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The incident occurred in one of the large London hospitals. The patient's name was Hopkins, and he was dying. The chaplain had left the room for a few moments to attend to another sufferer, hoping to return in time to give the last consolation and comfort to the dying soldier. The minister was too late; when he reached the ward the patient had just expired. The chaplain thus spoke to the hospital orderly :
Chaplain : “So poor Hopkins is dead. I should have liked to speak to him once again and soothe his last moments. Why didn't you call me?”
Hospital Orderly: "I didn't think you ought to be disturbed for 'Opkins, sir, so I just soothed him as best I could myself.”
Chaplain : “Why, what did you say to him?”
"I am," “'Opkins," sez I, "I don't think you'll get better." “ No," sez 'e.” “
“'Opkins," says I, "you're going fast.” “Yes," sez 'e. “'Opkins," sez I, “I don't think you can 'ope to go to 'eaven.” “I don't think I can,” sez 'e. “Well, then, 'Opkins,” sez I, "you'll go to 'ell. “I suppose so," sez 'e. “'Opkins," sez I, “You ought to be wery grateful as there's a place perwided for you, and that you've got somewhere to go. And I think 'e 'eard me sir, and then 'e died."
If it be true that all science is developed by imperfection, it will be found that in medical science the beginning of inquiry is disease. If there had been no disease, if every one enjoyed perfect functional and organic life or that unknown quantity called health (mens sana in corpore sano); if there existed in every one of us the harmonious action of all our organs, there would be no need of the science or art of medicine.
The well-known biblical phrase, “those that be whole need not a physician, but those who are sick," would tell the entire story. Does it not appear one of the most wonderful conditions of nature, an apparent paradox, that knowledge actually grows out of evil, or of ignorance? If Adam had not sinned there would be no need of redemption ; if man had not become diseased there would have been no need of doctors ; if there were no transgressions of law there would be no lawyers. Therefore, with such an understanding, we should be thankful to mother Eve, and still grant to woman priority in the establishment of our profession. Even here we find "a woman in the case.”
Dux femina facti. The physician differs from all other men in the varied pursuits of life, in the commodities which he handles, in the mechanism he endeavors to control, in the results he hopes to accomplish, and in the powers with which he has to contend. He deals with the mechanism of the human body, he fights with disease, he
endeavors to overthrow suffering, and to avert or postpone death. Often after his best directed efforts come
“ The knell, the shroud, the mattock and the grave,
The deep, damp vault, the darkness and the worm." Can there be more serious subjects than this, and can one's energies be better expended than in thus striving to relieve our common humanity ?
At the outset of the physician's life it is well for him to understand that there exists a tremendous force always powerful in the body known as the vis medicatrix naturæ.
It is a power likely to be forgotten, especially by the young medical man as he emerges from the college with a mind full of new medicines, new theories of diseases, new methods, new instruments, and new nomenclature.
He is liable to thwart, or to set aside, or to interfere with this agent which silently watches over the body, and is ready to expel the invader, to heal the breaches that have been made in the citadel and to restore a shattered framework to a comely and harmonious whole. I am persuaded that the reason that this tremendous force is often overlooked is because it is vital and not mechanical ; because it is invisible and not tangible, save by its results; because it is silent, and not obtrusive. I take it that the highest aim of the physician must be to assist, not to impede, this unseen power. An obstructionist is always dangerous, and it requires not only the most consummate skill and the largest experience, but also an intuitive perception of the workings of this power to prevent interfering with its results. All I ask of you is to carefully watch the silent manifestation of the power of the vis medicatrix; to ascertain, as does the experienced general, whether the enemy or the friend is in the ascendant. If this is done carefully ; if one perceives this silent and mysterious force preserving the economy of man from the inroads of disease, he will be more cautious in the application of his drugs. It is known, like good men, by its works. Its physical results, as exhibited by certain conditions of the system known as favorable to returning health, are appreciated and understood ; its vital power, which is invisible, is not capable of explanation. I am of opinion that the law of similars offers to the physician a facile method by which medicaments may be passed into the body in such manner as will not in any way interfere with the action of this all-powerful vis. There is no revulsion, there is no opposition, there is no contrariety of action in homeopathic medication. The symptoms of a disease develop, and are carefully noted. The similar is found with a certain precision which, though not always exact, on account of certain imperfections in our own knowledge and in the materia medica, is certainly better than the vague generalities upon which the old-time therapeutics is founded. A drug is administered with the most decided and positive aim of removing certain specified symptoms; it is not, as in the old school, given with the hope, on general principles, that because it will vomit, or sweat, or soothe or narcotize, that in such revulsive or convulsive action the symptoms will abate or disappear. Homeopathic medicine, guided by a scientific law, must go to its place and do the work intended for it, silently and without external evidence. The allopathic dose — pill, mixture or capsule, draught or potion causes some sort of a revulsion, often ending in a crisis of diaphoresis, emesis, or counter-irritation, by which the symptoms are expected to, and often may, abate ; that is, if the constitution of the patient is strong enough to bear the shock produced by this heroic medication. There are some individuals whose idea of the action of a medicinal agent upon the system of man is gauged by what is known as “its working,” and would have us believe that this “outward and visible sign ” of the medical action within the body must exist, otherwise such substances are inert. The wise and successful “regulars" of to-day are those who know the importance and the power of the vis medicatrix nature, and know it so well, as compared even with the improved pharmacy and therapeutics, that they have almost become a sect — “the expectants; they watch and wait, and are wise; they guide rather than compel ; they believe in all the hygienic surroundings that are known as conductive to health, and they “throw physic to the dogs," and are successful. I heard a distinguished member of the old school once make the assertion that “nine-tenths of all diseases would get well of themselves; that only one-tenth required treatment.” If this be a belief, it shows the drift of the medical mind of to-day ; but its adoption would soon close half the apothecary shops in the county, and I might say one-tenth is about the mortality of the school. Knowing these facts, therefore, when you prescribe your medicine, watch, wait for and assist the vis medicatrix, and you will find that your success in the very beginning of your career will bring you a step in advance of those who crowd the aisles of the temple you are entering, where, amid the confusion of poly-pharmacy, the fanatical worship of the bacillus, the chaotic prescription-writing upon vague general principles, the prostration of a crowd of worshippers before the god of experience (who forget that he has a hundred faces and a thousand tongues), the silent and mysterious power of the vital force is either misapprehended, forgotten or extinguished.
The next point I wish to urge upon you is that, as students and as physicians, you be true to your country.
There are certain classes in society, and I am sorry to say the upper and educated classes, who have been born and reared in America, whose ancestors have toiled on American soil, been made rich by America's increase; who know, or ought to know, the early struggles, the possibilities and probabilities of their country, who to-day are ashamed of America, ashamed of her institutions, ashamed of her accent, ashamed of her politics, and ashamed of her prosperity; who are so disgusted with her institutions that they send their offspring to England to be educated, nay even to be married ; who have their children born abroad; who buy titles with worthless and notorious men attached to them, at the price of millions, for their daughters; who, with the skill of the parrot, endeavor to introduce a foreign accent in their American speech ; who clothe their bodies in foreign garments, adopt foreign customs, often highly inappropriate, put on foreign manners, bow down before foreign friends, and for their pains are treated with ridicule and contempt by those they ape. So it is in medicine. It is the fashion now. to suppose that we must look to the “other side" for the great improvements, the great men, the new instruments, and the new operations. This is a mistake, a great mistake. While every one must acknowledge, not only in a social and educational point of view, the greatness, beauty and grace of the best social customs in the old country (I say best, for there are some very bad ones), and must admire the hospitality and genial kindness, the solidness of education, and the definite and exalted ends thầt are attained thereby, still you must give to your country its share in the originality and advancement in both the science and the art of surgery and medicine, so tardily acknowledged by most of our foreign brethren.
You must remember that ether anæsthesia belongs to us ; that ovariotomy came from Kentucky, excision of the inferior maxillary from Tennessee, skin grafting and litholapaxy from New England; the Sims speculum, which caused such revolutions in gynecology, silver sutures, trachelorraphy, the plaster jacket, the relations of the Y-ligament to dislocations of the hip, and numberless instruments for the perfect surgery of the day, are American ; and I am of opinion the balance of surgical skill, certainly in a practical sense, lies on this side of the Atlantic, and that the time is not far distant when to our shores will come the aspirants for surgical knowledge, and that surgical eminence will not be complete without the American stamp.
If the doctrines of natural selection, or the survival of the fittest, be true, American surgery will hold its place when compared with that of any other country in the world. I do not desire to make these remarks either to depreciate the status of
any department of medical science as at present taught and existing in other countries, and still would hold up for admiration and example the truly great minds in all countries who have toiled unceasingly for the well being of the race; but my advice is to study the advances in your own country, embrace the facilities she offers, recognize the ability of her teachers, and then, and only then, will you be able to draw a fair comparison between the national and the foreign. It is always a matter of surprise to me when I hear medical foreigners eternally and disadvantageously comparing (in print and in conversation) our institutions, our surgeons, our methods, our instruments, and our practice with that of the older countries. I always wonder why, America being so inferior, they condescend to stay with us, or why they do not remain amid the perfect glory and undimmed radiance of their own country. Why don't they go home? They are absolutely of no service here. Be American physicians and surgeons, admire what is good and great in every land and every clime, but do not make yourselves ridiculous in the eyes of the really educated portion of the community by becoming either Anglomaniacs, Teutonomaniacs, or Gaulomaniacs, or any other kind of imbecile.
Prof. Harold C. Wood, in a paper entitled “The Medical Profession, the Medical Sects and the Law," read at Yale University, with the intent of demolishing homeopathy, says that the doctor of to-day is scarcely more like the doctor of a hundred years ago than like our Darwinian forefather, blushing with shame at the sight of his first tailless offspring.
This is true, and I may carry the comparison still further, and say that the medical student of to-day bears as little resemblance to the medical student of fifty years ago as the full-fledged doctor described in the apothegm of Dr. Wood does to his prototype.
In the first place, it must be remembered that half a century ago the branches of learning taught in the medical universities numbered about seven — Anatomy, Surgery, Practice of Medicine, Obstetrics, Physiology, and Chemistry, and very often two of these were combined and taught by one chair ; thus, Anatomy and Surgery, Obstetrics and Diseases of Women, Institutes and Practice of Medicine, Chemistry and Toxicology, and so on. If we compare this meagre curriculum with that of this, or any other first-class medical college, you will readily see how the tentacles of medicine have spread in all directions, and that as the sciences have multipled and expanded, the student who essays to master them, or that portion of them necessary for the passage of his examinations, must have not only more cultivated mental capacities, but also more teachers and more time. Within the past half century Chemistry has become a new science ; in