THE ESSENTIAL OF THE ART OF MEDICINE
Journal of the American Medical Association (JAMA)
The closing years of the eighteenth century and the early years of the nineteenth century marked an epoch in medicine as transcendent for its welfare as the events of the past decade bespeak for the glory of the medicine of the future. In that epoch was witnessed the passing of the old; the dawn of the new. A long farewell was being said to schools of medicine and systems of pathology and false methods; a timorous but cordial welcome was extended to the beginnings of that which culminated in
... ch culminated in the realism of the nineteenth century. It is true, as echoes of the past, Brunonianism, Broussaisism, the Stimolo and Contrastimolo of Rasori, and subordinate "isms" furnished exercise for the expiring idealistic intellect, and seemed to condone for the pernicious therapeutics of the early periods of this century. Al though the reform period extended over the seventeenth and eighteenth centuries, the death agony of idealism began about the period we have indicated. It is true that Harvey and Willis and Glisson, and Malpighi, and Schwammerdam, in the seventeenth century supplemented the labors of the early anatomists and bid fair to found a science of medicine. In this earlier century, most important of all, arose the Baconian system of philosophy. Nevertheless the sway of the imagination and the rule of theory never seemed more powerful. Deductive philosophy seemed to be at its height. Instruments of precision had not been employed up to this time, and the collateral sciences were not sufficiently developed to invoke aid from them in the investigations of physiology and pathology. It is not to be wondered at that the indefinite data secured by observation restricted to the unaided eye, and to the touch, should lead them to indulge in elaborate classifications of disease and to refinements in symptomatology which now serve only to amuse and appal. Under these circumstances the Iatro-chemical, the Iatro mechanical, the Mechanico-dynamic schools, the schools of Animism and Vitalism and Solidism waxed and waned, and out of them the Brunonian, Rasorian, Hahnemannian and other fallacious schools were born. Along with pseudo-scientific systems, artificial classification reached its highest pitch in that of Sauvage. His system included ten classes of disease, each subdivided into several orders, and some as many as 295 genera and 2400 species of disease (Park). For Cullen, four classes with 149 genera were enough to •encompass the field of pathology. Time forbids entering into detail concerning the theoretic and speculative modes of treatment which grew out of such specious pathology. Again there was a rise and fall. To Willis again (seventeenth century) credit must first be given for approaching the rational and scientific in therapeutics (Leech), as in physiology and anatomy. Sydenham displayed the most astute scientific habit of mind in urging simple observation and simple treatment, in fully recognizing the healing power of nature, and in removing the immediate cause of the disease. Observation and experience was the central idea of his method, a revival of Hippocratic methods, which to this day influence medical thought. It is interesting to know on the authority of Leech that, with the exception of emetics, purgatives, bitters and carminatives, very few of the drugs he and Willis employed had the powers they claimed for them, and most of them have lapsed into a deserved oblivion. Both these great men were moderate polypharmacists, as many as eighteen herbs only being used in one prescription. Their rivals and successors, however, far surpassed them in the number and character of the ingredients of the formula? they employed. With the growth and decay of systems in the eighteenth century-the death agony lapsing into the nineteenth-flourished and declined, remedial measures debilitating or stimulating, alterative or évacuant, according to the specific view in vogue. Venesection followed shortly and lingered long; stimlation raged, polypharmacy grew apace and then, when results did not warrant practice, change in the type of disease was invoked (Allison and others) to fit fact to theory. Theoretic systems came to an end with the promulgation of the systems of Brown, Broussais and Hahnemann. A universal skepticism arose; the expectant treatment in France, and in Germany "Nihilismus," were the refuge of scientific inquirers (Benett). Therapeutics, with the development of chemistry and the growth of physiology and pathology, became rational. But, further reference, with your permission, will be made to rational therapeutics later. In the meantime it must not be forgotten that Stahl and his followers were among the earliest skeptics, denying the efficiency of medicine, even doubting the value of opium and cinchona. Let it be recorded here likewise, as an admonition to those who oppose and a hope for those who favor, that as early as 280 B. O, perhaps by others earlier, Erasistratus urged gymnastics, exercise, diet and baths, in preference to drugs, and that the echoes of his refrain never died out. Asclepiades discarded all violent remedies and relied on hygienic means alone. Moreover, from time immemorial climatic treatment was extolled. Coming to later days, among the not a few essays on climatic treatment, Rush's description of the advantages secured by long journeys on horseback for the treatment of consumption is as fascinating as the many writings of this almost myriad-minded man.