Medicine and surgery one inductive science; being an attempt to improve its study and practice ... and offering, as first fruits, the law of inflammation

Front matter

MEDICINE SURGERY

ONE

INDUCTIVE SCIENCE;

Preface

Before the reader peruses tlie following pages, I am desirous that he should have a general idea of the views and objects which have led to their publication.

In common with many others of the profession, 1 have long been dissatisfied with the condition of the science, in the cultivation of which the greater part of my life has been employed. I have sensibly felt the humiliating conviction that medical science has not kept pace with other departments of knowledge, either as to its progress or diffusion ; and that, as a consequence of this, it is encumbered by many circumstances which impede its progress, abridge its utility, and derogate from the rank of those who follow it as a profession.

We can in no way explain these circumstances by any reference, either to the paucity of our facts (for of these we have abundance), or to any deficiency of industry, in at least a considerable number of the cultivators of medical science ; but it is easy to perceive that there is a great difference in the manner which has characterized our investigations, when compared with that observable in the cultivation of the other sciences.

In these, there has been a pervading observance of inductive reasoning, as taught us by Lord Bacon : in medical science, we observe as pervading a violation of it. I speak generally ; I do not mean that it is always observed in the one case, nor always disregarded in the other.

When we connect with the foregoing the fact that there is, besides, a very demonstrable correspondence in the progress of every science, and the observance of inductive reasoning in its cultivation, it is impossible to be otherwise than anxious to enquire at least whether the slow progress of medical science may not be attributable to that general disregard or violation of rules of reasoning which have so materially assisted the progress of all others.

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As regards any benetit derivable from the diffusion of knowledge, medicine lias laboured under peculiar disadvantages. We observe a great difterence in the extent and nature of the ignorance of the public on medical and other matters. In general, ignorance consists in the simple absence of knowledge. In medicine, it is accompanied bj all sorts of error.

Instead of being left in a condition in which men, under the influence of inclination or necessity, seldom fail to discover something of the truth in nature, the public have been taught every variety of falsehood aad absurdity. Their passions, prejudices, and prevailing weaknesses, have all been excited in aid of every variety of quackery ; whilst the absence of information has left them without the smallest protection from imposition. To such an extent has this been carried, that the most successful quack almost ever known used to say that the secret of his success lay in the siaiple proposition — " Tell the public something in regard to medicine which common sense shews to be impossible." For the moment, we are astonished at the effrontery of such a confession ; and yet, if we look around us at the present hour, London alone furnishes too many exemplifications of the application of this precept : but we must not look for it alone in avowed empirics ; there is too much of regular as well as of irregular quackery. Teach the public but truth, they will become quick and intelligent detectors of all species of imposition : nor is this all ; by knowing how and what they are to observe, they will also become very useful assistants in scientific investigations, as I have already often experienced.

It has been usual to attribute the low state of medical science to the difficulties attending its cultivation. I can in no way subscribe to this opinion. Like other sciences, it has its difficulties, both general and peculiar, doubtless ; but it has also great advantages. The difficulties of which we complain, as resulting from that interminable variety of form under which disease obliges us to investigate the laws of nature, shew how little we have wrought in the right way. Properly regarded, these varieties are of the highest utility : they are the strongest and most necessary tests of any law concerning which it may be our object to acquire ; and furnish ready to our hands, in countless forms of disease, variations of conditions, which, in other sciences, we are obliged artificially to institute. Besides which, it is only through the multiform yradations in disease, that we learn the true relations of this " nu-

PREFACE, vii merous and dissimilar family whilst the verj diversity of character which they present produce this remarkable result — that those characters which they have in common (in all matters the most essential to know) stand out in stronger relief from the very diversities by which they are in different examples accompanied.

My first object has been to point out some of the causes which have impeded the progress of medical science, and to expose some of the more prevailing errors ; then to collect a certain number of facts, and to conduct the consideration of them more in the spirit of common sense or inductive philosophy ; and to offer, as the first fruits of this mode of study, what appears to me to be nothing less than the " law of inflammation."

I have here been, in one sense, breaking a new soil, and I am aware how poor the first harvest often is to those who do so : but the nature of the soil may be determined, its capabihties even ascertained ; although the more abundant produce may be reserved to future husbandmen, who, profiting ahke by the knowledge and mistakes of former cultivators, often discover improved modes of culture, and derive more abundant crops with diminished labour.

The task of improving any science is difficult ; but I am strongly impressed with the idea that truth has no character more striking than its simplicity ; that the discovery of it requires not extraordinary talent, so much as a plain, unfettered, and properly directed understanding ; and that, although the diffusion of truth varies in its progress, being always slow, yet in time it becomes established. Like hardy plants, it may thrive best in genial soils, but it will live in any.

The motives with which I have put forth the work will ensure me from, any severity of disappointment. The size of the edition, and the price of the work, are such as render any pecuniary object out of the question ; whilst, had reputation, in any sense of the word, been my leading object, I should have pursued it much more auspiciously by the pubhcation of various matters more in conformity with prevaihng opinions, and (with the materials around me) requiring scarcely a tithe of the labour.

I address myself chiefly to the medical student ; because it is to him that we must look for the advantages w^hich any improved mode of study may be ultimately calculated to produce ; in that, his faculties are less encumbered by preconceived errors — in the devotion of his time to the science — and in the longer period for observation which he will probably enjoy. I have thrown the viii

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whole into the form of Discourses, because, whilst this mode allows of a more familiar style, it enables me to employ that in which I have been accustomed to express m^'self.

To many of the profession I look with hope and confidence that the suggestions herein contained will not be disregarded ; for, with respect to the position of medical science generally, I know that 1 am not singular, either in my views or anticipations.

I am desirous, for reasons before mentioned, that the public should be informed ; and I should be vexed to feel that the book contained a single sentence which was not intelligible to every person of moderate education. I profess not, indeed, to instruct the ivhole mass; this, I think, cannot be done yet; — we must teach " down stream,"' as it were ; and, in time, that general intelligence will be diffused which can alone raise a glorious profession to that station which the high nature of its objects and its unquestioned utility alike deserve.

1 have sensibly felt, however, the difficulty of addressing such different classes of readers ; that which seemed necessary to one class uHl sometimes appear tedious, or even puerile to others : but in teaching, I know not how this is to be avoided ; even in the hmited audience of a medical school, the teacher, to instruct the whole, must often deliver that which is trite and wearisome to the better-informed. For the same reasons, 1 have not been able wholly to avoid repetitions ; but these, I hope, will be found unimportant and excusable.

The size of the volume (as in manuscript) has been considerably reduced, — 1st, by the omission of authorities, which would have increased its size and expense, and have made a parade of learning without adding to its utility ; 2ndly, by reducing the description of the body, originally intended to have been given, to a very few general remarks, for which the object must be the apology ; 3d]y, I have not scrupled to omit, in aid of the reduction in size, many arguments and illustrations in support of the law of inflammation. Nothing would have induced me to do this but ihe following considerations : — I am much more desirous of exciting reflection, than of at once carrying conviction ; and the facts and arguments omitted will, from time to time, appear in connection with different diseases. I' am not in the least degree anxious that my views should be hastily adopted: nothing is more injurious than the reception of propositions \\ithout examination. If they be false, it perpetuates error; if tme, it abridges their utihty in leaving

PREFACE.

ix their principles unexamined, and thus narrowing the mode and extent of their application.

As to the facts, I have endeavoured to select those which are either most common, most trite, or most indisputable. The conclusions the reader must examine. I would advise the student and the general reader not to attempt more than one Discourse, at most, at one time ; and to peruse first the general observations on the body (imperfect though thej be), contained in the Appendix. I shall conclude this Preface with the following story : —

It is said, that, in the family of the Sciences, MEDICINE was once afflicted with a certain " halt or lameness," which, whilst her sisters were yet young, did not deprive her of their society. As they grew up, however, she could scarcely ever accompany them in their various rambles into the fields of Nature ; and, when she did, she seldom brought home any of the i'ruits or flow^ers which they so abundantly gathered; so that she saw little society, and this too of an inferior description, beiug w^holly confined to a neighbouring family, the Arts. Various remedies had been tried for her relief ; all sorts of specifics from the animal, vegetable, and mineral kingdoms of Nature. I know not how many thousand animals had been slaughtered in every variety of mode, and by every conceivable process of torture, in the hope of finding something that might throw light on the complaint under which Medicine laboured ; but all in vain ; until at length it was generally thought that her malady was incurable. At last, EXPERIENCE suggested to Reflection, that at one period the whole family had been in a very delicate state, but that their health and strength had been established by the employment of a remedy recommended by one " Bacon." They decided, therefore, that this remedy should be tried, and the treatment conducted, as it had been in the other cases, by Common Sense.

At first. Common Sense met with great difficulty from various members of her acquaintance : — Medicine had little faith in her skill, and AvARiCE, Indolence, and Prejudice were constantly interfering with her plans ; they would also often lead Industry away, when Common Sense most required her help ; whilst Education, whose assistance Common Sense highly valued, would frequently be absent. Notwithstanding all these difficulties. Common Sense proceeded, audit was evident that Medicine improved ; and as the improvement became marked, the sister

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Sciences took a great interest in her case, and often furnished Common Sense with useful suggestions. As Medicine recovered, even Avarice and Indolence beheld her progress with satisfaction; and the scoffs of PREJUDICE were at length silenced. In the end, MEDICINE recovered, and when her health was restored, the beautj of her stately form was beheld by the whole family with admiration. MEDICINE now lived in harmony with her sisters ; and in the constant interchange of kindly offices in their respective labours ; but, as might be naturally expected, she looked up with most reverence to her benefactors, Common Sense, Experience, and Reflection.