MEDICAL IMPROVEMENT: AN ADDRESS READ TO THE MEDICAL SOCIETY, BY JOHN AITKEN, Fellow of the College of Surgeons of Edinburgh, A Surgeon of the Royal Infirmary; And a President of the Medical Society.
Nequid falsi dicere audeat, nequid veri non audeat.
Mobilitate viget et vires acquirit eundo.
EDINBURGH: Printed for and Sold by JOHN BELL.
M,DCC,LXXVII.
THE FOLLOWING PAGES ARE MOST RESPECTFULLY INSCRIBED TO THE PRESIDENTS AND OTHER MEMBERS OF THE MEDICAL SOCIETY.
AN ADDRESS,
&c.
GENTLEMEN,
IT is with much diffidence that I officially presume to deliver a few detach'd thoughts, chiefly respecting MEDICAL IMPROVEMENT; as an address introductory to the commencement of our literary business in this place. Your indulgent candour which I have so often experienced, I flatter myself, will, on this occasion, impute the faults which you will doubtless discover, not to intention, but inability or misconception.
I chearfully embrace this opportunity to express the most grateful impressions I entertain of the great and unsollicited honour you have been pleased to confer upon me, by twice calling me to the office of PRESIDENT. Had my powers been equal to my wishes, no part of my conduct in that elevated character, had been unworthy of you, or of this chair. Altho' indispensible avocation permits me no longer to hold any office among you; yet will I lose no opportunity of being present, and, as far as I may be able, of assisting in your instructive speculations; and of promoting to the utmost of my power, the general prosperity of a Society to which I ever have been so much attached.
In the commercial world, it is allowed by all, that the comparative rate of exchange, is a just
index
of the prosperous or adverse state of trade in different countries individually, or relatively considered. With no less truth, in my opnion, the comparative degree of cultivation to which
Belles Lettres
and philosophy, or the fine and useful arts, arrive in different kingdoms may be regarded as demonstrative of their relative civilization.
Judging by this criterion, altho' in this respect CALEDONIA may not justly boast of being the first, she is by no means the last of the European nations: Her progress in the walk of general science and liberality is rapid, and I hope will long continue so. Justice, however, constrains me to confess, that long, too long, in a great degree, she had neglected the MEDICAL PHILOSOPHY. In an
Aera
not beyond the recollection of some present, the immortal honour of planting a medical school in this
Metropolis;
now indeed second in fame and erudition to none in Europe, was reserved to a distinguished, a fortunate MONRO. To his memory consenting nations pay that just tribute of applause, which his country in general, but this City and its University in particular, ought to perpetuate by a statue.
By a WORTHY SELECT BAND of the numerous students, who flocked from all quarters, allured by the rising fame of the Edinburgh University; this MEDICAL SOCIETY in 1737, was happily instituted. Of its various progress and present flourishing independent state, I presume you to be well informed; and therefore avoid attempting any particular historical narration of these circumstances at present.
THE BUILDING
The MEDICAL HALL,—A handsome Edifice of various elegant appartments with a
Cupola
and Spire, ornamented with the
Insignia
of Aesculapius, erected chiefly by the liberal contributions of the Members.
in which we are now assembled is a grand
phenomenon
of medical ardor, unparallelled in any country; and may justly be regarded as a temple sacred to AESCULAPIUS, reared by the virtuous zeal of his youthful votaries, for purposes the most liberal and praiseworthy. The FRIENDS OF SCIENCE, not of your number,
Many Gentlemen, applauding the noble intentions of the Society, have been generously pleased to contribute towards defraying the expence of building the Hall,—Lists of whom are suspended in the principal appartment.
who have generously contributed towards its structure; are entitled to our most grateful thanks.
Contemplating this FABRIC, and the many other aids which the present advantageous state of our society affords to facilitate study; you must have anticipated me in this reflection, that, while our minds are gratefully affected to our MERITORIOUS PREDECESSORS, our every power ought to be exerted, if not to advance, at least, to maintain our extended reputation: that, the verdant laurels they have transmitted may not wither in our hands, overwhelming us with indelible ignominy and disgrace.
'Tis with the highest pleasure, I perceive, without being chargeable with adulation, I can fairly aver, that this Society at no period of its existence has been more secure of progress than at present: the learning, genius and manly liberality of sentiment, which I know you possess, and which, with much satisfaction and instruction, I have so often observed animating your debates; constitute the foundation on which this assertion rests.
You are not to be informed that the combined powers of GENIUS and INDUSTRY must perseveringly operate thro' the course of several years, that a tolerably complete knowledge of even the elementary parts of the science of medicine, as already ascertained and taught, may be acquired. To have proceeded so far in medical study, is indeed to have made no despicable progress: But I trust your ardent ambition is more aspiring than to remain satisfied with the acquisition of a bare acquaintance of the
dogmata
of this, or the other MEDICAL SECT or PROFESSOR,
i. e.
of the present state of the healing art. It would be offering an undeserved insult to your sagacity, were I but once to imagine, that you could entertain a belief, that the Medical Philosophy had already attained the utmost perfection of which it is susceptible. You well know, that the unexplored regions of the
terra incognita Medicinalis,
so to speak, still afford abundant scope for your most protracted labours; so just is the observation,
ars longa, vita brevis.
ANATOMY, as being the
grand basis
of the Medical Fabric, from the earliest periods of society, in every civilized country, has been cultivated with the most unrelenting ardor of investigation, which many most material improvements have from time to time rewarded. Are there not still, however, many very interesting parts and circumstances of the structure of the ANIMAL AUTOMATON which we but little know? and many others of great importance, of which we are totally ignorant? What anatomist has hitherto been able successfully to evolve the texture of the SPLEEN; an organ of considerable size, and probably of proportional importance in the animal oeconomy? Very lately it has been supposed the sole fabricator of the globular part of the blood
The late ingenious Mr Hewson of London, endeavoured to establish this opinion.
. The same question may be put with respect to the structure of the MUSCULAR FIBRE, or LIVING SOLID; and that SPECIFIC CONFIGURATION of the several orders of the SECRETORY ORGANS, upon which such a wonderful variety and opposition of secreted liquors probably depends. But, above all, it may be put with respect to the BRAIN, and ITS APPENDAGES; parts essential to life, often the seat of disease, evidently variously organized, of great volume and surprizingly diversified in their external form.
I will be pardoned for expressing my fears, that few anatomical improvements are to be expected from you while residing in this country; at least, while its present TONE continues, however great your ability and ardor: because an insuperable barrier is opposed to your progress; I mean the WANT OF PRIVATE DISSECTION. In the end of the eightteenth century, when philosophical liberality is diffused from Pole to Pole, what a pity, or rather what a shame, that, even in the Metropolis of a kingdom, not uncivilized, and in its principal University too, where the circle of education is otherwise tolerably complete; this GRAND and almost ONLY AVENUE to the AESCULAPIAN Temple, should remain most barbarously blocked up!
A public course of anatomical demonstration, exceeded by none, and equalled by few, is, I confess, annually made here; by a learned, discerning, accurate, indefatigable Professor: whom none of you can more respect than I do. I, notwithstanding, hesitate not to declare it as my positive opinion, and I will venture to say it is not solitary, that, no public anatomical exhibitions, where the student is merely a PASSIVE SPECTATOR, are sufficient to convey and impress those precise and multifarious ideas of this important branch of natural knowledge, absolutely requisite to complete the medical character; throwing discovery altogether out of the question.
To acquire a tolerable knowledge of even the great outlines of anatomy, it is indispensibly necessary to take the knife in hand, and, with the most unremitting attention, dissect a variety of bodies of different sizes, ages, and sexes, properly chosen, and prepared for the purpose: Much more must this plan be followed, if it be proposed to soar in the regions of discovery and improvement. I can experimentally assert, that more anatomical information will be reaped from the well conducted dissection of one body, than from repeated public courses.
If this opinion be well founded, it is a self-evident consequence, that attending one or two public courses of anatomy, must be much inadequate to accomplish the medical philosopher; especially, if the practice of surgery, the most evidently useful part of the healing art, be his destination. Humanity revolts at the idea of the many unavoidable, and, I fear, too often fatal blunders that must result from this capital defect of the medical education to be obtained in this country. It is abundantly mortifying indeed, to observe those who wish to attain a proper degree of anatomical knowledge, after spending several years at our Universities, and probably attaining their highest honours, reduced to the alternative of either undertaking expensive expeditions into foreign countries, in this respect more civilized than ours; or of remaining dangerously uninformed.
If one should attempt to adjust the wheels and springs of a nice and delicate mechanism, he, perhaps, had never before seen, or, at least, never minutely considered; with what indignant contempt would we treat the rude audacious pretender? Thousands, alas! are daily subjected to the unpractised knife of operators of necessity aukward, I had almost said unskilled; because they never could enjoy the requisite opportunity, of either acquiring proper dexterity to perform any proposed operation with due address; or full knowledge of the parts concerned: from the want of access to the dead human body.
This alarming consideration is surely of sufficient force to conquer the vulgar prejudices against private dissection, whether the offspring of superstition or ignorance. The violation of the sepulchre or the clandestine robbery of the tomb, is most justly regarded as a crime of a deep dye; but certainly private dissection, under proper regulations, is compatible with the most absolute security in this respect. Of this the practice of most of the European countries is an irrefragable proof;
viz.
of these countries to which our students are compelled to resort, to obtain opportunities of diffecting which might so easily be afforded at home. Were a proportional number of dead human bodies annually furnished by authority, to the medical Students in the different towns of Scotland in general, and to those attending our Universities, in particular, for private dissection: the salutary consequences would soon surpass conception. It is truly astonishing, that a matter of such endless importance had not, long e'er now, challenged the notice, and roused the attention of the HONOURABLE SUPERINTENDANTS of our Police, or even of the LEGISLATURE itself.
The
Criminal
and
Flagitious,
whether they expire under the hands of the executioner, or by disease; ought always to be consigned to the anatomical knife: that thus, in some degree, when dead, they may attone to society for their depredation and turbulence when alive. Public utility seems likewise to have a good title to the use of the dead bodies of those who by idleness and dissipation, have rendered themselves objects of public charity; and consequently, perhaps for many years, have been cloathed and fed at the public expence.
Humanity, Patriotism, and even self-interest conspire, to stimulate every individual to promote, at least, not to oppose the establishment of a measure so pregnant with the most solid advantages to mankind. The advancing liberality of this country, affords the strongest reasons to hope that the auspicious
Aera
is not very distant, when medical improvement shall be no more retarded by the impossibility of acquiring anatomical information in the only way that it can be acquired; a mischief hitherto so opprobrious, fatal, and gigantic.
If Anatomy be defective, PHISIOLOGY which teaches the functions of the various organs and parts detected by anatomy, must necessarily be proportionally defective. Not only is this the fact, but the uses even of many parts which the anatomist has described with tolerable accuracy, are far, very far, from being sufficiently explained by the phisiologist;
e. g.
Of several of the GENERATIVE ORGANS, of the DIFFERENT SUBSTANCES and PROTUBERANCES of the BRAIN, of the GANGLIONS, &c.
In like manner, many of the general laws and principles of the living system are not illustrated with satisfactory precision; while one physiologist affirms that MENSTRUATION depends on TOPICAL, another refers it to GENERAL PLETHORA. Some contend that NUTRITION is effected by the NERVES, others by the VESSELS: and a variety of facts are artfully adduced, to establish these opposite doctrines. With respect to many other physiological disquisitions the same contrariety of opinion exists.
If the question be put, "What shall be said when Doctors disagree?" I reply, recur to nature, collect useful facts, from them draw manly, liberal, chaste conclusions; disregard ideal, cobweb, flimsy theories, the baseless fabric of a vision. GENERAL PRINCIPLES, rationally deduced as corrollaries from established facts, only, in my opinion, can justly claim the dignified appellation of THEORY.
PATHOLOGY, you know, treats of the MORBID STATES of animal nature, with a view to effect their PREVENTION, ALLEVIATION or CURE. Many anatomical and physiological speculations are more curious than useful, and may, therefore, altho' not strictly just, have the merit of being innocent. Pathological disquisitions, on the contrary, must always produce the most serious consequences; because they influence the medical conduct of disease. Our small knowledge, or rather our great ignorance, of this department, affords but a melancholy theme to the anxious philosophic inquirer. The variety and opposition, the absurdity and confusion of numberless futile conceits, wild imaginations, fanciful opinions, dignified forsooth with the name of DOCTRINES, are the
opprobrium
of the medical profession: and present to the contemplative mind, the idea of primaeval
Chaos,
when darkness brooded over the great abyss.
Altho' I possessed ability, neither your time nor patience permit me to attempt a particular enumeration of the striking absurdities, which have, in a great degree, hitherto overwhelmed pathology, depressing medicine far beneath the rank of her sister arts; because these arts are established in the evolved unalterable laws of nature.
One class of pathologists have recourse to the SENSIBLE QUALITIES of the ATMOSPHERE, as chiefly contributing to create the numerous and important tribe of febrile disorders; and endeavour to support their reasonings by meteorological registers and observations without end. With equal confidence, another tribe, disregarding in a great measure, this opinion, muster up INVISIBLE MIASMATA and FLOATING POISONS, to untie every gordian knot; either as principal agents, or complete efficients. In like manner, while the favourite system of one period, refers us, with much plausibility, to the FLUIDS, and MORBIFIC MATTER there existing, for the SEAT and CAUSES of many diseases; that of another, with at least equal probability, directs our attention almost solely to SPASM and other AFFECTIONS of the SOLIDS.
I cannot avoid here to remark, that were the science of medicine like fluxions, infinitesimals, the quadrature of the circle,
&c. i. e.
purely a matter of curious uninteresting speculation; we might view the FLUCTUATING INSTABILITY of its DOGMATA or DOCTRINES, as they are called; with the same Tone of mind with which we contemplate the fantastic shiftings of the
aurora borealis,
or visions of the night. But how diametrically opposite must be the feelings of humanity, reflecting that these successive doctrines have respectively, during their fashionable periods of domination, greatly influenced the medical management of disease; compelling the passive entramelled, bewildered practitioner, to employ the most opposite curative means, in the same morbid states: the consequent havock, devastation, and massacre of mankind is more easily imagined than described.
The ancient maxim
"in medio tutissimus ibis,"
should perhaps never be entirely neglected. It seems exceedingly probable
a priori,
that, the fluids being made or elaborated by the solids; and these, on the other hand, supported by the fluids; their affections will not long remain distinct, but rather always be reciprocal: However,
"Non nostrum tantas componere lites."
Moreover, how little we do know with tolerable certainty, respecting the IMPRESSIONS made on the SENTIENT PARTS of our bodies, by what are named the
potentiae nocentes;
or of the DERANGEMENT of ORGANIZATION; or of the NUMBER and NATURE of the MORBID ALTERATIONS thence consequent! yet it seems absolutely necessary that these particulars be marked with the utmost possible precision. For instance, we are told, that there are two
species
of FEBRILE DELIRIUM, requiring the most opposite treatment; but who has hitherto pointed out, with sufficient accuracy, the symptoms ascertaining their important discrimination? If, therefore, in such a perilous predicament the GENIUS of blunder should but for a moment overcloud the practitioner's discernment, which is a very supposable, but I hope, a rare occurence;
conclamatum est.
'Till pathology, therefore, is more determined and complete, don't cases beset with dubiety and peril, seem justly to demand a suspension of hostilities (so to speak) or of our therapeutic efforts; which, permit me to say, may often with justice be termed the impertinence of art? These daring practitioners, who in the advanced critical febrile states, which they by no means understand, exhibit FEBRIFUGE NOSTRUMS,
Such as James's Powders.
with a temerity that equally shocks our feelings, and alarms our fears; may not ineptly be compared to the nonplus'd statesman; who, to smother dissention and broil, of which his mal-administration is probably the cause, risks the very existence of the state itself, by plunging it headlong into general combustion, and foreign war.
It is with much pleasure I acknowledge, that, in this most essential department of the medical philosophy, light and order happily begin to diffuse their genial influence over darkness and confusion. The GENIUS and LABOURS of some whom this Society can reckon among her honorary sons, have already contributed, in no small degree, to this most desirable purpose. I am confident I speak your sentiments, and most assuredly my own, when I mention with the most particular gratitude, the great advantages we have so often and so happily reaped in our inquiries, from the CULLENIAN NOSOLOGY: a work perspicuous tho' concise, elaborate yet not voluminous, in every part demonstrative of the liberal views, and extensive medical erudition of its very respectable and accomplished author, who with truth may say,
"Exegi monumentum aere perennius."
Supposing just indications of cure to be formed, in consequence of an advanced and chaste pathology, to be then provided with proper and active AGENTS or REMEDIES to fulfil these indications; becomes a matter of most important concern. The jarring opinions of authors respecting the nature, activity, dose and mode of exhibition, of almost every article of the MATERIA MEDICA; present a most extensive field for useful experiment and investigation.
With respect to medical improvement, I shall only in general add, that, your expectations, in my opinion, are less likely to be frustrated, if you look for it to result more from anatomical physiological and pathological progress, than from the discovery of any addition to the Materia Medica. This part of the medical science is by no means to be neglected, altho' it be probable, that advancing but a single step in any of the other walks, may be productive of more real and solid improvement and utility, than the acquisition of a thousand simples; if it be true, that it is an easier business to fulfil, than institute proper curative indications.
Be assured that the PHYSICIAN towers above the
Empiric,
the
nurse
and
old woman
almost only in proportion to his superior information respecting the PARTS, the LAWS, and MORBID STATES of animal nature; the more perfect his acquirements in these particulars, the higher his pre-eminence among the sons of Aesculapius. No mode of inauguration however solemn, no academic rites or authority however great or antient, can elevate to the honourable rank of Physician, a person of an opposite description. Such a one could only be regarded as an EMPTY DIGNIFIED FORM, around whose blighting temples, the VENAL, the SURREPTITIOUS, the PROSTITUTED LAURELS of APOLLO must basely fade to the utter discredit of all concerned; a more melancholy consequence still would be, that his practice could not fail to prove the bane of society, operating the destruction of such individuals as might become the unfortunate subjects of his temerity.
If therefore to become a Physician, (
i. e.
to be qualified to mark with precision, the almost infinitely various affections of animated matter, so as to direct, as far as may be, its movements to the blissful abode of longaevity and health,) be a task only terminating with life, to be exhausted by no labour, and to which the most discriminating mental powers are not superior; the folly, not to say criminality of attempts
Such as those of TISSOT,
&c.
to incite vulgar vanity to tamper with the most precious interests of mankind, needs no illustration.
In every species of philosophical investigation, particularly those of a medical nature, where certainty is so difficultly attained; to guard against CREDULITY, is a counsel, I deem of such infinite importance, that, before I put an end to this address, I cannot help tendering it in the most earnest manner to the particular notice of my YOUNGER SOCII. In all cases, where there is not absolute demonstration, or at least as high a degree of evidence, as the nature of the argument admits; to suspend belief or to exercise a proper degree of scepticism, till mature examination and reflection shall compel assent: I regard as a measure prudent, rational and philosophic. The unsupported
ipse dixit
of any man, however great his name in science, I always consider as a very weak argument: Recantation at best is exceedingly disagreeable.
The constitution of our Society, or its present system of laws, I am far from reckoning perfect; many meliorations, I doubt not will be made from time to time. No good reason can be assigned why our meetings should be suspended during half the year: In summer indeed they might probably be thin; but it does not follow, that your speculations on that account would be less instructive, or your essays more imperfect.
I conclude by congratulating you upon your affairs being now happily in such a prosperous train, as to afford the most flattering prospects. I contemplate the rising glory, and future greatness of the Medical Society, with no small degree of pleasurable ecstasy and expectation: Methinks, I hear its TOWERING GENIUS with the most complacent exultation exclaim
"sublimi feriam sidera vertice."
FINIS.
ERRATUM.
Page 27. l. 15.
for
we do
read
do we.