St. Luke and the Good Samaritan are yet the favourite signs of apothecaries, confirming the original charity of the art; and in the south of Europe may still be seen over the barbers’ shops the effigy of a human arm spouting blood from an open vein—an indication of the once universal custom of periodical depletion. It is now acknowledged that diverse climates require modified treatment of the same disease; that nervous susceptibility is far greater in one latitude than another, and that habits of life essentially individualize the constitution. Indeed, the widest difference exists in the relation of persons to the doctor; some never see him, and others must have a consultation upon the most trifling ailment,—so great is the dependence which can be had upon nature, and so extreme both the faith and the scepticism which exist in regard to curative science.
Popular literature is full of hits at the profession. ‘Le barbier fait plus de la moitié d’ un médecin,’ says Molière, who, in La Malade Imaginaire, has so acutely given the current philosophy of the subject by satirizing the pedantry and charlatanism of the doctors of his day; ‘Nous voyons que, dans la maladie tout le monde a recours aux médecins;—c’est une marque de la faiblesse humaine et non pas de la vérité de leur art;’ and of all ailments the hardest to cure is ‘la maladie des médecins.’ Imagination has been called by a German philosopher ‘the mediatrix, the nurse, the mover of all the several parts of our spiritual organism.’ ‘I have the worst luck of any physician under the cope of heaven,’ complains Sancho Panza; ‘other doctors kill their patients, and are paid for it too, and yet they are at no further trouble than scrawling two or three cramp words for some physical slip-slop, which the apothecaries are at all the pains to make up.’
It would seem, indeed, as if the advance of science improved medical practice negatively—that is, by inducing what in politics has been called a masterly inactivity; and there is no doubt that no small degree of the success attending Hahnemann’s theory is to be attributed to the comparative abstinence it inculcates in the use of remedial agents. The fact is a significant one, as indicative of the want of positive science in the healing art; and the consequent wisdom of leaving to nature, as far as possible, the restorative process. Indeed, to assist nature is acknowledged, by just observers, to be the only wise course; and this brings us to the inference that a good physician is necessarily a philosopher; it is incumbent on him, of all men, to exercise the inductive faculty; he must possess good causality, not only to reason justly on individual cases, but to apply the progress of science to the exigencies of disease. It is related of Bixio that such was his zeal for science, having long wished to ascertain whether a man instinctively turns when wounded in a vital part, asked his adversary in a duel to aim at one, and, although fatally hurt, exclaimed with ardour, as he involuntarily spun round—‘It is true, they do turn!’
The comparatively slow accumulation of scientific truth in regard to the treatment of disease, is illustrated by the fact that not until the lapse of two thousand years after medicine had assumed the rank of a science, under the auspices of Hippocrates, was the circulation of the blood discovered—an era in its history. The fiery discussion of the efficacy of inoculation, and its gradual introduction, is another significant evidence of the same general truth. But in our own day the rapid and valuable developments of chemistry have, in a measure, reversed the picture. Numerous alleviating and curative agents have been discovered; the gas of poisonous acids is found to eradicate, in many cases, the most fatal diseases of the eye; heat, more penetrating than can be created by other means, is eliminated from carbon in an aëriform state, passes through the cuticle without leaving a mark on its surface, and restores aching nerves or exhausted vitality. Vegetable and mineral substances are refined, analyzed, and combined with a skill never before imagined; opium yields morphine, and Peruvian bark quinine, and all the known salubrious elements are thus rendered infinitely subservient to the healing art. Chloroform is one of the most beneficent of these new agents; and has exorcised the demon of physical pain by a magical charm, without violating, in judicious hands, the integrity of nature.
There is a secret of curative art in which consists the genius of healing; it is that union of sympathy with intelligence, and of moral energy with magnetic gifts, whereby the tides of life are swayed, and one ‘can minister to a mind diseased.’ Fortunate is the patient who is attended by one thus endowed; but such are usually found out of the professional circle;—they are referees ordained by nature to settle the difficulties of inferior spirits; the arbiters recognized by instinct who soothe anger, reconcile doubt, amuse, elevate, and console, by a kind of moral alchemy; and potent coadjutors are they to the material aids of merely technical physicians. ‘Who dare say,’ asks Rénan, in allusion to the calming and purifying influence of Jesus, ‘that in many cases, and apart from injuries of a dreaded character, the contact of an exquisite person is not worth all the resources of pharmacy?’ ‘It was agony to me,’ wrote Hahnemann, ‘to walk in darkness, with no other light than could be derived from books.’ One of his opponents, from this confession, infers the fallacy of his system; ‘the conviction,’ he observes, ‘is irresistibly forced upon us that he was not a born physician.’ If our ancestors were less enlightened in regard to hygiène, and if their physicians were less scrupulous in tampering with the functions of nature, they had one signal advantage over us in escaping the inhuman comments, made after every fatal issue, on the practice and the treatment adopted—no matter with how much conscientious intelligence. We not only suffer the pangs of bereavement, but the reproaches of devotees of each school of medicine and of rival doctors, of having by an unwise choice sacrificed the life for which we would have cheerfully resigned our own! Somewhat of this occult healing force might have been read in the serene countenance of Dr. Physic, of Philadelphia; it predominated in the benevolent founder of the Insane Asylum of Palermo, who learned from an attack of mental disorder how to feel for, and minister to, those thus afflicted. The late Preissnitz, of Graefenberg, seems to have enjoyed the gift which is as truly Nature’s indication of an aptitude for the art, as a sense of beauty in the poet. But this principle is ‘caviare to the general.’
Medicine has lost much of its inherent dignity by the same element, in modern times, that has degraded art, letters, and society—the spirit of trade. This agency encourages motives, justifies means, and leads to ends wholly at variance with high tone and with truth. The gentleman, the philosopher, the man of honour, and with them that keystone in the arch of character—self-respect, are wholly compromised in the process of sinking a liberal art into a common trade. In the economy of modern society, however, the physician has acquired a new influence; he has gained upon the monopoly of the priest: for while the spirit of inquiry, by trenching on the mysterious prerogatives which superstition once accorded, has retrenched the latter’s functions, the same agency, by extending the domain of science and rendering its claims popular, has enlarged the sphere of the other profession. To an extent, therefore, never before known, the doctor fills the office of confessor; his visits yield agreeable excitement to women with whom he gossips and sympathizes; admitted by the very exigency of the case to entire confidence, often revered as a counsellor and friend, as well as relied on as a healer, not infrequently he becomes the oracle of a household. Privileges like these, when used with benevolence and integrity, are doubtless honourable to both parties, and become occasions for the exercise of the noblest service and the highest sentiments of our nature; while, on the other hand, they are liable to the grossest abuse, where elevation of character and gentlemanly instincts are wanting. Accordingly there has sprung into existence, in our day, a personage best designated as the medical Jesuit; whose real vocation, as well as the process by which he acquires supremacy, fully justifies the appellation. Like his religious prototype, he operates through the female branches, who, in their turn, control the heads of families; and the extent to which the domestic arrangements, the social relations, and even the opinions of individuals are thus regulated, is truly surprising. ‘Women,’ says Mrs. Jameson, ‘are inclined to fall in love with priests and physicians, because of the help and comfort they derive from both in perilous moral and physical maladies. They believe in the presence of real pity, real sympathy, where the look and tone of each have become merely habitual and conventional, I may say professional.’ Yet a popular novelist, in his ideal portrait of the physician, justly claims superiority to impulse and casual sympathy as an essential requisite to success. ‘He must enter the room a calm intelligencer. He is disabled for his mission if he suffer aught to obscure the keen glance of his science.’[12]
The natural history of the doctor has not yet been written, but the classes are easily nomenclated; we have all known the humorous, the urbane, the oracular, the facetious, the brusque, the elegant, the shrewd, the exquisite, the burly, the bold, and the fastidious; and the character of people may be inferred by their choice of each species. Those in whom taste predominates over intellect, will select a physician, for his agreeable personal qualities; while such as value essential traits, will compromise with the roughest exterior and the least flattering address for the sake of genuine skill and a vigorous and honest mind. As a general rule, in large cities, vanity seems to rule the selection; and it is a lamentable view of human nature to see the blind preference given to plausible but shallow men, whose smooth tongues or gallant air win them suffrages denied to good sense and candid intercourse. The most detestable genus is that we have described under the name of medical Jesuits; next in annoyance are the precisians; the most harmless of the weaker order are the gossips; and there is often little to choose in point of risk to ‘the house of life’ between the very timid and the dare-devils; in a great exigency the former, and in an ordinary case the latter are equally to be shunned. In the Horæ Subsecivæ of Dr. John Brown, we find some apt and needed counsel to the aspirants for medical success:—‘The young doctor must have for his main faculty, sense; but all will not do if Genius is not there; such a special therapeutic gift had Hippocrates, Sydenham, Pott, Purcell, John Hunter, Delpech, Dupuytren, Kellie, Cheyne, Baillie, and Abercrombie. Moreover, let me tell you, my young doctor friends, that a cheerful face and step and neckcloth and buttonhole, and an occasional hearty and kindly joke, and the power of executing and setting a-going a good laugh, are stock in our trade not to be despised.’ Brillat Savarin declares, doctors easily become gourmands because so well received.
In Paris, Edinburgh, and Philadelphia, all the world over, the medical student is an exceptional character. Their pranks are patent: the rough ones like to kick up rows, and the more quiet are unique at practical jokes. Bob Sawyer is a typical hero. If, like the portrait-painter, doctors are often the playthings of fortune in cities, where the arbitrary whims of fashion decree success; in the country their true worth is more apt to find appreciation, and the individualities of character having free scope, quite original children of Apollo are the result. The name of Hopkins is still memorable in the region where he practised, as one of the literary clique of which Humphries, Dwight, and Barlow were members. Dr. Osborn, of Sandwich, Mass., wrote the popular whaling-song yet in vogue among Nantucketers. Dr. Holyoke, of Salem, is renowned as a beautiful instance of longevity; and the wit of Dr. Spring was proverbial in Boston. The best example of a medical philosopher, in our annals, is that of Dr. Rush, of Philadelphia; he reformed the system of practice; first treated yellow fever successfully, made climate a special study, and, like Burke, laid every one he encountered under contribution for facts. His life of seventy years was passed in ardent investigation. It is remarkable that the first martyr to American liberty was a physician; and, before he fell, Warren eloquently avowed his principles, like Körner in Germany, rousing the spirit of his countrymen, and then consecrating his sentiments with his blood. Boylston, the ancestral portraits of whose family are among the best of Copley’s American works, nearly fell a victim to public indignation for his zealous and intelligent advocacy of inoculation, and natural science owes a debt to Barton, Morton, and De Kay, which is acknowledged both at home and abroad. A French doctor has noted the historical importance of his confrères, and tells us Hamond was Racine’s master, Lestocq helped to elevate Catharine to the Russian throne, Haller was a poet and romancer, Cuvier was the greatest naturalist of his age, and Murat was a doctor. French médecins have figured in the Chamber and on the Boulevards.
If by virtue of the philosophic instinct and liberal tastes the doctor is thus allied to belles-lettres, he is allured into the domain of science by a still more direct sympathy. To how many has the study of the materia medica, and the culling of simples, proved the occasion of botanical research; and hence, by an easy transition, of exploring the entire field of natural science. Thus Davy was beguiled into chemical investigation; and Abercrombie, by the vestibule of physiological knowledge, sought the clue to mental philosophy; while Spurzheim and Combe ministered to a great charity by clearly explaining to the masses the natural laws of human well-being. It is an evidence of the sagacity of the Russian Peter, that he sought an interview with Boerhaäve; for by these varied links of general utility the medical office enters into every branch of social economy, and is only narrowed and shorn of dignity by the limited views or inadequate endowments of its votaries. The Jewish physician preserved and transmitted much of the learning of the world, after the fall of the Alexandrian school.[13] Life-insurance and quarantines have become such grave interests, that through them the responsibility of the physician to society is manifest to all; that to individuals is only partially recognized. How Cowper and Byron suffered for wise medical advice, and what ameliorations in states of mind and moral conditions have been induced by the now widely-extended knowledge of hygienic laws! Charles Lamb reasons wisely as well as quaintly in this wise:—‘You are too apprehensive of your complaint. The best way in these cases is to keep yourself as ignorant as the world was before Galen, of the entire construction of the animal man; not to be conscious of a midriff; to hold kidneys to be an agreeable fiction; to account the circulation of the blood an idle whim of Harvey’s; to acknowledge no mechanism not visible. For once fix the seat of your disorder, and your fancies flux into it like bad humours. Above all, take exercise, and avoid tampering with the hard terms of art. Desks are not deadly. It is the mind, and not the limbs, that taints by long sitting. Think of the patience of the tailors; think how long the Lord Chancellor sits; think of the brooding hen.’
In literature the doctor figures with a genial dignity; he has affinities with genius, and a life-estate in the kingdom of letters: witness Garth’s poem of The Dispensary; Akenside’s Pleasures of the Imagination; Armstrong’s Art of Health; Cowley’s verses, Sprat’s life of him, and Currie’s of Burns; Beattie’s Minstrel; Darwin’s Botanic Garden; Moore’s Travels in Italy; Zimmerman’s Solitude; Goldsmith’s Vicar and Village; Aikin’s Criticisms; Joanna Baillie’s gifted brother, and Lady Morgan’s learned husband. Burke found health at the house of the benign Dr. Nugent, of Bath, at the outset of his career, and married the daughter of his medical friend. ‘Les médecins sont souvent tout a la fois conseillors, arbitres et magistrats au sein des familles.’ The best occasional verses of Dr. Johnson are those that commend the humble virtues of Levett, the apothecary.[14] Dr. Lettson wrote the life of Carver, the American traveller, and his account of that adventurous unfortunate led to the establishment of the Literary Fund Society. Among the graves near Archibald Carlyle’s old church at Inveresk, where that handsome clerical and convivial gossip is buried, is that of the sweet versifier, beloved as the ‘Delta’ of Blackwood, Dr. Moir, who so genially united the domestic lyrist and the good doctor; a Delta framed in bay adorns the pedestal of his monument. Rousseau, an invalid of morbid sensibility, recognizes the professional superiority of the physician as a social agent:—‘Par tous le pays ce sont les hommes les plus véritablement utiles et savants.’ The Médecin de Campagne of Balzac, and the Dr. Antonio of Ruffini, are elaborate and charming illustrations of this testimony of the author of Emile. What a curious chapter would be added to the Diary of a Physician, had Cabanis kept a record of his interviews with those two illustrious patients—Mirabeau and Condorcet. The social affinities of the doctor prove indirectly what we before suggested, that it is in the character more than in the learning, in the mind rather than the technical knowledge, that medical success lies. One of the shrewdest of the profession, Abernethy, declared thereof,—‘I have observed, in my profession, that the greatest men were not mere readers, but the men who reflected, who observed, who fairly thought out an idea.’ Almost intuitive is the venerable traditional ideal of the physician; among the aborigines of this continent, the ‘medicine man’ was revered as nearest to the ‘Great Spirit.’ ‘I hold physicians,’ said Dr. Parr, ‘to be the most enlightened professional persons in the whole circle of human arts and sciences.’ In our own day, Lever’s Irish novels, and in our own country the writings of Drake, Mitchell, Holmes, Bigelow, Francis, and others, indicate the literary claims of the profession. Think of Arbuthnot beside Pope’s sick-bed, and the latter’s apostrophe:—