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I





THE LIBRARY

OF

THE UNIVERSITY

OF CALIFORNIA

DAVIS



-

:



attrition



THE WORKS OF
OLIVER WENDELL HOLMES

ILLUSTRATED WITH STEEL PORTRAITS
AND PHOTOGRAVURES

IN THIRTEEN VOLUMES
VOLUME IX






-



* ,

V



Dr. Holmes in 1879



DAVIS



MEDICAL ESSAYS



18421882



BY



OLIVER WENDELL HOLMES




BOSTON AND NEW YORK
HOUGHTON, MIFFLTN AND COMPANY

(E&c tiiliennDe ^3rcsp,



LIBRARY

UNIVERSITY OF CALIFORNIA
DAVIS



Copyright, 1861, 1862, 1883, 1889, and 1891,
BY OLIVER WENDELL HOLMES.

Copyright, 1892,
BY HOUGHTON, MIFFLIN & CO.

All rights reserved.



The Riverside Press, Cambridge, Mass., U. S. A.
Elect retyped and Printed by H. O. Hough ton & Company.



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. Neg
atives 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 constituency. 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 in
form them, that some of the positions maintained in
these pages have been unsparingly attacked, with va
rious degrees of ability, scholarship, and good-breed
ing. The tone of criticism naturally changes with
local conditions in different parts of a country ex
tended 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 assailed have also been unflinchingly



VI PREFACE.

defended by unsought champions, among the ablest of
whom it is pleasant to mention, at this moment of po
litical alienation, the Editor of the Charleston Medical
Journal.

" Currents and Counter-Currents " was written and
delivered as an Oration, a florid rhetorical composi
tion, 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 misunder*
stood 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 title as an advertise
ment to a production of his own.

The commonest mode of misrepresentation was this :
qualified propositions, the whole meaning of which de
pended 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 educa
tion 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 Mas-
sasoit, which has furnished a coral, as it were, for
some teething critics, when subjected to a powerful
logical analysis, though correct in its essentials, proves
to have been told with exceptionable breadth of state
ment, and therefore (to resume the metaphor) has
been slightly rounded off at its edges, so as to be



PREFACE. Vll

smoother for any who may wish to bite upon it here
after. 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 superstitions it attacks lie
at the very foundation of Homoeopathy, 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 tradi
tions, 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, ad
mits 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 physi
cian'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



Vlll PREFACE.

in a patient. It is a doubtful policy to oppose the
freest speech in those of our own number who are try
ing to show us where they honestly believe our weak
ness 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 en
deavor 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 constitutional habit of his style
to a given standard, under penalty of giving offence
to a grave assembly ?

" Homoeopathy 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 formi
dable test of time. They appear to have stood it, so
far, about as well as most uninspired prophecies ; in
deed, some of them require much less accommodation
than certain grave commentators employ in their read
ings of the ancient Prophets.

If some statistics recently published 1 are correct,
Homoeopathy has made very slow progress in Europe.

1 Medical Investigator. Devoted to the Advancement of tht
Homcepathic System of Medicine. Chicago, January l, 1861.



PREFACE. IX

In all England, as it appears, there are hardly a fifth
more Homoeopathic practitioners than there are stu
dents attending Lectures at the Massachusetts Medi
cal 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 practitioner is by the patient's bed,
and the Homoeopathic counsellor overruled or dis
carded. Again, how many of the ardent and capri
cious persons who embraced Homoeopathy have run
the whole round of pretentious novelties ; have
been boarded at water-cure establishments, closeted
with uterine and other specialists, and finally wan
dered over seas to put themselves in charge of foreign
celebrities, who dosed them as lustily as they were ever
dosed before they took to globules ! It will surprise
many to learn to what a shadow of a shade Homoeop
athy has dwindled in the hands of many of its noted
practitioners. The itch-doctrine is treated with con
tempt. Infinitesimal doses are replaced by full ones
whenever the fancy-practitioner chooses. Good Ho
moeopathic reasons can be found for employing any
thing that anybody wants to employ. Homoeopathy
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.

Homoeopathy has not died out so rapidly as Tracto-
ration. Perhaps it was well that it should not, for it
has taught us a lesson of the healing faculty of Na-



X PREFACE.

ture 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, 1 against which
a part of the Discourse at the beginning of this volume
is directed.

The infinitesimal globules have not become a curi
osity 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 set
tled it that they do, the " not many years " of my pre
diction may be stretched out a generation or two be
yond 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 Fe
ver. 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.

1 Lachesis, arrow-poison, obtained from a serpent (Pnlte).
Crofalus horridus, rattlesnake's venom (Neidhard). The less
dangerous Pediculus capitis is the favorite remedy of Dr. Mure,
the English '* Apostle of Homoeopathy." These are examples of
the retrograde current setting towards barbarism.



A SECOND PKEFACE.



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 some
what altered connection, to the public. Several of
them were contained in a former volume which re
ceived 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 al
most half a century old.

Some of these papers created a little stir when they



Xll A SECOND PREFACE.

first fell from the press into the pool of public con
sciousness. 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 reminis
cences.

March 21, 1883.



PEEFACE TO THE NEW EDITION.



THESE Essays are old enough now to go alone with
out 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.

HOMOEOPATHY AND ITS KINDRED DELUSIONS.

Homoeopathy 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 wit
ness 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 op-



XIV PREFACE TO THE NEW EDITION.

posite conclusion is drawn by a much larger number
of persons. As they see that patients are very com
monly getting well under treatment by infinitesimal
drugging, which they consider equivalent to no medi
cation 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
class of practitioners 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, Homoeopathy has been
unintentionally showing that they would very gener
ally 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 class of persons open to such attacks.
Similia similibus may prove fatally true for once, if
Homoeopathy 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 Medicinse" of Van Helmont. I have given
some account of his chapter "Butler" in different



PREFACE TO THE NEW EDITION. XV

articles, but I would refer the students of our Homeo
pathic educational institutions to the original, which
they will find very interesting and curious.

CURRENTS AND COUNTER-CURRENTS.

My attack on over-drugging brought out some hos
tile comments and treatment. Thirty years ago I ex
pressed myself with more vivacity than I should show
if I were writing on the same subjects to-day. Some
of my more lively remarks called out very sharp an
imadversion. Thus my illustration 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 f" gave mortal offence to a
well-known New York practitioner and writer, who
advised the Massachusetts Medical Society to spit out
the offending speaker. Worse than this was my
statement of my belief that if a ship-load of miscella
neous drugs, with certain very important exceptions,
drugs, many of which were then often given need
lessly 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 epi
grammatic sting the sentiment would have been unno
ticed 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
practitioner " of making his profit out of the pills and
potions he administered was ruinous to professional



xvi PREFACE TO THE NEW EDITION.

advancement and the dignity of the physician. When
a half -starving medical man felt that he must give his
patient draughts 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 pa
tient because they were profitable to him. This prac
tice 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 Association
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 prop
agation of "Puerperal Fever as a Private Pestilence,"
and laying down rules for taking the necessary pre
cautions 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
passionate 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 fright
ful facts which I brought forward and the necessary



PREFACE TO THE NEW EDITION. XV11

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, MASS., August 3, 1891.



CONTENTS.



PAQK
L HOMCEOPATHY AND ITS KlNDRED DELUSIONS . .1

II. THE CONTAGIOUSNESS OF PUERPERAL FEVER . .103
IIL CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCI
ENCE 173

IV. BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF

MEDICAL SCIENCE 209

V. SCHOLASTIC AND BEDSIDE TEACHING .... 273
VI. THE MEDICAL PROFESSION IN MASSACHUSETTS . 312

VII. THE YOUNG PRACTITIONER 370

VIII. MEDICAL LIBRARIES 396

IX. SOME OF MY EARLY TEACHERS . . . . .420



LIST OF ILLUSTRATIONS



PAGE

OLIVER WENDELL HOLMES AT THE AGE OF 70. From a

Photograph by Notman Frontispiece

MASSACHUSETTS GENERAL HOSPITAL 104

DR. JOHN C. WARREN 252

DR. JAMES JACKSON 308

DR. JACOB BIGELOW . 434



MEDICAL ESSAYS.
i.

HOMCEOPATHY AND ITS KINDRED DELUSIONS.

Kairvov ffKias ovap.

[WHEN a physician attempts to convince a person, who has fallen into
the Homoeopathic delusion, of the emptiness of its pretensions, he is often
answered by a statement of cases in which its practitioners are thought to
have effected wonderful cures. The main object of the first of these Lec
tures is to show, by abundant/acfe, that such statements, made by persons
unacquainted with the fluctuations of disease and the fallacies of observa
tion, 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.

Those kind friends who suggest to a person suffering from a tedious
complaint, that he "Had better try Homoeopathy," are apt to enforce
their suggestion by adding, that "at any rate it can do no harm." This
may or may not be true as regards the individual. But it always does very
great harm to the community to encourage ignorance, error, or deception
in a profession which deals with the life and health of our fellow-creatures.
Whether or not those who countenance Homoeopathy are guilty of this
injustice towards others, the second of these Lectures may afford them
some means of determining.

To deny that good effects may happen from the observance of diet and
regimen when prescribed by Homceopathists as well as by others, would
be very unfair to them. But to suppose that men with minds so consti
tuted as to accept such statements and embrace such doctrines as make up
the so-called science of Homoeopathy are more competent than others to
regulate the circumstances which influence the human body in health and
disease, would be judging very harshly the average capacity of ordinary
practitioners.

To deny that some patients may have been actually benefited through
the influence exerted upon their imaginations, would be to refuse to Ho
moeopathy what all are willing to concede to every one of those numerous
modes of practice known to all intelligent persons by an opprobrious title.

Two lectures delivered before the Boston Society for the Diffusion of TJpeful
Knowledge. 1842.



2 MEDICAL ESSAYS.

So long as the bod}' is affected through the mind, no audacious device,
even of the most manifestly dishonest character, can fail of producing
occasional good to those who yield it an implicit or even a partial faith.
The argument founded on this occasional good would be as applicable in
justifying the counterfeiter and giving circulation to his base coin, on the
ground that a spurious dollar had often relieved a poor man's necessities.

Homoeopathy has come before our public at a period when the growing
spirit of eclecticism has prepared many ingenious and honest minds to listen,
to all new doctrines with a candor liable to degenerate into weakness. It
is not impossible that the pretended evolution of great and mj'sterious vir
tues from infinitely attenuated atoms may have enticed a few over-refining
philosophers, who have slid into a vague belief that matter subdivided
grows less material, and approaches nearer to a spiritual nature as it re
quires a more powerful microscope for its detection.

However this may be, some persons seem disposed to take the ground of
Menzel. that the Laity must pass formal judgment between the Physician
and the Homoeopathist, as it once did between Luther and the Romanists.
The practitioner and the scholar must not, therefore, smile at the amount of
time and labor expended in these Lectures upon this shadowy system;
which, in the calm and serious judgment of many of the wisest members
of the medical profession, is not entitled by anything it has ever said or
done to the notoriety of a public rebuke, still less to the honors of critical
martyrdom.]

I.

I HAVE selected four topics for this lecture, the first
three of which I shall touch but slightly, the last more
fully. They are

1. The Royal cure of the King's Evil, or Scrofula.

2. The Weapon Ointment, and its twin absurdity,
the Sympathetic Powder.

3. The Tar-water mania of Bishop Berkeley.

4. The History of the Metallic Tractors, or Per-
kinism.

The first two illustrate the ease with which numer
ous facts are accumulated to prove the most fanciful
and senseless extravagances.

The third exhibits the entire insufficiency of exalted
wisdom, immaculate honesty, and vast general acquire
ments to make a good physician of a great bishop.

The fourth shows us the intimate machinery of an



HOM<EOPATHY AND ITS KINDRED DELUSIONS. 3

extinct delusion, which flourished only forty years ago ;
drawn in all its details, as being a rich and compara
tively recent illustration of the pretensions, the argu
ments, the patronage, by means of which windy errors
have long been, and will long continue to be, swollen
into transient consequence. All display in superflu
ous abundance the boundless credulity and excitability
of mankind upon subjects connected with medicine.



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