part14-第1章

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　　　　　　　　〃UNLEARNED　VIEWS　OF　MEDICINE〃




　　　　　　　　_To　Dr。　Caspar　Wistar_

　　　　　　　　_Washington；　June　21；　1807_




　　　　　　　　DEAR　SIR；　　I　have　a　grandson；　the　son　of　Mr。　Randolph；　now

about　15　years　of　age；　in　whose　education　I　take　a　lively　interest。

His　time　has　not　hitherto　been　employed　to　the　greatest　advantage；　a

frequent　change　of　tutors　having　prevented　the　steady　pursuit　of　any

one　plan。　　Whether　he　possesses　that　lively　imagination；　usually

called　genius；　I　have　not　had　opportunities　of　knowing。　　But　I　think

he　has　an　observing　mind　&　sound　judgment。　　He　is　assiduous；　orderly；

&　of　the　most　amiable　temper　&　dispositions。　　As　he　will　be　at　ease

in　point　of　property；　his　education　is　not　directed　to　any　particular

possession；　but　will　embrace　those　sciences　which　give　to　retired

life　usefulness；　ornament　or　amusement。　　I　am　not　a　friend　to　placing

growing　men　in　populous　cities；　because　they　acquire　there　habits　&

partialities　which　do　not　contribute　to　the　happiness　of　their　after

life。　　But　there　are　particular　branches　of　science；　which　are　not　so

advantageously　taught　anywhere　else　in　the　U。S。　as　in　Philadelphia。

The　garden　at　the　Woodlands　for　Botany；　Mr。　Peale's　Museum　for

Natural　History；　your　Medical　school　for　Anatomy；　and　the　able

professors　in　all　of　them；　give　advantages　not　to　be　found　elsewhere。

We　propose；　therefore；　to　send　him　to　Philadelphia　to　attend　the

schools　of　Botany；　Natural　History；　Anatomy；　&　perhaps　Surgery；　but

not　of　Medicine。　　And　why　not　of　Medicine；　you　will　ask？　　Being　led

to　the　subject；　I　will　avail　myself　of　the　occasion　to　express　my

opinions　on　that　science；　and　the　extent　of　my　medical　creed。　　But；

to　finish　first　with　respect　to　my　grandson；　I　will　state　the　favor　I

ask　of　you；　which　is　the　object　of　this　letter。




　　　　　　　　Having　been　born　&　brought　up　in　a　mountainous　&　healthy

country；　we　should　be　unwilling　he　should　go　to　Philadelphia　until

the　autumnal　diseases　cease。　　It　is　important　therefore　for　us　to

know；　at　what　period　after　that；　the　courses　of　lectures　in　Natural

history；　Botany；　Chemistry；　Anatomy　&　Surgery　begin　and　end；　and　what

days　or　hours　they　occupy？　　The　object　of　this　is　that　we　may　be　able

so　to　marshal　his　pursuits　as　to　bring　their　accomplishment　within

the　shortest　space　practicable。　　I　shall　write　to　Doctor　Barton　for

information　as　to　the　courses　of　natural　history　&　botany　but　not

having　a　sufficient　acquaintance　with　professors　of　chemistry　&

surgery；　if　you　can　add　the　information　respecting　their　school　to

that　of　your　own；　I　shall　be　much　obliged　to　you。　　What　too　are　the

usual　terms　of　boarding？　　What　the　compensations　to　professors？　　And

can　you　give　me　a　conjectural　estimate　of　other　necessary　expenses？

In　these　we　do　not　propose　to　indulge　him　beyond　what　is　necessary；

decent；　&　usual；　because　all　beyond　that　leads　to　dissipation　&

idleness；　to　which；　at　present；　he　has　no　propensities。　　I　think　Mr。

Peale　has　not　been　in　the　habit　of　receiving　a　boarder。　　His　house　&

family　would；　of　themselves；　be　a　school　of　virtue　&　instruction；　&

hours　of　leisure　there　would　be　as　improving　as　busy　ones　elsewhere。

But　I　say　this　only　on　the　possibility　of　so　desirable　a　location　for

him；　and　not　with　the　wish　that　the　thought　should　become　known　to

Mr。　Peale；　unless　some　former　precedent　should　justify　it's

suggestion　to　him。　　I　am　laying　a　heavy　tax　on　your　busy　time；　but　I

think　your　goodness　will　pardon　it　in　consideration　of　it's　bearing

on　my　happiness。




　　　　　　　　This　subject　dismissed；　I　may　now　take　up　that　which　it　led　to；

and　further　tax　your　patience　with　unlearned　views　of　medicine；

which；　as　in　most　cases；　are；　perhaps；　the　more　confident　in

proportion　as　they　are　less　enlightened。




　　　　　　　　We　know；　from　what　we　see　&　feel；　that　the　animal　body　in　it's

organs　and　functions　is　subject　to　derangement；　inducing　pain；　&

tending　to　it's　destruction。　　In　this　disordered　state；　we　observe

nature　providing　for　the　re…establishment　of　order；　by　exciting　some

salutary　evacuation　of　the　morbific　matter；　or　by　some　other

operation　which　escapes　our　imperfect　senses　and　researches。　　She

brings　on　a　crisis；　by　stools；　vomiting；　sweat；　urine；　expectoration；

bleeding；　&c。；　which；　for　the　most　part；　ends　in　the　restoration　of

healthy　action。　　Experience　has　taught　us；　also；　that　there　are

certain　substances；　by　which；　applied　to　the　living　body；　internally

or　externally；　we　can　at　will　produce　these　same　evacuations；　and

thus　do；　in　a　short　time；　what　nature　would　do　but　slowly；　and　do

effectually；　what　perhaps　she　would　not　have　strength　to　accomplish。

Where；　then；　we　have　seen　a　disease；　characterized　by　specific　signs

or　phenomena；　and　relieved　by　a　certain　natural　evacuation　or

process；　whenever　that　disease　recurs　under　the　same　appearances；　we

may　reasonably　count　on　producing　a　solution　of　it；　by　the　use　of

such　substances　as　we　have　found　produce　the　same　evacuation　or

movement。　　Thus；　fulness　of　the　stomach　we　can　relieve　by　emetics；

diseases　of　the　bowels；　by　purgatives；　inflammatory　cases；　by

bleeding；　intermittents；　by　the　Peruvian　bark；　syphilis；　by　mercury：

watchfulness；　by　opium；　&c。　　So　far；　I　bow　to　the　utility　of

medicine。　　It　goes　to　the　well…defined　forms　of　disease；　&　happily；

to　those　the　most　frequent。　　But　the　disorders　of　the　animal　body；　&

the　symptoms　indicating　them；　are　as　various　as　the　elements　of　which

the　body　is　composed。　　The　combinations；　too；　of　these　symptoms　are

so　infinitely　diversified；　that　many　associations　of　them　appear　too

rarely　to　establish　a　definite　disease；　and　to　an　unknown　disease；

there　cannot　be　a　known　remedy。　　Here　then；　the　judicious；　the　moral；

the　humane　physician　should　stop。　　Having　been　so　often　a　witness　to

the　salutary　efforts　which　nature　makes　to　re…establish　the

disordered　functions；　he　should　rather　trust　to　their　action；　than

hazard　the　interruption　of　that；　and　a　greater　derangement　of　the

system；　by　conjectural　experiments　on　a　machine　so　complicated　&　so

unknown　as　the　human　body；　&　a　subject　so　sacred　as　human　life。　　Or；

ifthe　appearance　of　doing　something　be　necessary　to　keep　alive　the

hope　&　spirits　of　the　patient；　it　should　be　of　the　most　innocent

character。　　One　of　the　most　successful　physicians　I　have　ever　known；

has　assured　me；　that　he　used　more　bread　pills；　drops　of　colored

water；　&　powders　of　hickory　ashes；　than　of　all　other　medicines　put

together。　　It　was　certainly　a　pious　fraud。　　But　the　adventurous

physician　goes　on；　&　substitutes　presumption　for　knolege。　　From　the

scanty　field　of　what　is　known；　he　launches　into　the　boundless　region

of　what　is　unknown。　　He　establishes　for　his　guide　some　fanciful

theory　of　corpuscular　attraction；　of　chemical　agency；　of　mechanical

powers；　of　stimuli；　of　irritability　accumulated　or　exhausted；　of

depletion　by　the　lancet　&　repletion　by　mercury；　or　some　other

ingenious　dream；　which　lets　him　into　all　nature's　secrets　at　short

hand。　　On　the　principle　which　he　thus　assumes；　he　forms　his　table　of

nosology；　arrays　his　diseases　into　families；　and　extends　his　curative

treatment；　by　analogy；　to　all　the　cases　he　has　thus　arbitrarily

marshalled　together。　　I　have　lived　myself　to　see　the　disciples　of

Hoffman；　Boerhaave；　Stalh；　Cullen；　Brown；　succeed　one　another　like

the　shifting　figures　of　a　magic　lantern；　&　their　fancies；　like　the

dresses　of　the　annual　doll…babies　from　Paris；　becoming；　from　their

novelty；　the　vogue　of　the　day；　and　yielding　to　the　next　novelty　their

ephemeral　favor。　　The　patient；　treated　on　the　fashionable　theory；

sometimes　gets　well　in　spite　of　the　medicine。　　The　medicine　therefore

restored　him；　&　the　young　doctor　receives　new　courage　to　proceed　in

his　bold　experiments　on　the　lives　of　his　fellow　creatures。　　I　believe

we　may　safely　affirm；　that　the　inexperienced　&　presumptuous　band　of

medical　tyros　let　loose　upon　the　world；　destroys　more　of　human　life

in　one　year；　than　all　the　Robinhoods；　Cartouches；　&　Macheaths　do　in　a

century。　　It　is　in　this　part　of　medicine　that　I　wish　to　see　a　reform；

an　abandonment　of　hypothesis　for　sober　facts；　the　first　degree　of

value　set　on　clinical　observation；　and　the　lowest　on　visionary

theories。　　I　would　wish　the　young　practitioner；　especially；　to　have

deeply　impressed　on　his　mind；　the　real　limits　of　his　art；　&　that　when

the　state　of　his　patient　gets　beyond　these；　his　office　is　to　be　a

watchful；　but　quiet　spectator　of　the　operations　of　nature；　giving

them　fair　play　by　a　well…regulated　regimen；　&　by　all　the　aid　they　can

derive　from　the　excitement　of　good　spirits　&　hope　in　the　patient。　　I

have　no　doubt；　that　some　diseases　not　yet　understood　may　in　time　be

transferred　to　the　table　of　those　known。　　But；　were　I　a　physician；　I

would　rather　leave　the　transfer　to　the　slow　hand　of　accident；　than

hasten　it　by　guilty　experiments　on　those　who　put　their　lives　into　my

hands。　　The　only　sure　foundations　of　medicine　are；　an　intimate

knolege　of　the　human　body；　and　observation　on　the　effects　of

medicinal　substances　on　that。　　The　anatomical　&　clinical　schools；

therefore；　are　those　in　which　the　young　physician　should　be　formed。

If　he　enters　with　innocence　that　of　the　theory　of　medicine；　it　is

scarcely　possible　he　should　come　out　untainted　with　error。　　His　mind

must　be　strong　indeed；　if；　rising　above　juvenile　credulity；　it　can

maintain　a　wise　infidelity　against　the　authority　of　his　instructors；

&　the　bewitching　delusions　of　their　theories。　　You　see　that　I

estimate　justly　that　portion　of　instruction　which　our　medical

students　derive　from　your　labors；　&；　associating　with　it　one　of　the

chairs　which　my　old　&　able　friend；　Doctor　Rush；　so　honorably　fills；　I

consider　them　as　the　two　fundamental　pillars　of　the　edifice。　　Indeed；

I　have　such　an　opinion　of　the　talents　of　the　professors　in　the　other

branches　which　constitute　the　school　of　medicine　with　you；　as　to　hope

&　believe；　that　it　is　from　this　side　of　the　Atlantic；　that　Europe；

which　has　taught　us　so　many　other　things；　will　at　length　be　led　into

sound　principles　in　this　branch　of　science；　the　most　important　of　all

others；　being　that　to　which　we　commit　the　care　of　health　&　life。




　　　　　　　　I　dare　say；　that　by　this　time；　you　are　sufficiently　sensible

that　old　heads　as　well　as　young；　may　sometimes　be　charged　with

ignorance　and　presumption。　　The　natural　course　of　the　human　mind　is

certainly　from　credulity　to　scepticism；　and　this　is　perhaps　the　most

favorable　apology　I　can　make　for　venturing　so　far　out　of　my　depth；　&

to　one　too；　to　whom　the　strong　as　well　as　the　weak　points　of　this

science　are　so　familiar。　　But　having　stumbled　on　the　subject　in　my

way；　I　wished　to　give　a　confession　of　my　faith　to　a　friend；　&　the

rather；　as　I　had　perhaps；　at　time；　to　him　as　well　as　others；

expressed　my　scepticism　in　medicine；　without　defining　it's　extent　or

foundation。　　At　any　rate；　it　has　permitted　me；　for　a　moment；　to

abstrac