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action, and operation, and effect of every article, must be accounted for pathologically, physiologically, rationally. It is astonishing to witness the pertinacity, activity, and ingenuity of this "detestable mania for explanation," as a French author on materia medica calls it. It is not enough that any given medicine or mode of treatment eures. This knowledge would be mere empiricism, unworthy altogether of the scientific physician. We must know how it cures, and why it cures; and unless these things are made out, we are bound to believe that it does not cure at all-that we have been mistaken, and that the two circumstances of the use of the remedy and the cure, which simple observation had taught us, sustained to each other the relation of cause and effect, must have been only accidentally so connected. If a any one circumstance exhibits more strikingly than another, the folly and absurdity of this passion, it is that of multifarious and contradictory explanations that are continually and successfully invented and maintained.
There is hardly a page of Dr. Dunglison's book which does not contain more or less paper spoiled, and worse than spoiled, by magisterial and confident statements of the hows, and whys, and wherefores of pathology and therapeutics. Does any one doubt this? Then, let him study the book for the purpose of settling this particular point; and when he comes upon an explanation, let him inquire whether it is any thing more than a conjecture.
If fanciful and speculative men choose to amuse
themselves, or the rest of the world, with their conjectures and explanations, surely we have no objection. They may find the occupation as pleasant and as profitable as any other species of air-castle building; but let them not dignify this guess-work with the misnomer of inductive philosophy; and let them cease to think that they are doing any thing to advance the utility of medicine as an art; the object of which is the mitigation of human suffering, and the lengthening out of the term of human life.
Cursory remarks on the state of Practical Medicine since the commencement of the present century. See John Mason Good's work on the study of medicine, chap. XIII. As the historian of medicine approaches nearer to his own times, he finds his path encumbered with almost insurmountable difficulties. The subject on which he has to treat, differs, perhaps, from every other branch of science in this circumstance, that our actual information does not increase, in any degree, in proportion to our experience. Hence, it follows, that the accumulation of materials frequently rather retards than promotes its progress. In other sciences, although truth is not to be attained without a certain degree of laborious research, yet to those who are willing to bestow on it the requisite attention, it is, for the most part, attainable; or, if it still eludes our grasp, we are at least sensible of the deficiency, and generally ascertain the precise nature of the obstacles which impede our progress. In other sciences, when we
enter upon an inquiry, or propose to ourselves definite object for experiment or observation, we are able to say whether the result of our inquiry has been satisfactory, and whether the object in view has or has not been accomplished. But this is, unfortunatety, not the case in medicine. In our experiments, we are seldom able to ascertain, with accuracy, the previous state of the body on which we operate; and, in our observations, we are seldom able to ascertain what is the exact cause of the effect which we witness. The history of medicine, in all its parts, and especially that of the materia medica, affords ample testimony to the truth of these remarks. In modern times, and more remarkably in Great Britain, no one thinks of proposing a new mode of practice without supporting it by the results of practical experience. The disease exists, the remody is prescribed, and the discase is removed: we have no reason to doubt the veracity or the ability of the narrator: his favorable report induces his contemporaries to pursue the same means of cure,-the same favorable result is obtained; and it appears impossible for any fact to be supported by more decisive testimony. Yet, in the space of a few short years, the boasted remedy has lost its value: the disease no longer yields to its power, while its place is supplied by some new remedy, which, like its predecessors, runs through the same career of expoctation, success, and disappointment.
Let us apply these remarks to the case of fever,-the disease which has been styled the touch-stone of medical
theory, and which may be pronounced to be its opprobrium. At the termination of the last century, while the doctrine of Cullen was generaly embraced, typhus fever was called a disease of debility, and was, of course, to be cured by tonics and stimulants. No sooner was it ascertained to exist, than bark and wine were administered in as large doses as the patient could be induced, or was found able to take. No doubt was entertained of this power over the disease. The only question that caused any doubt in the mind of the practitioner was, whether the patient could bear the quantity that would be necessary for the cure. To this treatment succeeded that of cold effusion. The high character and literary reputation of the individual who proposed this remedy; its simplicity and easy application; the candid spirit which was manifosted, and the strong testimonials which were adduced by his contemporaries, bore down all opposition: and we flattered ourselves that we had at length subdued the formidable monster. But we were doomed to experience the ordinary process of disappointment. The practice, as usual, was found inefficient or injurious, and was, after a short time, supplanted, by the use of the lancet. But this practice was even more short-lived than either of its predecessors; and thus, in a space of less than forty years, we have gone through three revolutions of opinions with respect to our treatment of a disease of very frequent occurrence, and of the most decisive and urgent symptoms. How many controversies have occupied the mind for
ages, and have filled almost innumerable volumes, which have essentially turned upon the definition of a word? How frequently has an article of the materia medica been employed, not from an experience of its actual effect, but from some nominal property assigned to it by an imperfect analogy or imaginary quality? The means. that have been proposed to check these observations, to rectify errors, and to reduce medical science to its appropriate and correct limits, are, indeed, few and simple, and of no difficult application; but there is one essential requisite without which they can be of no avail,—a mind disposed to the reception of truth, determined to follow it wherever it may lead the inquirer, united to a high sense of moral obligation, which may induce the medical practitioner to bear in mind, that his profession is a deposite, placed in his hands for the benefit of mankind, and that he incurs an awful degree of moral responsibility who abuses this sacred trust, or diverts it to a base or selfish purpose.
Professor Samuel Jackson's introductory lecture to the medical students of the University of Pennsylvania. "Can this reform be much longer postponed? I believe not. The interests of the profession-the immediate pecuniary interests of practitioners are too deeply implicated to admit that things should long continue in their present state. It cannot be concealed, that public confidence in the knowledge and intelligence of the profession has been shaken-has been most materially