, and similar materials. Here, nevertheless, far from precipitancy in working them, all necessary time is afforded in order to perfection. Should any requisite instrument be wanting, the work is suspended, and remains imperfect. In all these cases, in which slowness is more inconvenient than useful, such delay is nevertheless approbated. Medicine is the only art, in which, although error is almost invariably irreparable, haste is required to satisfy the impatience of the sick, without due attention to its rules, although, as we have stated, it is incapable of attaining a knowledge of many diseases, by the sense of feeling or of sight. It neither perceives the diseases of the liver or of the kidneys, nor the abscess that may exist in the chest or other cavity. Here, and in like cases, it has adopted other means of conduct. Thus, it considers the voice, as to its clearness or hoarseness. It examines the discharges from certain regular channels; and drawing consequences from their odour, colour, consistence or fluidity,—he judges of the character of the disorders, and the existing state of the patient; and by the same means, medicine is even enabled, not only to ascertain the past, but likewise his future state. After having thus become acquainted with diseases, by their symptoms, if nature is unable to effect a cure, art then teaches how to excite those salutary movements, by which, without danger, the system may discharge itself of what is injurious to it.
It is in the efforts of nature that an attentive and skilful physician perceives the measures he ought to adopt. If pituita predominates, by diet and acrid drinks, he excites the natural heat, and thus discharges it. By exercise, he causes respiration to testify still further to his senses. Sometimes, he has recourse to sweating, through the agency of warm baths. In some cases, he prefers to examine the urinary evacuation; and by appropriate food and drinks, the humours are aided in their discharge, which would not otherwise be accomplished. But as the vitiations differ, so also are there different symptoms, and different remedial means, through which the physician becomes enabled to estimate the treatment he ought to pursue.
It is then by no means surprising, that the physician should be slow in forming his judgment of diseases, before he undertakes their cure; since he has, as it were, to negotiate with them, by the agency of an interpreter. It appears, then, from all I have said, that medicine has an appropriate means of discovering the mode of cure, or at least of assuaging the sufferings of disease; and that it is not deficient in substantial reasons, for declining those that are incurable, or at any rate, of overthrowing the unjust reproaches made against physicians when unsuccessful in such cases. Much more might be said in these particulars, as derived from the manifest and daily proofs afforded by skill and attention. Facts are far superior to reasoning; and instead of calling for admiration of their eloquence, such practitioners will refer you to the visible effects of their care and attention.
THE ART OF MEDICINE IN FORMER TIMES.
SECTION I.—TREATISE IV.
This treatise, says Haller, is correctly considered as spurious, by Mercurialis. It is manifestly posterior to the time of Aristotle, whose principles it altogether repudiates. It is entirely devoted to reasoning, but learnedly and acutely written. The origin ascribed to medicine is very probable, in a due attention to what proved hurtful or useful in diet, and in conforming its employment to the state of disease. It was undoubtedly imperfect at first, but is not undeserving of praise. It confutes the hypothesis of four primary qualities, viz., hot, moist, cold, and dry. Asserts diseases to arise independently of these, and attributes them to an acid, saline, acerb or bitter humour, secreted, and acting alone, or conjointly, by which changes occur in them; or to a change of form in various ways, productive of fluxions, wind, &c.
The treatise is stated as pointing out the antiquity, invention, certainty, and importance of medicine. Of food, generally and particularly, as of broths, drinks, bread, wine—by the first of which, seems to be chiefly meant barley water of varied strength, and constituting a chief part of dietetic practice; it then proceeds to consider primary and secondary qualities, and is followed by that of fluxions, humours, and flatus.—Ed.
Those who have undertaken to treat of medicine, have manifestly been deceived in most particulars, by attempting to found this doctrine on the hypothetical notions of cold and hot, of dry and moist, thus reducing to one or two principles the causes of death and of disease. Of this our art may reasonably complain, since its reality is acknowledged by its daily employment, and its cultivation in the hands of the most able practitioners. Doubtless there are among physicians both good and bad; and this is another proof of its existence, since, if it did not exist, this could not be the case, for all would be alike ignorant, and chance alone would decide as to the mode of treatment. We see, however, in medicine, as in other arts, workmen of infinite difference, as it respects the practice, both manual and mental.
Recourse to hypothesis should therefore be avoided in medicine, and left to subjects obscure and doubtful, which afford nothing better to their advocates. Thus in astronomy, &c., however persuaded we may be of the truth of our opinions, yet we cannot establish them fully, so as to destroy completely the doubts of others, since there is no established rule of truth, to which we can at all times refer. Such a rule, however, exists in medicine; it is an art of long existence, of sure principles, and certain regulations, through which, for a long period, numerous discoveries have been made, and which are confirmed by experience, unmixed with hypothesis. Much is, however, still required to render it perfect, by the researches of the learned; and by the aid of what is already known, endeavour to obtain the knowledge of that we know not. All those who depart from well-established rules, to riot in the path of novelty, and boast of having discovered something in our art, deceive themselves as well as others. I shall endeavour to prove this, by pointing out what medicine really is; from which it will appear, that all deviation from its present route is to be avoided.
And first it seems to me, that in treating of this art, we ought chiefly to notice such things as all mankind will agree in, for the researches of the physician should be confined to diseases to which every one is liable. It is true, that as the majority are uninformed, they cannot of themselves know how their disorders commence, nor how they will end; what increases, nor what moderates their force. This is, however, readily acquired through the information derived from those acquainted with the subject, and this more easily, since nothing is remembered with more facility than that which is the result of self-experience. A physician who is unable to make himself understood by the most ignorant, or convince them as to the nature of their complaints, would be ignorant himself, and would not mend the matter by mere speculation. Medicine would never have been discovered, had not speculation come to its assistance. No one, indeed, would have troubled himself respecting it. What need could the sick have had of medicine, who lived exactly as those in health, had they never drawn a comparison between their own state, and of those who pursued a different regimen, and observed the superiority of the one to the other? It was by noticing an apparent injury or benefit, which led them to a discovery of our art. This arose from the sick discovering that they were injured by the use of food that was beneficial in health, just as we now find to be the case. We may even go further, and say, that the diet and food in health that is now employed, would not have been found out, if men had been content with that of animals, such as grass, hay, and the fruits and productions of the earth. All animals well fed, are healthy, without any other kind of nourishment. At first, mankind lived like the beasts; and food, as at present prepared, has only been introduced, because that which was first employed was too simple and indigestible, and was, as at present, the source of indisposition, violent pains, severe disease, and even of death. It is true, habit, then, rendered it less dangerous and more supportable, yet still it proved injurious. They whose stomach was enfeebled, soon perished, whilst such as were of a stronger constitution, resisted for a longer time. Just so we find it at present; some readily digest the strongest food, which to others is difficult in the extreme. Hence arose the necessity for seeking a diet adapted to their nature, and by degrees they were led to that we now employ. After having thrashed out and washed the grain, ground and sifted it, it was kneaded and made into bread and cakes, or boiled and roasted with other things. A mixture was formed by food of different strength, in order to accommodate it to the constitution, from the belief, that eating any thing too strong and indigestible would induce pain, disease, and even death, whilst that which was appropriate and readily digested, became the source of health and strength.
Now, what more fitting name could be given to this discovery than that of medicine, which means the method of remedying evil, since this invention was intended to produce a healthy nourishment, and to preserve health, by securing them from an irregular diet, productive of pain and disease? It may indeed be said, that this primary invention is not an art, since, in what is now well known, and uniformly employed, it would perhaps be unusual, to qualify the practice by the name of an art. It at least is the fact, that such practice and invention is highly important, and is the fruit of great art and much consideration. We see in the present day, individuals appointed in our gymnasia to superintend the Athletæ, continually making discoveries in the same way, as to the most appropriate diet for those persons.
Let us examine now, how medicine, properly so called, and invented for the benefit of the sick, deserves the name; how it gave rise to artists, and why there is so much difference between them. I believe firmly, as I said before, that no one would have been led to seek for it, had the same food and regimen been equally proper both in health and sickness. We still observe among nations where medicine is unknown, that both in health and sickness, the same diet is employed. Every thing gives way to the wish of the moment, nor do they abstain from any thing that gratifies them. But, where the art is known and its dictates pursued, it is reasonable to presume that similar impressions led to the same results, as in the case above mentioned. They began by lessening the amount of food in case of sickness. This proving beneficial in some instances, but insufficient in others of greater intensity, a still weaker diet was deemed requisite. Thus they were led to employ diluted food or broths, by mixing small quantities of stronger food with water, and thereby weakening them, as well as by their mode of preparation. If even this nourishment proved too powerful in some diseases, it was discontinued, and liquids of a simple nature, regulated both as to quantity and quality, came into use. Even such slops (Sorbitiones) are occasionally injurious, increasing the complaint without strengthening the patient—all which proves, that food over-proportioned to the state of the patient, is equally injurious as in health. What difference then is there between the discovery of an appropriate regimen in disease, by a physician, and that originally contrived, in the change of the primary savage diet, to that which is now universally adopted? I think it is the result, in both instances, of one and the same invention. There is only this difference, that the last is more varied and extensive, requiring greater reflection and experience, although it is plainly deducible from the former.
If we compare the regimen of health and that required in disease, it will be perceived that ordinary food would be much more injurious in sickness than the first rude and savage nourishment would be in health. Thus, a person attacked with a disease, not of extraordinary violence, and yet somewhat dangerous, unacquainted with the risk he runs, eats bread, flesh, or other food appropriate to health, whilst another, in health, employs that which is used for animals, such as peas, barley, &c. It is certain that the latter will not be equally incommoded as the former, and this is an additional proof of the art of medicine having been discovered in the manner I have stated.
If it was the fact, as some imagine, that too strong food alone is hurtful, and that a weaker kind was equally useful in health and in disease, nothing would be easier than to fix upon a good regimen; for all that would be required, would be the mere reduction of all to a proper medium. Unhappily this is not the case. The fault is not lessened, yet the evil is as great, from the excess or defect of nourishment.—Hunger has an amazing power over man, either to cure, to weaken, or even to destroy life. Repletion causes many different disorders; inanition is productive of others not less hazardous. Hence this last, as a remedial means, is more extensive than the former, and demands more care and attention. A happy medium is a desideratum; but for this we have neither weight nor measure to assist us. The personal feeling of the individual seems the best resource; but how we are to avoid all error in the case, is the difficulty; and I will cheerfully praise the physician, who, in such circumstances, is guilty of but trifling mistakes; to avoid them entirely is almost impossible.
Most physicians resemble unskilful pilots, whose faults are unperceived in calm weather, but should a storm arise their ignorance is manifest, and destruction follows. So with the ignorant physician, in his treatment of trifling diseases, wherein he may make the grossest mistakes with impunity and escape detection; but if by misfortune they meet with a violent and dangerous disease, they are at fault; their ignorance and presumption are apparent to all, and their punishment promptly follows.
That improper fasting is as dangerous as over-eating may be proved by the example of those in health. Some have made it a rule to eat but once a day. Others, to preserve their health, make two meals daily. I do not refer to those who occasionally, or from revelry, do the same, for there are constitutions which are enabled to bear such changes with impunity, and make one or two repasts, although not accustomed thereto. There are many, however, who cannot deviate from their customary habits, without immediately feeling its influence. If, used to one meal only, they take another, they feel tired and stupid; they yawn, are drowsy, and very thirsty. Flatulence and colics assail them, and not unfrequently some severe disease attacks them; and all this arises from deviation from their single meal. On the other hand, when the first accustomed repast is neglected, the usual period for it has scarcely past, when they feel weak and tremulous; their eyes are languid, their urine becomes hot and turbid, and a bitter taste is felt in the mouth. Bellyache succeeds, with vertigo, irritability, moroseness, and dulness. At the arrival of the period for their second meal, they are incapable of digesting it. It is attended with flatulence and colic, and costiveness ensues. Their sleep is disturbed, uneasy, and troubled by dreams. And in like manner, these symptoms are the precursors of severe sickness.
From whence do these symptoms originate? In my opinion, he who is accustomed to one meal alone, is incommoded only from not allowing his digestive organ full time for disposing of his previous meal of the preceding day—but he fills it afresh, before the former food is properly concocted. Such stomachs digest much more slowly than others; they require more relaxation and repose. He, on the other hand, who has been accustomed to two meals, and omits the first, suffers from not affording his system the nourishment it required at a fixed period; that which had been previously taken having been completely exhausted. It is hunger that undermines and consumes him, and his situation I ascribe altogether to it; and any one who should pass two or three days without food would experience similar symptoms. Those constitutions that feel violently and speedily the slightest errors, may be considered as being weaker than others. Disease is the near neighbour of such debility of constitution. The difference is, that the debility in this case being greater, the slightest error in diet must be felt in a greater degree. Medicine requires, therefore, in such cases, very great strictness. It is undoubtedly difficult to attain a certainty; but art has discovered various modes of approximation, which ought to be well known, and will be duly treated of. There is no justice in opposing the ancient medicine as being founded on bad principles, from the pretext that it is not yet perfect. On the contrary, it is deserving of admiration from its advancing so far towards it, and from its having, in a period so unenlightened, discovered the route pointed out by reason, as the sure way to reach perfection.
As to those who have endeavoured to attain the art by a plan altogether new, and strive to establish its foundation on hypothesis, I would ask them which it is that is prejudicial, hot or cold, dry or moist; and if a skilful physician ought to correct each of these qualities by their opposites? Give me an individual of a weak constitution, and let him feed on wheat just thrashed, or raw flesh, and drink only water; they must admit that such fare will produce much evil, such as violent pains, deranged stomach, debility; he would not long survive. What assistance does he require? Cold, hot, dry, or moist? Which shall we select? If it is one of these four that has caused the disorder, we must choose its opposite, according to them. But the most direct and certain remedy is a change of food, giving bread instead of grain, cooked meat in place of raw, and add wine to his water. Such a change would speedily restore him to health, unless the injurious regimen had been too long persisted in. Will they persist in saying that his disease had been caused by cold, and that they had dissipated it by heat, or reversely? It would be difficult to prove the truth of such responses.
In making bread, the above four qualities are removed from the wheat. Besides this, water, fire, and many other things, each possessing its own peculiar powers and qualities, are employed. It loses part of what it had, and what remains is a compound mixture. I am convinced, that the action of bread on man is very different, according as it is made from well-washed grain or from that which has not been washed; or from white or brown bread; between that which has been kneaded with much or little water, and between ill and well-baked bread. Many other circumstances produce great difference. The same may be said of barley cakes, where we find numerous and different qualities. How can one, who has never examined this, nor thought about it, become acquainted with diseases, when each of the particulars above mentioned is productive of different sensible effects, on which depend the lives of healthy persons, of convalescents, and of the sick? Nothing is more important than a full acquaintance with all these different qualities. They who have rightly pursued the art of medicine, have therein found the variation in the nature of man: a subject so extraordinary, as to have ascribed it to a Deity. They have not considered whether it was the cold, hot, dry, or moist, that benefited or injured man; but believed that injury was the result of an excess of power, which human nature could not overcome, and which they therefore strove to weaken, by opposing mild things to stronger of the same nature, weak bitters to the more powerful, &c., and thus of every thing carried to its highest grade. They observed that all these qualities were found in man, and all at times became prejudicial. In fact, there is in him, both bitter, saline, mild, acid, acrid, insipid, and many other qualities, possessed of different powers, in proportion to their quantity and degree of strength. All of these, when well united, and tempered by each other, are insensible to us, and do no injury; but if one should separate, and exist alone, it then becomes sensible, and ravages the system. It is the same with aliment. That which is improper for us, is either bitter, saline, acid, or too strong. Hence it is productive of the same inconvenience as the humours I have mentioned, whilst that which is appropriate possesses none of those injurious qualities, nor is it too powerful. Such is the case with bread, barley cakes, and other similar articles, employed in profusion by mankind. I do not speak of dishes and preparations, intended solely to gratify the taste or irritate the appetite. Such are highly pernicious. I refer to common nourishment, which causes no uneasiness, or any separation of the particles of the humours of the body, and serving only to strengthen, nourish, and promote its growth. All these benefits arise from its well-attempered state, in which nothing predominates, nothing is irritating, nothing too strong. Every thing is reduced to a point, so as to be esteemed simple, homogeneous, and at the same time, of adequate strength.
I cannot imagine how the partisans of this doctrine, which is so distant from the true route of medical science, and so beset with conjectures, could contrive to practise on their system, for I do not think they have ever discovered any thing, that is, per se, hot, cold, dry, or moist, and unparticipating in any other quality; nor that they have other varieties of food and drinks than those familiar to us; but it has pleased them to call such a thing hot, that one cold, this dry, and another moist! Now they must be embarrassed should they order something hot, and the patient should ask them which; they must therefore either trifle with him, or change their notions; for if the hot is always conjoined with the bitter in one thing, with the insipid in another, and with the nauseous in a third, and if many other qualities are also united with the hot, even such as are of a contrary nature, which of all these hot things will he direct? the hot and bitter, or hot and insipid, or perhaps, something that is cold and bitter, for such there are as well as cold and tasteless. But we well know that each of these four varieties produces contrary effects, not on man alone, but likewise on leather, wood, and many other bodies, far less sensible than that of man.
It is not the hot that exercises such power, but the bitter, the tasteless, and the other qualities I have mentioned, that produce a powerful effect both externally and internally on man, whether in eating or drinking, or in employment of external applications. In a word, heat and cold, of all qualities, I conceive to be those that have the least power over our bodies, and for the following reasons. Whilst the hot and cold are well united together, they do no harm, since they mutually neutralize each other; but if disunited, or either predominates, then they prove injurious. Even here, however, if it is cold that affects us, the injury is not of long duration; for our internal heat immediately opposes it with all its power, without the need of other assistance, and this both in health and disease; hence we see that if in health we are made extremely cold, by winter or cold bathing, or other cause, the greater the degree of cold, not amounting to an actual freezing of the body, in the same proportion will he be warmed by clothing himself, or getting under cover. So likewise, if much heated by the warm bath, or a large fire, he continues with the same clothing, in a place but little cooler, it will appear much colder to him; and should he expose himself to a draft of air, or fan himself, the sense of cold will be greatly augmented. This is still more evident from walking upon ice or snow. The feet, the hands and face, suffer much from the cold, and when covered up in bed, they suffer from heat and irritation, and sometimes small vesicles appear on the skin, as if it had been burnt by fire. So long as the cold continued, this was not felt, so true it is, that these two opposing powers succeed each other quickly. Many other instances might be adduced, but we will now examine what ensues in case of sickness. In the instance of fevers, in proportion to the violence of the chill, will be that of the subsequent hot stage. If the chill was not of long continuance, the fever is commonly of short duration, and rarely dangerous. In terminating, the heat retires last from the feet, as being the part of the body in which the cold had been most severe, or of longer continuance. At length, when the sweating stage has carried off the fever, the patient’s sensations are much more cool and refreshed, than if he had not had the preceding febrile state. Since, then, these two opposites so quickly succeed each other, and thereby temper their respective excess, what great harm can result, or what need of much foreign assistance?
It is asserted that those who have ardent fevers, or inflammation of the lungs or other parts, are not so speedily liberated from the heat, nor do they feel this beneficial influence of the cold. I reply to this, that I consider it a certain proof, that fever does not arise from heat alone, but requires the co-operation of other causes. We have a hot bitter, a hot acid, a hot salt, and many more of different character; and the same may be said of cold. Now these are the causes of the disease. Heat is present undoubtedly, but it exerts no injurious effects, unless conjoined with some other quality, which irritates, and augments its influence, without which it possesses alone its own appropriate power of warming.
We have one fact, among many others, of the most conclusive character, that is, when attacked with a cold in the head, and a discharge from the nose takes place, the humour is more acrid at the beginning than that which is natural to the parts. The nose is swelled and inflamed, and the increased heat is manifest to the touch. If long continued, the humour produces excoriation; at length the symptoms become moderated, but not until the humours become thicker, less acrimonious, more concocted and commingled, than at first. It is true we have such fluxions, manifestly induced by cold alone; such are cured by warmth, just as affections resulting from heat alone are removed by cold, and in both cases, promptly and without coction. All other fluxions arising from acrimony and an ill state of the humours, are only cured by the concoction and bland state that is brought about in them. So also we see fluxions on the eyes, owing to various acrimonies that ulcerate the lids, excoriate the cheeks, and even destroy the cornea. These violent effects are only terminated by the concoction of the humours, becoming thereby more consistent, and of a purulent nature. Now this concoction is accomplished through the mixture and modified temperature of the humours. We observe in like manner fluxions on the fauces, throat, &c., inducing hoarseness, quinsy, erysipelas, peripneumony;—all such humours are at first salt and irritating, and thus produce and maintain these complaints; but when they become thicker, and by concoction lose their acrimony, then the fever declines, and the evil passes away. Now if hot or cold, without the addition of any other quality, should induce disease, and such is sometimes the case, then it ought to terminate so soon as they are respectively changed for each other; in all other cases, the evil ensuing arises from the agency of other powers. Thus, when a humour, called yellow bile, is diffused through the system, what anxiety, heat, and debility immediately ensue! A spontaneous discharge from the bowels, or produced by medicine duly and appropriately, almost as rapidly put them to flight. But if this humour is allowed to remain, crude and unconcocted, the fever and pains will continue unabated. But if the humour be that called green bile (æruginosi humores), how raging are the symptoms, and the pains in the intestines and chest! Nor do they cease, until this bile, mixed and weakened by other humours, is discharged. There are several ways of concocting, weakening, and inducing the natural consistence of such humours; and to these we are wonderfully assisted, by a knowledge of crises, and of critical days. It is neither on the hot nor the cold that we are to operate, for they can neither concoct, nor render consistent. What then is accomplished? We reply, that they are capable of admixture, and that by this they destroy each other’s influence. Mixed with any thing else, they still are hot and cold, and cease not to act, unless commingled together. The other qualities in man, the more they are mixed together, so much the milder and better they become; and man is never in better health, than when these humours are thoroughly concocted and at rest, without any one predominating; and this, I trust, is sufficient, so far as respects the hypothesis of these four qualities!
I will now say a few words relative to sundry philosophers and physicians, who affirm, that it is impossible to become acquainted with medicine without previously knowing the nature of man, and how he was first formed and created. I think myself, that all that they have written or said about nature, is infinitely less useful to the physician than to the book-maker; and that, whatever can be best attained respecting the nature of man, is through the means of medicine itself; nor can it be attained, without a full acquaintance with this art in all its vast extent. I have known many persons thoroughly acquainted with all that has been said by those writers respecting the nature of man, &c. But all that is requisite for the physician, on this head, in order to practise successfully, is that which is connected with his food and drink, and the changes which different articles are capable of producing in him. It is not sufficient to say that cheese is injurious, because it induces pain from eating it in excess. We must know also, what kind of pain, and which, and why, such or such parts of the body suffer from it. Amidst our food and drinks, there are many that are bad, which do not affect the system in the same way. Pure wine, taken in excess, weakens—as those acquainted with its powers well know, as well as the parts of the body on which it acts. Now I wish the same information, as to other things. Cheese, since we have mentioned this, is not injurious to every one. Many employ it largely, without any bad effect. Nay, it is beneficial to thin persons; although, it is true, that some are much incommoded by its employment. This depends on a difference of constitution, and this is owing to something in the system that is inimical to cheese, and by its presence it becomes excited; and the more abundant the humour and powerful, the greater will be the opposition it occasions. If, however, cheese was contrary to the nature of man, all should equally suffer from it, and those who are fully sensible of all this, will not be led into mistake. In convalescence, as well as in chronic diseases, many troublesome symptoms ensue, some arising spontaneously, others from the rash or imprudent use of different things. I have known many physicians, as well as common people, attribute such symptoms to something out of the way done by the patient, as bathing, walking, or eating what they were not accustomed to; and limiting their views to this alone, although, in many instances, it might be the most appropriate step they could have taken. Ignorant of the cause, they blame at hazard, and prohibit that which is most proper. This is an evil of no trifling import. In order to avoid it, the physician should be acquainted with the different effects of bathing at a fit or improper time, and so of other things, for all act diversely according to circumstances. Now, a physician unacquainted with the comparison of action of different things, on man, under different circumstances, can neither know their effects nor employ them properly.
He ought, moreover, to know how to distinguish between those affections that arise from the functions, and those of his organization. I mean by the functions or faculties, the highest grade and power of the humours; by organization, the conformation of the parts that compose the body. Some of these are hollow and contractile, some expanded, others solid and round, or broad and pendent; some are broad, long, dense, thin, florid, spongy, and soft. Of all these, which are best adapted to attract moisture from the rest? The hollow and equally expanded, or the solid and round, or the hollow, gradually diminishing? Doubtless, the last, as exemplified externally. A man, for instance, cannot drink with his mouth open; but he closes his lips, so as to leave only a small opening, or by employing a tube, when the liquid is readily attracted. Cups, have been made on this principle, with a large belly and small orifice, to attract the humours from the flesh. There are in nature many things analogous. In the human body, the head and bladder, and uterus, for they all manifestly attract, and hence are always full of moisture. Those that are hollow, but expanded, although retaining fluids that are poured into them, yet they cannot attract them. Such parts as are solid and round, neither attract nor contain, for the liquids finding no place, will run over them. The spongy and soft parts, as the spleen, the lungs, the breasts, suck up the moisture presented to them, by which they swell and become hard. It is so likewise, with the cavities containing humours, as the stomach, or any into which a daily flow is made, with no power to distribute from its structure. These imbibe the humour, and by its incorporation, although small and empty, they become dense, firm, and hard, if concoction does not ensue, and the humour is not discharged. All this promotes flatus and pain, causing the sound that is heard in the large and hollow cavities of the chest and belly; for as this wind is not confined to one spot, its motion is accordingly accompanied by noise and uneasiness. Should it press upon the soft and fleshy parts, these will feel a sense of fulness and of numbness. Or should it be opposed by some large part, which is not strong enough to resist it without suffering, nor yet so weak as to yield, and give way to it; if, like the liver, the part is tender, florid, sanguineous, &c., its size and firmness prevents it giving way; the wind, from this resistance becomes more powerful, and greatly augments the evil. Hence so frequently arise such severe pain in the liver, terminating often in tumours and abscess. So also with the diaphragm, though in a less degree. It is a firm and resisting part, but being more tendinous and stronger, it is less sensible to pain; yet this occurs at times, and even abscesses are formed.
Many other varieties of form exist, both in and externally, very different from each other, and modifying the occurrences both of health and of disease. A large or small head,—a large, long, or short neck, a round or flaccid abdomen, narrow or broad chest and ribs, and many more, whose variations all require to be known, in order to be enabled to discover correctly, the true cause of the symptoms we perceive.
As to the powers of the humours, or what they effect on the system, we should be acquainted with their respective affinities. For instance, we should know, if a mild humour is changed into another kind, not by any mixture, but by degenerating from its pristine state, what is the first alteration it undergoes; whether it becomes bitter, saline, austere, or acid. The last of these is certainly the most injurious of all these changes which it could pass through; and whoever can, by his research on external circumstances, extend it to those of internal character, will be the best qualified to estimate their proper treatment, which consists in the removal, as far as possible, of every thing hurtful to the body.
OF THE PHYSICIAN.
SECTION I.—TREATISE V.
Haller, in his preface to this treatise, says, a more appropriate title for it would have been, “Of the Shop or Office of the Physician or Surgeon,” which is minutely described;—nothing is stated as to plants or medicines. It might be supposed to be written after the subdivision of the art, and during a period of peace, since the author recommends attendance on foreign campaigns, in order to attain a knowledge of the treatment of wounds. The treatise is intended to point out what a physician ought to be, both in respect to body and mind. It then describes the plan of his office or shop, in regard to situation, light, the various instruments and appurtenances required, and speaks of several operations, as cupping, scarification, bleeding, &c., of the extraction of darts, &c., of ulcers, and of tubercles.—Ed.
This treatise is intended to point out some short precepts and advice, as to what is essential to the physician; and first, as to his exterior; he ought to have a healthy appearance, and be of proportionate size to his particular constitution: for should he be otherwise, the public will believe him unqualified to attend to the health of others.—His dress should be neat, and his person clean and unperfumed, lest it might be supposed he employed perfumes to conceal some disagreeable emanation, that might be unpleasant to the sick.
As to internal qualifications, he should possess much prudence; not that merely which prevents indiscreet or untimely conversation, but in all his concerns. His mode of life should be perfectly correct; for good manners and modesty contribute greatly to his reputation. He ought to possess circumspection and humanity: haste and assurance will be followed by contempt, although they may occasionally benefit him, for it is not always possible to avoid his services. They are at times useful, but rarely to be employed by the physician who desires to secure esteem.
In regard to manners, he should be grave, without austerity, lest he should be considered proud or misanthropical; and he should avoid perpetual laughter and hilarity, for they are not at all times acceptable.—In his moral character, justice should predominate. It is at all times of infinite importance, and especially in that intercourse that exists between the physician and his patients. These place themselves entirely in his hands; at all times, wives, daughters, and goods are placed at his discretion. Well then does it behoove the physician to be continually on his guard.—And thus much in regard to his mind and body.
We will now take notice of what is requisite in the study and practice of his profession. In order to excel, it is essential to be careful in the choice of a teacher. Those who give instruction, usually have every thing requisite about them. They ought to be careful in the location of their dwelling, that it should not be incommoded by the wind or sun, to the injury of the sick. Too strong a light, though not felt by the physician, is painful to the sick, and detrimental to the sight; the meridian sun ought to be carefully guarded against, and the light should rather be admitted from the opposite side.* The seats of the patients should be of proper dimensions. No ornaments of brass about them; such are only adapted for the instruments; in any other respect they should be considered inappropriate. Good and pure water for drink should be provided for the sick, and the towels should be clean and soft. For the eyes, soft linen is employed, and sponges for wounds; the property they possess of swelling up, renders them very useful. All the instruments ought to be well made for use, as respects size, weight, and finish. In regard to external applications, such as compresses, bandages, plasters, and cataplasms, the greatest attention should be paid to their accurate adjustment, especially when they are to be of long continuance. The removal of dressings, and their renewal after washing and cleansing wounds, is soon done; the thing to be chiefly attended to, is as to the frequency of this, for much depends on acting correctly herein. As to bandaging, two things are essential, that the pressure should be on the appropriate part, and not be unduly tight. Attend also to the temperature, for the impression of the air is at times to be guarded against. He must also be acquainted with those weak parts, that will not bear too strong a pressure. Pay no regard to those intricate bandages that are more ostentatious than useful; they are superfluous, and often injurious. It is not ornament, but utility that is required. With respect to operations, either by the knife or by cautery, they demand both promptitude and caution, for both at times are proper. When a single incision is required, do it quickly; for, as cutting is attended with great pain, we must make it as short as possible; but when accurate dissection is necessary, it must be slowly accomplished, since, if too hastily effected, the pain is continual and severe, whilst some intermission of it is experienced by the former proceeding. Of instruments, it may be stated, that large or small knives are not to be indiscriminately employed. In the body are parts from whence the blood flows largely, and is not readily arrested, as from varices, &c. Small incisions here are proper, and give us the means of more ready restraint, whenever it may be necessary to allow its discharge, but in parts not dangerous, nor attended with hæmorrhage, large knives may be made use of, and the blood will be evacuated, which would not otherwise be the case. It is disgraceful in the surgeon not to effect properly the intention he had in view.
Cups are employed in two ways. If the fluxion is deep-seated, the neck and belly should be narrow, and the handle long, but light. Cups of this description draw in a direct line, and attract towards the surface the deep-seated humours. But if the affection is more external and diffused, the cups, in other respects similar to the above, should have a wide orifice, which adapts it to draw from a more extensive surface what is to be evacuated. If they are at the same time heavy, by their greater pressure, they act more deeply, and less superficially, thus perhaps leaving behind a part of the external humours. So likewise, if the fluxion is profound, should the orifice of the cups be large; they then act upon the surface, which thereby, from the moisture thus attracted, prevents that of the deeper-seated humours, thus leaving behind what was injurious, and drawing off that which did no harm. The size of the cups must depend on the parts to which they are applied. If scarification is necessary, make the incisions perpendicular to the surface, which affords a greater discharge from the tumid part, in which the blood has accumulated. The bistouries for this purpose should be rounded, and of a moderate size, for sometimes the serous and bloody fluid evacuated, is thick and tenacious, and would be left, should the incisions be too small.
The vessels in bleeding must be sustained by ligatures, for in some cases, they readily move under the skin, from not being sufficiently adherent to the parts beneath, and hence the skin is pierced without touching the vessel. If only slightly penetrated, the parts swell, the discharge of blood is impeded, and suppuration may ensue. Two evils hence follow, pain for the patient, and disgrace for the operator. And this remark holds good in all similar cases.
Besides the instruments mentioned as essential, others are also required, such as forceps for drawing the teeth, and for taking hold of the uvula; these are in common use and extremely simple.
Tumours and ulcers are diseases of more importance, and deserve attention. The principal point as to the former, is to disperse them, and prevent their enlargement. Should this take place, we must endeavour to reduce them as much as possible, and equably; otherwise they may chance to become excoriated, and form ulcers of difficult cure. They are not to be rashly removed, nor should they be opened, until their contents are fully concocted. The means for promoting this are elsewhere described. As to wounds and ulcers, four kinds are observed. 1. Characterized from depth: these are fistulous, cicatrizing above, but hollow and filled with sanies. 2d. Characterized by elevated carnosities. 3d. By their breadth or extent of surface, and denominated creeping. 4th, and most natural, is attended with suppuration;—all these are seated in fleshy parts, and have a common relationship. We have elsewhere detailed their respective symptoms and method of treatment; viz., to resolve congestions, to fill up cavities, destroy excrescences, and restrain their enlargement. We must particularly attend to the due adaptation of poultices, dressings, and bandages. The first, correctly placed, are of immense utility, and help to sustain the dressings. Their composition assists in the cure, by their action on the surrounding parts. Time and circumstances must determine their composition; this cannot be noticed at present, but it requires both knowledge and experience.
We have only further to take notice of battle wounds from javelins, &c., of which few examples occur in towns, though frequent in hostile encounters. Whoever wishes to excel in such cases, must follow the camp, and quit his home, as the only means of pursuing this the most laborious and yet useful branch of his profession. A knowledge of the symptoms of a concealed weapon in the body, by which its presence is denoted, is a high degree of surgery; its continuance detects the ignorant, for science only is capable of undertaking those cases. Of this we have elsewhere treated.
ON DECENCY IN MANNERS AND IN DRESS.
SECTION I.—TREATISE VI.
Haller says this treatise has been always considered spurious, and is unnoticed by the ancients. The writer, whoever he may have been, is nevertheless a philosophic physician, and the work is replete with sound morality. It instructs the practitioner as to what is essential in his attendance on the sick, so that he may be esteemed a learned, prudent, careful, and attentive man.
It is with justice that philosophers commend wisdom in the common concerns of life. There are, however, many kinds of wisdom or philosophy which tend in my opinion to no useful purpose. I mean such as consist of mere verbiage on points of no importance. Yet of these something may be learned, provided it is unmixed with depravity—I say depravity, for ignorance and inutility are nearly allied to mischief, and often lead to it. Every thing that awakens attention and accustoms the mind to think, leads to good habits; even discussions on subjects not in themselves of much utility. Such things as are connected with the improvement of science, and subservient to the welfare and honour of mankind, are with reason to be preferred; whatever is not base in itself, or merely connected with worldly advantage, is deserving of attention, but it must at the same time be perfectly innocent. Youth often fall into the hands of persons who are continually arguing; but when arrived at maturity, they regard them with contempt, and at a later period, from indignation perhaps, obtain the passage of some law, to banish them. Such persons are well adapted to hold forth in public assemblies, where they industriously propagate their deceptions, and thus extend them through a community. They may be known by their dress and their manners. The more extravagant their attire, the more carefully should they be shunned. How different are those who are neat and simple in their dress; you see at a glance that they are deserving of esteem, and their prudence and moderation are readily appreciated; always uniform, there is neither pride nor ostentation in their demeanour. Serious in conversation and mild in reply, they are nevertheless acute in argument, and not readily discomposed in pursuing it. They are amiable amongst friends and moderate towards all; silent to the clamours of others, and deliberating before they speak, they await patiently for the proper occasion. Temperate in their mode of living, a little contents them, and when necessary, can submit to abstinence. Lucid in their discourses, they conceal nothing that they are acquainted with; and from their graceful delivery, are respected by all who hear them, for they assert nothing which they cannot demonstrate. To nature they are principally indebted for all these qualifications, which, when attained, enable them rapidly to advance in science, for in the acquirement of knowledge, some preparatory attainments are absolutely requisite. Nature and art then happily combine in their improvement. We see many who, from the deficiency both from nature and from teaching, attract no notice; hence if required by any one to demonstrate what they have asserted, neither nature nor art can aid them. Yet they have pursued the method of the Sophists we have animadverted on, but being deficient in essentials, they are exposed, and finally become contemptible.
Instruction, to be beneficial, should be founded on facts. Arts are deduced from reflection; but any reflections or reasoning, not accompanied by facts, evince that fault somewhere exists. To think merely, and produce nothing, is a proof of error, or of ignorance especially in medicine. Here, opinion alone is criminal, and becomes injurious to the sick. Confidence in self-opinion is delusive, since fact too often proves its falsehood, as impure gold is tried in the furnace. The common remark, that “finis coronat opus,” is lost on such persons as I have pointed out, although the true method of attaining the science is daily manifested to all who desire its acquirement.
It may be concluded then, admitting the truth of the preceding remarks, that knowledge and medicine must go hand in hand. The physician who is truly a philosopher is a demigod. Medicine and philosophy are closely allied. That which is taught by the latter, is practised by the former,—contempt of riches, moderation, decency, modesty, honour, justice, affability, cleanliness, gravity, a just appreciation of all the wants of life, courage in adversity—opposition to fraud and superstition, and due consideration of the Divine power. The physician is perpetually exposed to the hazards of incontinence, turpitude, avarice, intemperance, detraction, and insolence. How far these may influence his character, may be estimated by his conduct towards his patients, his friends, and families. In all these particulars, the appropriate connexion of wisdom and of medicine is conspicuous; but particularly so in respect to the Deity, towards whom the thoughts of the physician must be perpetually directed; for the various accidents of life which come under his notice must compel him to acknowledge His omnipotence. He dare not ascribe to his art unqualified power, when he reflects on its frequent failure; even when success attends, it is to Heaven alone he owes it. We perceive now, how medicine leads to wisdom. They, even, who disbelieve in Providence, are compelled to recognise it in their examination of what takes place in the system, in the change of forms produced, and of the cures, both surgical and medical, from operations, or from internal remedies, and good regimen. These are considerations of extreme importance.
Besides what is said above, something more is wanting to the physician. This is urbanity. Austerity, repulsive to those in health, is much more so to the sick. He must carefully avoid exposing his body too much, or discoursing with the bystanders beyond what is absolutely necessary. A good physician avoids all measures that are not conducive to the welfare of the patient; he adopts nothing that is singular or inefficient.
A physician should always be prepared for whatever may occur, by having every thing essential to his practice duly at hand, or it may chance that some article may be wanting when he is most in need of it. He ought to accustom himself at all times to prepare his remedies, &c., such as lotions, liniments, pledgets, compresses, and bandages of different kinds,—collyria, &c.; and he should have in readiness all sorts of instruments, machines, and apparatus. Deficiency in these, implies a want of foresight that may prove injurious. A smaller collection should be kept ready in case of a distant call. All should be properly arranged, so that what is necessary may be immediately found, for it is impossible to carry every thing with him. His mind should fully retain the recollection of his medicines and their virtues,—that also of diseases, their various forms and accompanying symptoms. This may be esteemed the A, B, C, of medicine. He is also to acquaint himself with the compounding of his drugs for the various intentions he has in contemplation; such as different drinks, purgative potions, &c., having due regard to the articles he employs, not only as respects their source and species, but likewise the bulk, and age, &c., all in reference to what is required in visiting his patients, so as to be certain of having them at the time they are essential.
Previous to seeing the sick, he should consider what he may find it necessary to do,—for it is assistance that is needed, and not speculation. Experience will enable him to foresee what may take place; this gives him credit, and is not always very difficult. On entering a sick chamber, he should pay attention to his mode of seating himself, and arranging his dress (mantle); he should talk but little, and neither be disturbed himself, nor trouble others. Address the patient cautiously, and let his own remarks be calm, even if agitation and apprehension exist around him. By this he will show that he knows what is to be done on the existing occasion. He then may give his directions, and mention his opinion as to what further may ensue.
Frequent visits are required to regulate the changes that may take place from error or inattention. The disease will thus be better understood, and mistakes less liable. The humours are perpetually varying, either from their peculiar nature or from accident. If the proper moment is neglected for timely assistance, the disease soon increases, and the patient may be carried off from the concurrence of numerous unsurmountable symptoms, that would have readily subsided had they been foreseen and promptly attended to, by the experience acquired from similar cases. Notice should be taken of the faults committed by the sick, who often deceive with respect to their remedies. Many fall victims to this duplicity, arising from their aversion to them. So far from avowing this neglect, they blame the physician.—Care is requisite respecting the sleeping apartments, which should be accommodated to the season, and to the nature of the disease. Some require beds in an elevated situation; others, low, and in dark rooms. All noise and odours should be guarded against, especially that of wine, which is very hurtful. If changes of situation are requisite, let all be done with perfect silence, and as quickly as convenient, so as not to disturb the patient, for tranquillity is highly essential to his welfare.—The physician should possess the tact of directing his patient’s longings, by a proper intermixture of mildness and determination,—and afford them every consolation, without letting them know the nature of their disease, or its probable event.—Inattention in these particulars has tended to augment the present danger, and hasten on the future.
It is requisite to have the co-operation of a pupil or assistant, to receive and execute the orders of the physician. He should be selected from amongst the more advanced in their studies, capable of acting, in any sudden emergency, without injury and of detailing with accuracy all that has taken place during his absence. By no means should the patient be committed to the ignorant and unskilful; their ill conduct will be ascribed to the physician. Nothing should be equivocal; by which all blame will be avoided, and his merit acknowledged.—Let the physician therefore announce to the attendants all that may be anticipated.
Since what we have said respecting decorum and wisdom is equally applicable to philosophy and to medicine, and to all other arts, the physician will attend to them in their particular connexion with himself, without neglecting what is common to him with society at large; for what is favourable to a good name should be generally pursued by all mankind. Such is the method by which celebrity may be attained, both present and future.—If intelligence is, however, unhappily wanting, at any rate, let prudence, as far as possible, supply its place.
PRECEPTS OF HIPPOCRATES.
SECTION I.—TREATISE VII.
With respect to this treatise, Haller says, that although spurious, it is by no means unimportant. Its commencement and conclusion appear to be derived from Hippocrates, to whose brevity and gravity it approximates. It gives advice to the physician concerning his fees, his remedies, and food. Treats of consultations, and denounces the impudence of quackery. In short, like the preceding treatise, it contains many general precepts that are well calculated to excite reflection in a philosophic physician, and to prove useful to him.
Opportunity is the work of a moment; itself, of short duration. Aid from medicine is sometimes the work of time, but not unfrequently, it is immediately called for. This is to be well considered in our intercourse with the sick, who require to be treated, not from mere probabilities, but by observation in connexion with reason. Reflection is a well-regulated remembrance of events perceptible to the senses. Events are evident facts, which are transmitted to the mind through the medium of the senses. Impressions thus frequently produced, the regular train of such events, antecedently and subsequent, is preserved by memory. Reasoning becomes allowable, provided it is based on the complete train of events which are retraced by memory in their proper order and succession. It would seem that nature is impelled to its various changes and movements by many different causes, which serve to illustrate it; because the event that ensues is fixed and certain, and the mind can only become acquainted with it in the way I have pointed out, the only way in which it can arrive at certainty. If, on the contrary, our reasoning is not founded on an evident chain of certain facts, but merely of probable events, the most fatal consequences may result from the opinions that may be formed; resembling the case of a traveller in an unknown and trackless country. Such persons, therefore, who practise medicine on such doubtful principles, deserve to suffer for their bad success. Is it not sufficient that the unhappy patient is prostrated by sickness, without having it augmented through the unskilfulness of his physician? I repeat therefore, that success cannot be anticipated from reasoning alone, but through the agency of the means above referred to. The mere babbler is certain of nothing, and is replete with error and deceit. An accurate attention to events, without neglecting attending circumstances, can alone promote that sure and certain practice which is called medicine. It is this only that can render the physician useful to those around him.
No difficulty should be made at receiving information from the most illiterate, provided it appears that they have some knowledge of the subject under consideration. It was thus, I think, that our art had its origin; collecting together, from all quarters, a body of facts. We ought not to neglect what chance may present, especially if it be reiterated; listening with attention in order to profit, and not repulsing our informant, by boasting of our cures, and deeming his experience void of utility. Doubts as to remedies spoken of as if alone appropriate, are highly proper. This does not imply obstinacy; all diseases, from a variety of circumstances, require at times a difference of treatment.
A point deserving of attention in medicine, is respecting the fee of the physician. If he commences by speaking of payment, the patient will presume that he will not be neglected. By not attending to this, he will be led to imagine that your attendance will be irregular. I apprehend therefore that a stipulation as to this particular is perfectly correct, except in cases of an acute nature. Here, the rapidity of the disease admits of no delay; and humanity will lead the physician to think more of the esteem he may acquire, than of mere profit. It is far preferable in such cases to bear the ingratitude of those you preserve, than to stipulate for payment whilst the patient is in danger. It is true, some persons who under the pretence of the hospitality afforded, or the facility of cure, object to payment. Such are worthy of contempt alone. The sick should be considered in the light of the shipwrecked mariner. And where is the real physician who will not rather faithfully afford his services, than act with inhumanity and rigour? Wherefore, when you have made yourself acquainted with the disease, pursue a regular mode of treatment, and neglect nothing that may prove conducive to a cure. Your views as to payment should be moderate, yet sufficient to recompense your labour, without however despising wealth. And with respect to the poor, to visit them gratuitously; preferring thus the pleasure of a grateful mind, to the increase of pomp and parade. Strangers and the poor demand peculiar attention from the physician, for no one can have a proper regard for medicine, who forgets his duty to his fellow-creatures. Some, on their recovery from sickness, appreciating the danger they have gone through, extol the benevolence of their physician, repaying thus a debt of gratitude. It is highly praiseworthy to give advice, preservative of health, and even of bodily appearance. The ignorant physician cannot comprehend such wholesome preventive admonitions; but being carried away by self-sufficiency, he evinces by his conduct that his standing is misplaced, and his sole desire is that of gain; hence he demands payment both from the rich and poor. Proud in prosperity, he spares no expense in his luxurious habits, and cares not for the faults he commits, under a conviction of impunity; but if adversity overtakes him, he is submissive and base in the extreme. The true physician earnestly strives to avoid mistakes, and by this, deservedly merits the name of master of his art. In the pursuit of his duty, he neglects nothing, not even to those in the most abject poverty, for good faith and justice accompany him in all his actions. The reverse of this, is evident in those of an opposite character. Dangerous diseases they sedulously avoid, and undertake those only that can give them éclat. Consultation with other physicians they carefully shun, by declaring their want of confidence in their opinion and judgment. Their patients consequently experience all the unhappy effects, resulting from their imprudent choice. A better selection might at least have proved beneficial, a circumstance of no trifling importance at times, even if inadequate to a perfect cure. The same reasons that led them to have recourse to quacks, the hope of a speedy and perfect restoration to health, frequently induce great impatience and neglect in the due continuance of remedies, or in perpetually changing them.
If, now, you would institute a comparison as to the ingratitude of patients, it will be seen that for the most part all are deficient in a due recognition of the services of the physician. The poor, at first, are mild and obedient, but ingratitude and ill behaviour too often succeed. The affluent, in sickness, are exuberant in their professions and promises; but in health, when reminded of payment, they excuse their neglect by their rents not being received, and then think no more on the subject. Enough, however, on this head. The physician must act according to circumstances.
A physician, if embarrassed by the state of the patient, or by the novelty of the disease, ought to feel no repugnance in calling for aid in consultation, for it often happens that in a dangerous and unyielding disease, anxiety leads to the omission of much that might be useful, by destroying that presence of mind which is so highly necessary to the medical man. Many regard it as a right, that in consultation, their opinion should be acquiesced in; or perhaps they sustain it by calling in question that of others. Now I am persuaded, that a physician who is prompt to blame others, must render himself contemptible: it is the common practice of quacks. Consultations, however, are not constituted on such illiberal principles, for it is fully admitted, that with even the highest attainment of medicine, still, much is wanting to be known.
These particulars being thus disposed of, one still remains to be noticed, as marking the accomplished practitioner, viz., the due encouragement of the sick, and checking that anxiety with regard to the progress of disease, which so usually is present. Such anxiety is extremely prejudicial, and he who knows how to prevent or allay it, is of infinite service. How many fall victims to this despair that invades them! When, therefore, any one is charged with the care of the sick, their confidence will be gained by stating that our art consists in following nature, and not striving to oppose her. Any other plan will prove unsuccessful. In truth, health is that natural state, in which foreign agencies are not employed, but a certain harmony of action existing between the air and heat and the concoction of the humours. Nature exerts herself in the promotion of health, by means of our food, and the appropriate functions of the body, unless, indeed, some malformation exists from birth, in which case attempts to remedy it should be made; for all derangement is unnatural, even although it may progress but slowly.
The physician should carefully avoid all affectation, such as the use of perfumes and similar superfluities. His dress should be neat and decent, without an admixture of finery or ostentation. An excess of attention, even to this, is sometimes morbid; of little importance, if duly confined, but when carried to an extreme, it is injurious to him. I would on no account depreciate gentility. It is essential to him in his pursuits; but it is important that he should know its boundaries, and its true intent. In a public discourse, he should not be too flowery or poetical in his remarks; they rather proceed from idleness or ignorance, than from real knowledge. All information, if even the offspring of deep research, is to be carefully avoided, if it has no bearing on the subject before us. This is particularly the case in medicine, which is sufficiently attractive in itself, and requires not the foreign aid of ornament.
They who begin the study of medicine late in life are much to blame. Self-experience is insufficient; that of others is often of great importance;—but their memory of what has been handed down, is so confused as to confound and render useless all they say.—They talk of their superior knowledge, as if desirous to instruct the friends around their patients, who have attended to receive their orders. For my part, when called in consultation with such boasters, I do not stop to argue with them about the disease, but come at once to the point, by asking what plan they propose for adoption. As they may chance to know something of what should be done, although otherwise deficient, I desire only their practical information, and pay no attention to their assumed knowledge in the principles of the art.—Experience, constant, and of long continuance, can alone lead to a full and thorough acquaintance with them. Those who profess to understand them, may be allowed the privilege of talking; but their practice must be deemed the test of their knowledge.
A severe regimen, if not too long continued, increases the desire for food, but if not cautiously administered, it will augment disease. Should all the wishes of a blind man be indulged, how much injury would it not be productive of, even in those which he might most particularly desire.
Some few remarks of an aphoristic character here follow.—Ed.
Sudden changes of the air are to be carefully avoided.
In youth every thing seems pleasing;—such is not the case in age.
Difficulty in speaking may arise from some disease, or from imperfection in the organs of hearing;—from too rapid pronunciation, or extreme rapidity in the evolution of ideas.—Such is by no means uncommon in those who pursue the different paths of science.
Youth is sometimes the best remedy in slight affections.
The continuance of disease, with no alteration, indicates that it will prove of long duration.
Diseases are terminated by crises.
Little is required to cure, unless the part affected is of great importance.
As we suffer by sympathy from the affections of others, so also will pain in one part of the system sympathetically call into action other parts.
We should bear with patience the complaints of those in pain.
Extreme labour is deserving of some indulgence.
A healthy locality is very desirable.
[a ]Z. Zwingerus, J. Gorræus, B. Hollerius, Rauchinus, &c., are among the most celebrated.
[a ]Pessum subdititium ad fœtum corrumpendum, Fœsius; Pessum abortivum, Haller; Πεϛϛον φθοριον, Hippocrates.—A dangerous pessary.
[a ]Ostentationem scientiæ.
[* ]It would appear as if a dispensary or hospital is here described. It seems scarcely allied to the private domicile of the practitioner.