Medical Essays, 1842-1882 Part 20

He was very firm, with all his kindness. He would have the truth about his patients. The nurses found it out; and the shrewder ones never ventured to tell him anything but a straight story. A clinical dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse in the Ma.s.sachusetts General Hospital, a mistress in her calling, was as good questioning and answering as one would be like to hear outside of the court-room.

Of his practice you can form an opinion from his book called "Letters to a Young Physician." Like all sensible men from the days of Hippocrates to the present, he knew that diet and regimen were more important than any drug or than all drugs put together. Witness his treatment of phthisis and of epilepsy. He retained, however, more confidence in some remedial agents than most of the younger generation would concede to them. Yet his materia medica was a simple one.

"When I first went to live with Dr. Holyoke," he says, "in 1797, showing me his shop, he said, 'There seems to you to be a great variety of medicines here, and that it will take you long to get acquainted with them, but most of them are unimportant. There are four which are equal to all the rest, namely, Mercury, Antimony, Bark and Opium.'" And Dr.

Jackson adds, "I can only say of his practice, the longer I have lived, I have thought better and better of it." When he thought it necessary to give medicine, he gave it in earnest. He hated half-practice--giving a little of this or that, so as to be able to say that one had done something, in case a consultation was held, or a still more ominous event occurred. He would give opium, for instance, as boldly as the late Dr. Fisher of Beverly, but he followed the aphorism of the Father of Medicine, and kept extreme remedies for extreme cases.

When it came to the "non-naturals," as he would sometimes call them, after the old physicians,--namely, air, meat and drink, sleep and watching, motion and rest, the retentions and excretions, and the affections of the mind,--he was, as I have said, of the school of sensible pract.i.tioners, in distinction from that vast community of quacks, with or without the diploma, who think the chief end of man is to support apothecaries, and are never easy until they can get every patient upon a regular course of something nasty or noxious. n.o.body was so precise in his directions about diet, air, and exercise, as Dr.

Jackson. He had the same dislike to the a peu pres, the about so much, about so often, about so long, which I afterwards found among the punctilious adherents of the numerical system at La Pitie.

He used to insist on one small point with a certain philological precision, namely, the true meaning of the word "cure." He would have it that to cure a patient was simply to care for him. I refer to it as showing what his idea was of the relation of the physician to the patient. It was indeed to care for him, as if his life were bound up in him, to watch his incomings and outgoings, to stand guard at every avenue that disease might enter, to leave nothing to chance; not merely to throw a few pills and powders into one pan of the scales of Fate, while Death the skeleton was seated in the other, but to lean with his whole weight on the side of life, and shift the balance in its favor if it lay in human power to do it. Such devotion as this is only to be looked for in the man who gives himself wholly up to the business of healing, who considers Medicine itself a Science, or if not a science, is willing to follow it as an art,--the n.o.blest of arts, which the G.o.ds and demiG.o.ds of ancient religions did not disdain to practise and to teach.

The same zeal made him always ready to listen to any new suggestion which promised to be useful, at a period of life when many men find it hard to learn new methods and accept new doctrines. Few of his generation became so accomplished as he in the arts of direct exploration; coming straight from the Parisian experts, I have examined many patients with him, and have had frequent opportunities of observing his skill in percussion and auscultation.

One element in his success, a trivial one compared with others, but not to be despised, was his punctuality. He always carried two watches,--I doubt if he told why, any more than Dr. Johnson told what he did with the orange-peel,--but probably with reference to this virtue. He was as much to be depended upon at the appointed time as the solstice or the equinox. There was another point I have heard him speak of as an important rule with him; to come at the hour when he was expected; if he had made his visit for several days successively at ten o'clock, for instance, not to put it off, if he could possibly help it, until eleven, and so keep a nervous patient and an anxious family waiting for him through a long, weary hour.

If I should attempt to characterize his teaching, I should say that while it conveyed the best results of his sagacious and extended observation, it was singularly modest, cautious, simple, sincere.

Nothing was for show, for self-love; there was no rhetoric, no declamation, no triumphant "I told you so," but the plain statement of a clear-headed honest man, who knows that he is handling one of the gravest subjects that interest humanity. His positive instructions were full of value, but the spirit in which he taught inspired that loyal love of truth which lies at the bottom of all real excellence.

I will not say that, during his long career, Dr. Jackson never made an enemy. I have heard him tell how, in his very early days, old Dr.

Danforth got into a towering pa.s.sion with him about some professional consultation, and exploded a monosyllable or two of the more energetic kind on the occasion. I remember that that somewhat peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson succeeded to his place as Professor of Theory and Practice. A young man of Dr. Jackson's talent and energy could hardly take the position that belonged to him without crowding somebody in a profession where three in a bed is the common rule of the household. But he was a peaceful man and a peace-maker all his days. No man ever did more, if so much, to produce and maintain the spirit of harmony for which we consider our medical community as somewhat exceptionally distinguished.

If this harmony should ever be threatened, I could wish that every impatient and irritable member of the profession would read that beautiful, that n.o.ble Preface to the "Letters," addressed to John Collins Warren. I know nothing finer in the medical literature of all time than this Prefatory Introduction. It is a golden prelude, fit to go with the three great Prefaces which challenge the admiration of scholars,--Calvin's to his Inst.i.tutes, De Thou's to his History, and Casaubon's to his Polybius,--not because of any learning or rhetoric, though it is charmingly written, but for a spirit flowing through it to which learning and rhetoric are but as the breath that is wasted on the air to the Mood that warms the heart.

Of a similar character is this short extract which I am permitted to make from a private letter of his to a dear young friend. He was eighty-three years old at the time of writing it.

"I have not loved everybody whom I have known, but I have striven to see the good points in the characters of all men and women. At first I must have done this from something in my own nature, for I was not aware of it, and yet was doing it without any plan, when one day, sixty years ago, a friend whom I loved and respected said this to me, 'Ah, James, I see that you are destined to succeed in the world, and to make friends, because you are so ready to see the good point in the characters of those you meet.'"

I close this imperfect notice of some features in the character of this most honored and beloved of physicians by applying to him the words which were written of William Heberden, whose career was not unlike his own, and who lived to the same patriarchal age.

"From his early youth he had always entertained a deep sense of religion, a consummate love of virtue, an ardent thirst after knowledge, and an earnest desire to promote the welfare and happiness of all mankind. By these qualities, accompanied with great sweetness of manners, he acquired the love and esteem of all good men, in a degree which perhaps very few have experienced; and after pa.s.sing an active life with the uniform testimony of a good conscience, he became an eminent example of its influence, in the cheerfulness and serenity of his latest age."

Such was the man whom I offer to you as a model, young gentlemen, at the outset of your medical career. I hope that many of you will recognize some traits of your own special teachers scattered through various parts of the land in the picture I have drawn. Let me a.s.sure you that whatever you may learn in this or any other course of public lectures,--and I trust you will learn a great deal,--the daily guidance, counsel, example, of your medical father, for such the Oath of Hippocrates tells you to consider your preceptor, will, if he is in any degree like him of whom I have spoken, be the foundation on which all that we teach is reared, and perhaps outlive most of our teachings, as in Dr. Jackson's memory the last lessons that remained with him were those of his Old Master.

THE MEDICAL PROFESSION IN Ma.s.sACHUSETTS.

A Lecture of a Course by members of the Ma.s.sachusetts Historical Society, delivered before the Lowell Inst.i.tute, January 29, 1869.

The medical history of eight generations, told in an hour, must be in many parts a mere outline. The details I shall give will relate chiefly to the first century. I shall only indicate the leading occurrences, with the more prominent names of the two centuries which follow, and add some considerations suggested by the facts which have been pa.s.sed in review.

A geographer who was asked to describe the tides of Ma.s.sachusetts Bay, would have to recognize the circ.u.mstance that they are a limited manifestation of a great oceanic movement. To consider them apart from this, would be to localize a planetary phenomenon, and to provincialize a law of the universe. The art of healing in Ma.s.sachusetts has shared more or less fully and readily the movement which, with its periods of ebb and flow, has been raising its level from age to age throughout the better part of Christendom. Its pract.i.tioners brought with them much of the knowledge and many of the errors of the Old World; they have always been in communication with its wisdom and its folly; it is not without interest to see how far the new conditions in which they found themselves have been favorable or unfavorable to the growth of sound medical knowledge and practice.

The state of medicine is an index of the civilization of an age and country,--one of the best, perhaps, by which it can be judged. Surgery invokes the aid of all the mechanical arts. From the rude violences of the age of stone,--a relic of which we may find in the practice of Zipporah, the wife of Moses,--to the delicate operations of to-day upon patients lulled into temporary insensibility, is a progress which presupposes a skill in metallurgy and in the labors of the workshop and the laboratory it has taken uncounted generations to acc.u.mulate. Before the morphia which deadens the pain of neuralgia, or the quinine which arrests the fit of an ague, can find their place in our pharmacies, commerce must have perfected its machinery, and science must have refined its processes, through periods only to be counted by the life of nations. Before the means which nature and art have put in the hands of the medical pract.i.tioner can be fairly brought into use, the prejudices of the vulgar must be overcome, the intrusions of false philosophy must be fenced out, and the partnership with the priesthood dissolved. All this implies that freedom and activity of thought which belong only to the most advanced conditions of society; and the progress towards this is by gradations as significant of wide-spread changes, as are the varying states of the barometer of far-extended conditions of the atmosphere.

Apart, then, from its special and technical interest, my subject has a meaning which gives a certain importance, and even dignity, to details in themselves trivial and almost unworthy of record. A medical entry in Governor Winthrop's journal may seem at first sight a mere curiosity; but, rightly interpreted, it is a key to his whole system of belief as to the order of the universe and the relations between man and his Maker. Nothing sheds such light on the superst.i.tions of an age as the prevailing interpretation and treatment of disease. When the touch of a profligate monarch was a cure for one of the most inveterate of maladies, when the common symptoms of hysteria were prayed over as marks of demoniacal possession, we might well expect the spiritual realms of thought to be peopled with still stranger delusions.

Let us go before the Pilgrims of the Mayflower, and look at the sh.o.r.es on which they were soon to land. A wasting pestilence had so thinned the savage tribes that it was sometimes piously interpreted as having providentially prepared the way for the feeble band of exiles. Cotton Mather, who, next to the witches, hated the "tawnies," "wild beasts,"

"blood-hounds," "rattlesnakes," "infidels," as in different places he calls the unhappy Aborigines, describes the condition of things in his lively way, thus: "The Indians in these Parts had newly, even about a Year or Two before, been visited with such a prodigious Pestilence; as carried away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of Twenty) among them so that the Woods were almost cleared of those pernicious Creatures to make Room for a better Growth."

What this pestilence was has been much discussed. It is variously mentioned by different early writers as "the plague," "a great and grievous plague," "a sore consumption," as attended with spots which left unhealed places on those who recovered, as making the "whole surface yellow as with a garment." Perhaps no disease answers all these conditions so well as smallpox. We know from different sources what frightful havoc it made among the Indians in after years,--in 1631, for instance, when it swept away the aboriginal inhabitants of "whole towns," and in 1633. We have seen a whole tribe, the Mandans, extirpated by it in our own day. The word "plague" was used very vaguely, as in the description of the "great sickness" found among the Indians by the expedition of 1622. This same great sickness could hardly have been yellow fever, as it occurred in the month of November. I cannot think, therefore, that either the scourge of the East or our Southern malarial pestilence was the disease that wasted the Indians. As for the yellowness like a garment, that is too familiar to the eyes of all who have ever looked on the hideous mask of confluent variola.

Without the presence or the fear of these exotic maladies, the forlorn voyagers of the Mayflower had sickness enough to contend with. At their first landing at Cape Cod, gaunt and hungry and longing for fresh food, they found upon the sandy sh.o.r.e "great mussel's, and very fat and full of sea-pearl." Sailors and pa.s.sengers indulged in the treacherous delicacy; which seems to have been the sea-clam; and found that these mollusks, like the sh.e.l.l the poet tells of, remembered their august abode, and treated the way-worn adventurers to a gastric reminiscence of the heaving billows. In the mean time it blew and snowed and froze.

The water turned to ice on their clothes, and made them many times like coats of iron. Edward Tilley had like to have "sounded" with cold. The gunner, too, was sick unto death, but "hope of trucking" kept him on his feet,--a Yankee, it should seem, when he first touched the sh.o.r.e of New England. Most, if not all, got colds and coughs, which afterwards turned to scurvy, whereof many died.

How can we wonder that the crowded and tempest-tossed voyagers, many of them already suffering, should have fallen before the trials of the first winter in Plymouth? Their imperfect shelter, their insufficient supply of bread, their salted food, now in unwholesome condition, account too well for the diseases and the mortality that marked this first dreadful season; weakness, swelling of the limbs, and other signs of scurvy, betrayed the want of proper nourishment and protection from the elements. In December six of their number died, in January eight, in February, seventeen, in March thirteen. With the advance of spring the mortality diminished, the sick and lame began to recover, and the colonists, saddened but not disheartened, applied themselves to the labors of the opening year.

One of the most pressing needs of the early colonists must have been that of physicians and surgeons. In Mr. Savage's remarkable Genealogical Dictionary of the first settlers who came over before 1692 and their descendants to the third generation, I find scattered through the four crowded volumes the names of one hundred and thirty-four medical pract.i.tioners. Of these, twelve, and probably many more, practised surgery; three were barber-surgeons. A little incident throws a glimmer from the dark lantern of memory upon William Direly, one of these pract.i.tioners with the razor and the lancet. He was lost between Boston and Roxbury in a violent tempest of wind and snow; ten days afterwards a son was born to his widow, and with a touch of homely sentiment, I had almost said poetry, they called the little creature "Fathergone" Direly.

Six or seven, probably a larger number, were ministers as well as physicians, one of whom, I am sorry to say, took to drink and tumbled into the Connecticut River, and so ended. One was not only doctor, but also schoolmaster and poet. One practised medicine and kept a tavern.

One was a butcher, but calls himself a surgeon in his will, a union of callings which suggests an obvious pleasantry. One female pract.i.tioner, employed by her own s.e.x,--Ann Moore,--was the precursor of that intrepid sisterhood whose cause it has long been my pleasure and privilege to advocate on all fitting occasions.

Outside of this list I must place the name of Thomas Wilkinson, who was complained of, is 1676, for practising contrary to law.

Many names in the catalogue of these early physicians have been a.s.sociated, in later periods, with the practice of the profession, --among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge, Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams, Woodward. Touton was a Huguenot, Burchsted a German from Silesia, Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the honor of the profession, was only Peac.o.c.k disguised under this alias, which would not, I fear, prove very attractive to patients.

What doctrines and practice were these colonists likely to bring, with them?

Two princ.i.p.al schools of medical practice prevailed in the Old World during the greater part of the seventeenth century. The first held to the old methods of Galen: its theory was that the body, the microcosm, like the macrocosm, was made up of the four elements--fire, air, water, earth; having respectively the qualities hot, dry, moist, cold. The body was to be preserved in health by keeping each of these qualities in its natural proportion; heat, by the proper temperature; moisture, by the due amount of fluid; and so as to the rest. Diseases which arose from excess of heat were to be attacked by cooling remedies; those from excess of cold, by heating ones; and so of the other derangements of balance. This was truly the principle of contraries contrariis, which ill-informed persons have attempted to make out to be the general doctrine of medicine, whereas there is no general dogma other than this: disease is to be treated by anything that is proved to cure it. The means the Galenist employed were chiefly diet and vegetable remedies, with the use of the lancet and other depleting agents. He attributed the four fundamental qualities to different vegetables, in four different degrees; thus chicory was cold in the fourth degree, pepper was hot in the fourth, endive was cold and dry in the second, and bitter almonds were hot in the first and dry in the second degree. When we say "cool as a cuc.u.mber," we are talking Galenism. The seeds of that vegetable ranked as one of "the four greater cold seeds" of this system.

Galenism prevailed mostly in the south of Europe and France. The readers of Moliere will have no difficulty in recalling some of its favorite modes of treatment, and the abundant mirth he extracted from them.

These Galenists were what we should call "herb-doctors" to-day. Their insignificant infusions lost credit after a time; their absurdly complicated mixtures excited contempt, and their nauseous prescriptions provoked loathing and disgust. A simpler and bolder practice found welcome in Germany, depending chiefly on mineral remedies, mercury, antimony, sulphur, a.r.s.enic, and the use, sometimes the secret use, of opium. Whatever we think of Paracelsus, the chief agent in the introduction of these remedies, and whatever limits we may a.s.sign to the use of these long-trusted mineral drugs, there can be no doubt that the chemical school, as it was called, did a great deal towards the expurgation of the old, overloaded, and repulsive pharmacopoeia. We shall find evidence in the practice of our New-England physicians of the first century, that they often employed chemical remedies, and that, by the early part of the following century, their chief trust was in the few simple, potent drugs of Paracelsus.

We have seen that many of the pract.i.tioners of medicine, during the first century of New England, were clergymen. This relation between medicine and theology has existed from a very early period; from the Egyptian priest to the Indian medicine-man, the alliance has been maintained in one form or another. The partnership was very common among our British ancestors. Mr. Ward, the Vicar of Stratford-on-Avon, himself a notable example of the union of the two characters, writing about 1660, says,

"The Saxons had their blood-letters, but under the Normans physicke, begunne in England; 300 years agoe itt was not a distinct profession by itself, but practised by men in orders, witness Nicholas de Ternham, the chief English physician and Bishop of Durham; Hugh of Evesham, a physician and cardinal; Grysant, physician and pope; John Chambers, Dr.

of Physick, was the first Bishop of Peterborough; Paul Bush, a bachelor of divinitie in Oxford, was a man well read in physick as well as divinitie, he was the first bishop of Bristol."

"Again in King Richard the Second's time physicians and divines were not distinct professions; for one Tydeman, Bishop of Landaph and Worcester, was physician to King Richard the Second."

This alliance may have had its share in creating and keeping up the many superst.i.tions which have figured so largely in the history of medicine.

It is curious to see that a medical work left in ma.n.u.script by the Rev.

Cotton Mather and hereafter to be referred to, is running over with follies and superst.i.tious fancies; while his contemporary and fellow-townsman, William Dougla.s.s, relied on the same few simple remedies which, through Dr. Edward Holyoke and Dr. James Jackson, have come down to our own time, as the most important articles of the materia medica.

Let us now take a general glance at some of the conditions of the early settlers; and first, as to the healthfulness of the climate. The mortality of the season that followed the landing of the Pilgrims at Plymouth has been sufficiently accounted for. After this, the colonists seem to have found the new country agreeing very well with their English const.i.tutions. Its clear air is the subject of eulogy. Its dainty springs of sweet water are praised not only by Higginson and Wood, but even the mischievous Morton says, that for its delicate waters "Canaan came not near this country." There is a tendency to dilate on these simple blessings, which reminds one a little of the Marchioness in d.i.c.kens's story, with her orange-peel-and-water beverage. Still more does one feel the warmth of coloring,--such as we expect from converts to a new faith, and settlers who want to entice others over to their clearings, when Winslow speaks, in 1621, of "abundance of roses, white, red, and damask; single, but very sweet indeed;" a most of all, however, when, in the same connection, he says, "Here are grapes white and red, and very sweet and strong also." This of our wild grape, a little vegetable Indian, which scalps a civilized man's mouth, as his animal representative scalps his cranium. But there is something quite charming in Winslow's picture of the luxury in which they are living. Lobsters, oysters, eels, mussels, fish and fowl, delicious fruit, including the grapes aforesaid,--if they only had "kine, horses, and sheep," he makes no question but men would live as contented here as in any part of the world. We cannot help admiring the way in which they took their trials, and made the most of their blessings.

"And how Content they were," says Cotton Mather, "when an Honest Man, as I have heard, inviting his Friends to a Dish of Clams, at the Table gave Thanks to Heaven, who had given them to suck the abundance of the Seas, and of the Treasures Aid in the Sands!"

Strangely enough, as it would seem, except for this buoyant determination to make the best of everything, they hardly appear to recognize the difference of the climate from that which they had left.

After almost three years' experience, Winslow says, he can scarce distinguish New England from Old England, in respect of heat and cold, frost, snow, rain, winds, etc. The winter, he thinks (if there is a difference), is sharper and longer; but yet he may be deceived by the want of the comforts he enjoyed at home. He cannot conceive any climate to agree better with the const.i.tution of the English, not being oppressed with extremity of heats, nor nipped by biting cold:

"By which means, blessed be G.o.d, we enjoy our health, notwithstanding those difficulties we have undergone, in such a measure as would have been admired, if we had lived in England with the like means."

Edward Johnson, after mentioning the shifts to which they were put for food, says,--

"And yet, methinks, our children are as cheerful, fat, and l.u.s.ty, with feeding upon those mussels, clams, and other fish, as they were in England with their fill of bread."

Higginson, himself a dyspeptic, "continually in physic," as he says, and accustomed to dress in thick clothing, and to comfort his stomach with drink that was "both strong and stale,"--the "jolly good ale and old," I suppose, of free and easy Bishop Still's song,--found that he both could and did oftentimes drink New England water very well,--which he seems to look upon as a remarkable feat. He could go as lightclad as any, too, with only a light stuff ca.s.sock upon his shirt, and stuff breeches without linings. Two of his children were sickly: one,--little misshapen Mary,--died on the pa.s.sage, and, in her father's words, "was the first in our ship that was buried in the bowels of the great Atlantic sea;"