ADDRESS OF THE PRESIDENT.

THE ADVANCE IN MEDICINE.

T. B. HARVEY, M. D., INDIANAPOLIS, IND.

Medicine, in all ages, has been influenced by its surroundings. Its growth is dependent on general intelligence and the progress in collateral sciences. Practical medicine has always been an interesting theme, alike to those suffering and those administering relief. The changes and improvements which have occurred in it within our own observation, and the causes leading to them, constitute a worthy subject of thought. This period includes about the time of the existence of this society; it has been observed by the majority of its members, and certainly includes the era in which the greatest changes and improvements have been made.

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Justice to the science, the profession, and the public, calls for substantial reasons for any great or radical change in the healing To those disposed to criticise such investigation, we must say that the true interests of medicine have never suffered by acknowledging errors and seeking to amend them, as by so doing we give assurance of an honest desire to find the truth. There may yet be some in our ranks who are unwilling to admit that any material change has taken place, and others who admit the change, but cannot see the improvement, and long for the return of the "lost art." To such-or rather to their patients-we may extend our sympathy.

The minutes of the first meeting of this society, thirty-one years ago, show that it adjourned to meet at "early candlelighting," to hear the address of the President. In calling your attention to this minute, my object is to vindicate our fathers in medicine, rather than to arraign them for condemnation or adverse comment in what may follow.

Of those who constitute the connecting link between the past and the present, we recall the memory of many who were distinguished, and while they had not the advantages of gas-light, the microscope, laryngoscope, opthalmascope and thermometer, but worked in the dim "candle-light" of medicine, they were more thorough in the cultivation of what was known.

In reviewing the theories and practice of the past, we should endeavor to glean the truth and eliminate that which is erroneous. The superiority of to-day is attained only through improved methods of investigation and application of results. It has scarcely been thirty years since much more confidence was entertained in depressing remedies than at present. The liver was too often regarded as at fault, and the term "bilious" disguised a want of pathological information, and was in as frequent use as the answer of a venerable physician, who replied to anxious or meddlesome inquiries on doubtful points, that it was "owing to the nature of the case," which answer secured for him the reputation of being a learned and accurate observer.

Venesection, mercurials and antimony were the principal remedies in the treatment of phlegmasia and fevers. "We were bled when sick, and in accordance with the theory that prevention is better than cure, frequently bled to prevent sickness." Bleeding was practiced to prepare the system for mercurials and develop the nature of the disease. Alteratives and cathartics, to correct or arouse the secretions, were regarded as essential, while the experience of the present day proves that, in general, they are not only useless, but mischievous in their effects, no matter how beautiful and philosophical the theory sounds.

Does this appear to be an overdrawn picture of medicine in the past? The text books and practice of that time support it.

There once lived in this city a doctor so sanguinary in his treatment that he had a trough constructed to carry the blood of

numerous patients from his office. This method not giving satisfaction, he became a homœopathist, and accepted in full faith the theory of potencies. His patients still dying, he turned Thompsonian, and, after fruitless efforts to steam out disease, renounced medicine. Is it marvelous that men, who look upon disease as having an independent existence, should pass from one extreme to another? The practice of thirty years ago was based on what was regarded as a correct knowledge of pathology, and the therapeutic properties and powers of certain medicines and measures.

It was claimed that great improvements in physiology, pathology and therapeutics had been made over the "divinity” of the system of Hippocrates, the "Archeus" of Paracelsus, the good and evil spirits of Stahl and Hoffman.

The spirits had materialized and though disease was still regarded as an entity, it had taken on the form of plethora, determination of blood, excess of fibrine, increased placticity and arterial predisposition, and inflammation was universally considered as a sthenic form of disease.

The opinions of a few impractical men of learning and renown were given undue weight and hence retarded progress. Had their labors not been governed so much by hypothesis, empiricism and disputation, their great ability would have led to the development of richer trophies in medicine, and we can but lament that often their memories furnish but little more than monuments of wasted talent. Medical books, journals and societies were comparatively few, and in the societies there was lacking that independent expression of honest conviction which characterizes the medical society of to day. Theory, unsustained by anything save the authority from which it emanated, ruled the medical world. Facts were made to bend to theories; efforts to establish principles by by observed truths were denounced, and thus false theories and worse practices were perpetuated. Respect for authority and fear of professional alienation smothered the feeble, flickering rays of light as did the Inquisition of the dark ages.

Under these circumstances, why wonder at the expression of Mulier, that "as his constitution was not strong enough to withstand both disease and doctors, he would dispense with the latter,"

or the saying of Themison, that "the study of medicine is a meditation on death"?

Medicine was allopathic in every sense of the word. The specific action of mercury was to establish a mercurial disease, and well do we remember our teachings and observation as to the character of the mercurial pulse. Blood-letting established anemia to counteract plethora, sthenia or hyperemia.

Cullen, Rush, Eberle, Dewees and Wood stand in our midst and properly ask why this change, and whence the authority? We may answer that it is not so much from what we have learned as new facts, as that we have learned to unlearn old errors. Instead of looking upon disease as an entity, and that for each variety there is a specific, we have learned that disease is simply a departure from health, an abnormal condition of the organs, a perversion of physiological laws or actions, depending on some anomalous or specific cause. We have studied its natural history, and found that often it is self-limited; therefore, instead of attempting to forcibly drive it from the body, we now try to clear the path of all complications and aid nature to restore health. But we are told that John Hunter, the great physiologist, and Bichat, the great pathological anatomist, taught these doctrines over a hundred years ago. We admit it, but the honor of putting them into practice, was left to our day. We know there is a "vis medicatrix naturæ.' Celsus hinted at this, and adopted treatment accordingly, and Cullen taught it, but only for the purpose of completing a theory in regard to fever without making any practical application of it.

The medical mood of to-day does not respect authority unless sustained by demonstrative proof. It rejects dogmas from within as well as heresies without. As has been said, we "have arrived

at that stage which forces its students to that most valuable position, a knowledge of when a thing is proved and when it is not proved. A position which sustains real medicine, and is a deadly enemy to quackery." A position which was recognized by John Hunter, who, in a letter to his pupil, Edward Jenner, wrote: "I think your solution is just. But why think? why not try the experiment?"

Progressive medicine accepts inductive philosophy only so far as it is sustained by practical deduction. It consists in the union

of theory and empiricism. We have learned to appreciate the golden rule of Chomel: "It is only the second law of therapeutics to do good;" the first being, "not to do harm."

We adopt the statement of Sir Humphry Davy: "Hypothesis should be considered merely as an intellectual instrument of discovery, which may, at any time, be relinquished for a better instrument. It should never be spoken of as a truth; its highest praise is versimilitude. Knowledge can only be acquired by the senses; nature has no archetype in the imagination; her empire is given only to industry and action, guided and governed by experience."

Granted that the above statements are true, what has produced the change? Attempts have been made to explain it in different

ways.

First, by a change in the type of disease, since the first appearance of cholera, in 1833, from a sthenic to an asthenic form, or rather an asthenic condition of the system, by which the destructive tendency of remedies is not tolerated as in former years.

This view has not been generally adopted, but Allison, Christoson, Stokes and Sir Thomas Watson were advocates of it; although Watson duly acknowledged the error and said publicly, that he had been governed more by respect for his learned predecessor Dr. Allison, than by his own observations. Allison went so far as to state that the change in disease forms a "part of the general dispensation of Providence, and is, as far as is yet known, an ultimate fact in its history."

These venerable medical men drew upon their memories, merely; to prove the change from the sthenic to the asthenic by contrasting the soft and compressible pulse of inflammation," at that time, with the frequent, hard, full, firm and sharp pulse, *“and vehement action of the heart, the vivid redness of the venous blood, and the force with which it spouted, almost per saltum, from the orifice in the vein," in their earliest days, in the pneumonia of Cullen and Gregory.

Prof. Balfour unearthed in the medical libraries of London and Edinburg, the MSS. notes of clinical cases by Cullen and Gregory, and found that their histories of cases were "precisely similar to