Medical Essays, 1842-1882 Part 1

Medical Essays.

by Oliver Wendell Holmes, Sr.

PREFACE.

The character of the opposition which some of these papers have met with suggests the inference that they contain really important, but unwelcome truths. Negatives multiplied into each other change their sign and become positives. Hostile criticisms meeting together are often equivalent to praise, and the square of fault-finding turns out to be the same thing as eulogy.

But a writer has rarely so many enemies as it pleases him to believe.

Self-love leads us to overrate the numbers of our negative const.i.tuency.

The larger portion of my limited circle of readers must be quite indifferent to, if not ignorant of, the adverse opinions which have been expressed or recorded concerning any of these Addresses or Essays now submitted to their own judgment. It is proper, however, to inform them, that some of the positions maintained in these pages have been unsparingly attacked, with various degrees of ability, scholarship, and good-breeding. The tone of criticism naturally changes with local conditions in different parts of a country extended like our own, so that it is one of the most convenient gauges of the partial movements in the direction of civilization. It is satisfactory to add, that the views a.s.sailed have also been unflinchingly defended by unsought champions, among the ablest of whom it is pleasant to mention, at this moment of political alienation, the Editor of the Charleston Medical Journal.

"Currents and Counter-Currents" was written and delivered as an Oration, a florid rhetorical composition, expressly intended to secure the attention of an audience not easy to hold as listeners. It succeeded in doing this, and also in being as curiously misunderstood and misrepresented as if it had been a political harangue. This gave it more local notoriety than it might otherwise have attained, so that, as I learn, one ingenious person made use of its t.i.tle as an advertis.e.m.e.nt to a production of his own.

The commonest mode of misrepresentation was this: qualified propositions, the whole meaning of which depended on the qualifications, were stripped of these and taken as absolute. Thus, the attempt to establish a presumption against giving poisons to sick persons was considered as equivalent to condemning the use of these substances.

The only important inference the writer has been able to draw from the greater number of the refutations of his opinions which have been kindly sent him, is that the preliminary education of the Medical Profession is not always what it ought to be.

One concession he is willing to make, whatever sacrifice of pride it may involve. The story of Ma.s.sasoit, which has furnished a coral, as it were, for some teething critics, when subjected to a powerful logical a.n.a.lysis, though correct in its essentials, proves to have been told with exceptionable breadth of statement, and therefore (to resume the metaphor) has been slightly rounded off at its edges, so as to be smoother for any who may wish to bite upon it hereafter. In other respects the Discourse has hardly been touched. It is only an individual's expression, in his own way, of opinions entertained by hundreds of the Medical Profession in every civilized country, and has nothing in it which on revision the writer sees cause to retract or modify. The superst.i.tions it attacks lie at the very foundation of h.o.m.oeopathy, and of almost every form of medical charlatanism. Still the mere routinists and unthinking artisans in most callings dislike whatever shakes the dust out of their traditions, and it may be unreasonable to expect that Medicine will always prove an exception to the rule. One half the opposition which the numerical system of Louis has met with, as applied to the results of treatment, has been owing to the fact that it showed the movements of disease to be far more independent of the kind of practice pursued than was agreeable to the pride of those whose self-confidence it abated.

The statement, that medicines are more sparingly used in physicians'

families than in most others, admits of a very natural explanation, without putting a harsh construction upon it, which it was not intended to admit. Outside pressure is less felt in the physician's own household; that is all. If this does not sometimes influence him to give medicine, or what seems to be medicine, when among those who have more confidence in drugging than his own family commonly has, the learned Professor Dunglison is hereby requested to apologize for his definition of the word Placebo, or to expunge it from his Medical Dictionary.

One thing is certain. A loud outcry on a slight touch reveals the weak spot in a profession, as well as in a patient. It is a doubtful policy to oppose the freest speech in those of our own number who are trying to show us where they honestly believe our weakness lies. Vast as are the advances of our Science and Art, may it not possibly prove on examination that we retain other old barbarisms beside the use of the astrological sign of Jupiter, with which we endeavor to insure good luck to our prescriptions? Is it the act of a friend or a foe to try to point them out to our brethren when asked to address them, and is the speaker to subdue the const.i.tutional habit of his style to a given standard, under penalty of giving offence to a grave a.s.sembly?

"h.o.m.oeopathy and its Kindred Delusions" was published nearly twenty years ago, and has been long out of print, so that the author tried in vain to procure a copy until the kindness of a friend supplied him with the only one he has had for years. A foolish story reached his ears that he was attempting to buy up stray copies for the sake of suppressing it.

This edition was in the press at that very time.

Many of the arguments contained in the Lectures have lost whatever novelty they may have possessed. All its predictions have been submitted to the formidable test of time. They appear to have stood it, so far, about as well as most uninspired prophecies; indeed, some of them require much less accommodation than certain grave commentators employ in their readings of the ancient Prophets.

If some statistics recently published are correct, h.o.m.oeopathy has made very slow progress in Europe.

In all England, as it appears, there are hardly a fifth more h.o.m.oeopathic pract.i.tioners than there are students attending Lectures at the Ma.s.sachusetts Medical College at the present time. In America it has undoubtedly proved more popular and lucrative, yet how loose a hold it has on the public confidence is shown by the fact that, when a specially valued life, which has been played with by one of its agents, is seriously threatened, the first thing we expect to hear is that a regular pract.i.tioner is by the patient's bed, and the h.o.m.oeopathic counsellor overruled or discarded. Again, how many of the ardent and capricious persons who embraced h.o.m.oeopathy have run the whole round of pretentious novelties;--have been boarded at water-cure establishments, closeted with uterine and other specialists, and finally wandered over seas to put themselves in charge of foreign celebrities, who dosed them as l.u.s.tily as they were ever dosed before they took to globules! It will surprise many to learn to what a shadow of a shade h.o.m.oeopathy has dwindled in the hands of many of its noted pract.i.tioners. The itch-doctrine is treated with contempt. Infinitesimal doses are replaced by full ones whenever the fancy-pract.i.tioner chooses. Good h.o.m.oeopathic reasons can be found for employing anything that anybody wants to employ. h.o.m.oeopathy is now merely a name, an unproved theory, and a box of pellets pretending to be specifics, which, as all of us know, fail ignominiously in those cases where we would thankfully sacrifice all our prejudices and give the world to have them true to their promises.

h.o.m.oeopathy has not died out so rapidly as Tractoration. Perhaps it was well that it should not, for it has taught us a lesson of the healing faculty of Nature which was needed, and for which many of us have made proper acknowledgments. But it probably does more harm than good to medical science at the present time, by keeping up the delusion of treating everything by specifics,--the old barbarous notion that sick people should feed on poisons [Lachesis, arrow-poison, obtained from a serpent (Pulte). Crotalus horridus, rattlesnake's venom (Neidhard). The less dangerous Pediculus capitis is the favorite remedy of Dr. Mure, the English "Apostle of h.o.m.oeopathy." These are examples of the retrograde current setting towards barbarism] against which a part of the Discourse at the beginning of this volume is directed.

The infinitesimal globules have not become a curiosity as yet, like Perkins's Tractors. But time is a very elastic element in Geology and Prophecy. If Daniel's seventy weeks mean four hundred and ninety years, as the learned Prideaux and others have settled it that they do, the "not many years" of my prediction may be stretched out a generation or two beyond our time, if necessary, when the prophecy will no doubt prove true.

It might be fitting to add a few words with regard to the Essay on the Contagiousness of Puerperal Fever. But the whole question I consider to be now transferred from the domain of medical inquiry to the consideration of Life Insurance agencies and Grand Juries. For the justification of this somewhat sharply accented language I must refer the reader to the paper itself for details which I regret to have been forced to place on permanent record.

BOSTON, January, 1861.

A SECOND PREFACE.

These Lectures and Essays are arranged in the order corresponding to the date of their delivery or publication. They must, of course, be read with a constant reference to these dates, by such as care to read them. I have not attempted to modernize their aspect or character in presenting them, in this somewhat altered connection, to the public.

Several of them were contained in a former volume which received its name from the Address called "Currents and Counter-Currents." Some of those contained in the former volume have been replaced by others. The Essay called "Mechanism of Vital Actions" has been transferred to a distinct collection of Miscellaneous essays, forming a separate volume.

I had some intention of including with these papers an Essay on Intermittent Fever in New England, which received one of the Boylston prizes in 1837, and was published in the following year. But as this was upon a subject of local interest, chiefly, and would have taken up a good deal of room, I thought it best to leave it out, trusting that the stray copies to be met with in musty book-shops would sufficiently supply the not very extensive or urgent demand for a paper almost half a century old.

Some of these papers created a little stir when they first fell from the press into the pool of public consciousness. They will slide in very quietly now in this new edition, and find out for themselves whether the waters are those of Lethe, or whether they are to live for a time as not wholly unvalued reminiscences.

March 21, 1883.

PREFACE TO THE NEW EDITION.

These Essays are old enough now to go alone without staff or crutch in the shape of Prefaces. A very few words may be a convenience to the reader who takes up the book and wishes to know what he is likely to find in it.

h.o.m.oEOPATHY AND ITS KINDRED DELUSIONS.

h.o.m.oeopathy has proved lucrative, and so long as it continues to be so will surely exist,--as surely as astrology, palmistry, and other methods of getting a living out of the weakness and credulity of mankind and womankind. Though it has no pretensions to be considered as belonging among the sciences, it may be looked upon by a scientific man as a curious object of study among the vagaries of the human mind. Its influence for good or the contrary may be made a matter of calm investigation. I have studied it in the Essay before the reader, under the aspect of an extravagant and purely imaginative creation of its founder. Since that first essay was written, nearly half a century ago, we have all had a chance to witness its practical working. Two opposite inferences may be drawn from its doctrines and practice. The first is that which is accepted by its disciples. This is that all diseases are "cured" by drugs. The opposite conclusion is drawn by a much larger number of persons. As they see that patients are very commonly getting well under treatment by infinitesimal drugging, which they consider equivalent to no medication at all, they come to disbelieve in every form of drugging and put their whole trust in "nature." Thus experience,

"From seeming evil still educing good,"

has shown that the dealers in this preposterous system of pseudo-therapeutics have cooperated with the wiser cla.s.s of pract.i.tioners in breaking up the system of over-dosing and over-drugging which has been one of the standing reproaches of medical practice. While keeping up the miserable delusion that diseases were all to be "cured"

by drugging, h.o.m.oeopathy has been unintentionally showing that they would very generally get well without any drugging at all. In the mean time the newer doctrines of the "mind cure," the "faith cure," and the rest are encroaching on the territory so long monopolized by that most ingenious of the pseudo-sciences. It would not be surprising if its whole ground should be taken possession of by these new claimants with their flattering appeals to the imaginative cla.s.s of persons open to such attacks. Similia similabus may prove fatally true for once, if h.o.m.oeopathy is killed out by its new-born rivals.

It takes a very moderate amount of erudition to unearth a charlatan like the supposed father of the infinitesimal dosing system. The real inventor of that specious trickery was an Irishman by the name of Butler. The whole story is to be found in the "Ortus Medicinm" of Van Helmont. I have given some account of his chapter "Butler" in different articles, but I would refer the students of our h.o.m.oeopathic educational inst.i.tutions to the original, which they will find very interesting and curious.

CURRENTS AND COUNTER-CURRENTS

My attack on over-drugging brought out some hostile comments and treatment. Thirty years ago I expressed myself with more vivacity than I should show if I were writing on the same subjects today. Some of my more lively remarks called out very sharp animadversion. Thus my ill.u.s.tration of prevention as often better than treatment in the mother's words to her child which had got a poisonous berry in its mouth,--"Spit it out!" gave mortal offence to a well-known New York pract.i.tioner and writer, who advised the Ma.s.sachusetts Medical Society to spit out the offending speaker. Worse than this was my statement of my belief that if a ship-load of miscellaneous drugs, with certain very important exceptions,--drugs, many of which were then often given needlessly and in excess, as then used "could be sunk to the bottom of the sea, it would be all the better for mankind and all the worse for the fishes." This was too bad. The sentence was misquoted, quoted without its qualifying conditions, and frightened some of my worthy professional brethren as much as if I had told them to throw all physic to the dogs. But for the epigrammatic sting the sentiment would have been unnoticed as a harmless overstatement at the very worst.

Since this lecture was delivered a great and, as I think, beneficial change has taken place in the practice of medicine. The habit of the English "general pract.i.tioner" of making his profit out of the pills and potions he administered was ruinous to professional advancement and the dignity of the physician. When a half-starving medical man felt that he must give his patient draught and boluses for which he could charge him, he was in a pitiable position and too likely to persuade himself that his drugs were useful to his patient because they were profitable to him. This practice has prevailed a good deal in America, and was doubtless the source in some measure of the errors I combated.

THE CONTAGIOUSNESS OF PUERPERAL FEVER.

This Essay was read before a small a.s.sociation called "The Society for Medical Improvement," and published in a Medical Journal which lasted but a single year. It naturally attracted less attention than it would have done if published in such a periodical as the "American Journal of Medical Sciences." Still it had its effect, as I have every reason to believe. I cannot doubt that it has saved the lives of many young mothers by calling attention to the existence and propagation of "Puerperal Fever as a Private Pestilence," and laying down rules for taking the necessary precautions against it. The case has long been decided in favor of the views I advocated, but, at the time when I wrote two of the most celebrated professors of Obstetrics in this country opposed my conclusions with all the weight of their experience and position.

This paper was written in a great heat and with pa.s.sionate indignation.

If I touched it at all I might trim its rhetorical exuberance, but I prefer to leave it all its original strength of expression. I could not, if I had tried, have disguised the feelings with which I regarded the attempt to put out of sight the frightful facts which I brought forward and the necessary conclusions to which they led. Of course the whole matter has been looked at in a new point of view since the microbe as a vehicle of contagion has been brought into light, and explained the mechanism of that which was plain enough as a fact to all who were not blind or who did not shut their eyes.

O. W. H.

BEVERLY Farms, Ma.s.s., August 3, 1891

h.o.m.oEOPATHY AND ITS KINDRED DELUSIONS

[Two lectures delivered before the Boston Society for the Diffusion of Useful Knowledge. 1842.]

[When a physician attempts to convince a person, who has fallen into the h.o.m.oeopathic delusion, of the emptiness of its pretensions, he is often answered by a statement of cases in which its pract.i.tioners are thought to have effected wonderful cures. The main object of the first of these Lectures is to show, by abundant facts, that such statements, made by persons unacquainted with the fluctuations of disease and the fallacies of observation, are to be considered in general as of little or no value in establishing the truth of a medical doctrine or the utility of a method of practice.