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THE RISE, PROGRESS, AND PRESENT STATE OF MEDICINE. A DISCOURSE, Delivered at CONCORD, July 6th, 1791. BEFORE THE MIDDLESEX MEDICAL ASSOCIATION.

BY B. WATERHOUSE, M. D. PROFESSOR OF THE THEORY AND PRACTICE OF PHYSIC IN THE UNIVERSITY OF CAMBRIDGE, AND VICE-PRESIDENT OF THE ASSOCIATION.

CONCORDIA PARVAE RES CRESCUNT. Sallust.

BOSTON: Printed by THOMAS and JOHN FLEET, M,DCC,XCII.

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AT a Meeting of the Middlesex Medical Association, held at Concord, July 6th, 1791.

VOTED, That the Hon. Oliver Prescott, James Winthrop, Esq and the Rev. Ezra Ripley, be a Committee to wait on Doctor Benjamin Waterhouse, and return him the Thanks of this Association for his inge­nious and learned Discourse, delivered this Day, and request of him a Copy for the Press.

Attest. Joseph Hunt, Secretary.
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SHOULD this Discourse ever be read beyond the bounds of the Massachusetts, it perhaps would be ne­cessary to inform the reader, that the MIDDLESEX Medical Association is so called from it's being composed of practitioners living in the County of Middlesex only.

This county deviates a little from a square, but it's area is nearly equal to a square of forty miles on a side. It is divided into forty one towns, and from a late enume­ration is found to contain rather more than forty two thousand inhabitants.

The principal towns are Cambridge, Concord, Charles­town, Medford and Watertown. CAMBRIDGE is di­stinguished by the UNIVERSITY. A Society, that has for more than a century furnished supplies of Statesmen, qualified to support the rights of mankind, and men eminent in every branch of literature.

CONCORD, a town pleasant and flourishing, is situ­ated nearly in the center of the county. CHARLES­TOWN is connected with BOSTON by a bridge fifteen hundred feet long. Cambridge, Concord, and Charles­town, were rendered famous by the military events of 1775 and 1776.

Middlesex is watered by five rivers; the Merimac, the Charles, the Concord, the Nashua, and the Mistic.

The southern and northern sides of the country are hilly; but cannot be considered as mountainous, few of the hills exceeding an hundred feet in height, being generally wooded or cultivated quite to the summit.

The climate is very fine, the air generally serene, and the temperature mild. The extreme variation of Fahrenheit's thermometer may be considered as an hundred degrees in an year; but it is in very few in­stances that in the course of the year it reaches either [Page v] extreme. Ninety two degrees may be considered as the extreme of summer heat; and five or six degrees below 0 as that of the winter cold. Instances are to be found of it's exceeding these limits, but they are so rare, as to be exceptions to the general rule. *

Apples, pears, peaches, cherries, grapes, and currants are among our fruits, and by cultivation arrive at great perfection. The three last sorts are indigenous, but it is not so certain of the rest. The oak, chesnut, wal­nut, oilnut, pine, maple, button or plane tree, elm, ash and birch are among the trees that variegate our forests and beautify the face of the country.

The best part of the foregoing description is extracted from a more particular account of Middlesex, written by Judge Winthrop, which we hope he will publish at large.

[Page vi]

An Abstract from the Constitution of the MIDDLESEX MEDICAL ASSOCIATION.

I. AS health is a blessing which sweetens all enjoyments, and long life that which all men naturally desire, so he who labours to teach his fellow creatures how to secure the one, and to attain the other, may justly be numbered among the benefactors of mankind.

II. SEEING, the mind and body have such a mutual influence on each other, that, examined apart, they can never be thoroughly understood, it is incumbent on every one who taketh upon himself the title of Physician, to examine and study the constitution and influence of both, in order that he may preserve to his fellow crea­tures that greatest of blessing, a sound mind in a sound body.

III. IT is the duty of the Physician, by a skil­ful direction of the powers of human nature, to preserve as long as possible, the life, the health, and faculties committed to his care. The charge is important, the field extensive, and the calling honourable.

IV. To qualify himself for such noble purpo­ses, it is his duty to examine the animal economy, to attend to the outward operations of nature, and to the qualities and operations of medicines, [Page vii] in order to investigate the causes of diseases, and to learn their cure.

V. As of all natural bodies, none are found so variously compounded as the human; so the in­quiry into its nature, is to be placed among the most subtle and difficult of studies. The most improved and readiest measures ought therefore to be pursued to facilitate an inquiry so difficult.

VI. THE Medical Art is the offspring of expe­rience: yet life is too short, occasion too sudden, experiment too dangerous, and judgment too in­sufficient for any one person to acquire a compe­tent knowledge of diseases, and their remedies, by his own experience.

VII. As Physick therefore must grow up from a succession of discoveries and experiments hand­ed down from generation to generation, it is evi­dent, that any individual, however warmly dis­posed to promote the utility of his profession, can do but little, unless he has the united observati­ons of others to assist him. Hence the expediency of Societies and Associations.

VIII. OF the various methods of attaining and diffusing Medical knowledge, none is found so effectual or desirable, as a friendly intercourse and association of its professors, especially when their principal aim is mutual improvement.

[Page viii] IX. MOREOVER, by thus associating, such liberal and generous sentiments will probably be culti­vated, as tend to eradicate prejudices and unwor­thy practices, which at times have not only dis­graced the profession, but injured mankind.

X. CONVINCED of these things, and of the necessity of making observations ourselves, instead of relying on those made in a distant quarter of the globe, WE, whose names are hereunto sub­scribed, do form ourselves into a Society, by the name of the MIDDLESEX MEDICAL ASSO­CIATION, and do agree to the regulations following:

I.

THERE shall be annually chosen, by ballot, a PRESIDENT, VICE-PRESIDENT, SECRE­TARY, Three COUNSELLORS and a TREA­SURER.

XIII. *

AND it shall be the duty of each member to promote the interest of this Association, to advance its honour and its reputation. He shall vin­dicate and support the character of each associate, as far as justice and propriety will admit, ever esteeming it dishonourable to advance his own reputation on the ruin of another.

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XIV.

Whereas manifold inconveniences have arisen, from the want of a regular and uniform method of educating pupils in physick, especially in the country, whereby candidates for practice, when offered to the regularly appointed examiners, have been embarrassed and obstructed, though otherwise not ill informed: It is therefore the desire of this Association to remedy as speedily and prudently as possible, an inconvenience so loudly complained of.

XV.

As this matter may not have been sufficiently considered, it will not perhaps be useless to re­mark, that for want of regularity and method, the young mind often perplexes itself, and makes not an advantageous use of the real helps within its reach. Much the greatest difficulty the stu­dent has to encounter, is to know how to avoid those who are only the compilers and transcribers of those who went before them, and apply him­self to the few original authors. The systems of physick are mostly compilations, and differ from one another, rather in neatness, order, and ele­gance, than in any thing material. Hence the expediency of using a set of approved authors in the various branches of medicine. It is there­fore earnestly recommended to each and every [Page x] member of this Association, to direct his pupils to as regular and uniform course of study as may be, and to imitate, as nearly as possible, the order now established in the most eminent medical schools.

XVI.

In order that the education of pupils should be more uniform and reputable, it is the sense of this Association, that before a person be qualified to enter upon the study of physick, it is necessary that he have not only an accurate knowledge of his native tongue, but so much of the Latin and Greek, as to translate them by the help of a dictionary.

XVII.

Before any pupil offer himself to the Censors of the Massachusetts Medical Society, for examina­tion, the Physician who recommends him shall be certain that he has such a knowledge of Anatomy as is necessary to understand the animal economy, both in its sound and morbid state; likewise an acquaintance with diseases, and the usual method of treating them; also a knowledge of the prin­ciples of Chemistry, Materia Medica, and the ope­ration of remedies—an acquaintance with at least the elementary parts of Mathematicks, of Natural History, and Natural Philosophy, although not ab­solutely enjoined, are deemed very desirable.

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XVIII.

The advantage of teaching Physick by Lectures is confessed by the usage of all Europe, but has never been enjoyed among us until within a few years: WE being persuaded that great advan­tages will result from such a systematical mode of teaching all the branches of the medical art, do hereby recommend to all such as are or may become our pupils, to attend the Medical Lectures which are annually given at our UNIVERSITY at CAMBRIDGE.

XIX.

By such a procedure, the pupil will be fitted for examination by the Medical Professors in the UNIVERSITY, or by the Censors of the MAS­SACHUSETTS MEDICAL SOCIETY.

XX.

By these and similar modes, this Association hope not only to inspire and diffuse a spirit of order and regularity in medical education, but to enlarge the sphere of it; being thoroughly con­vinced that it is only from such a system, that quackery can be banished from the land, and the honest physician rise to usefulness and eminence.

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QUERIES put to each Member at the opening of every meeting.

1. HAVE you met with any thing in any medical author, since our last meeting, suitable to be communi­cated to this association?

2. What was the last Epidemic that visited the district where you reside, and what were the remedies particularly serviceable in it?

3. Do you know of any instance, since our last meeting, of the resuscitation of any one apparently dead; and the method pursued?

4. Is there any difficult point in the theory or prac­tice of physic, which you would gladly have discussed at this time?

5. Do you know of any deserving beginner in the practice of physic, too young to become a member, whom this association can any way serve or encourage?

6. Have you any weighty affair in hand as a phy­sician, in which you think the advice of this association may be of service?

7. Do you think of any thing at present in which this association may be serviceable to mankind, to their country, or to themselves?

The OFFICERS of the MIDDLESEX MEDICAL ASSOCIATION for the year 1792.

PRESIDENT.
Hon ble OLIVER PRESCOTT, M. D.
VICEPRESIDENT.
BENJAMIN WATERHOUSE, M. D.
COUNSELLORS.
  • Hon ble JOHN BROOKS,
  • JOSIAH BARTLETT, M. B.
  • ISAAC HURD, A. M.
TREASURER.
TIMOTHY MINOT, A. M.
SECRETARY.
JOSEPH HUNT, A. M.
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ON THE RISE, PROGRESS, AND PRESENT STATE OF MEDICINE, A DISCOURSE.

IN complying with the request of this associa­tion, I perceive nothing more difficult, than to bestow on what is common the grace of novelty, and to render so dry a subject as physick in any degree entertaining to a mixed audience. Our theme leading to the frigid and formal style of a lecture, rather than the animated strains of an oration.

THE history of the medical art is so well known to the members of this society, that my task will be rather to remind than inform them: Yet what subject can be more suitable for our first discourse, than the history of the rise and progress of the HFALING ART: That art whose improve­ment and diffusion is the end and aim of our association?

[Page 2] THE origin of most arts is involved in fable, and wrapt in great obscurity; that of medicine seems covered with almost an impenetrable veil. Until the greater purposes of society were answered, the necessities of mankind supplied, architecture and other necessary arts introduced, men of genius had neither leisure nor inclination to record their theories of the origin of mankind, and the rise of the arts. The remedies first sought for, in the earlier ages, were probably some mild, tenacious, plastic substances, suitable to defend a wound from air, and secure it from external injuries. Accident and random experiment may have en­creased the number of such simple remedies, which may have been treasured up by a particular family, or some individual of a tribe. But at these early periods of society, when letters were unknown, what was once out of sight was lost forever.

IF we search the oldest book we have for infor­mation on this subject, we search in vain. This will not appear so extraordinary to those, who re­flect that the sacred history is confined to but a part of Asia, and a small portion of the north east part of Africa; and that it is so concise in regard to time, that the history of twenty centuries is comprised in eleven short chapters. *

[Page 3] WE find the author of these annals, the hebrew legislator and general, giving directions for the health of his people; but no mention is made of Physicians, as a distinct profession, until the em­balming of Jacob. Prior to these writings, is the aera of absolute darkness; and we have no account by which we can judge of ancient tradition, un­less we admit that of the Chinese, whose great an­tiquity, corroborated by astronomical observa­tions, carries the history of the human race a vast way further back. Yet their slight acquaintance with anatomy, and their ignorance of chemistry, render their great knowledge in physic as doubt­ful as their chronology.

AS we receive so little light from these ancient prose writers, let us turn towards those earlier luminaries the Poets.

POETRY has every where preceded prose, and the powers of the imagination always have been indulged, before the operations of the judgment were exercised. Those early effusions of genius were epic poetry, or exaggerated history, record­ing battles, heroes and ghosts; dwelling on the marvellous, and often the incredible. In these fabulous ages it was the custom to dress instruction in the garb of allegory. Thus the Egyptian, Gre­cian and Roman poets attributed the origin of the Healing Art to the Sun, who was called Orus by [Page 4] the Egyptians, Phoebus and Apollo by the Greeks and Romans. Conceiving the sun to be the pa­rent of life and cheerfulness, whose genial warmth and vivifying energy animated and sustained all nature; they adored it as the resplendent source of light, life, health and joy. They saw nothing on earth which bore so striking a resemblance to this heavenly luminary, as he, who relieved pain, dissipated melancholy, dispelled diseases, and pro­longed life. Thence they concluded that the first physician was an offspring or emanation of the "Prime cheerer light." Accordingly we find the classical poets representing Apollo, as the primary GOD of physic; and his son Aesculapius whom they also deified, as its first professor. They like­ned the human body to a delicate musical instru­ment, easily disordered, and therefore united music and medicine in Apollo. They conceived that the office of the physician, was to tune this com­plicated organ the body, to make every part act in concert, and reduce the whole to harmony. *

THE person of Aesculapius is so envelloped in fable, that we scarcely know when, or where he lived. He is confounded by some with Melam­pus, who lived about 100 years after Moses, and who having travelled into Egypt, brought from thence into Greece, not only the art of physic, but much of their theology and superstition, together with their magic or divination.

[Page 5] FROM every account we must conclude, that Aesculapius was highly venerated for his know­ledge and usefulness. The antients not only pla­ced him among their GODS, but erected more than sixty temples to his honor in Greece, and in the Grecian colonies. These Aesculapian temples were the first schools of physic. People resorted to them from all quarters, in order to be healed of their diseases. Remarkable cures were engra­ven and hung round their walls in form of votive tablets; * and from thence were sent out the first clinical practitioners.

AMONG the ruder nations, the priest, the conju­ror, and the physician were united in the same person. It was so among the Aegyptians, Baby­lonians and Grecians; among the people of India, [Page 6] where they are called Brachmans; among the an­tient Germans, French, and Britons, where they were called Druids. It was so among the Mex­icans and Peruvians; and obtains at this day among our Aboriginals. The untutored mind is apt to ascribe all dismal diseases and shocking accidents to the influence of invisible beings: and the priests, not only cherished this opinion, but studiously inculcated, that their cure must be sought from the Deities, through the interposition of their ministers.

THE state of physic in Greece, at the period celebrated by Homer, was very similar to what it now is among the aboriginals of this continent. Like their heroes, our Indians know how to treat wounds; and when baffled in the cure of any ter­rible disorder, have recourse like the Grecians, to incantations and inchantments. * They likewise derived their skill from the same source, random trials, or empericism.

THE Philosophers of Greece were so much en­gaged in the vain and useless search after the pri­mary matter, that they neglected medicine, which was so far from being digested into a system, that no one gave it sufficient attention to make it a distinct profession. This was the case till about 400 years before Christ, when the famous HYPPOCRATES made collections from the public records of cure, [Page 7] the inscriptions or tablets in the Aesculapian tem­ples, where he was educated, reduced the whole into some order of science, and laid so just and rational a foundation of physic for future ages, that he deservedly obtained the name of the FATHER OF MEDICINE. *

THEMISON was the founder of the methodic sect. He professed to have discovered a short, and easy method of attaining medical knowledge, by redu­cing all diseases into two classes, viz. from tension, and from the opposite fault, relaxation. As this doctrine has lately been revived, we shall speak of it, with its patron Themison and his follower Thessalus, in another place.

ABOUT 200 years before the christian aera, phy­sic and surgery, which in Greece had been prac­tised by the same person, were separated at Rome into three distinct provinces, the Dietetic, Phar­maceutic and Surgical. The above mentioned sects were in existence when the celebrated GALEN quitted his native country, Asia minor, to practise at Rome. GALEN was a man of real genius, im­proved by a careful education under the best teachers of the age He laid the foundation of his greatness in the school of the Stoics, then studied with the Academics, and finish'd with the Peri­patetics [Page 8] and Epicureans. After this he devoted himself to medicine, and collected the writings of the most celebrated physicians, especially Hippo­crates, whom he professed to admire and follow. There is, however, says Boerhaave, this essential difference between the doctrine of Hippocrates and Galen, the first is almost always supported by experience, and consists of observations, while the other depends almost wholly on reasoning; and it has accordingly happened, that the system of Hippocrates has afforded but little matter of ex­ception to those who came after him, whereas, that of Galen has been a subject of just and well groun­ded censure. Nevertheless, Galen's doctrine, though in general false, and inapplicable, says Cullen, was received and implicitly followed by all the Physicians of Asia, Africa, and Europe, for more than 1400 years! He was supposed to have brought every part of medicine to perfection, and his system thought infallible, and universally appealed to as an oracle.

WE cannot set a very high value on the theories of the antient physicians, when we consider the data upon which they reasoned. Their notions re­specting the animal oeconomy were absurd and con­fused to the highest degree. They supposed that the veins had their origin in the liver; that they were the only vessels that conveyed blood through [Page 9] the body; that in these it only moved backward and forward: that the arteries arising from the heart, contained the animal spirits which were ela­borated in that organ. They believed that the blood never entered the arteries, unless in a diseased state. As to the means of our nourishment, they had no just idea of it, and even supposed that the chyle was absorbed in the liver, and there con­cocted into blood. *

AFTER the sixth century, a dark and dismal chasm intervened in medicine, literature, and the arts. All was ignorance, wonder, and credulity. The human mind, neglected, uncultivated, and op­pressed, sunk to the lowest grade of debasement.

THE most remarkable revolution recorded in the history of the human mind, is, the darkness and ignorance which enveloped Europe, while the Arabians were making progress in useful knowledge. The Caliph Haroun Al Raschid established an University at Bagdad, and qualified his countrymen to be instructors of all Europe. Wherever these Mahometans built a temple for worship, there they erected a medical school and an hospital. They first introduced chemistry into medicine; and, though blended with many absur­dities, its introduction occasioned a great revo­lution in the theory and practice of physic. [Page 10] Diseases were now supposed to arise from a pre­dominant acid, or an alkali; and the various ope­rations of the human body, were attempted to be explained on the principles of fermentation or effervescence. Nay, they asserted that all the ope­rations of the Universe were explicable on che­mical principles. At this period, many wasted their time and talents in the delirious pursuit of transmuting the baser metals into gold.

IN the beginning of the XVIIth century, the whole system of Galen, as well as the theory of the chemists, was overturned by the discovery of the circulation of the blood by Harvey; who de­monstrated that the human body was an hydraulic machine, whose actions and offices depended upon the circulation of the blood, which alone being stopp'd, the whole must perish. For, in this system, the blood was considered as the primum mobile of the whole machine; and to something in the blood were attributed all the disorders to which we are liable. Harvey first made an application of this doctrine by publishing his practice of physic conformable to the laws of the circulation, and by degrees all Europe followed him.

THIS was the aera of experiment in which se­veral great geniuses flourished. Societies for promoting and diffusing experimental knowledge were established in different parts of Europe, [Page 11] and patronized by monarchs. * The art of printing had already produced a glorious change in the affairs of men. It gave wings to literature; and spread it around the globe. Philosophy revisited the earth, and converted Europe, which a cen­tury before was one large field of battle, into a theatre of triumph!

[Page 12] Upon the discovery of any new principles by philosophers or the introduction of any new and popular theory, physicians almost always attempt to apply them to the explanation of the actions of the human body, and all the causes of diseases. Thus, when Galileo had introduced mathematical reasoning, and excited the world to investigate the laws of mechanics, physicians attempted to explain all the phaenomena of the animal oecono­my, on mathematical and mechanical principles. The same was noticed concerning the chemists, and may be remarked at this time of the laws of electricity.

[Page 13] THE famous Stabl perceiving the insufficiency of the preceeding systems, maintained that the rational and immaterial soul was the true source of every function, both vital and natural. Thus experiment, or the use of our senses, was discarded for a time from medicine, and metaphysics, or reasoning on probabilities, usurped its place.

SUCH was the state of medicine when Boerhaave began to teach. The figure this great man made in the medical world, will justify our dwelling a little on his character and works. It is perhaps unnecessary to say, that he was a professor in the University of Leyden, and that he died about 50 years ago. Boerhaave was son of the parish mini­ster of a village near Leyden, and he himself was educated for that profession. From the infor­mation of his biographers and his own writings, we learn, that from the perusal of early writers in divinity, he was struck with the profoundest vene­ration for the simplicity and purity of their doc­trines, and the sanctity of their discipline; but as he descended to the lower ages, he found the peace of christianity broken by useless controversies, and its doctrines sophisticated by the subtleties of the schools. He found the holy writers interpreted according to the reigning philosophers, and chi­meras of metaphysicians adopted as articles of faith. He then quitted the pursuit of divinity, [Page 14] and applied to the study of physic, when he was more than xxx years of age. But he found it nearly the same in physic as he experienced in divinity. He perceived that the moderns had widely deviated from the simplicity and purity of the antients; chimeras and idle notions adopted as articles of belief, or rules of practice, and the writings of the founder of our profession strangely corrupted and misapplied.

WHEN Boerhaave began to practise physic, he received but little encouragement. His business was at first very small, and his circumstances by no means easy. But superior to every discourage­ment, he continued his search after truth and knowledge; determined that prosperity, were he ever to enjoy it, should be the consequence, not of mean artifice, cringing solicitation, or degrading complacency, but of real merit and solid learning. Nor was he disappointed. After giving lectures at Leyden for a series of years with great applause, his reputation bore some proportion to his merit, and extended itself to distant countries; insomuch, that scarcely a learned society in Europe, but was eager to elect him a member, scarcely a crowned head, but sought some means to honor him. He died at Leyden in the year 1738, aged 79 years, leaving behind a glorious and untainted me­mory. *

[Page 15] BOERHAAVE'S Institutes, or theoritical work, con­tains all the discoveries in anatomy and physiolo­gy known at that time; and whatever relates to the laws of the animal oeconomy and the operati­ons of medicines. His aphorisms or practical work, are collected from the Greek medicinal writers, the Arabians and some of the Moderns; and his reasonings are founded on the structure of the parts and laws of mechanics. In his lectures on these aphorisms he laboured to shew how na­ture acts in producing the symptoms of distempers, and her methods of relieving herself either with, or without the assistance of art. Perhaps it com­prises more medical knowledge, than any book extant of its size.

THE most striking feature in the Boerhaavian theory, is the explanation of all the phaenomena of the animal oeconomy on mechanical principles. It asserts, that the human body is truly a me­chanical structure, and possesses all the properties belonging to a subject best qualified for mecha­nical speculation; therefore a mechanical frame and that the human machine, is by the same laws explicable by geometry; and there is nothing, he thinks, in all its solids or fluids but what is ex­plicable upon mathematical principles.

HE founds his pathology, or doctrine of diseases, on the change of the quality of the fluids, pro­ducing sometimes a predominant acid, and some­times [Page 16] times a predominant alkali. Another fruitful source of diseases, was a spontaneous gluten, or lentor in the fluids, and a too violent motion of the circu­lating blood; this he supposed arose from the preternatural irritation of the heart, or from some acrimony present in the blood itself. These opinions make the foundation of his theory of fevers and inflammations.

THE first who ventured to attack the Boerhaavi­an system, was the learned Dr. Frederic Hoffman: who asserted that the body was so far from de­pending on the quality of the fluids, that the state and crasis of the fluids themselves, entirely de­pended on the nervous power; and that a flight alteration in this power was capable of instanta­neously changing the blood, and all the other hu­mors, into a different nature from what they for­merly were. He therefore published it as his opinion "that the greater part of diseases, if not all of them, were affections of the nervous system." This hypothesis, amplified and further illustrated, is the celebrated Cullenian System. *

DR CULLEN, who died a year or two since in Scotland, after bestowing great encomiums on Boerhaave, who he says improved and refined upon every thing that had before been offered, pointed out, as he supposed, the imperfections [Page 17] and desiciencies of this famous system, in order to shew the necessity of attempting a new one. And he has shewn pretty clearly, that the doctrine of acidity, and an alkali, is erroneous; and that the causes which Boerhaave adduces as producing the spontaneous gluten, are by no means probable. Nay, he asserts farther, that Boerhaave's doctrine of acrimony and lentor of the fluids is purely hypo­thetical; and that the reasonings concerning them, are so far from improving physic, that they have often misled the practice of it.

THE brain is considered in the Cullenian hypo­thesis as the primary organ, on which the welfare of the system principally depends; and the Ner­vous system, as the substratum, or fundamental sta­men of the whole body: for it supposes the living muscular fibres to be a continuation of the sub­stance of the brain, or congeries of those infini­tessimally small threads called nerves. * Cullen conjectures, that the cortical part of the brain, or common origin of the nerves, is a secretory organ, in which the gluten of the blood, or coagulable lymph, being freed from all saline matter, before adhering to it, becomes fit for the nourishment of the solids, [Page 18] and being poured in a sufficiently diluted state, upon the origin of the nerves, is filtrated along their fibres, and is thence conveyed to every part of the body for its nourishment.

BY this system, the circulation of the blood instead of being the principal, or vital function, as in the Boerhaavian, becomes so much a secon­dary one, in the animal oeconomy, that it serves little other purpose than the nutrition of the body. When a large blood-vessel is wounded, the eva­cuation of the blood, causes a collaps of the vessels, and death ensues: yet Cullen reminds us, that the vessels must necessarily be in a certain state of distention, in order that the nervous fluid should move. * Boerhaave tells us, that when a person faints away, or lies some time under water, there is wanted a circumgiration of the liquors in the blood vessels. Cullen admitting this, only con­tends, that the first movement must arise in the nervous system, which exciting the blood vessels to action, they propel the fluids contained in them and life immediately returns, with heat, color, agility, cogilation, and every vital and natural ac­tion. Hence we see that these eminent teachers meant the same thing, they only began the expla­nation in different parts of the circle. It would not be very difficult to prove, that both in their theory and their practice, the difference is more [Page 19] in words, than in reality. Cullen considers almost all diseases as arising from an affection of the nervous power. This power, or vis medicatrix natureae, is the same that Hippocrates calls "NATURE," whose efficacy he so much celebrates in removing diseases; a power acknowledged and extolled by Boerhaave.

THE state of science is very different now from what it was 200 years since. The philosophy of Aristotle misunderstood, the false theories of Galen, and the jargon of the Chemists, formed so thick a cloud, that truth and nature could scarcely be seen through it. When this was dispelled by Lord Bacon and others, the aera of experiment followed. Philosophers and physicians labored to accumulate facts. Societies were every where established for this express purpose. A diffusive manner of writing crept in, and grew up among authors. It was the fashion to print not only all that a man thought, but to quote all that he found any body else thought: and he was scarcely esteemed a lite­rary man, who published any thing less than a folio. But now it is wholly different. Instead of that diffusive manner of writing, authors feel the necessity of consolidating and concentrating science. They find that the substance of folios may be digested into a few pages, and the essence of libraries compressed within a few volumes. [Page 20] The late Dr John Brown has attempted to simplify the science of medicine, by reducing all diseases to two forms, namely, sthenic and asthenic, the former signifying an excess, and the latter a defect of the vis vitae, or invigorating principle. *

THUS Themison 1700 years since, boasted that he had discovered a short and easy method of attaining medical knowledge, by reducing the causes of all diseases to two heads; the one tension, and the other relaxation; or in the language of Dr. Brown, sthenic and asthenic. He considered every remedy as a tonic or relaxant. His follower Thessalus carried this doctrine still farther, and by declaring that he could abridge the study of me­dicine, to fix months, he gained many pupils from among those who wished to acquire a science without the trouble of study, or pains of think­ing.

It must be left to the old and experienced physician to determine, whether the disorders arising from those peculiar conditions observable in particular persons, or in particular parts of the [Page 21] body, called Idiosyncrasies can be explained by that general principle which pervades the Brunonian system. Boerhaave and Cullen were experienced practitioners, but Brown never confirmed his spe­culations by much practice. It is possible that this sudden meteor of intelligence, which for a while may appear to shoot its beams into the regions of obscurity, will as suddenly withdraw its lustre, and leave mortals again to grope their way. *

NEED we be surprised that our profession has been accused of contradictory theories and systems, as well as discordant maxims in practice: or wonder that many suppose it merely a conjectural art? Have we not seen that opinions prevalent in one age, as truths above the reach of controversy, have been confuted and rejected in another, and have risen again to reception in remoter times? Yet the ignorance and inattention of some physi­cians should not be adduced against the stability of the art itself. Amid the fluctuations of theories, a discerning eye may discover certain fundamen­tal principles which are as firmly established as those of any science. Does not daily practice convince us, that both acute and chronic diseases have the same marks annexed to them, which were described 2000 years ago? Even in nervous disorders, amid all their tumultuous anarchy of [Page 22] accessary symptoms, we recognize their essential marks and elementary types. *

PHYSIC, like many other arts, may be prac­tised without theory, or knowledge of it's prin­ciples. A man may know how to bleed with­out understanding any thing of physiology, or anatomy. He may have learnt how to stop that bleeding, and yet be ignorant of the circulation of the blood. And a man may learn how to cure an acute pain in the side, by copious bleeding, without knowing there is such a membrane as the pleura. Many practitioners have known the efficacy of Tartar Emetic, without having che­mistry enough to know it's component parts. And, yet, such is the weakness and credulity of many of our country people, that they often pre­fer such to a learned physician. The fact is, theory, and practice are mutually subservient to each other. Theory is defective without experience; which in its turn is equally defective without the­ory. It has been observed that the man who acts from experience alone, though he act ever so well is but an Empiric, or Quack, and that not only in medicine, but in every other subject. It is then only, that we recognize art, and that the Empiric quits his name for the more honor­able one of artist, when to his experience he adds science, and is thence enabled to tell us, not only [Page 23] what is to be done, but why it is to be done. * Nevertheless a Physician does not establish his character by what he knows and thinks, so effect­ually as by what he actually does and orders for the sick.

FEW things discourage the student of medicine more than the great variety of disorders, and astonishing number of concomitant symptoms. When he reflects on the short period of human life, the necessary avocations, which must un­avoidably divert his attention, he is ready to re­linquish the pursuit in despair.

YET modern improvements in a great measure have removed this inconvenience, by reducing all known disorders that afflict mankind to certain determinate species, in imitation of the writers upon botany. Such a systematic arrangement, called, Nosology, by bringing those diseases toge­ther, which agree in the greater number of cir­cumstances, and require nearly similar treatment, shews, that though there may be a great variety in the names, there needs not much in the method of cure.

Nosology, therefore, in some measure, has rescu­ed the study of medicine from confusion, and re­duced it to such order and simplicity, that the [Page 24] discouraging catalogue of diseases, so perplexing to students, is resolved by Dr. Cullen into four classes, and these to 150 genera, which are again divided into 1387 species. So true it is, that the more we know of any art, or science, the greater number of particulars, we are able to resolve in­to generals; and thus reduce its principles within narrower bounds.

Anatomy and Physiology have experienced great improvement within these 50 years. One of the great sources of error among our forefathers (says Pott) was the imperfect state of their anatomy, which kind of knowledge, has been so cultivated in our times, as to convert ignorance into a vice. *

Baron Haller, has collected and condensed, all the valuable anatomical and physiological disco­veries; and after having displayed every part of the human body, he explained every function, pointed out the errors of preceeding authors, and made such important additions of his own, that were all the books of anatomy and physiolo­gy, excepting his, destroyed, they would, alone, be [Page 25] sufficient to convey to future ages, the present stock of knowledge in those branches of science. *

Surgery has been cleared from the lumber of a thousand errors, and raised from it state of degra­dation. Not only the coarse and useless applica­tions, but the multitude of awkard and unmanage­able instruments, which encumbered the art, have given way to methods less painful, and more in­telligible. Surgeons perform, now, not only many cures by mild and gentle means, which for­merly were deemed incurable, but give nature an opportunity of exerting those powers with which she is invested by the Creator.

THE study of Natural History, so necessary and ornamental to the physician, is now rendered easy and delightful. Linnaeus, by his learned classification, leads the student, as by an Ariadne's [Page 26] clue, through the turnings and labyrinths of the three kingdoms of nature. Botany too, that beau­tiful handmaid of physic, so much neglected by the antients, has been successfully addressed by the moderns. The lovers of botany will find in this country an unexplored treasure, amply rewarding their attention. Notwithstanding theory cannot claim the power of discovering the medicinal vir­tues of plants, it has nevertheless greatly faciliated this charming study by arranging all the vegeta­bles that diversify and adorn the earth into classes, orders, genera and species.

SINCE knowledge has become more generally diffused, a benevolent philosophy, subservient to life and public utility, has taken the place of those theological disputations, which distracted the last century. A spirit of free iniquiry distin­guishes the medical, and other professions. The authority of great names is less venerated. The world begins to grow weary of theories which lead to no useful consequences, and have no foundation but in the imagination of ingenious men. *

MUCH literary as well as political advantages have accrued to the UNITED STATES, and to those of New-England in particular, from the American [Page 29] Revolution. It had been heretofore thought indis­pensably necessary to resort to foreign universities, to complete the system of medical education, and to acquire there the theory and practice of physic, which the want of regular schools and established hospitals in this country, rendered unattainable. At that period, an ambition of acquiring the high­est qualifications in the profession, naturally led the medical student to the celebrated European Schools: and the honors they bestowed, were considered as conferring distinction and respecti­bility on the candidates. The ambition was laudable. But it must at the same time be con­fessed, that from the novelty of situation, it some­times failed of being followed by the advantages expected; and the expence attending it was a circumstance, which must necessarily have cram­ped their exertions.

THE various institutions founded within a few years in this commonwealth, have laid a broad foundation for improvement in science, and the arts: and the establishment of a MEDICAL SCHOOL in the UNIVERSITY at CAMBRIDGE, by affording regular means of instruction, in the different branches of the profession, has given to the present a decided superiority over former times, and in a great degree has forever precluded the necessity of a foreign education.

[Page 28] A country so completely independent in other respects as the United States, however ready to receive information in the higher grades of science, by the cultivation of literary correspondences abroad, should blush to be indebted to foreign seminaries for the first principles of professional instruction.

OF the various methods of cultivating and dif­fusing medical knowledge, none is more desirable, than an amicable association of neighbouring practiotiners; especially when their aim is mutual improvement and the good of mankind. These generous sentiments gave birth to the Middlesex Medical Association; a society whose grand object is to improve our art by a free and friendly com­munication of our skill and experience, and to cul­tivate those manly sentiments, which tend to era­dicate narrow prejudices and unworthy practices.

A military spark, which was first struck out in this County, burst into a flame and spread through­out the continent. This till then almost unnoti­ced part of the world, drew the attention of all nations, who regarded us with admiration, while we conquered armies, and founded such an Em­pire as the world has never seen, and framed a constitution, which is the pride of man, and glory of the human understanding. The European world [Page 29] still regards us: many with an anxious solicitude to see in what order and degree those dispositions and arts, which characterize polished humanity arise among us. They cannot but observe that the County so famous for having first dared to re­sist what they deemed to be despotism, stands the first in the cultivation of those arts which grace social life and encrease human happiness. MID­DLESEX, so distinguished for its University and for its Militia; so celebrated in arts and arms, will we doubt not, still continue to take a liberal pride in promoting those arts which improve the world and dignify mankind.

A noble example is afforded in your worthy townsman Dr. Cuming. You who were his fel­low citizens must feel at the mention of his name the tender remembrance of friendship reviving in your breasts! you, who recollect him the sensible, generous, warmhearted, upright friend; the able honest and experienced physician! Dr. Cuming possessed an understanding fraught with the prin­ciples of his profession, happily blended with great benevolence. And his generous donation to the medical branch of your University, while it excites our gratitude sufficiently evinces his opinion of the importance, and practibility of a complete medical education within ourselves.

[Page 30] ANIMATED by the example of the Eminent, who have gone before us, let us press on to still fur­ther improvements. Let us leave the flowery path of speculation for the more arduous one of experiment. That benevolent philosophy which distinguishes this age, and this country, will help us to cultivate and diffuse the benefits of the art we profess, and inspire us with the pleasing hope of being able to preserve to our fellow creatures, that greatest of blessings, "A SOUND MIND, IN A SOUND BODY."—The field is extensive, the charge important, and the calling honourable.

[Page 31]

A List of the Members of the Middlesex Medical Association, and their places of residence.

  • Josiah Bartlett, Charlestown.
  • William Bowers, Billerica.
  • John Brooks, Medford.
  • Amos Cotting, Marlborough.
  • Joseph Fisk, Lexington.
  • Joseph Fisk, jun. Lexington.
  • William Gamage, Cambridge.
  • Timothy Harrington, Chelmsford.
  • John Hart, Reading.
  • John Hay, Reading.
  • Martin Herrick, Reading.
  • Joseph Hunt, Concord.
  • Isaac Hurd, Concord.
  • T. L. Jennison, Cambridge.
  • Timothy Minot, Concord.
  • Oliver Prescott, Groton.
  • Oliver Prescott, jun. Groton.
  • * Isaac Rand, Cambridge.
  • Marshall Spring Watertown.
  • Ebenezer Starr, Dunstable.
  • Benjamin Waterhouse, Cambridge.
  • * Samuel Whitwell, Newtown.
  • Leonard Williams, Waltbam.
  • Charles Whitman, Stowe.
HONORARY MEMBERS,
  • Rev. Ezra Ripley, Concord.
  • James Winthrop, Esq Cambridge.

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