LOCKE AND SYDENHAM &c. ' Knowledge and Wisdom, far from being one, Have ofttimes no connexion. Knowledge dwells In heads replete with thoughts of other men ; Wisdom in minds attentive to their own. Knowledge is proud, that he has learnt so much ; Wisdom is humble, that he knows no more: THE UMKAI FOR EDMONSTON AND DOUGLAS. LONDON HAMILTON, ADAMS, AND CO. CAMBRIDGE, MACMILLAN AND CO. GLASGOW, JAMES MACLEHOSE. LOCKE AND SYDENHAM &c. &c. BY JOHN BROWN, M.D. F. R. S. E. EDITION EDINBURGH EDMONSTON AND DOUGLAS 1866 TO JAMES SYME, F.R.S.E. SURGEON IX ORDINARY TO THE QUEEN IN SCOTLAND PROFESSOR OK CLINICAL SURGERY IN THE UNIVERSITY OK EDINBURGH WITH THE AFFECTIONATE REGARDS OF HIS OLD APPRENTICE. 1 CSG593 VERAX CAPAX SAGAX PERSPICAX EFF1CAX TEN AX. CONTENTS. PAGE PREFACE, i INTRODUCTORY, 9 LOCKE AND SYDENHAM, 33 DR. ANDREW COMBE, 135 DR. HENRY MARSHALL AND MILITARY HYGIENE, 165 ART AND SCIENCE : A 7 CONTRASTED PARALLEL, . 225 OUR GIDEON GRAYS, 243 DR. ANDREW BROWN AND SYDENHAM, . . 261 FREE COMPETITION' IN MEDICINE, ... 277 EDWARD FORBES 1 285 DR. ADAMS OF BANCHORY, 297 HENRY VAUGHAN, . 309 EXCURSUS ETHICUS, . . . . . . 357 PREFACE. THESE occasional Papers appeared, with a few exceptions, in the early editions of HOR^E SUBSECIV^E, and were afterwards excluded as being too professional for the general reader. They have been often inquired for since, and are now reprinted with some fear that they may be found a sort of compromise of flesh and fowl, like the duck-billed Platypus neither one thing nor the other not medical enough for the doctors, and too medical for their patients. If they are of any use, it will be in confirming in the old, and impressing on the young prac- titioners of the art of healing, the importance of knowledge at first hand ; of proving all things, and holding fast only that which is good ; of travelling through life and through its campaigns, as far as can be, like Caesar ii Preface. relictis impedimentis neither burdened over- much with mere word-knowledge, nor led cap- tive by tradition and routine, nor demoralized by the pestilent lusts of novelty, notoriety, or lucre. This is one great difficulty of modern times ; the choosing not only what to know, but what to trust ; what not to know, and what to forget. Often when I see some of our modern Admirable Crichtons leaving their university, armed cap-a- pie, and taking the road, where they are sure to meet with lions of all sorts, I think of King Jamie in his full armour ' Naebody daur meddle wi' me, and,' with a helpless grin, ' I daur meddle wi' naebody.' Much of this excess of the material of knowledge is the glory of our age, but much of it likewise goes to its hind- rance and its shame, and forms the great diffi- culty with medical education. Every man ought to consider all his lecture-room knowledge as only so much outside of himself, which he must, if it is to do him any good, take in mode- rately, silently, selectly ; and by his own gastric juice and chylopoietics, turn, as he best can, in Preface. iii succum et sanguinem. The muscle and the cin- eritious matter, the sense and the power, will follow as matters of course. And every man who is in earnest, who looks at nature and his own proper work, with his own eyes, goes on through life demolishing as well as building up what he has been taught, and what he teaches himself. He must make a body of medicine for himself, slowly, steadily, and with a single eye to the truth. He must not on every emergency run off to his Cyclo- pey well those that are on the ground. Nicely to observe the history of diseases in all their changes and cir- cumstances is a work of time, accurateness, attention, and judgment, and wherein if men, through pre- possession or oscitancy, mistake, they may be con- vinced of their error by unerring nature and matter of fact. What we know of the works of nature, especially in the constitution of health and the operations of our own bodies, is only by the sensible 5 2 Locke and Sydenham. effects, but not by any certainty we can have, of the tools she uses, or the ways she works by. 1 Exact, patient, honest, ' nice ' observation, is neither easy nor common ; as Buffon says : ' II y a une espece de force de gdnie, et de courage d'esprit, a pouvoir envisager sans s'e'tonner, la Nature dans la multitude innombrable de ses pro- ductions, et a se croire capable de les comprendre et de les comparer ; il y a une espece de gout, a les aimer, plus grand que le gout qui n'a pour but, que des objets particuliers, et 1'un peut dire, que 1'amour et 1'etude de la Nature, suppose dans 1'esprit deux qualite's qui paroissent opposees, les grandes vues d'un gdnie ardent, qui embrasse tout d'un coup-d'ceil, et les petites attentions d'un in- stinct laborieux, que ne s'attache qu'a un seul point' Gaubius calls it ' masculum illud observandi studium veteribus tantopere excultum ;' and Dr. Samuel Brown, heu nimiuni brevis cevi decus et desi- derium ! thus enforces the same truth : ' Few people are aware of the difficulty of the art of simple observation ; to observe properly in the simplest of the physical sciences requires a long and severe training. No one knows this so feel- ingly as the great discoverer. Faraday once said that he always doubts his own observations. Mit- scherlich said it required fourteen years to discover Locke and Sydenham. 53 and establish a single new fact in chemistry. An enthusiastic student one day betook himself to Cuvier with a new muscle he supposed he had discovered. The master bade his scholar return to him with the same discovery in six months ! ' But we must draw this notice of Locke in his character of Doctor to a close. In the Philosophical Transactions for 1697, there is an account by him of an odd case of hypertrophied nails, which he had seen at La Charite' when in Paris, and he gives pictures of the hornlike excrescences, one of them upwards of four inches long. The second Lord Shaftesbury, who was Locke's pupil, and for whom he chose a wife, in a letter to Furley, who seems to have been suffering from a relapse of intermittent fever, explains, with great distinctness and good sense, ' Dr. LockJs and all our ingeniouse and able doctors' method' of treating this disease with the Peruvian bark ; adding, ' I am satisfied, that of all medicines, if it be good of its kind, and pro- perly given, it is the most innocent and effectual, whatever bugbear the world makes of it, especially the tribe of inferior physicians, from whom it cuts off so much business and gain.' We now con- clude our notices of Locke's medical history which, however imperfect, seem to us to warrant our original assertion with the following weighty sentence taken from the ' Fragment on Study' 54 Locke and Sydenham. given by Lord King, and which was written when Locke was at his studies at Oxford. It accords curiously with what we have already quoted from Dugald Stewart: 'Physic, polity, and prudence are not capable of demonstration, but a man is principally helped in them, i, By the history of matter of fact ; and 2, By a sagacity of inquiring into probable causes, and finding out an analogy in their operations and effects. Whether a certain course in public or private affairs will succeed well whether rhubarb will purge, or quinquina cure an ague, can be known only by experience.' l SYDENHAM, the prince of practical physicians, whose character is as beautiful and as genuinely English as his name, did for his art what Locke did for the 1 The all -accomplished, and, in the old sense, 'the admir- able' Dr. Thomas Young, puts this very powerfully in the preface to his Introduction to Medical Literature. ' There is, in fact, no study more difficult than that of physic : it exceeds, as a science, the comprehension of the human mind ; and those who blunder onwards, without attempting to understand what they see, are often nearly on a level with those who depend too much upon imperfect generalizations.' ' Some departments of knowledge defy all attempts to subject them to any didactic method, and require the exercise of a peculiar address, a judg- ment, or a taste, "which can only be formed by indirect means. It appears that physic is one of those departments in which there is frequent necessity for the exercise of an incommunicable faculty of judgment, and a sagacity which may be called tran- scendental, as extending beyond the simple combination of all that can be taught by precept? Locke and Sydenham. 55 philosophy of mind he made it, in the main, obser- vational ; he made knowledge a means, not an end. It would not be easy to over-estimate our obligations as a nation to these two men, in regard to all that is involved in the promotion of health of body and soundness of mind. They were among the first in their respective regions to show their faith in the in- ductive method, by their works. They both pro- fessed to be more of guides than critics, and were the interpreters and servants of Nature, not her diviners and tormentors. They pointed out a way, and them- selves walked in it ; they taught a method, and used it, rather than announced a system or a discovery; they collected and arranged their visa before settling their cogitata a mean-spirited proceeding, doubtless, in the eyes of the prevailing dealers in hypotheses, being in reality the exact reverse of their philosophy. How curious, how humbling, to think that it was not till this time, that men in search of truth were brought to see that ' it is not the insufficiency or incapacity of man's mind, but the remote standing or placing thereof, that breedeth mazes and incomprehensions ; for as the sense afar off is full of mistaking, but is exact at hand, so is it of the understanding, the remedy whereof is not to quicken or strengthen the organ, but to go nearer to the object.' Well might this greatest of Lord Chancellors now even say, as he does in the context (he is treating of medicine) ' Medicine is a 56 Locke and Sydenham. science which hath been more professed than laboured, more laboured than advanced, the labour being in my judgment more in a circle than in progression : I find much iteration but small addition ;' and he was right in laying much of this evil condition to the dis- continuance of ' the ancient and serious diligence of Hippocrates.' This serious diligence, this d/c/oi&i'a or nicety of observation by which the ' divine old man of Cos' achieved so much, was Sydenham' s master-principle in practice and in speculation. He proclaimed it anew, and displayed in his own case its certain and inestimable fruits. It appears to us one of the most interesting, as it is certainly one of the most difficult and neglected departments of medical literature, to endeavour to trace the progress of medicine as a practical art, with its rules and instruments, as distinguished from its consolidation into a systematic science with its doc- trines and laws, and to make out how far these two, which conjoined form the philosophy of the subject, have or have not harmonized with, and been helpful to each other, at different periods of their histories. Much might be done to make such an inquiry instruc- tive and attractive, by marking out the history of medicine into several great epochs, and taking, as representative of each, some one distinguished arts- man or practitioner, as well as teacher or discoverer. We might have Hippocrates and his epoch, Syden- L ocke and Sydenham. 5 7 ham and his, John Hunter, Pinel, Laennec and theirs. These great men differed certainly widely enough in character and in circumstances, but agreed all in this, their possessing in large measure, and of rare quality, that native sagacity, that power of keen, serious, choice, patient, continuous, honest observation, which is at once a gift and a habit ; that instinct for seeking and finding, which Bacon calls ' experientia literata, sagacitas potius et odoratio qucedam venatica, quam sciential that general strength and soundness of un- derstanding, and that knack of being able to apply their knowledge, instantly and aright, in practice, which must ever constitute the cardinal virtues of a great physician, the very pith and marrow of his worth. Of the two first of these famous men, we fear there survives in the profession little more than the names; and we receive from them, and are made wiser and better by inheriting, their treasures of honest and ex- quisite observation, of judicious experience, without, we fear, knowing or caring much from whom it has come. 'One man soweth, and another reapeth.' The young forget the old, the children their fathers ; and we are all too apt to reverse the saying of the wise king, ' I praised the dead that are already dead, more than the living th'at are yet alive.' As we are not sufficiently conscious of, so we assuredly are not adequately grateful for, that accu- 58 Locke and Sydenham. mulated volume of knowledge, that body of practical truth, which comes down as a heritage to each one of us, from six thousand years of human endeavour ; and which, like a mighty river, is moving for ever onwards widening, deepening, strengthening, as it goes ; for the right administration and use of whose untold energies and wealth, we, to whom it has thus far descended, are responsible to Him from whom it comes, and to whom it is hastening responsible to an extent we are too apt to forget, or to underrate. We should not content ourselves with sailing victori- ously down the stream, or with considering our portion of it merely ; we should go up the country oftener than we do, and see where the mighty feeders come in, and learn and not forget their names, and note how much more of volume, of momentum, and power, the stream has after they have fallen in. It is the lot of the successful medical practitioner, who is more occupied with discerning diseases and curing them, than with discoursing about their essence, and arranging them into systems, who observes and reflects in order to act rather than to speak, it is the lot of such men to be invaluable when alive, and to be forgotten soon after they are dead ; and this not altogether or chiefly from any special ingratitude or injustice on the part of mankind, but from the very nature of the case. Much that made such a man what the community to their highest profit found him Locke and Sydenham. 59 to be, dies, must die with him. His inborn gifts, and much of what was most valuable in his experience, were necessarily incommunicable to others, this de- pending somewhat on his forgetting the process by which, in particular cases, he made up his mind, and its minute successive steps, from his eagerness to possess and put in action the result, and likewise from his being confident in the general soundness of his method, and caring little about formally recording to himself his transient mental conditions, much less announcing them articulately to others ; but mainly, we believe, because no man can explain directly to another man how he does any one practical thing, the doing of which he himself has accomplished, not at once, or by imitation, or by teaching, but by re- peated personal trials, by missing much, before ulti- mately hitting. You may be able to expound excellently to your son the doctrines of gunnery, or read him a course of lectures upon the principles of horsemanship, but you cannot transfer to him your own knack as a dead- shot, or make him keep his seat over a rasping fence. He must take pains to win these for himself, as you have done before him. Thus it is that much of the best of a man like Sydenham, dies with him. It is very different with those who frequent the field of scientific discovery. Here matters are re- versed. No man, for instance, in teaching anatomy 60 Locke and Sydcnham. or physiology, when he comes to enounce each new subordinate discovery, can fail to unfold and to en- hance the ever-increasing renown of that keen black- a-vised little man, with his piercing eye, ' small and dark, and so full of spirit / his compact broad fore- head, his self-contained peremptory air, his dagger at his side, and his fingers playing with its hilt, to whom we owe the little book, De motu cordis et sanguinis drculatione. This primary, capital discovery, which no succeeding one can ever supersede or obscure, he could leave consummate to mankind ; but he could not so leave the secret of his making it ; he could not transmit that combination of original genius, inven- tion, exactness, perseverance, and judgment, which enabled him, and can alone enable any man, to make such a permanent addition to the fund of scientific truth. But what fitted Harvey for that which he achieved, greatly unfitted him for such excellence in practice as Sydenham attained. He belonged to the science more than to the art. His friend Aubrey says of him, that ' though all his profession would allow him to be an excellent anatomist, I have never heard of any who admired his therapeutic way.' A mind of his substance and mettle, speculative and arbitrary, passing rapidly and passionately from the particular to the general, from multiformity to unity, with, moreover, a fiery temper and an extemporane- ous dagger as its sting, was not likely to take kindly Locke and Sydenham. 01 to the details of practice, or make a very useful or desirable family doctor. Sydenham, again, though his works everywhere manifest that he was gifted with ample capacity and keen relish for abstract truth, moved habitually and by preference in the lower, but at the time the usefuller sphere of everyday practice, speculating chiefly in order to act, reducing his gene- ralizations back to particulars, so as to answer some immediate instance, the result of which was the signallest success of ' his therapeutic way.' We have had in our own day two similar examples of the man of science and the man of art ; the one, Sir Charles Bell like Harvey, the explorer, the discoverer, the man of genius and science, of principles and laws, having the royal gifts of invention and eloquence was not equally endowed with those homelier, but in their degree not less rare qualities, which made Dr. Abercrombie, our Scottish Sydenham, what he was, as a master in the diagnosis and treatment of disease. The one pursued his profession as a science, to be taught, to be transmitted in its entireness the other as an art to be applied. The one was, in the old phrase, luciferous ; the other frugiferous. One great object we have in now bringing for- ward the works and character of Sydenham, is to enforce the primary necessity, especially in our day, of attending to medicine as the art of healing, not less than as the science of diseases and drugs. We 62 Locke and Sydenham. want at present more of the first than of the second. Our age is becoming every day more purely scien- tific, and is occupied far more with arranging sub- jects and giving names, and remembering them, than with understanding and managing objects. There is often more knowledge of words than of things. We have already stated our notion, that to the great body of modern physicians, Sydenham is little more than a name, and that his works, still more than those of his companion Locke, are more spoken of than read. This is owing to several causes ; partly to their being buried in Latin, which men seem now-a-days ashamed to know: partly to much in them being now scientifically obsolete and useless ; partly from their practical value being im- paired by our ignorance of his formulas of cure ; and greatly also, we fear, from what Baglivi calls ' an inept derision and neglect of the ancients,' which is more prevalent than seemly. We include ourselves among these ; for until we got Dr. Green- hill's edition, we had never read seriously and thoroughly these admirable tracts, which were all of an occasional character, and were forced from their author by the importunity of friends, or the envious calumny of enemies, often in the form of familiar letters. We had, when at college, picked up like our neighbours the owrrent commonplaces about Syden- Locke and Sydenham. 63 ham ; such as that he went by the name of ' the Prince of English physicians;' that Boerhaave (of whom by the way we knew quite as little, unless it were a certain awful acquaintance with his ugly, squab, and gilded visage, which regarded us grimly from above a druggist's door, as we hurried along the Bridges to the University) was wont to take his hat off, whenever he mentioned his name, and to call him ' Anglice lumen, Artis Phozbum, veram Hippocratici veri speciem : ' that his life was written by Samuel Johnson in the Gentleman's Magazine, and was one of his earliest and worst paid perfor- mances : that he was a Whig, and went into the field as a Parliament man. Moreover, that when asked by Sir Richard Blackmore what he would advise him for medical reading, he replied, 'Read Don Quixote, Sir,' an answer as full of sense as wit, and the fitness and wisdom of which it would be not less pleasant than profitable to unfold at length. We had been told also, in a very general way by our teachers, that Sydenham had done some things for his profession, which, considering the dark age in which he worked, were highly to his credit ; that his name was well connected with the history and management of the small-pox ; the nature of epidemics, the constitutions of years, dropsies, etc., and that he had recorded his own sufferings from the gout in a clever and entertaining way. 64 Locke and Sydenham. All this was true, but by no means the whole truth. Not only are his observations invaluable to any one engaged in tracing the history of medicine as a practical art, and as an applied science ; in marking in what respects it is changed, and in what unchanged ; in how much it is better now than then, and in what little it is not so good. In addi- tion to all this, they are full of valuable rules for the diagnosis and treatment of disease ; and we can trace to him as their origin, many of our most com- mon and important therapeutic doctrines. They everywhere manifest how thoroughly he practised what he taught, how honestly he used his own ' method,' that of continued, close, serious obser- vation. But we confess, after all, our chief delight is from the discovery he makes in his works of his personal character the exemplar he furnishes in himself of the four qualities Hippocrates says are indispensable in every good physician learning, sagacity, humanity, probity. This personality gives a constant charm to everything he writes, the warmth of his large, humane, practical nature is felt throughout. Above all, we meet with a habitual reference to what ought to be the supreme end of every man's thoughts and energies the two main issues of all his endeavours, the glory of God and the good of men. Human life was to him a sacred, a divine, Locke and Sydenham. 65 as well as a curious thing, and he seems to have possessed through life, in rare acuteness, that sense of the value of what was at stake, of the perilous material he had to work in, and that gentleness and compassion for his suffering fellow-men, without which no man be his intellect ever so transcen- dent, his learning ever so vast, his industry ever so accurate and inappeasable need hope to be a great physician, much less a virtuous and honest man. This characteristic is very striking. In the midst of the most minute details, and the most purely professional statements, he bursts out into some abrupt acknowledgment of ' The Supreme Judge,' ' The true Archiater and Archeus.' We may give one among many such instances. He closes his observations on The Epidemic Cough and Pleurisy Peripncumony of 1675, w i tn this sudden allusion to the Supreme Being : ' Qui post sequentur morbi, solus novit, Qui novit omnia.' And again, after giving his receipt for the preparation of his laudanum liquidum, so much of Spanish wine, of opium, of saffron, of cinnamon, and cloves, he adds, ' Pro- fecto non hie mini tempero, quin gratulabundus animadvertam, DEUAI omnipotentem TTO.VTWV Ao>r?)pa eawi/ non aliud remedium, quod vel pluribus malis debellandis par sit, vel eadem efficacius extirpet, humano generi in miseriarum solatium concessisse, quam opiata.' 66 Locke and Sydenham. If we may adapt the simple but sublime saying of Sir Isaac Newton, Sydenham, though diligent beyond most other 'children' in gathering his pebbles and shells on the shore of the great deep, and in winning for mankind some things of worth from the vast and formless infinite, was not uncon- scious of the mighty presence beside which he was at work ; he was not deaf to the strong music of that illimitable sea. He recognised in the midst of the known, a greater, an infinite, a divine unknown ; behind everything certain and distinct, he beheld something shadowy and unsearchable, past all find- ing out ; and he did not, as many men of his class have too often done, and still do, rest in the mere contemplation and recognition of the TI fleibv. This was to him but the shadow of the supreme sub- stance, o 6cos. How unlike to this fervour, this reverence and godly fear, is the hard, cool, noncha- lant style of many of our modern men of science, each of whom is so intent on his own little pebble, so bent upon finding in it something no one else ever found, so self-involved and self-sufficient, that his eyes and his ears are alike shut to the splendours and the voices the brooding darkness, and the 'look that threatens the profane' of the liberal sea, from out whose abyss it has been flung, and ' Which doth with its eternal motion make A sound like thunder everlastingly.' Locke and Sydcnham. 67 . This habit of Sydenham's mind is strikingly shown in the first sentence of his Preface to the first edition of his Medical Observations : ' Qui medicinae dat operarn, hsec secum ut ssepe perpendat oportet : Primo, se de aegrorum vita ipsius curse commissa, rationem aliquando SUPREMO JUDICI redditurum. Deinde quicquid artis aut scientisa Divino beneficio consecutus est, imprimis, ad SUMMI NUMINIS laudem, atque humani generis salutem, esse dirigendum : indignum autem esse, ut coelestia ilia dona, vel avaritiae, vel ambitus officio inserviant Porro, se non ignobilis alicujus aut contemnendi animalis curam suscepisse; ut enim, humani generis pretium agnoscas, UNIGENITUS DEI FILIUS, homo factus est adeoque naturam assumptam sua dignatione nobili- tavit. Denique, nee se communi sorte, exemptum esse, sed iisdem legibus mortalitatis, iisdem casibus et oerumnis, obnoxium atque expositum, quibus alii quilibet ; quo diligentius et quidem teneriori cum affectu, ipse plane o/zoioTra^s osgrotantibus opem ferre conetur.' When it is the free outcome of an earnest, sin- cere, and ample nature, this sudden reference to Divine things this involuntary Oh altitudo ! in the midst of a purely technical exposition, has an effect, and moves the hearer far beyond any mere elaborate and foreseen argumentation. When a youth is told beforehand what you mean to make 68 Locke and Sydenham. him believe, and, above all, what you mean to insist that he must feel you have much of him against you. You should take him before he is aware ; and, besides, if this burst of emotion is the expression of an inward restraint, carried to its ut- most, and then forced into utterance ; if the speaker has resisted being moved, and is moved in spite of himself, then is he surest to move those upon whom he is acting. The full power of lightning is due to speed and concentration you have it in the Teuto- nic Blitz, gone as soon as come. Such of our readers (a fast-lessening band !) as were pupils of that remarkable man and first-rate teacher, Dr. John Barclay, must remember well his sudden bursts of this kind, made all the more memorable, that he disliked formal moralizing upon his favourite science. There was one occasion when he never failed to break out. It was when concluding his description of the bones of the skull. His old pupils knew what was coming, the new ones were set a wondering; all saw some sup- pressed emotion working within him, his language was more close and rapid ; that homely, sensible, honest face, was eager with some unacknowledged central feeling, and after finishing the Sella Turcica, and the clinoid processes, he threw down the sphe- noid bone, and the time being up, and his hand on the open door of that well-known arena in which Locke and Sydenham. 69 he moved, he seemed as if leaving; indeed, we believe he intended then to leave, when turning round upon the class, with a face serious almost to anger, and a voice trembling with feeling, he said, ' Yes, gentlemen ! there is a God, omnipotent, omniscient, and eternal] as he vanished under the gallery into his room. Depend upon it, this single sentence made a deeper impression on his hearers than any more elaborate demonstration after the manner of Paley. The ardent old man did not linger among particulars, but passed at once, and with a sort of passionate fervour, to the full abso- lute assertion. Two examples of these brief lightnings, which at one flash ' unfold both earth and heaven,' occur to us now. Dr. Dick, in his System of Theology, at the close of his lecture on the Immensity and Omnipre- sence of the Deity, pictures a man about to commit some great sin, as shutting himself in his room, or going into the depths of an unfrequented wood, so as to get absolutely by himself, and then turning and looking and looking again to make sure 'let him turn and look again /' And John Foster, in that intense bit of spiritual vivisection, the Preface to Doddridge's Rise and Pro- gress, when minuting the process of a step-by-step descent into the deepest meditative wickedness and impiety, the very ' superfluity of naughtiness,' repre- 70 Locke and SydenJiain. sents the person as speaking his last thought aloud, and starting at his own voice, and his desperate sin, and then exclaiming, ' If any one were within hear- ing !' If any -one were within hearing! as if some One had not all the while been within hearing. The following are a few quotations, taken at random, from Sydenham's various treatises and letters, in which we may see what he himself was as a practi- tioner, and what were his views as to the only way in which Medicine, as an art, could be advanced. In his Epistle to Dr. Mapletoft, prefixed to the Observations Medico:, his first publication, when he was forty-two years of age, he gives his friend a long and entertaining account of his early professional life, and thus proceeds : ' Having returned to London, I began the practice of Medicine, which when I studied curiously with most intent eye \intentoadmodumoculo] and utmost diligence, I came to this conviction, which to this day increases in strength, that our art is not to be better learned than by its exercise and use ; and that it is likely in every case to prove true, that those who have directed their eyes and their mind, the most accurately and diligently, to the natural phenomena of diseases, will excel in eliciting and applying the true indications of cure. With this thread as my guide, I first applied my mind to a closer observation of fevers, and after no small amount of irksome waiting, and perplexing mental agitations, Locke and Sydenkam. 7 r \vhich I had to endure for several years, I at last fell upon a method by which, as I thought, they might be cured, which method I some time ago made public, at the urgent request of my friends.' He then refers to the persecution and calumnies he had been exposed to from the profession, who looked upon him as a pestilent fellow, and a setter forth of strange doctrines ; adopting the noble saying of Titus Tacitus in reply to Metellus : ' Facile est in me dicere, cum non sim responsurus ; tu didicisti maledicere ; ego, conscientia teste, didici maledicta contemnere. Si tu linguae tuse dominus es, et quic- quid lubet effutias ; ego aurium mearum sum dominus, ut quicquid obvenerit audiant inoffensae.' 1 It is easy to speak against me when I make no reply ; you have learned to speak evil ; I, my conscience bearing me witness, have learned to despise evil speaking. You are master of your tongue, and can make it utter what you list ; I am master of my ears, and can make them hear without being offended. And, after making the reference we have already 1 Sydenham here quotes from memory, as Bacon, and many other men of that time, whose minds were full of the classics, often did, and none of the commentators have discovered the exact passage. The remark is in Beyerlinck, Magn. Theatr, Vit. Human., torn. vi. page 60, H. (Lugd. 1666, folio), referred to by Dr. Greenhill. It is as follows : ' Tacitus Lucio Metello ei in Senatu maledicenti respondit, " Facile est in me dicere, quia non responsurus sum, potentia ergo tua, non mea patientia est accusanda." ' Seneca is referred to by Beyerlinck. 7 2 Locke and Sydenham. mentioned, to his method having had the sanction and assistance of Locke, he thus concludes in regard to the ultimate success of his newly discovered way, 'As concerns the future, I cast the die, not over- careful how it may fall, for, since I am now no longer young, and have, by the blessing of the Almighty, a sufficient provision for the remainder of my journey (tantum mihi est viatici, quantum restat vice), I will do my best to attain, without trouble to myself or others, that measure of happiness so beautifully depicted by Politian : " Felix ille animi, divisque simillimus ipsis, Quern non mendaci resplendens gloria fuco Sollicitat, non fastosi mala gaudia luxus. Sed tacitos sinit ire dies, et panptre cultu Exigit innoctue tranquilla silentia vita" ' We shall now give more fully his peculiar views, and in order to render him due honour for originat- ing and acting upon them, we must remember in the midst of what a mass of errors and prejudices, of theories actively mischievous, he was placed, at a time when the mania of hypothesis was at its height, and when the practical part of his art was overrun and stultified by vile and silly nostrums. We must have all this in our mind, or we shall fail in estimat- ing the amount of independent thought, of courage and uprightness, and of all that deserves to be called magnanimity and virtue, which was involved in his thinking and writing and acting as he did. Locke and Sydenht 73 ' The improvement of physic, in my opinion, de- pends, ist, Upon collecting as genuine and natural a description or history of diseases as can be procured ; and, 2tt, Upon laying down a fixed and complete method of cure. With regard to the history of diseases, whoever considers the undertaking deliberately will perceive that a few such particulars must be attended to : isf, All diseases should be described as objects of natural history, with the same exactness as is done by botanists, for there are many diseases that come under the same genus and bear the same name, that, being specifically different, require a different treat- ment. The word carduus or thistle, is applied to several herbs, and yet a botanist would be inaccurate and imperfect who would content himself with a generic description. Furthermore, when this distri- bution of distempers into genera has been attempted, it has been to fit into some hypothesis, and hence this distribution is made to suit the bent of the author rather than the real nature of the disorder. How much this has obstructed the improvement of physic any man may know. In writing, therefore, such a natural history of diseases, every merely philosophical hypothesis should be set aside, and the manifest and natural phenomena, however minute, should be noted with the utmost exactness. The usefulness of this procedure cannot be easily overrated, as compared with the subtle inquiries and trifling notions of modern 74 Locke and Sydenkain. writers ; for can there be a shorter, or indeed any other way, of coming at the morbific causes, or of discovering the curative indications, than by a certain perception of the peculiar symptoms r \ By these steps and helps it was that the father of physic, the great Hippocrates, came to excel ; his theory (flew/Ha) being no more than an exact description or view of Nature. He found that Nature alone often terminates diseases, and works a cure with a few simple medicines, and often enough with no medicines at all. If only one person in every age had accurately described, and consistently cured, but a single disease, and made known his secret, physic would not be where it now is ; but we have long since forsook the ancient method of cure, founded ripon the knowledge of conjunct causes, insomuch that the art, as at this day practised, is rather the art of talking about diseases than of curing them. I make this digression in order to assert, that the discovering and assigning of remote causes, which now-a-days so much engrosses the minds and feeds the vanity of curious inquirers, is an impossible at- tempt, and that only immediate and conjunct causes fall within the compass of our knowledge.' Or as he elsewhere pithily states it : ' Cognitio nostra, in rerum cortice, omnis ferme versatur, ac ad TO 6 sive quod res hoc modo se habeat, fere tantum assurgit ; TO Stem, sive rerum causas, nullatenus attingit.' His friend Locke could not have stated the case Locke and Sydenham. 75 more clearly or sensibly. It is this doctrine of ' con- junct causes,' this necessity for watching the action of compound and often opposing forces, and the having to do all this not in a machine, of which if you have seen one, you have seen all, but where each organism has often much that is different from, as well as common with all others. Here you must mend your watch while it is going, you must shoot your game on the wing. It is this which takes medi- cine out of the category of exact sciences, and puts it into that which includes politics, ethics, navigation, and practical engineering, in all of which, though there are principles, and those principles quite within the scope of human reason, yet the application of these principles must, in the main, be left to each man's skill, presence of mind, and judgment, as to the case in hand. It is in medicine as in the piloting of a ship rules may be laid down, principles expounded, charts ex- hibited ; but when a man has made himself master of all these, he will often find his ship among breakers and quicksands, and must at last have recourse to his own craft and courage. Gaubius, in his admirable chapter, De disciplina Medici, thus speaks of the reasonable certainty of medicine as distinguished from the absolute certainty of the exact sciences, and at the same time gives a very just idea of the infinite (as far as concerns our limited powers of sense and 7 6 Locke and Sydenham. judgment) multiplicity of the phenomena of disease : ' Nee vero sufficit medicum communia modo intueri ; oportet et euiiris homini propria, quae quidem diversitas tarn immensa occurrit ut nulla observationum vi ex- hauriri possit. Sola denique contemplatione non licet acquiescere, inque obscuris rebus suspendere judicium, donee lux affulgeat. Actionemexigitoffidwn. Captanda hinc agendi occasio, quiz sizpe prceceps, per conjecturam cogit determinare, quod per scientiam sat cito nequit. Audiant hsec obtrectatores, et cum didicerint sdentias puras, ab iis quas applicatas vocant, contemplativas a practids, distinguere, videant quo jure medicinam pras aliis, ut omnis certi expertem, infament.' It would not be easy to put more important truth into clearer expression. Conjecture, in its good sense, as meaning the throwing together of a number of the elements of judgment, and taking what upon the whole is the most likely, and acting accordingly, has, and will ever have, a main part to play in any art that concerns human nature, in its entireness and in action. When in obscure and dangerous places, we must not contemplate, we must act, it may be on the instant. This is what makes medicine so much more of an art than a science, and dependent so much more upon the agent than upon his instruc- tions ; and this it is that makes us so earnest in our cautions against the supposition that any amount of Locke and Sydenham. 77 scientific truth, the most accurate and extensive, can in medicine supersede the necessity of the recipient of all this knowledge having, as Richard Baxter says, by nature ' a special sagacity, a naturally searching and conjecturing turn of mind.' Moreover, this faculty must be disciplined and exercised in its proper function, by being not a hearer only, but also a doer, an apprentice as well as a student, and by being put under the tutorage of a master who exer- cises as well as expounds his calling. This native gift and its appropriate object have been so justly, so beautifully described by Hartley Coleridge in his Life of Fothergill, that we cannot refrain from closing our remarks on this subject by quoting his words. Do our readers know his Bio- graphia Borealis ? If they do, they will agree with us in placing it among the pleasantest books in our language, just such a one as Plutarch, had he been an Englishman, would have written : ' There are certain inward gifts, more akin to genius than to talent, which make the physician prosper, and de- serve to prosper ; for medicine is not like practical geometry, or the doctrine of projectiles, an applica- tion of an abstract, demonstrable science, in which a certain result may be infallibly drawn from certain data, or in which the disturbing forces may be cal- culated with scientific exactness. It is a tentative art, to succeed in which demands a quickness of 78 Locke and Sydcnham. eye, thought, tact, invention, which are not to be learned by study, nor, unless by connatural aptitude, to be acquired by experience ; and it is the posses- sion of this sense, exercised by a patient observation, and fortified by a just reliance on the ins medicatrix, the self-adjusting tendency of nature, that constitutes the true physician or healer, as imagination consti- tutes the poet, and brings it to pass, that sometimes an old apothecary, not far removed from an old woman, and whose ordinary conversation savours, it may be, largely of twaddle, who can seldom give a rational account of a case or its treatment, acquires, and justly, a reputation for infallibility, while men of talent and erudition are admired and neglected ; the truth being, tJiat there is a great deal that is mysterious in whatever is practical? But to return to our author. He was the first to point out what he called the varying ' constitutions' of different years in relation to their respective epidemics, and the importance of watching the type of each new epidemic before settling the means of cure. In none of his works is his philosophic spirit, and the subtlety and clearness of his understanding, shown more signally than in his successive histories of the epidemics of his time. Nothing equal to them has ever appeared since ; and the full importance of the principles he was the first to lay down, is only now beginning to be acknowledged. His confession Locke and Sydenham. 79 as to his entirely failing to discover what made one epidemic so to differ from another, has been amply confirmed by all succeeding observers. He says, ' I have carefully examined the different constitutions of different years as to the manifest qualities of the air, yet I must own I have hitherto made no progress, having found that years, perfectly agreeing as to their temperature and other sensible properties, have pro- duced very different tribes of diseases, and vice versa. The matter seems to stand thus : there are certain constitutions of years that owe their origin neither to heat, cold, dryness, nor moisture, but upon a certain secret and inexplicable alteration in the bowels of the earth, whence the air becomes impregnated with such kinds of effluvia as subject the human body to distempers of a certain specific type.' As to the early treatment of a new epidemic, he says, ' My chief care, in the midst of so much darkness and ignorance, is to wait a little, and pro- ceed very slowly, especially in the use of powerful remedies, in the meantime observing its nature and procedure, and by what means the patient was re- lieved or injured ;' and he concludes by regretting the imperfection of his observations, and hoping that they will assist in beginning a work that, in his judg- ment, will greatly tend to the advantage of mankind. Had his successors followed in his track with equal sagacity and circumspection, our knowledge of these 80 Locke and Sydenham. destructive and mysterious incursions of disease, would, in all likelihood, have been greatly larger and more practical than it is now. .Sydenham is well known to have effected a revolu- tion in the management of the small-pox, and to have introduced a method of treatment upon which no material improvement has since been made. We owe the cool regimen to him. Speaking of the pro- priety of attending to the wishes of the sufferer, he says, with equal humanity and good sense, ' A per- son in a burning fever desires to drink freely of some small liquor ; but the rules of art, built upon some hypothesis, having a different design in view, thwart the desire, and instead thereof, order a cordial. In the meantime the patient, not being suffered to drink what he wishes, nauseates all kinds of food, but art commands him to eat. Another, after a long illness, begs hard, it may be, for something odd, or ques- tionable ; here, again, impertinent art thwarts him and threatens him with death. How much more excellent the aphorism of Hippocrates " Such food as is most grateful, though not so wholesome, is to be preferred to that which is better, but distasteful." Nor will this appear strange, if it be considered that the all-wise Creator has formed the whole with such exquisite order, that, as all the evils of nature emi- nently conspire to complete the harmony of the whole work, so every being is endowed with a Divine direc- Locke and Sydenham. 8 1 tion or instinct, which is interwoven with its proper essence, and hence the safety of mankind was pro- vided for, who, notwithstanding all our doctoring, had been otherwise in a sad enough plight.' Again ' He would be no honest and successful pilot who were to apply himself with less industry to avoid rocks and sands, and bring his vessel safely home, than to search into the causes of the ebbing and the flowing of the sea, which, though very well for a philosopher, is foreign to him whose business it is to secure the ship. So neither will a physician, whose province it is to cure diseases, be able to do so, though he be a person of great genius, who bestows less time on the hidden and intricate method of nature, and adapting his means thereto, than on curious and subtle speculations.' The following is frank enough : ' Indeed, if I may speak my mind freely, I have been long of opinion that I act the part of an honest man and a good physician as often as I refrain entirely from medicines, when, upon visiting the patient, I find him no worse to-day than he was yesterday ; whereas, if I attempt to cure the patient by a method of which I am uncertain, he will be endangered both by the experiment I am going to make on him and by the disease itself; nor will he so easily escape two dangers as one. 1 That practice, and that alone, will bring relief F 82 Locke and Sydenham. to the sufferer, which elicits the curative indications from the phenomena of the diseases themselves, and confirms them by experience, by which means the great Hippocrates made himself immortal. And had the art of medicine been delivered by any one in this wise, though the cure of a disease or two might come to be known to the common people, yet the art in its full extent would then have required men more prudent and skilful than it does now, nor would it lose any of its credit ; for as there is in the opera- tions of Nature (on the observations of which a true medical praxis is founded) more of nicety and subtlety than can be found in any art supported on the most specious hypotheses, so the science of Medicine which Nature teaches will exceed an ordi- nary capacity in a much greater degree than that which mere' philosophy teaches.' There is much profound truth in this. Observa- tion, in its strict sense, is not every man's gift, and but few men's actual habit of mind. Newton used to say, that if in any one way he differed from other men, it was in his power of continued attention of faithful, unbroken observation ; his ladder had all its steps entire, and he went up with a composed, orderly foot. It requires more strength and fineness of mind, more of what deserves to be called genius, to make a series of genuine observations in Medicine, or any other art, than to spin any amount of nice Locke and Sydenham. 83 hypotheses, or build any number of ' castdla in aere,' as Sydenham calls them. The observer's object and it is no mean one is ' To know ivhat 's what, and that 's as high As Metaphysic wit can fly.' Sydenham adds, ' Nor will the publication of such observations diminish but rather increase the reputation of our art, which, being rendered more difficult, as well as more useful, only men of sagacity and keen sound judgment would be admitted as physicians' How true to the sayings of his great master in his Novum Organum, ' Nature is only subdued by submission.' ' The subtil ty of nature is far beyond that of sense, or of the understanding, and the specious meditations and theories of mankind are but a kind of insanity, only there is no one to stand by and observe it !' There is a very remarkable passage in Sydenham's Treatise of the Dropsy, in which, after quoting this curious passage from Hippocrates, ' Certain phy- sicians and philosophers say that it is impossible for any man to understand medicine without knowing the internal structure of man ; for my part, I think that what they have written or said of nature pertains less to the medical than the pictorial art,' he asserts not only his own strong conviction of the importance of a knowledge of minute anatomy to the prac- titioner, but also his opinion that what Hippocrates meant, was to caution against depending too much 84 Locke and Sydenham. on, and expecting too much help from anatomical researches, to the superseding of the scrupulous observation of living phenomena, of successive ac- tions. 1 ' For in all diseases, acute and chronic, it must be owned there is an inscrutable TI Oeiov, a specific property which eludes the keenest anatomy.' He then goes on to say, that as Hippocrates cen- sured the abuse of anatomy, so in his own day, there were many who, in like manner, raised hopes for Physic from discoveries in Chemistry, which, in the 1 As far as the cure of diseases is concerned, Medicine has more to do with human Dynamics than Statics, for whatever be the essence of life and as yet this ri Oeiov, this nescimus qiiid divinum, has defied all scrutiny it is made known to us chiefly by certain activities or changes. It is the tendency at the pre- sent time of medical research to reverse this order. Morbid anatomy, microscopical investigations, though not confined to states or conditions of parts, must regard them fully more than actions and functions. This is probably what Stahl means when he says, ' Ubi Physicus desinit, Mediais incipit ;' and in the following passage of his rough Tudesque Latin, he plainly alludes to the tendency, in his day, to dwell too much upon the materials of the human body, without considering its actions 'utvivms.' 1 The passage is full of the subtilty and fire and depth of that wonderful man. ' Undique hinc materiiz adver- titur animus, et qute crassius in sensum impingit conformatio, et mutua proportio corporea consideratur ; motuum ordo, vis, et absoluta magis in materiam ener s ia, tempora ejus, gradus, vices, maxime autem omnium, fines obiter in animum admit- tuntur.' The human machine has been compared to a watch, and some hope that in due time doctors will be as good at their craft as watchmakers are at theirs ; but watchmakers are not called on to mend their work while it is going ; this makes all the difference. L ocke and Sydenham . 8 5 nature of things, never could be realized, and which . only served to distract from the true Hippocratic method of induction ' for the chief deficiency of medicine is not a want of efficacious medicine. Who- ever considers the matter thoroughly, will find that the principal defect on the part of physic proceeds, not from a scarcity of medicines to answer particular inten- tions, but from the want of knowing the intentions to be answered, for an apothecary's apprentice can tell me what medicine will purge, vomit, or sweat, or cool ; but a man must be conversant with practice who is able to tell me when is the properest time for ad- ministering any of them.' He is constantly inculcating the necessity of getting our diagnostic knowledge at first-hand, ridiculing those descriptions of disease which the manufacturers of ' Bodies of medicine,' ' Hand-books,' and such like, make up in their studies, and which are often er compo- sitions than portraits, or at the best bad copies, and which the young student will find it hard enough to identify in real life. There is too much of this we fear still ; and Montaigne, who rejoices in having a sly hit at his cronies the doctors, might still say with some reason, ' Like him who paints the sea, rocks, and heavens, and draws the model of a ship as he sits safe at his table ; but send him to sea, and he knows not how or where to steer ; so doctors often- times make such a description of our maladies as a 86 Locke and Sydenham. town-crier does of a lost dog or donkey, of such a colour and height, such ears, etc. ; but bring the very animal before him, and he knows it not for all that' Everywhere our author acknowledges the vis medi- catrix naturce, by which alone so many diseases are cured, and without or against which none, and by directing and helping which medicine best fulfils its end, ' For I do not think it below me or my art to acknowledge, with respect to the cure of fevers and other distempers, that when no manifest indication pointed out to me what should be done, I have con- sulted my patient's safety and my own reputation, most effectually, by doing nothing at all. But it is much to be lamented that abundance of patients are so ignorant as not to know, that it is sometimes as much the part of a skilful physician to do nothing, as at others to apply the most energetic remedies, whence they not only deprive themselves of fair and honourable treatment, but impute it to ignorance or negligence.' We conclude these extracts with a picturesque de- scription. It is a case of ' the hysterics' in a man : ' I was called not long since to an ingenious gentle- man who had recovered from a fever, but a few days before he had employed another physician, who blooded and purged him soundly, and forbade him the use of flesh. When I came I found him up, and heard him talking sensibly. I asked why I was sent Locke and Sydenham. 87 for, to which one of his friends replied with a wink, Wait and you'll see. Accordingly, sitting down and entering into discourse with the patient, I perceived his under lip was thrust outwards, and in frequent motion, as happens to peevish children, who pout before they cry, which was succeeded by the most violent fit of crying, with deep convulsive sobs. I conceived this was occasioned partly by his long illness, partly by the previous evacuations, and partly by emptiness ; / therefore ordered him a roast chicken, and a pint of Canary.' Felix tile 1 His shrewdness and humour are shown in the story Dr. Paris tells in his Pharmacologia. ' This great physician, Sydenham, having long attended a gentleman of fortune with little or no advantage, frankly avowed his inability to render him any further service, adding at the same time, that there was a physician of the name of Robert- son, at Inverness, who had distinguished himself by the performance of many remarkable cures of the same complaint as that under which his patient laboured, and expressing a conviction that, if he applied to him, he would come back cured. This was too encouraging a proposal to be rejected ; the gentleman received from Sydenham a statement of his case, with the necessary letter of introduction, and proceeded without delay to the place in ques- tion. On arriving at Inverness, and anxiously 88 Locke and Sydenham. inquiring for the residence of Dr. Robertson, he found to his utter dismay and disappointment that there was no physician of that name, nor ever had been in the memory of any person there. The gentleman returned, vowing eternal hostility to the peace of Sydenham, and on his arrival at home, instantly expressed his indignation at having been sent on a journey of so many hundred miles for no purpose. " Well," replies Sydenham, " are you better in health?" " Yes, I am now quite well; but no thanks to you." " No," says Sydenham, " but you may thank Dr. Robertson for curing you. I wished to send you a journey with some object of interest in view; I knew it would be of service to you ; in going, you had Dr. Robertson and his wonderful cures in contemplation ; and in return- ing, you were equally engaged in thinking of scold- ing me.'" In making these selections we have done our author great injustice, partly from having to give \hern either in Swan's translation or our own, and thereby losing much of the dignity and nerve the flavour, or what artists would call the crispness of the original ; partly also from our being obliged to exclude strictly professional discussions, in which, as might be expected, his chief value and strength lie. We know nothing in medical literature more finished than his letter to Dr. Cole on the hysteri- Locke and Sydenham. 89 cal passion, and his monograph of the gout. Well might Edward Hannes, the friend of Addison, in his verses on Sydenham, thus sing : ' Sic te scientem non faciunt libri Et dogma pulchrum ; sed sapientia Enata rebus, mensque facti Experiens, animusque felix.' It would not be easy to over-estimate the perma- nent impression for good, which the 'writings, the character, and the practice of Sydenham have made on the art of healing in England, and on the Conti- nent generally. In the writings of Boerhaave, Stahl, Gaubius, Pinel, Bordeu, Haller, and many others, he is spoken of as the father of rational medicine ; as the first man who applied to his profession the Ba- conian principles of interpreting and serving nature, and who never forgot the master's rule, ' Non fin- gendum aut excogitandum, sed inveniendum, quid natura aut faciat aut ferat.' He was what Plato would have called an ' artsmanj as distinguished from a doctor of abstract science. But he was by no means deficient in either the capacity or the relish for speculative truth. Like all men of a large practical nature, he could not have been what he was, or done what he did, without possessing and often exercising the true philosophizing faculty. He was a man of the same quality of mind in this re- spect with Watt, Franklin, and John Hunter, in go Locke and Sydenham. whom speculation was not the less genuine that it was with them a means rather than an end. This distinction between the science and the art or craft, or as it was often called the cunning of medi- cine, is one we have already insisted upon, and the importance of which we consider very great, in the present condition of this department of knowledge and practice. We are now-a-days in danger of ne- glecting our art in mastering our science, though medicine in its ultimate resort must always be more of an art than of a science. It being the object of the student of physic to learn or know some thing or things, in order to be able safely, effectually and at once, to do some other thing; and inasmuch as human nature cannot contain more than its fill, a man may not only have in his head much scientific truth which is useless, but it may shut out and hinder and render altogether ineffectual, the active, practical, workmanlike faculties, for whose use his knowledge was primarily got. It is the remark of a profound thinker, that ' all professional men labour under a great disadvantage in not being allowed to be ignorant of what is useless ; every one fancies that he is bound to receive and transmit whatever is believed to have been known.' ' It appears to be possible,' says Dr. Thomas Young, in his Life of Parson, ( that a memory may in itself be even too retentive for real practical utility, Locke and Sydenham, 9 1 as if of too microscopic a nature ; and it seems to be by a wise and benevolent, though by no means an obvious arrangement of a Creative Providence, that a certain degree of oblivion becomes a most useful instrument in the advancement of human knowledge, enabling us readily to look back on the prominent features only of various objects and occurrences, and to class them, and reason upon them, by the help of this involuntary kind of abstraction and generaliza- tion, with incomparably greater facility than we could do if we retained the whole detail of what had been once but slightly impressed on our minds. It is thus, for example, in physic, that the experienced practi- tioner learns at length to despise the relation of in- dividual symptoms and particular cases, on which alone the empiric insists, and to feel the value of the Hippocratic system of " attending more to the prognostic than the diagnostic features of disease ;" which, to a younger student, appears to be perfect imbecility.' This subject of art and science is hinted at, with his usual sagacity, by Plato, in a singular passage in his Theaetetus : ' Particulars,' he says, ' are infinite, and the higher generalities give no sufficient direc- tion in medicine ; but the pith of all sciences, that which makes the artsman differ from the inexpert, is in the middle propositions, which, in every particular knowledge, are taken from tradition and inexperi- 92 Locke and Sydenkam. ence.' 1 It would not be easy to convey in fewer words, more of what deserves the name of the philo- sophy of this entire subject, and few things would be more for the advantage of the best interests of all arts and sciences, and all true progress in human knowledge and power, than the taking this passage and treating it exegetically, as a divine would say, bringing out fully its meaning, and illustrating it by examples. Scientific truth is to the mind of a physician what food is to his body ; but, in order to his mind being nourished and growing by this food, it must be assimilated it must undergo a vital in- ternal change must be transformed, transmuted, and lose its original form. This destruction of former identity this losing of itself in being received into the general mass of truth is necessary in order to 1 Being anxious to see what was the context of this remark- able passage, which Bacon quotes, as if verbatim, in his Advance- ment of Learning, we hunted through the Thesetetus, but in vain. We set two friends, throughbred Grecians, upon the scent, but they could find no such passage. One of them then spoke to Sir William Hamilton, and he told him that he had marked that passage as not being a literal translation of any sentence in Plato's writings. He considered it a quotation from memory, and as giving the substance of a passage in the Philebus, which occurs in the 6th and 7th of the forty-two sections of that Dia- logue. Perhaps the sentence which comes nearest to the words of Bacon is the last in the 6th section, beginning with the words ol. 5 vvv T&V &v6ptjvaiv Hippocratis describit Galenus lib. de Crisibus, et 1. 5. de Sympt. Caus. Facidtatem Corporis noslri Rectricem optima jure Natures nomine insigniendam, decernit. Sed inundavit hinc Facultatim variarum, congeries, & omnem Physiologies anti- quioris paginam ade6 absolvit, ut nihil offenderetur, quam merae Facilitates, Vitalis, Natural is, Animalis, Genitalis, Rationalis, Expultrix, Relentrix, Attractrix, Locomotrix, Coctrix, Excrcttix, Sanguifica, Chylifica, &c. &c.' To the Homoeopathic delusion, or shall we call it 'persuasion,' whose chief merit and mischief it is to be ' not anything so much as a nothing which looks like a something, ' we owe the recogni- tion, in a much more practical way than before, of the self- regulating principle in living bodies the physician inside the skin. It is hardly necessary to state, that the best modern exposition of this doctrine, and its relation to therapeutics, is to be found in SIR JOHN FORBES' courageous, thoughtful, and singularly candid little book, Art and Nature in the Cure of Disease. Many years ago, a countryman called on a physician in York. He was in the depths of dyspeptic despair, as often happens with the chawbacons. The doctor gave him some plain advice as to his food, making a thorough change, and ended by writing a prescription for some tonic, saying, ' Take that, and come back in a fortnight.' In ten day Giles came in, blooming and happy, quite well. The doctor was delighted, and not a little proud of his skill. He asked to see what he had given him. Giles said he hadn't got it. ' Where was it ? ' 'I took it, Sir. ' ' Took it ! what have you done with it ? ' 'I ate it, Sir ! you told me to take it ! ' We once told this little story to a Homoeo- pathic friend, adding, ' Perhaps you think the iron in the ink may be credited with the cure ? ' ' Well,' said my much-believ- ing friend, 'there is no saying.' No saying, indeed! and no thinking either ! such matters lie at least in the region of the non-knowable. DR. HENRY MARSHALL AND MILITARY HYGIENE. ' To labour diligently, and to be content J says the son of Sirach, ' is a sweet life.' ' My greatest delight has been to promote a melioration of the condition of soldiers, and in the prosecution of this important object, I hope 1 have done some good.'' DR. MARSHALL. DR. HENRY MARSHALL AND MILITARY HYGIENE. '"TWENTY-FIVE years ago, the British soldier (taking ninety-nine out of a hundred) was a man who, when in the eye of the law a minor, had in a fit of passion, or when drunk, or from idleness, want, or to avoid civil punishment, sold his personal liberty, his life in one word, himself to the State without reservation. In return for this, he got a bounty of ^3, IDS., which was taken back as soon as he was attested, to pay for his outfit his kit, as it is called, and he enjoyed an annuity of is. id. a day, out of which, after paying his share of the mess, his shoes, etc., there remained of daily surplus about 3d. The State provided lodging and medical attendance, and the name, but little else, of religious and general edu- cation. In return, he put his will in the hands of the State, and was bound, at any time, and upon any ground, to destroy any other man's life, or lose his 1 68 Dr. Marshall own, at the word of command. 1 He was, as rapidly as possible, drilled into that perfect man-slaying in- strument, that consummate destroyer, that we and our enemies know him to be. And having no hope, no self-respect, no spiritual progression, nothing to look forward to, he sank into the sullen, stupid, in- domitable human bull-dog. He lived in hopeless celibacy, shut out from the influence of any but the worst of the other sex. He became proverbially drunken, licentious, and profane. He knew his officer only to obey him, and often to hate and de- spise him. Memory and hope died within him ; for what had he to remember but his own early follies and fatal enlistment, or to anticipate but the chances 1 Every one knows Herr Diogenes Teufelsdrock's account of this in that fantastic and delightful book Sartor Resartus : ' What, speaking in quite unofficial language, is the net purport and upshot of soldiers and of war ? To my own knowledge, for example, there dwell and toil in the British village of Drum- drudge, usually some five hundred souls. From these, by certain "natural enemies of the French, there are necessarily selected, during the French war, say thirty able-bodied men. Drumdrudge, at her own expense, has suckled and nursed them ; she has, not without difficulty and sorrow, fed them up to manhood, and even trained them to crafts, so that one can weave, and another build, another hammer or stitch, and the weakest can stand under thirty pounds avoirdupois. Neverthe- less, amid much weeping and swearing, they are selected, all dressed in red, and shipped away at the public charges, some two thousand miles, or say only to the south of Spain, and fed and scourged there till wanted. And now to that same spot in the south of Spain are thirty French handicraftsmen from a and Military Hygiene. 1 69 of his being killed, or dying wretchedly of disease, or being turned off a stupid, .helpless, and friendless old man 1 No wonder that he was, as is proved by the greater frequency of suicide in military than in civil life, more miserable and less careful of himself than other men. His daily routine was somewhat as follows : He was drummed out of bed at five o'clock, his room being a large common dormitory, where three or four blackguards might make all the rest comfortless and silent He rushed out of doors to the pump, and washed himself out of his hands, there being no basin provided for him, as he best could, and went to drill; breakfasted substantially, then out to parade, where he must be in proper trim, pipe-clay immaculate ; then through the everlasting French Drumdrudge, in like manner wending ; till at length, after infinite effort and expense, the two parties actually meet, and thirty stand confronting thirty, each with a gun in his hand. Straightway the word " fire" is given, and they blow the souls out of one another ; and in place of sixty brisk, useful workmen, the world has sixty dead carcasses which it must bury, and anew shed tears for. Had these men any quarrel? Busy as the devil is, not the smallest ; they lived far enough apart, nay, in so wide a world, there was even unconsciously, by commerce, some mutual helpfulness between them. How then ? Simple- ton ! Their governors had fallen out, and instead of shooting one another, had the cunning to make their poor blockheads shoot. In that fiction of the English Smollett, it is true, the final cessation of war is perhaps prophetically shadowed forth when the "two natural enemies " (France and Britain) in person take each a tobacco-pipe filled with brimstone, light the smae, and smoke in each other's faces till one or both give in.' i 70 Dr. Marshall round of ' Attention ! Eyes right ! Stand at ease,' etc. Dinner at one o'clock, of broth and boiled meat, and after that nothing to do till nine at night, or to eat till breakfast next morning. Can there be any wonder that the subjects of this system became so often drunkards, and ran into all sorts of low dissipation, ruining themselves, soul and body? Much of this evil is of course inherent and necessary ; it is founded in the constitution of man that such should be, in the main, the result of such an unnatural state of things. But within these five- and-twenty years there have been numerous improve- ments. The soldier is now a freer, happier, healthier man, more intelligent and moral, and certainly not less efficient than he ever was since the institution of a standing army. In an admirable speech in February last, when moving the estimates for the army, Mr. Sidney Her- bert made the following remark : ' He did not believe that at any period had the soldier been more comfortable than at the present moment ;' he might safely have said as comfortable as at the present moment. After showing that, by strict and con- tinuous vigilance in this department, in eighteen years, since 1835, 'the pattern year of economy,' there had been a reduction of ^132,766, as compared with the estimate of that year, while, for the smaller sum, we maintained 21,000 men more, the cost of each man and Military Hygiene. \ 7 1 being 42, 153. nd. in 1835, anc ^ in the present year ^40, 35. 6d., ;io of this being for the cost of the officers, making the expense of each private ^30, 35. 6d. ; after making this exposition of the greater economy in the production and maintenance of our soldiers, Mr. Herbert went on to show that this had been effected not only without in any way curtailing their comforts, but with an immense increase in their material and moral wellbeing. We shall mention some of the more marked causes and proofs of this gratifying and remarkable improvement in the condi- tion of the army, as regards the intelligence, morality, health, and general condition of the common soldier. ist, The Good-Conduct Pay has been increased to ^65,000 a year. Formerly, every man got an in- crease of pay for long service ; now he gets id. a day added to his pay at the end of every five years it was at first seven provided he has been clear of the defaulter's books for two years, and he carries one- half of it to his pension, in addition to the amount he is entitled to for length of service. This scheme is working well zd, Barrack Libraries have been instituted, and with signal benefit. There are now 150 libraries, with 117,000 volumes, and 16,000 subscribers, the men giving a penny a month. 3oo 'After 1836 no higher number could be awarded, even by a General Court-Martial, than 200 lashes; and Military Hygiene. 2 1 5 while a District Court-Martial was limited to 150, and a Regimental one to 100. Since 1847 the maximum of this description of punishment has been limited to 50 lashes ; but the effect of that restriction on the admissions into hospital will fall to be con- sidered rather in a subsequent Report than on the present occasion. ' When this amelioration commenced, grave appre- hensions were entertained that it would give rise to such relaxation of discipline as to cause a consider- able increase in the description of offences for which corporal punishment had usually been awarded, and that transportation and capital punishment would become more frequent ; but never were apprehensions less warranted by the result, as will be seen by the following abstract of the Table prepared from the Adjutant-General's Return, No. xn. of Appendix : ' In 1838, out of 96,907 men, there were 9944 Courts-Martial; 441 general, and 4813 district; sen- tenced to death, 14; transportation, 221; while in 1846, out of 126,591, there were 9212 Courts-Martial, whereof there were 200 general and 3959 district; sentenced to death, i ; transportation, 114.' All this has occurred without any relaxation of dis-- cipline, the army never having been in a more efficient state than at present This paper was written in 1853. Since that time much has been done in carrying out genuine army 216 Dr. Marshall reform and hygiene. The Crimean War, with its glory and its havoc, laid bare and made intolerable many abuses and wants. Above all, it fixed the eyes of their country on the miseries, the wrongs, and the virtues of the common soldier. Whatever may be said by history of our skill in the art of war, as dis- played during that campaign, one thing was tried and not found wanting in that terrible time the stout- ness, the endurance, the 'bottom,' of our race, what old Dr. Caius calls 'the olde manly hardnes, stoute courage, and peinfulnes of Englande.' 1 We need not say how much more the nation loved and cared for these noble fellows, when it saw that to these, the cardinal virtues of a soldier, were added, in so many instances, the purest devotion, patience, intelligence, and a true moral greatness. It is the best test, as it is the main glory and chief end of a true civilisation, its caring for the great body of the people. This it is which distinguishes our time from all others, and the common soldier is now sharing in this movement, which is twice blessed. But all great and true generals, from King David, Hannibal, Caesar, Cromwell, the great Frederic, etc., down to our own Sir Colin, have had their men's comforts, interests, and lives at heart. The late Lord Dunfermline magni parentis filius hand degener 1 From his ' Booke or Counseil against the disease called the Sweate, made by Jhon Caius, Doctour in Phisicke, 1552.' and Military Hygiene. 2 1 7 when speaking, with deep feeling and anger, to the writer, about the sufferings of the men, and the frightful blunders in the Crimea, told the following story of his father, the great and good Sir Ralph Abercromby. After his glorious victory, the dying general was being carried on a litter to the boat of the ' Foudroyant,' in which he died. He was in great pain from his wound, and could get no place to rest. Sir John Macdonald (afterwards adjutant-general) put something under his head. Sir Ralph smiled and said, ' That is a comfort ; that is the very thing. What is it, John]' 'It is only a soldier's blanket, Sir Ralph.' ' Only a soldier's blanket, Sir !' said the old man, fixing his eye severely on him. ' Whose blanket is it?i ' One of the men's.' ' I wish to know the name of the man whose this blanket is ;' and everything paused till he was satisfied. ' It is Duncan Roy's of the 42d, Sir Ralph.' ' Then see that Duncan Roy gets his blanket this very night;' and, wearied and content, the soldier's friend was moved to his death-bed. ' Yes, Doctor,' said Lord Dunfermline, in his strong, earnest way, ' the whole question is in that blanket in Duncan getting his blanket that very night.' I cannot conclude these remarks more fitly, than by quoting the following evidence, given before the Commissioners on the sanitary state of the Army, by Dr. Balfour, the worthy pupil of Dr. Marshall, and now 218 Dr. Marshall medical officer of the Royal Asylum, Chelsea ; any , man may see from it what good sense, good feeling, and sanitary science, may accomplish and prevent. ' On the retirement of Dr. Marshall, I was associ- ated with Colonel Tulloch in the preparation of the subsequent reports. In the course of that duty I was much struck with the great amount of mortality generally, and the large proportion of it which ap- peared to be caused by preventible disease. I subse- quently had the opportunity of verifying my opinion on this point, by watching the results which followed the adoption of various sanitary measures which we recommended in our report, and which were carried out to a greater or less extent. The results obtained from these changes fully confirmed my previous opinions, and led me to continue to make the sub- ject my special study. ' Is the present diet of the soldier well calculated to produce this effect ? I think not ; it would scarcely be possible to devise anything worse calculated for the purpose, than the diet of the soldier was when I first joined the service. He had then two meals a day, breakfast and dinner ; and the period between dinner and breakfast the following day was nineteen hours. His dinner consisted of perpetual boiled beef and broth. Subsequently the introduction of the evening meal, which had been pressed upon the attention of the military authorities by the medical officers for and Military Hygiene. 2 1 9 many years, effected a very great improvement In other respects, his diet, as laid down by regulation, continues the same as at that period. It is mono- tonous to a degree. I have frequently seen, in a barrack-room, soldiers, and especially the older ones, leave the broth untouched. Would it be possible to improve the soldiers' diet by infusing into it greater variety 1 ? I know practi- cally it is quite possible to do so. When I was appointed to the Royal Military Asylum, I found the system of feeding the boys pretty much the same as that in the army, but not quite so monotonous, as they had baked mutton on Sundays, suet pudding three days in the week, and boiled beef on the other three days : the meat was always boiled, but they did not get broth, the liquor being thrown away. They had abundance of food, their dinner consisting, on meat days, of eleven ounces of meat, without bone, which is more than is given to the soldier ; but they did not eat it with relish, and quantities of food were taken away to the hog-tub. The boys were pale and feeble, and evidently in a very low state of health. Mr. Benjamin Phillips, a very high authority on scro- fulous disease, told me, that when he examined the school, while engaged in preparing his work on scro- fula for publication, he found the boys lower in point of physique than almost any school he had examined, even including those of the workhouses. After a care- 22O Dr. Marshall ful examination of the dietaries of almost all the prin- cipal schools established for children in England and Scotland, I prepared a scale of diet, which was sanc- tioned by the Commissioners in December 1848, and, with a few slight modifications, is now in use at the asylum. The chief points I kept in view were, to give a sufficient amount of food in varied and palatable forms, and without long intervals of fasting. The following are the old and the present scales of dietaries : ' ROYAL MILITARY ASYLUM, CHELSEA. DIET TABLE OF THE BOYS OF THE ASYLUM IN 1848. Days of Week. Breakfast at 8 A.M. Dinner at Supper at 6P.M. Sunday . "| Tuesday . ! and Thursday . J Cocoa \ oz. Sugar \ oz. Milk gill Bread 5 oz. Beef . . . 1 1 oz. Potatoes . 8 ,, Bread . . <; ,, Table-beer \ pt. 1 Bread Is z - f Milk Jfpt Monday . 1 Wednesday 1 and Friday . . j Ditto . - Suet . . 2 oz. Flour . . 8 ,, Potatoes . 8 Bread . . 5 ,, Table-beer \ pt. 1 \ Do. I J Saturday . j Rt. Mutton, 1 1 oz. Potatoes . 8 ,, Bread . . 5 Beer . . . | pt. }, Children under eight years of age have 8 oz. of meat instead of ind 4 oz of bread instead of 5 oz and Military Hygilne. 2 2 1 ' DIET TABLE OF THE BOYS OF THE ASYLUM IN JULY 1857. Days of Week. Breakfast at 8A.M. Dinner at i P.M. At half-past 3 P.M. Supper at 8 I'.M. r Docoa i oz. T ., fbeef . 6oz. I Sunday <{ Sugar J ,, Milk |gill Bread 5 oz. stew < > P * atoes 8 [onions J ,, Pud- j flour . 2 ,, 1 [ Bread [2*02. Bread 5oz. Milk ding I suet . i , , Bread . . . 2\ J |pt f Boiled beef . 6 oz. -^ Monday . J Broth . . . J pt. Greens ... 6 oz. " I Bread . . . 2j r Xoast mutton 6 oz. 1 Tuesday . -i Yorkshire (flour 4 pudding (suet j ,, Bread . . . 2\ j- 1 Wednesday r T . , fbeef . 6 oz. ! potatoes 6 ,, [ onions \ ,, Bread . . . 2\ ,, i- Roast mutton 8 oz. -j Rice f rice . 2 ,, Thursday . Dud- < milk . pt. } > M ding [_ sugar . \ oz. 1 . Bread . . . 2\ J Stewed beef . 6 oz. 1 Friday Rice . . . 3 Treacle . . \ ,, 1 Bread . . . 2^ ,, J r Boiled beef . 6 oz. ] Saturday . - Potatoes . . 6 Broth . . . i pt. - ,, i Bread ... 2^ oz. J Children under eight to have 4 oz. of meat instead of 6 oz. 222 Dr. Marshall 'Did the improvement in the dietary greatly in- crease its cost? On the contrary, it saved nearly ^300 a year in the feeding of the establishment. By introducing a greater variety, the boys took the whole of their food with relish, and I was able to get them into good condition by distributing the same amount of meat over seven days that they previously had in four. ' Were the results satisfactory 1 The results were far beyond my expectation. Comparing the sickness and mortality in the establishment for the ten years previous to my appointment, and for the eight years and a half that have passed since these alterations were introduced, I find that the sickness has been re- duced by about one-third, and the annual mortality has fallen from 97 per 1000 of the strength on the aver- age of ten years to 4-9 per 1000 on the average of eight years and a half. This is not entirely attribu- table to the change of diet, though that was a most important means. At the same time there were other improvements introduced, such as increased space in the dormitories, improved ventilation, and abundant means of cold bathing all of which are most important elements in preserving health. ' I may mention another point with regard to health, that on the average of the ten years the proportion of boys reported unfit for military service by the surgeon was 1 2 -4 per 1000 annually, principally on account of and Military Hygiene. 223 scrofulous cicatrices on the neck that would have pre- vented them wearing the military stock, and during the eight years and a half it has been reduced to 4-55 per 1000. // is now very little more than one-third of what it used to be.' 224 D?' Marshall and Military Hygiene . NOTE P. 195. EXTRACT from a work entitled 'Plans for the Defence of Great Britain and Ireland, by Lieutenant-Colonel Dironi, D. Q. M. G. in North Britain, 1797.' ' In the island of Jamaica, in the West Indies, where the troops are generally unhealthy in the garrisons along the coast, and were particularly so in the years 1750 and 1751* a calamity doubly alarming, as the island was threatened with an attack by the combined forces of France and Spain, the late eminent Sir Alexander Campbell determined to try a new experiment for the accommodation of the troops. He chose an elevated situation on the mountains behind Kingston, called Stony Hill, where there was good water, a free circulation of air, and a temperature of climate in general ten degrees cooler than in the low country along the coast. The wood, which was cleared from the hill, and the soil, which was clay, were the chief materials used in constructing the barracks. The igth and 38th Regiments were sent there on their arrival from America, and ground was allotted them for gardens. They enjoyed a degree of robust health very unusual in that climate. When not upon duty or under arms, they were employed in their gardens, or in amusements, the whole day long. Their wives and children enjoyed equal happiness ; and, in the course of two years, this military colony, for so it appeared, had not at any time a greater, if even so great, a proportion of men sick as they would have had in Europe ; and there is reason to believe that during that time they had nearly as many children born in the regiment as they had lost men by death.' The author was at this time adjutant-general in Jamaica. ART AND SCIENCE Hepl yfrfffi* Txvr)Trfpi ri> bv eTTHrrri/jn). ARIST. AN. POST, ii. xix. 4. QtupijTiKrjs fi.lv (e7rtcrr?7/i?js) re'Xos dX^eta' irpaKTiKTJs o' lypov. ARIST. Per spccidatkam scimns nt sciaimts ; per praclicam scimns nt operemnr. A VERROES. ART AND SCIENCE. "\ 1 TE give these thoughts with this caution to our readers as well as to ourselves, that they do not run them out of breath. There is always a temp- tation to push such contrasts too far. In fact, they are more provocatives to personal independent thought than anything else ; if they are more, they are mis- chievous. Moreover, it must always be remembered that Art, even of the lowest and most inarticulate kind, is always tending towards a scientific form to the discovery and assertion of itself; and Science, if it deserves the name, is never absolutely barren, but goes down into some form of human action becomes an art. The two run into each other. Art is often the strong blind man, on whose shoulders the lame and seeing man is crossing the river, as in Bewick's tail- piece. No artsman is literally without conscious and systematized, selected knowledge, which is science ; and no scientific man can remain absolutely inoperative ; but of two men one may be predomi- 228 Art and Science. nantly the one, and another the other. The word Science, in what follows, is used mainly in the sense of information, as equivalent to a body of ascertained truths as having to do with doctrines. The word Art is used in the sense of practical knowledge and applied power. The reader will find some excellent remarks on this subject, in Thomson's Laws of Thought, Introduction, and in Mill's Logic, book vi. chap. xi. IN MEDICINE, ART Looks to symptoms and occa- sions. Is therapeutic and prognostic. Has a method. Is ante mortem. Looks to function more than structure. Runs for the stomach-pump. Submits to be ignorant of much. Acts. SCIENCE Looks to essence and cause. Is diagnostic. Has a system. Is post mortem. Looks vice versa. Studies the phenomena of poisoning. Submits to be ignorant of nothing. Speaks. Science and Art are the offspring of light and truth, of intelligence and will ; they are the parents of philosophy that its father, this its mother. Art comes up out of darkness, like a flower, is there before you are aware, its roots unseen, not to be meddled with safely ; it has grown from a seed, itself once alive, perishing in giving birth to its child. It A rt and Science. 229 draws its nourishment from all its neighbourhood, taking this, and rejecting that, by virtue 'of its elective instinct knowing what is good for it ; it lives upon the debris of former life. It is often a thing with- out a name, a substance without an articulate form, a power felt rather than seen. It has always life, energy automatic energy. It goes upon its own feet, and can go anywhere across a country, and hunts more by scent than sight. Science goes upon wheels, and must have a road or a rail. Art's leaves and stem may be harsh and uncomely ; its flower when its does flower is beautiful, few things in this world more so. Science comes from the market ; it is sold, can be measured and weighed, can be handled and gauged. It is full of light ; but is lucid rather than luminous ; it is, at its best, food, not blood, much less muscle the fuel, not the fire. It is taken out of a nursery, and is planted as men plant larches. It is not propagated by seed ; rather by bud, often by cutting. Many stick in leafy branches of such trees, and wonder like children, why they don't grow; they look well at first, 'but having no root they wither away.' You may cover a hillside with such plantations. You must court the sowing of the winds, the dropping of the acorns, the dung of birds, the rain, the infinite chances and helps of time, before you can get a glen feathered with oak-coppice or birks. You will soon sell your larches ; they are 230 A rt and Science. always in demand ; they make good sleepers. You will not get a walking-stick out of them, a crutch for your old age, or a rib for a 74. You must take them from a wind-sown, wind-welded and heartened tree. Science is like cast-iron ; soon made, brittle, and without elasticity, formal, useless when broken. Art is like malleable iron ; tough, can cut, can be used up ; is harder and has a spring. Your well-informed, merely scientific men, are all alike. Set one agoing at any point, he brings up as he revolves the same figures, the same thoughts, or rather ghosts of thoughts, as any ten thousand others. Look at him on one side, and, like a larch, you see his whole; every side is alike. Look at the poorest hazel, hold- ing itself by its grappling talons on some grey rock, and you never saw one like it ; you will never see one like it again ; it has more sides than one ; it has had a discipline, and has a will of its own ; it is self- taught, self-sufficient. Wisdom is the vital union of Art and Science ; an individual result of the two : it is more excellent than either ; it is the body animated by the soul ; the will, knowing what to do, and how to do it ; the members capable of fulfilling its bidding ; the heart nourishing and warming the whole ; the brain stimulating and quickening the entire organism. Art arid Science. 231 SCIENCE AND ART, A CONTRASTED PARALLEL. ART SCIENCE Knows little of its birth. Knows its birth; registers it, and its after history. Knows more of its progeny. Has often no progeny at all. Invents. Discovers. Uses the imperative. Uses the indicative. Is founded on experience. Is antecedent to experience. Teaches us to do. Teaches us to know. Is motive and dynamical. Is statical and has no feet. Is eductive and conductive. Is inductive and deductive. Involves knowledge. Evolves it Buys it, making of it what it Makes it up, and sells it. likes, and needs, and no more. Mas rules. Has laws. Is synthetical more than ana- Is the reverse. lytical. Is regulative and administra- Is legislative and judicial ; says tive, and shows the halvoiro tipKOvrus, ovdtv irpoffderiffei TOV 5i6rt Principium est enim scire rem ita esse ; quod si satis sit perspicuum, cur ita sit non magnopere desidera- bitur. ARIST. ETH. A. iv. A rt and Science. 233 It may be thought that I have shown myself, in this parallel and contrast, too much of a partisan for Art as against Science, and the same may be not unfairly said of much of the rest of this volume : it was in a measure on purpose ; the general tendency being counteractive of the purely scientific and posi- tive, or merely informative current of our day. We need to remind ourselves constantly, that this kind of knowledge puffeth up, and that it is something quite else which buildeth up. 1 It has been finely said that Nature is the Art of God, and we may as truly say that all art in the widest sense, as practical and productive is his science. He knows all that goes to the making of everything, for He is himself, in the strictest sense, the only maker. He knows what made Shakspere and Newton, Julius Cassar and Plato, what we know them to have been, and they are his by the same right as the sea is, and the strength of the hills, for He made them and his hands formed them, as well as the dry land. This making the circle for ever meet, this bringing Omega eternally round to Alpha, is, I think, more and more revealing itself as a great central, personal, regulative truth, and is being carried down more than ever into the recesses of physical research, where Nature is fast telling her long-kept secrets, all her tribes speak- ing each in their own tongue the wonderful works of 1 Advancement of Learning, pp. 8-n. Pickering's Ed. 234 Art and Science. God the sea is saying, It is not in me, everything is giving up any title to anything like substance, beyond being the result' of the one Supreme Will. The more chemistry, and electrology, and life, are searched into by the keenest and most remorseless experiment, the more do we find ourselves admitting that motive power and force, as manifested to us, is derived, is in its essence immaterial, is direct from Him in whom we live and move, and to whom, in a sense quite peculiar, belongeth power. Gravitation, we all allow, is not proveable to be inherent in matter; it is ab extra; and as it were, the attraction of his offspring to the infinite Parent, their being drawn to Him the spirit, the vis motiva, returning to Him who gave it. The Dynamical Theory, as it is called, tends this way. Search into matter, and try to take it at the quick ere it is aware, the nearer you are to it the less material it seems ; it as it were recedes and shrinks like moonlight vanishing as soon as scanned, and seems, as far as we can yet say, and as old Boscovich said, little else than a congeries of forces. Matter under the lens, is first seen as made up of atoms swimming in nothing; then further on, these atoms become themselves translucent, and, as if scared, break up and disappear. So that, for anything we are getting to know, this may be the only essence of matter, that it is capable of being acted upon, so as A rt and Science. 235 to re-act ; and that here, as well as in all that is more usually called spiritual and dynamical, God is all in all, the beginning, as he certainly is the ending ; and that matter is what it is, simply by his willing it, and that his willing it to be, constitutes its essence. 1 1 The doctrine of the unity of nature, however difficult of physical proof by experiment, and we might a priori expect it to be very difficult, for in such a case we must go up against the stream, instead of, as in analytics, going with it, it is a secret of nature, and she refuses stoutly to give it up, you can readily split the sunbeam into its spectrum, its chemical and electric rays ; you cannot so readily gather them up into one, but metaphysically, it has always seemed to me more than probable. If God is one, as we believe, and if he made all worlds out of nothing by his word, then surely, the nearest thing to the essence of all nature, when she came from God, the materies materia:, must partake of his unity, or in words used elsewhere (Preface to Dr. Samuel Brown's Lectures and Essays], and somewhat altered : ' If we believe that matter and all created existence is the immediate result of the will of the Su- preme, who of old inhabited his own eternity, and dwelt alone ; that he said "fiat!" etfit, that Nature is for ever uttering to the great I AM, this one speech " THOU ART!" is not the conclusion irresistible, that matter thus willed, resulting, as it does, in an external world, and, indeed, in all things visible and invisible, must partake of the absolute unity of its Author, and must, in any essence which it may be said to possess, be itself necessarily ONE, being by the same infinite Will made what we find it to be, multiform and yet one : "One God, one law, one element."' In reference to this doctrine, Faraday, and indeed all advanced chemists and physicists, indicate that they are, as children used to say in their play, 'getting warm,' and nearing this great consummation, which will be the true philosophy of material science, its education from the multiple and complex, into the simple and one-fold. 236 A rt and Science. The more the microscope searches out the mole- cular structure of matter, the thinner does its object become, till we feel as if the veil were not so much being withdrawn, as being worn away by the keen scrutiny, or rent in twain, until at last we come to the true Shechinah, and may discern through it, if our shoes are off, the words ' I AM,' burning, but not consumed. There is a Science of Art, and there is an Art of Science the Art of Discovery, as by a wonderful instinct, enlarging human knowledge. Some of the highest exercises of the human spirit have been here. All primary discoverers are artists in the sciences they work in. Newton's guess that the diamond was inflammable, and many instances which must occur to the reader, are of the true artsman kind ; he did it by a sort of venatic sense knowing somewhat, and venturing more coming events forecasting their shadows, but shadows which the wise alone can interpret. A man who has been up all night, while the world was asleep, and has watched the day-spring, the light shooting and circulating in the upper heavens, knows that the sun is coming, that ' the bright pro- cession' is 'on its way.' It shines afar to him, be- cause he has watched it from his Fesole, and presaged the dawn. The world in general has not been an early riser ; it is more given to sit late ; it frequents the valleys more than the mountain-tops. Thus it is, A rt and Science. 237 that many discoveries, which to us below seem mysterious, as if they had a touch of witchcraft about them, are the plain, certain discoveries of sagacious reason higher up. The scientific prophet has done all this, as Ruskin says, by 'the instinctive grasp which the healthy imagination 1 has of possible truth ;' but he got the grasp and the instinct, and his means, from long rigorous practice with actual truth. We ought to reverence these men, as we stand afar off on the plain, and see them going up 'the 1 The part which imagination plays in all primary discoveries might be here enlarged on, were there room. Here, as every- where else, the difficulty is to keep the mean, and avoid too much wing, or too little. A geologist or chemist without imagination, is a bird without wings ; if he wants the body of common sense, and the brain of reason, he is like a butterfly ; he may be a 'child of the sun,' and his emblazoned wings be 'rich as an evening sky,' but he is the sport of every wind of doctrine, he nutters to and fro purposeless, is brilliant and evanescent as the flowers he lives on. Rather should he be like the seraphim, ' who had six wings, with twain he covered his feet, with twain he covered his face, and with twain he did fly ; ' reverence, modesty, and caution a habit of walking humbly are as much part of a great philosopher as insight and daring. But I believe there has been no true discoverer, from Galileo and Kepler, to Davy, Owen, and our own Goodsir the Nimrods of ' possible truth' without wings; they have ever had as their stoutest, stanchest hound, a powerful and healthy imagination to find and 'point' the game. None of these men remained within the positive known, they must hypothesize, as Warburton calls it ; they must, by a necessity of their nature, reach from the known out into the unknown. The great thing is to start from .1 truth ; to have a punctum stans from which to move. 238 Art and Science. mount,' and drawing nearer into the darkness where God dwells : they will return with a message for us. This foretelling, or power of scientific anticipation, is, as we have said, the highest act of scientific man, and is an interpenetration of 'Emo-n^r/ and Te^vij. Such a view as I have given, is in harmony with revelation, and unites with it in proclaiming the moral personality, not less than the omnipotence of God, who thus, in a sense quite literal, 'guides all the creatures with his eye, and refreshes them with his influence, making them feel the force of his Almightiness.' (Jeremy Taylor.) 1 Every one must remember the sublimely simple shutting up of the Principia, as by 'a sevenfold chorus of hallelujahs and harping symphonies.' The humility of its author has a grandeur in it greater than any pride ; it is as if that lonely, intrepid thinker, who had climbed the heavens by that ladder he speaks of in such modest and homely phrase (patient observation, in which, if in anything, he thought he excelled other men, the never missing a step), after soaring ' above the wheel- ing poles,' had come suddenly to 'heaven's door,' and at it looked in, and had prostrated himself before 'the thunderous throne.' 8 There is here the same strength, simplicity, and r6 irav, fiftfav TOV TrdvTos u T# overly, oOrws Kal d/g. RESP. AD ORTHOD. 2 Milton, Vacation Exercise, anno tztalis 19. A rt and Science. 239 stern beauty and surprise, as of lightning and thunder, the same peremptory assertion and reiteration of the subject, like 'harpers harping upon their harps,' and the same main burden and refrain, as in the amazing chorus which closes Handel's ' Messiah.' We give it for its own grandeur, and for its inculcation of the personality of God, so much needed now, and without which human responsibility, and moral obligation, and all we call duty, must be little else than a dream. ' Hie omnia regit non ut anima mundi, sed ut universorum dominus. Et propter dominium suum, dominus deus Tl.avroKpa.TMp dici solet. Nam deus est vox relativa et ad servos refertur : et deitas est dominatio dei, non in corpus proprium, uti sentiunt quibus deus est anima mundi, sed ifi servos. Deus summus est ens aeternum, infinitum, absolute per- fectum : sed ens utcunque perfectum sine dominio non est dominus deus. Dicimus enim deus meus, deus vester, deus Israelis, deus deorum, et dominus dominorum : sed non dicimus aeternus meus, seternus vester, aeternus Israelis, aeternus deorum ; non dicimus infinitus meus, vel perfectus meus. Hae appellationes relationem non habent ad servos. Vox deus passim significat dominum : sed omnis dominus non est deus. Dominatio entis spiritualis deum constituit, vera verum, summa summum, ficta fictum. Et ex dominatione vera sequitur deum verum esse vivum, 240 Art and Science. intelligentem et potentem ; ex reliquis perfectionibus summum esse, vel summe perfectum. ^Eternus est et infinitus, omnipotens et omnisciens, id est, durat ab aeterno in asternum, et adest ab infinite in infini- tum : omnia regit ; et omnia cognoscit quae fiunt aut fieri possunt. Non est ceternitas et infinitas, scd tzternus ct infinitus ; non est duratio et spatium, scd durat et adest. Durat semper, et adest ubique, et existendo semper et ubique, durationem et spatium constituit. . . . ' Hunc (Deum) cognoscimus solummodo per pro- prietates ejus et attributa, et per sapientissimas et optimas rerum structuras et causas finales, et admir- amur ob perfectiones ; veneramur autem et colimus ob dominium. Colimus enim ut servi, et deus sine dominio, providentia, et causis finalibus nihil aliud est quam fatum et natura. A caeca necessitate meta- physica, quae utique eadem est semper et ubique, nulla oritur rerum variatio. Tota rerum condita- rum pro locis ac temporibus diversitas, ab ideis et voluntate entis necessario existentis solummodo oriri potuit.' Prindpia, Ed. 3 tia> pp. 528-29 ; London, 1726. ' Nous accordons a la raison le pouvoir de nous demontrer 1'existence du Createur, de nous instruire de ses attributs infinis et de ses rapports avec 1'en- semble des etres ; mais par le sentiment nous entrons en quelque sorte en commerce plus intime avec lui, A rt and Science. 2 4 1 et son action sur nous est plus immediate et plus pre'sente. Nous professons un dgal eloignement et pour le mysticisme qui, sacrifiant la raison au senti- ment et 1'homme a Dieu, se perd dans les splendeurs de 1'infini et pour le panthe'isme, qui refuse a Dieu les perfections mgmes de 1'homme, en admettant sous ce nom on ne sait quel etre abstrait, prive* de con- science et de libertd. Grace a cette conscience de nous-memes et de notre libre arbitre, sur laquelle se fondent a la fois et notre me'thode et notre philoso- phic tout entiere, ce dieu abstrait et vague dont nous venons de parler, le dieu du panthe'isme devient a jamais impossible, et nous voyons a sa place la Provi- dence, le Dieu libre et saint que le genre humain adore, le tegislateur du monde moral, la source en m6me temps que 1'objet de cet amour insatiable du beau et du bien qui se mele au fond de nos ames a des passions d'un autre ordre.' Dictionnaire des Sciences Philosophiques, par une Socie'te' des Profes- seurs et Savans. Preface, pp. viii. ix. OUR GIDEON GRAYS. ' Agricolam laudal Sub galli canlum consultor ubi ostia puisai. ' '/ would rather go back to Africa than practise again at Peebles' MUNGO PARK. OUR GIDEON GRAYS. 1 TT might perhaps have been better, if our hard- headed, hard-hitting, clever, and not over-man- suete friend ' Fuge Medicos' 1 had never allowed those ' wild and stormy writings' of his to come into print, and it might perhaps also have been as well, had we told him so at once ; but as we are inclined to be optimists when a thing is past, we think more good than evil has come out of his assault and its repulse. ' F. M.' (we cannot be always giving at full length his uncouth Hoffmannism) has, in fact, in his second letter, which is much the better, answered his first, and turned his back considerably upon himself, by abating some of his most offensive charges ; and our 1 The following short paper from the Scotsman was occa- sioned by a correspondence in that newspaper, in which doctors in general, and country doctors in particular, were attacked and defended. It is reprinted here as a record of the amazing facts brought out by Dr. Alison's Association. In the attack by ' Fuge Medicos,' consisting of two long letters, there was much ability with not much fairness, and not a little misapplied energy of language, and sharpness of invective. 246 Our Gideon Grays. country doctors in their replies have shown that they have sense as well as spirit, and can write like gentlemen, while they of the town have cordially and to good purpose spoken up for their hard-working country brethren. We are not now going to adjudicate upon the strictly professional points raised by ' F. M.,' whether, for instance, bleeding is ever anything but mischiev- ous ; whether the constitution, or type of disease, changes or not ; whether Dr. Samuel Dickson of ' the Fallacies' is an impudent quack or the Newton of medicine ; whether Dr. Wilkinson is an amiable and bewildered Swedenborgian, with much imagina- tion, little logic, and less knowledge, and a wonderful power of beautiful writing, or the herald of a new gospel of health. We may have our own opinions on these subjects, but their discussion lies out of our beat ; they are strictly professional in their essence, and ought to remain so in their treatment. We are by no means inclined to deny that there are ignorant and dangerous practitioners in the country, as well as in the city. What we have to say against ' F. M.' and in favour of the class he has attacked is, that no man should bring such charges against any large body of men, without offering such an amount and kind of proof of their truth, as, it is not too much to say, it is impossible for any mere amateur to pro- duce, even though that amateur were as full of will Our Gideon Grays. 247 and energy as ' F. M. ;' and unless he can do so, he stands convicted of something very like what he him- self calls ' reckless, maleficent stupidity.' It is true, ' F. M.' speaks of ' ignorant country doctors ;' but his general charges against the profession have little meaning, and his Latin motto still less, if ignorance be not predicated of country doctors in general. One, or even half a dozen worthless, mischievous country doctors, is too small an induction of par- ticulars, to warrant ' F. M.' in inferring the same qualities of some 500 or more unknown men. But we are not content with proving the negative : we speak not without long, intimate, and extensive know- ledge of the men who have the charge of the lives of our country population, when we assert, that not only are they as a class fully equal to other rural profes- sional men in intelligence, humanity, and skill, and in all that constitutes what we call worth, but that, take them all in all, they are the best educated, the most useful, the most enlightened, as they certainly are the worst paid and hardest-worked country doctors in Christendom. Gideon Gray, in Scott's story of the Surgeon's Daughter, is a faithful type of this sturdy, warm-hearted, useful class of men, ' under whose rough coat and blunt exterior,' as he truly says, 'you find professional skill and enthusiasm, intelli- gence, humanity, courage, and science.' Moreover, they have many primary mental quali- 248 Our Gideon Grays. ties in which their more favoured brethren of the city are necessarily behind them self-reliance, presence of mind, simplicity and readiness of resource, and a certain homely sagacity. These virtues of the mind are, from the nature of things, more likely to be fully brought out, where a man must be self-contained and everything to himself; he cannot be calling in another to consult with him in every anxious case, or indulge himself in the luxury of that safety which has waggishly been expounded as attaching more to the multitude of counsellors than to the subject of their counsel. Were this a fitting place, we could relate many instances of this sagacity, decision, and tact, as shown by men never known beyond their own countryside, which, if displayed in more public life, would have made their possessors take their place among our public great men. Such men as old Reid of Peebles, Meldrum of Kincardine, Darling of Dunse, Johnston of Stirling, Clarkson (the original of Gideon Gray) and Anderson of Selkirk, Robert Stevenson of Gilmerton, Kirkwood of Auchterarder, and many as good these were not likely to be the representatives of a class who are guilty of ' assaults upon life,' ' who are let loose upon some unhappy rural district, to send vigorous men and women to their graves,' who 'in youth have been reckless and cruel, given to hanging sparrows and cats, and fit for no humane profession/ etc. etc. Our Gideon Grays. 249 Now, is there either good sense, good feeling, or good breeding, in using these unmeasured terms against an entire class of men? Assuming as from the subtlety and hairsplitting character of his argu- ments, and the sharpness and safety of his epithets, we are entitled to do that 'F. M.' belongs to an- other of the learned professions, we ask, ' What would he say if a ' Fuge Juiidicos' were to rise up, who considered that the true reading in Scripture should be, ' The devil was a lawyer from the begin- ning,' asserting that all country lawyers in Scotland were curses to the community, that it would be well if the Lord Advocate ' would try half a dozen every year,' for devouring widows' houses, and other local villanies ; and, moreover, what would he think of the brains and the modesty of an M.D. making an assault upon the legal profession on purely profes- sional questions, and settling, ab extra, and off-hand and for ever, matters which the wisest heads ab intra have left still in doubt ? The cases are strictly parallel; and it is one of the worst signs of our times, this public intermeddling of everybody, from the Times down to ' F. M.,' with every science, pro- fession, and trade. Sydney Smith might now say of the public, what he said of the Master of Trinity, ' Science is his forte, omniscience is \i\sfoible? Every profession, and every man in it, knows something more and better than any non-professional man can, 250 Our Gideon Grays. and it is the part of a wise man to stick to his trade. He is more likely to excel in it, and to honour and wonder at the skill of others. For it is a beautiful law of our nature that we must wonder at everything which we see well done, and yet do not know how it is done, or at any rate know we could not do it. Look at any art, at boot-closing, at a saddler at his work, at basket-making, at our women with their nimble and exact fingers somebody is constantly doing something which everybody cannot do, and therefore everybody admires. We are afraid ' F. M.' does not know many things he could not do. We repeat that our Gideon Grays are, as a class, worthy and intelligent, skilful and safe, doing much more good than evil. 1 They deserve well of, and live in the hearts of the people, and work day and night for less than anybody but themselves and their wives are likely ever to know, for they are most of them unknown to the Income-tax collectors. They are like the rest of us, we hope, soberer, better read, more enlightened, than they were fifty years ago ; they study and trust Nature more, and conquer her by submission ; they bleed and blister less, and are more up to the doctrine that prevention is the best of all cures. They have participated in the general acknowledgment among the community, thanks to the two Combes and others, and to the spirit of the 1 Note, p. 257. Our Gideon Grays. 2 5 1 age, of those divine laws of health which He who made us implanted in us, and the study and obedi- ence of which is a fulfilling of His word. We can only hope that our clever and pancratic friend, ' F. M.,' if on his autumn holidays in Teviotdale or Lochaber, he has his shoulder or his lower jaw dis- located, or has a fit of colic or a hernia, or any of those ills which even his robust self is heir to, may have sense left him to send for Gideon Gray, and to trust him, and, making a slight alteration on his HorTmannism, may be led to cry lustily out, in worse Latin and with better sense ' Fuge pro Medico? Run for the Doctor ! As already said, all of us who have been much in the country know the hard life of its doctors how much they do, and for how little they do it ; but we daresay our readers are not prepared for the follow- ing account of their unremunerated labour among paupers : In 1846, a voluntary association of medical men was formed in Edinburgh, with the public-hearted Dr. Alison as chairman. Its object was to express their sympathy with their brethren in the remote country districts of Scotland, in regard to their un- remunerated attendance on paupers, and to collect accurate information on this subject. The results of their benevolent exertions may be found in the Appendix to the First Report of the Board of Super- 252 Oiir Gideon Grays. vision. It is probably very little known beyond those officially concerned ; we therefore give some of its astounding and lamentable revelations. The queries referred to the state and claims of the medical practitioners in the rural districts of Scot- land, in relation to their attendance upon the per- manent or occasional parochial poor. Out of 325 returns, 94 had received some remuneration for attendance and outlay. In one of these instances, the remuneration consisted of three shillings for twelve years' attendance on seventy constant, and thirteen occa- sional fatipers ; a fine question in decimals what would each visit come to? But worse remains. One man attended 400 paupers for eight years, and never received one farthing for his skill, his time, or his drugs. Another has the same story to tell of 350, some of them thirty miles off ; he moderately cal- culates his direct loss, from these calls on his time and his purse, at ^"70 a year. Out of 253 who report, 208 state that, besides attending for nothing, they had to give on occasions food, wine, and clothes, and had to pay tolls, etc. 136 of the returns contain a more or less definite estimate, in money value, of their unrequited labours ; the sum-total given in by them amounts to thirty-four thousand four hundred and ffty-seven pounds in ten years I being at the rate of ^238 for each / They seem to have calculated the amount of medical attendance, outlay, and drugs, Our Gideon Grays. 253 for each pauper annually, at the very moderate average of four shillings. Is there any other country on the face of the earth where such a state of matters can be found ? Such active charity, such an amount of public good, is not likely to have been achieved by men whose lives were little else than the development of a juvenile mania for hanging sparrows and cats. We believe we are below the mark when we say, that over head, the country doctors of Scotland do one-third of their work for nothing, and this in cases where the receiver of their attendance would scorn to leave his shoes or his church seats unpaid. We are glad to see that ' F. M.' reads Sir William Hamilton. We doubt not he does more than read him, and we trust that he will imitate him in some things besides his energy, his learning, and his hardi- hood of thought. As to his and other wise men's pleasantries about doctors and their drugs, we all know what they mean, and what they are worth ; they are the bitter-sweet joking human nature must have at those with whom it has close dealings its priests, its lawyers, its doctors, its wives and hus- bands ; the very existence of such expressions proves the opposite ; it is one of the luxuries of disrespect. But in 'F. M.Y hands these ancient and harmless jokes are used as deadly solemnities "upon which arguments are founded. 254 O ur Gideon Grays. To part pleasantly with him, nevertheless, we give him three good old jokes : The Visigoths abandoned an unsuccessful surgeon to the family of his deceased patient, ' ut quod de eo facere voluerint, habeant potes- tatem? Montaigne, who is great upon doctors, used to beseech his friends, that if he felt ill they would let him get a little stronger before sending for the doctor ! Louis the Fourteenth, who, of course, was a slave to his physicians, asked his friend Moliere what he did with his doctor. ' Oh, Sire,' said he, ' when I am ill I send for him. He comes, we have a chat, and enjoy ourselves. He prescribes. I don't take it and I am cured !' We end with four quotations, which our strong- headed friend 'F. M.,' we are sure, will cordially relish : ' In Juvene Theologo conscientias detrimentum, In Juvene Legista bursse decrementum, In Juvene Medico coemeterii incrementum.' ' To imagine Nature incapable to cure diseases, is blasphemy ; because that would be imputing imper- fection to the Deity, who has made a great provision for the preservation of animal life.' SYDENHAM. ' When I consider the degree of patience and at- tention that is required to follow nature in her slow manner of proceeding, I am no longer surprised that men of lively parts should be always repeating, " con- traria adhibenda? But Hippocrates says : " Con- Our Gideon Grays. 255 traria paulatim adhibere oportet, et interquiescere. Periculosius censeo inddere in medicum, qui nesciat quiescere, quam qui nesciat contraria adhibere, nam qui nescit quiesccre, nescit occasiones contraria adhibendi ; quare nescit contraria adhibere, Qui nescit contraria adhibere, tamen, si prudens est, scit quiescere, atque si prodesse non potest, tamen non obest. Prcestantissimus vero est medicus eruditus pariter ac prudens, qui novit festinare lente; pro ipsius morbi urgentia, auxiliis instare, atque in occasione uti maxime opporttmis, alioque qttiescere." ' GRANT ON FEVERS, page 311. ' Philosophi qui vitse rationem doceant, vitiis eripiant oerumnas, metus, angustias, anxietates, tristitias impotentias expugnent tranquillitati, hilari- tati avTapKfta vindicent' STAHL. I don't know who ' Quis' was, but the Hudibrastics are vigorous : THE COUNTRY SURGEON. Luckless is he, whom hard fates urge on To practise as a country surgeon To ride regardless of all weather, Through frost, and snow, and hail together To smile and bow when sick and tired Consider' d as a servant hired. At every quarter of the compass, A surly patient makes a rumpus, Because he is not seen the first (For each man thinks his case the worst). And oft at two points diametric Called to a business obstetric. 256 Our Gideon Grays. There lies a man with broken limb, A lady here with nervous whim, Who, at the acme of her fever, Calls him a savage if he leave her. For days and nights in some lone cottage Condemned to live on crusts and pottage, To kick his heels and spin his brains, Waiting, forsooth, for labour's pains ; And that job over, happy he, If he squeeze out a guinea fee. Now comes the night, with toil opprest, He seeks his bed in hope of rest ; Vain hope, his slumbers are no more, Loud sounds the knocker at the door, A farmer's wife at ten miles' distance, Shouting, calls out for his assistance ; Fretting and fuming in the dark, He in the tinder strikes a spark, And, as he yawning heaves his breeches, Envies his neighbour blest with riches. Quis. Rdin. Ann. Register, 181; Our Gideon Grays. 257 NOTE. P. 250. I HAVE to thank his son, Dr. Henry Anderson, who now reigns in his stead, for the following notes of an ordinary day's work of his father, whose sister was Mungo Park's wife. Sel- kirk is the 'Middlemas' of Sir Walter. ' Dr. Anderson practised in Selkirk for forty-five years, and never refused to go to any case, however poor, or however deep in his debt, and however far off. One wife in Selkirk said to her neighbours, as he passed up the street, "There goes my honest doctor, that brought a' my ten bairns into the world, and ne'er got a rap for ane o' them." ' His methodical habits, and perfect arrangement of his time, enabled him to overtake his very wide practice, and to forget no one. He rose generally at six every morning, often sooner, and saw his severe cases in the town early, thus enabling him to start for his long journeys ; and he generally took a stage to breakfast of fifteen or twenty miles. ' One morning he left home at six o'clock, and after being three miles up the Yarrow, met a poor barefoot woman, who had walked from St. Mary's Loch to have two teeth extracted. Out of his pocket with his "key" (she, of course, shouting " Murder ! murder ! mercy !") ; down sat the good woman ; the teeth were out at once, and the doctor rode on his journey, to breakfast at Eldinhope, fourteen miles up, calling on all his patients in Yarrow as he rode along. After breakfast, by Dry- hope, and along St. Mary's Loch, to the famed Tibby's, whose son was badly, up to the head of the Loch of the Lows, and over the high hills into Ettrick, and riding up the Tima to Dalgliesh, and back down the Ettrick, landed at "Gideon's o' 258 Our Gideon Grays. the Singlie " to dinner ; and just when making a tumbler of toddy, a boy was brought into the kitchen, with a finger torn off in a threshing-mill. The doctor left after another tumbler, and still making calls about Ettrickbridge, etc. , reached home about eight, after riding fifty miles ; not to rest, however, for various messages await his return ; all are visited, get medicines from him, for there were no laboratories in his days, then home to prepare all the various prescriptions for those he had seen during the long day. He had just finished this when off he was called to a midwifery case, far up Ale Water. ' To show how pointed to time he was, one day he had to go to Buccleugh, eighteen miles up the Ettrick, and having to ride down the moors by Ashkirk, and then to go on to St. Boswell's to see old Raeburn, he wished a change of horse at Riddell fixed one o'clock, and one of his sons met him at a point of the road at the very hour, though he had ridden forty miles through hills hardly passable. ' I have seen him return from the head of Yarrow half frozen, and not an hour in bed till he had to rise and ride back the same road, and all without a murmur. ' It was all on horseback in his day, as there was only one gig in the county ; and his district extended west up the valleys of Ettrick and Yarrow about twenty miles ; south in Ale Water seven to ten miles ; the same distance east ; and north about fourteen miles by Tweedside, and banks of the Gala and Cad- don. His early rising enabled him also to get through his other work, for he made up all his books at that time, had accounts ready, wrote all his business letters, of which he had not a few. ' In coming home late in the night from his long journeys, he often slept on horseback for miles together. In fine, he was the hardest-worked man in the shire ; always cheerful, and always ready to join in any cheerful and harmless amusement, as well as every good work ; but he killed himself by if, bringing on premature decay. ' He was many years Provost of the Burgh, took his full share of business, was the personal adviser of his patients, and had more curatorships than any one else in the county. What a Our Gideon Grays. 259 pattern of active beneficence, bringing up three sons to his pro- fession, giving his family a first-rate education, and never getting anything for the half of his everyday' s work! We can fancy we see the handsome, swarthy, ruddy old man coming jogging (his normal pace) on his well-known mare down the Yarrow by Black Andro (a wooded hill), and past Foulshiels (Mungo Park's birthplace), after being all night up the glen with some ' crying wife,' and the cottagers at Glower-ower-'im, blessing him as he passed sound asleep, or possibly wakening him out of his dreams, to come up and 'lance' the bairn's eye-tooth. Think of a man like this a valuable, an invaluable public servant, the king of health in his own region having to start in a winter's night ' on-cling o' snavv' for the head of Ettrick, to preside over a primiparo.us herd's wife, at the back of Boods- beck, who was as normal and independent as her cows, or her husband's two score of cheviots j to have to put his faithful and well-bred mare (for he knew the value of blood) into the byre, the door of which was secured by an old harrow, or possibly in the course of the obstetric transaction by a snow-drift ; to have to sit idle amid the discomforts of a shepherd's hut for hours, no books, except perhaps a ten-year-old Belfast Almanac or the Fourfold State (an admirable book), or a volume of ballads, all of which he knew by heart, when all that was needed was, ' Mrs. Jaup,' or indeed any neighbour wife, or her mother. True, our doctor made the best of it, heard all the clavers of the country, took an interest in all their interests, and was as much at home by the side of the ingle, with its bit of 'licht' or cannel coal, as he would be next day at Bowhill with the Duchess. But what a waste of time, of health ! what a waste of an admirable man ! and, then, with impatient young men, what an inlet to mischievous interference, to fatal curtailing of attendance ! DR. ANDREW BROWN AND SYDENHAM. ' Physick of its own nature has no. more uncertainty or conjec- turalness than these other noble professions of War, Law, Politicks, Navigation, in all which the event can be no more predicted or ascertained than in Physick, and all that the Artist is accomptable for is the rational and prudent conduct that nothing be overdone or undone." 1 Epilogue to the Five Papers lately passed betwixt the two Physicians, Dr. O. and Dr. E. , containing some re- marks pleasant and profitable, concerning the usefulness of VOMITING and PURGING in FEVERS, by ANDREW BROWN, M.D. DR. ANDREW BROWN AND SYDENHAM. A HUNDRED and ninety years ago, Dr. Andrew Brown, the laird of Dolphinton, was a well- known and indeed famous man in Edinburgh, and not unknown in London and the general medical world. Who now has ever heard of him ? Sic tran- sit. To us in Edinburgh he is chiefly memorable as having been the ancestor of Dr. Richard Mackenzie, who perished so nobly and lamentably in the Crimea ; and whose is one of the many graves which draw our hearts to that bleak field of glory and havoc. We who were his fellows, are not likely to see again em- bodied so much manly beauty, so much devotion to duty, so much zeal, honour, and affection. But to the profession in Scotland, his great great grandfather ought to be better known than he is, for he was the first to introduce here the doctrines of Sydenham, and to recommend the use of antimonial 264 Dr. Andrew Brown emetics in the first stage of fever. This he did in a little book, called ' A Vindicatory Schedule concern- ing the new cure of Fevers, containing a disquisition, theoretical and practical, of the new and most effec- tual method of cureing continual fevers, first invented and delivered by the sagacious Dr. Thomas Syden- hani.' Edin. 1691. This book, and its author's energetic advocacy of its principles by his other writings and by his prac- tice, gave rise to a fierce controversy; and in the library of the Edinburgh College of Physicians, there is a stout shabby little volume of pamphlets on both sides ' Replies,' and ' Short Answers,' and ' Refu- tations,' and ' Surveys,' and ' Looking-Glasses,' ' De- fences,' ' Letters,' ' Epilogues,' etc., lively and furious once, but now resting together as quietly and as dead as their authors are in the Old Greyfriars church-yard, having long ceased from troubling. There is much curious, rude, vigorous, hard-headed, bad-Englished stuff in them, with their wretched paper and print, and general ugliness ; much also to make us thankful that we are in our own now, not their then. Such tearing away with strenuous logic and good learning, at mere clouds and shadows, with occasional lucid intervals of sense, observation, and wit, tending too frequently to wut. Brown was a Whig, and a friend of Andrew Fletcher and King William ; and in his little book on ' The and Sydenham. 265 Character of the True Publick Spirit,' besides much honest good sense and advanced politics, there is a clever and edifying parallel drawn between the dis- eases of the body politic and those of the body natural, and also an amusing classification of doc- tors; 1 but for .all this, and much more excellent matter, I have no space here. Dr. Brown thus de- scribes his going up to London to visit Sydenham, and see his practice : ' But in the year 1687, perusing the first edition of his Schedula Monitoria, where he delivers, as con- firmed by manifold experience, not only a new, but a quite contrarie method to the common, of curing Continual Fevers : I did long hesitate, thinking that either he, or all other Physicians, were grossly de- ceived about the cure of Fevers ; if not, as their patients used to be, they were in an high delirium ; and lest the preconceived opinion that I had of the man's ingenuity should so far impose upon my cre- dulity, as to draw me into an error likeways with him, and make me to experiment that method, when I knew not but I might run the hazard to sacrifice some to my temerity, nothing could settle my tossed thoughts below the sight and knowledge of the thing itself. ' Presently, therefore, hastening to London, and having met with the man, and exposed the occasion 1 Note, page 275. 266 Dr. Andrew Brown of my coming, I found all these tokens concerning him and his practice, that use to beget unwarry per- sons and prudent people making serious inquiry, trust, and knowledge. Then after some months spent in this society, returning home as much overjoyed as I had gotten a treasure, I presently set myself to that practice : which has proved so successful to me, that since that time, of the many fevers that I have treated, none were uncured, except my Lord Creichton, whose case is related here ; and another woman, whose dangerous circumstances made her condition hopeless.' There is a well-known story of Sydenham, which goes by the name of ' The Lettsom Anecdote.' Dr. Latham says it was communicated by Dr. Lettsom to the Gentleman's Magazine of August 1801, and was copied by him from the fly-leaf of a copy of the Methodus curandi febris, which had been in the pos- session of Dr. Sherson's family for fifty years. He then quotes the story. I was much surprised and pleased to find the original in Dr. Brown's Vindica- tory Schedule ; it differs in some respects from the second-hand one, and no one after reading it can have any doubts that Sydenham bore arms for the Commonwealth. Dolphinton (as he was called by his townsmen) writes as follows : ' Neither can it go well away with good men, to and Sydenham, 267 think, that this great man, so oft by strange and special Providences pluckt out of the very jaws of death, has been preserved for an imposture, so dis- male to mankind : Tho' I cannot stay to reckon all the dangers among the calamities of the late civil warrs (where he was an actor), that passed with great difficulty over his head, as his being left in the field among the dead, and many other dangers he met with : yet there is one that, representing rather a miracle than a common providence, cannot be passed over, which, as I had from his own mouth, is thus, at the same time of these civil warrs, where he dis- charged the office of a captain, he being in his lodging at London, and going to bed at night, with his cloaths loosed, a mad drunk fellow, a souldier, likewise in the same lodging, entering the room, with one hand gripping him by the breast of his shirt, with the other discharged a loaden pistol in his bosome, yet, O strange ! without any hurt to him, most wonderfully indeed, by such a narrow sheild as the edge of the souldier's hand, was his breast defended ; for the admirable providence of God placed and fixed the tottering hand that gripped the shirt into that place and posture, that the edge there- of and all the bones of the metacarpe that make up the breadth of the hand, were situate in a right line betwixt the mouth of the pistol and his breast, and so the bullet discharged neither declining to the one 268 Dr. Andrew Brown side nor to the other, but keeping its way thorrow all these bones, in crushing them lost its force, and fell at his feet. O ! wonderful situation of the hand, and more wonderful course of the bullet ! by any industry or art never again imitable ! And moreover within a few days the souldier, taken with a fever arising from so dangerous and complicat a wound, died ; surely Providence does not bring furth so stupendous miracles, but for some great and equiva- lent end.' We may take the Doctor's facts without homo- logating his conclusions. There is nothing here indicating on what side Sydenham served, but all the probabilities from family connexion, from his own incidental expressions and other circumstances, and his having to flee from Oxford, the headquarters of the Royalists, etc., go to make it more than likely that he was what his laborious, ineffectual, and latest biographer calls, in his unwieldly phrase, a 'Parlia- mentarian.' This passage is followed by a remarkable statement by Dr. Brown, as to the persecution of Sydenham by his brethren. This is peculiarly valuable as coming from one personally acquainted with the great phy- sician, having heard these things 'from his own mouth,' and being published two years after his death. Dr. Latham cannot now have any doubt as to the envy and uncharitableness of the profession, and Sydenkam . 269 and the endeavour of his 'collegiate brethren' to banish him out of 'that illustrious society' for ' medi- cinal heresie.' . I give the entire passage, as I have never before seen it noticed. ' And further can it be thought that this great man, who in all the course of his life gave so full evidence of an ingenuous, generous, and perspicatious spirit, would or could die an imposter and murderer of mankind (which imputation to deserve, he fre- quently professed, would be more heavy to him than any punishment could be), for he it was, despising the blandishments of the world, popular applause, riches, and honour, yea his own health wasted with intense and assiduous meditations and thoughtfulness, that liberally sacrificed them all for the publick good : In so far, that after he had long weighed and expended the common and received methods of curing most diseases, and therefore had forsaken and relinquished them as vain and improper, and after his intimate search into the bowels of nature he had discovered others more aposite and powerful ; He thereby only gained the sad and unjust recompence of calumny and ignominy ; and that from the emulation of some of his collegiate brethren, and others, whose indigna- tion at length did culminat to that hight, that they endeavored to banish him, as guilty of medicinal heresie, out of that illustrious society ; and by the whisperings of others he was baulked the imployment 270 Dr. Andrew Brown in the Royal Family, where before that he was called among the first physicians.' He then names those who had publicly given in their adhesion to the new doctrines Dr. Goodal, Dr. Brady, Dr. Paman, Dr. Cole, Dr. Ettmuller of Leipsic, Dr. Doleus, physician to the Landgrave of Hesse, Dr. Spon of Lyons, Dr. Michelthwait of London, Dr. Morton, and Dr. Harris ; all these before 1691. Amid the dreary unreadable rubbish in this old bundle, there is a most characteristic onslaught by the famous Dr. George Cheyne upon Dr. Oliphant, Dolphinton's friend and defender ; it is his pugilistic, honest, reckless style, and is valuable for the testi- mony he (at this time) a free-thinker in religion, and a mathematical and mechanical physician (he is defending Dr. Pitcairn) gives to the strictly Divine origin of animal species. ' All animals, of what kind soever, were originally and actually created at once by the hand of Almighty God, it being impossible to account for their production by any laws of mechanism : and that every individual animal has, in minimis, actually included in its loins all those who shall de- scend from it, and every one of these again have all their offspring lodged in their loins, and so on ad infinitum; and that all these infinite numbers of animalcules may be lodged in the bigness of a pin's head.' Our own Owen would relish this intrepid and Sydenham. 2 7 1 and robust old speculator. But the jewel of this old book is a letter from a physician at London, appended to Dr. Oliphant's answer to the pretended refutation of his defence. I am sure my readers will agree with the Doctor, that it is 'neither impertinent nor tedious,' and that it must have been written ' by one whose wit and good humour are equal to his learning and ingenuity.' There was one man in London, a young Scotch physician, who could have written this, and we may say, Aut Arbuthnot, auf quis ? All the chances are in favour of its being that famous wit and admirable man, of whom Pope says, ' Swift said " he could do everything but walk ;'" and Pope himself thinks he was ' as good a doctor as any man for one that is ill, and a better doctor for one that is well.' He had shortly before this gone up to London from Aber- deen, and had published in 1697, his examination of Dr. Woodward's Account of the Deluge. ' DEAR SIR, I thank you for the present of your small Treatise about Vomiting in Fevers, but at the same time I approve of your reasons, you must give me leave to condemn your conduct : I know you begin to storm at this ; but have a little patience. There was a physician of this town, perhaps the most famous in his time, being called to his patient, com- plaining (it may be) of an oppression at his stomach ; he would very safely and cautiously order him a 272 Dr. Andrew Brown decoction of carduus, sometimes hot water ; I don't know but he would allow now and then fat mutton broth too. The patient was vomited, and the doctor could justifie himself that he had not omitted that necessary evacuation ; this was his constant practice. Being chid by his collegues, who well knew he neglected antimony, not out of ignorance or fear, he would roguishly tell them, " Come, come, gentle- men, that might cure my patient, but it would kill the distemper, and I should have less money in my pocket. A pretty business indeed, a rich citizen overgorges himself, which by management may be improved into a good substantial fever, worth at least twenty guineas ; and you would have me nip the plant in the bud, have a guinea for my pains, and lose the reputation of a safe practitioner to boot." The gentleman had reason, all trades must live. Alas ! our people here are grown too quick-sighted, they will have antimonial vomits, and a physician dares not omit them, tho' it is many a good fee out of his pocket. Join, I say, with these wise gentle- men ; they wish well to the Faculty ; procure an order of the Colledge, and banish antimony the city of Edinburgh, and the liberties thereof. 'Tis a bar- barous thing in these hard times to strangle an infant distemper ; they ought no more to be murdered than young cattle in Lent. Let it be as great a crime to kill a fever with an antimonial vomit, as to fish in and Sydenham. 273 spawning time. The Dutch physicians are like the rest of their nation wise ; they banish that heathenish Jesuitical drug, that would quickly reduce their prac- tice to a narrow compass in the hopefulest distemper of the countrey. These rogues that dream of nothing but specificks and panaceas, I would have them all hang'd, not so much for the folly of the attempt, as the malice of their intention ; rascals, to starve so many worthy gentlemen, that perhaps know no other- wise to get their livelihood. Will the glasiers ever puzle themselves to make glass malleable, would the knitters ever so much as have dreamed of a stocking- loom, or the young writers petition'd to have informa- tions printed ; all those are wise in their generation, and must the physicians be the only fools 1 'We all know here there is no danger in anti- tnonial vomits, but this is inter nos ; you must not tell your patient so, let him believe as I said before, that antimonial vomits are dangerous, deleterial, break the fibres of the stomach, etc., and that you cannot safely give them. So shall you be stiled a cautious, safe physician, one that won't spoil the curll of a man's hair to pull him out of the river. We have some dangerous dogs here, that in a quinsy, when a man is ready to be chock'd, will blood him forty ounces at once ; is not this extreamly hazardous 1 They cut off limbs, cut for the stone ; is this safe ? I tell you the reputation of a wary safe physician is worth all 274 Dr. Andrew Brown the parts of his character besides. Now I hope you will allow I have reason for what I said. ' I have seen the Melius Inquirendum, and am too well acquainted with the stile and spelling, not to know that it is Dr. Eyzat's ; but here I must be with you again, how come you to write against one that says two drams of emetick wine is a sufficient doze for a man ? Suffer not such things to come abroad ; they will imagine you are not got so far as the cir- culation of the blood in Scotland; write seriously against such people. Fy upon't, I will never allow them to be above the dispensation of ballads and doggrel, etc. I am, Sir, yours, etc. 'LONDON, August^, 1699.' Nothing can be finer than the edge of this, nothing pleasanter than its pleasantry ; that about murdering young cattle in Lent, and the ' curll,' is Charles Lamb all over; we know no one now-a-days who could write thus, except the author of Esmond. and Sydenhani. 75 NOTE. P. 265. CLASSIFICATIONS OF DOCTORS. I. THOSE who drive the trade of ban companionrie and good, fellowship. 2. The high-flown bigots in religion or State. 3. Hangers-on of great families, ' as having been domesticks ! ' 4. Those of 'a gentile meen.' Here is Dr. Beddoes' more elaborate latrologia, or Linnoean method of physicians, like Baron Born's of the Monks. i. The philanthropic Doctor, having two varieties, a and /3, the shy and the renegado. 2. The bullying D. , with Rad- cliffe at their head. 3. The Bacchanalian D. 4. The solemn D. 5. The club-hunting D. 6. The Burr D., centaurea cal- citrapa. 7. The wheedling D. , with the variety of the Adonis wheedling D. 8. The case-coining D. 9. The good-sort- of-man D., with variety, and the gossiping good-sort-of-man D., who 'fetches and carries scandal.' 10. The sectarian D. ; variety o, the inspired sectarian D. Beddoes concludes this Decade of Doctors, with notandiim cst in toto hoc genere naturam mirabiles edere lusus. This is applicable to all the species, there being mules and hybrids, and occasionally monsters magnificent and dreadful, lil^e Para- celsus. Hartley Coleridge in his pleasant Life of Fothergill, after alluding to this latrology, has the following on the exoteric qualifications of a doctor : ' Of these exoteric qualifications, some are outward and visible ; as a good gentlemanly person, not alarmingly handsome (for the Adonis Doctor, though he has a fair opening to a 276 Dr. A. Brown and SydenJiam. wealthy marriage, seldom greatly prospers in the way of busi- ness), with an address to suit that is to say, a genteel self- possession and subdued politeness, not of the very last polish a slow, low, and regular tone of voice (here Dr. Fothergill's Quaker habits must have been an excellent preparative), and such an even flow of spirits as neither to be dejected by the sight of pain and the weight of responsibility, nor to offend the anxious and the suffering by an unsympathetic hilarity. The dress should be neat, and rather above than below par in costliness. ' In fine, the young physician should carry a something of his profession in his outward man, but yet so that nobody should be able to say what it was.' FREE COMPETITION IN MEDICINE. ' That doctors are sometimes fools as well as other people, is not, in the present times, one of those profound secrets which is known only to the learned ; it very seldom happens that a man trusts his health to another, merely because that other is an M. D. The person so trusted has almost always either some knowledge, or some craft, which would procure him nearly the same trust, though he was not decorated with any such title ! Adieu ! my dear doctor ; I am afraid I shall get my lug (ear) in my lufe (hand), as ^ve say, for what I have written? ADAM SMITH to DR. CULLEN, September 20, 1774. ' Lawyers, soldiers, tax-gatherers, policemen, are appendages of a state, and some account should be taken of them by the civil power. The clergy are officers of the church, and if the church is a divine institution, they skotild have her license. Doctors are the ministers of physical humanity at large, and should for a thou- sand good reasons be left under the jurisdiction of the leviathanic man whom they serve, yet under this condition that they shall be answerable to the civil power for bodily injuries culpably inflicted upon any of its subjects' COVENTRY DICK. FREE COMPETITION IN MEDICINE. T HAVE long thought that it was nonsense and worse, the avowed and universal exception of the craft of healing from the action of Adam Smith's law of free competition, introducing legislative enact- ment and license into the public relations of medicine, thus constituting a virtual monopoly. I may be per- mitted to express this in an extract from a Review of Professor Syme and Dr. Burt's Letters to Lord Pal- merston, on Medical Reform. 1 ' And now for a closing word for ourselves. Mr. Syme's scheme is, as we have fully stated, the best, the simplest, and the least objectionable, if it be wise and necessary for the State to do anything in the matter. There is much in this if; and after consi- deration of this difficult and little understood subject, we are inclined to hold, that Adam Smith's law of free competition is absolute, and applies to the doctors of the community as well as to its shoe- 1 Edinburgh Medical Journal, December 1857. 2 So Free Competition in Medicine. makers. In a letter to Dr. Cullen, published for the first time by Dr. John Thomson, in his life of that great physician, written before the publication of The Wealth of Nations, he, with excellent humour, argu- ment, and sense, asserts that human nature may be allowed safely, and with advantage, to choose its own doctor, as it does its own wife or tailor. We recommend this sagacious letter to the serious atten- tion of all concerned. We give some specimens; its date is 1774: "When a man has learned his lesson well, it surely can be of little importance where, or from whom he has learnt it. ... In the Medical College of Edinburgh, in particular, the salaries of the professors are insignificant, and their monopoly of degrees is broken in upon by all other universities, foreign and domestic. I require no other explication of its present acknowledged superiority over every other society of the same kind in Europe. ... A degree can pretend to give security for no- thing but the science of the graduate, and even for that it can give but very slender security. For his good sense and discretion, qualities not discoverable by an academical examination, it can give no security at all. . . . Had the Universities of Oxford and Cambridge been able to maintain themselves in the exclusive privilege of graduating all the doctors who could practise in England, the price of feeling a pulse might have by this time risen from two and three Free Competition in Medicine. 281 guineas" (would that "Time would run back and fetch that age of gold !") "the price which it has now happily arrived at, to double or triple that sum. . . . The great success of quackery in England has been altogether owing to the real quackery of the regular physicians. Our regular physicians in Scotland have little quackery, and no quack, accordingly, has ever made his fortune among us." ' Dr. Thomson did not find in Dr. Cullen's papers any direct replies to the arguments of his friend ; but in a Latin discourse pronounced two years after- wards, at the graduation, he took occasion to state in what respects the principles of free competition, though applicable to mechanical trades, do, in his opinion, not extend to the exercise of the profession of medicine. His argument is conducted temper- ately, and by no means confidently. He remarks, with sagacity and candour, " that there are some who doubt whether it is for the interest of society, or in any way proper, to make laws or regulations for pre- venting unskilled or uneducated persons from engag- ing in the practice of medicine ; and it is very obvious, that neither in this nor in most other countries, are effectual measures adopted for this purposed His argu- ment is the common, and we think unsound one, that mankind can judge of its carpenter, but not of its doctor; and that in the one case, life is at stake, and not in the other, a fallacy easily exposed 282 Free Competition in Medicine. a floor may fall in and kill dozens, from bad joinery, as well as a man die from mala praxis. We believe that the same common sense regulates, or at least may regulate, the choice of your family doctor, as it does the choice of your architect, engineer, or teacher. ' If a man choose his architect or engineer from his own personal knowledge of their respective arts and sciences, he must either choose himself, and forget his stair, or make very sure of choosing the wrong man ; in this, as in so many things, we de- pend on testimony and general evidence of capacity and worth. ' In a word, our petition to Parliament is, Make a clean sweep ; remove every legislative enactment regarding the practice of medicine ; leave it as free, as unprotected, as unlicensed, as baking or knife- grinding; let our Colleges of Physicians and Sur- geons, Faculties, and Worshipful Companies, make what terms they like for those who choose to enter them; let the Horse Guards, let the Customs, let the Poor Law Boards, let the Cunard Company, demand and exact any qualification they choose for the medical men they employ and pay, just as Lord Breadalbane may, if he like, require red hair and Swedenborgism, in his Lordship's surgeon to his slate quarries at Easdale. Give the principle its full swing, and, by so doing, be assured we would lose Free Competition in Medicine. 283 some of our worst Quacks ; but we would not lose our Alisons, our Symes, our Christisons, Begbies, and Kilgours, or our Brodies, Lathams, Brights, Wat- sons, and Clarks ; and we would, we are persuaded, have more of the rough-and-readies, as Dr. Burt calls them. Gideon Gray would have an easier mind, and more to feed himself and his horse on, and his life would be more largely insured for his wife and children. And if from the corporate bodies, who are trying to live after they are dead, the ancient cry of compensation rises up wild and shrill, give the Belisarii their pence, and let them be contemptible and content.' But let there be no interference, under the name of qualification or license, with free trade in medical knowledge and skill. There is in the body politic, as in the body natural, a self-regulating power to which we ought to take heed, and trust its instincts, and not our own contrivances. This holds in reli- gion, in public morals, in education; and we will never prosper as we might till we take the advice Henry Taylor relates that an old lady of rank gave to her anxious daughter-in-law, when asked by her what she would advise as to the education of chil- dren : ' I would advise, my dear, a little wholesome neglect.' EDWARD FORBES. ' Nature never did betray The heart tkat loved her ; "'tis her privilege, Through all the years of this our life, to lead from joy to joy : for she can so inform The mind that is within its, so impress With quietness and beauty, and so feed With lofty thoughts, that neither evil tongues, Rash judgments, nor the sneers ofselfisl men, Nor greetings -where no kindness is, nor all The dreary intercourse of daily life, Shall e'er prevail against us, or disturb Our cheerful faith, that all which we behold Is full of blessings. ' WORDSWORTH. EDWARD FORBES. J \\T E have too long delayed noticing the memoir of this delightful man the gifted teacher, the consummate naturalist. Indeed, it is so long now since we read it, and so long since all the world has done so, that we cannot and need not go into the details of his life and history, or into any minute criticism of the treatment of their theme by his two biographers, Dr. George Wilson and Mr. Geikie. It is an interesting and a likeable book, loose in its texture in the first half, from the natural tendency, on the part of its genial author, to expatiate and efflo- resce ; and deficient necessarily in personality in the second, which, however, is most ably and thoroughly done from its writer's point of view, just, painstaking, and full of" excellent science. Mr. Geikie's genius is mainly geological, and it is well that it is so ; but he writes with clearness and force ; and judgment in its own place is always 1 From The Scotsman. 288 Edward Forbes. better than genius out of it. There are exquisite bits, perfect flowers for fragrance and beauty in Dr. Wilson's sketch. The account of Edinburgh College life, and all about that great and primary man, that master in natural history, Professor Jameson, a man of rare purity, and force of life and purpose, and most genuinely good, is quick with our lost friend's fine play of fancy, and his affectionate humour ; but it labours, as we all to our sorrow know, under the loss of his revision. The first chapter, on the Isle of Man and its tail- less cats, is out of all proportion, and with its in- formation and fun, is more suited to the Odds and Ends of a Manx historian of the Knickerbocker breed, than to the work of a steady biographer. The next chapter, on Edward Forbes's infant and boyish years, is finely done, developing with a tender and firm touch the natural bent of his mind, and showing how truly ' the child is father of the man.' Edward Forbes was one of four men who studied together at Edinburgh, all bound together closely, but each curiously different from the rest. Samuel Brown, George Wilson, and John Goodsir were the others. The last, in many respects the greatest, certainly the completest and most satisfying, still lives, one of the main glories of our medical school, a man who will leave a name not unworthy to be placed alongside of John Hunter's. He has no speciality, Edward Forbes. 289 but is a true discerner and discoverer of nature, a teacher of what he himself knows. It is impossible to overrate his influence in our medical school in grounding the students in a genuine anatomy, and in basing speculation of the widest, the most daring, and transcendental kind upon downright matter of fact. Edward Forbes was a child of nature, and he lived in her presence and observance. She was his Alma Mater to the end. He enjoyed science ; this was the chief end to him of life ; its bloom, and its fruit, and its own exceeding great reward. ' George Wilson made science enjoyable to others ; he illustrated, adorned, and commended it ; standing, as it were, with his face to the world, he told what of the mystery and truth of science it could or cared to know and its fa'cetice too, for he was an inveterate wag, having more wit than humour, and less imagi- nation than fancy. Samuel Brown was his typical reverse. He stood with his back to the public, intent at the high altar of his service, bent on questioning, on divination, and on making nature reveal her secret. He worked up the stream ; his was that science of sciences, which is philosophy proper. He desired to bring knowledge to a point, to draw all multiformity into the focus of unity. Goodsir advances it as a whole, and makes it our T 290 Edward Forbes. inheritance, while he enriches it with something from the stores of his other brethren. In an eloquent and tender eloge upon Dr. Samuel Brown, in the North British Review for February 1857, there is quoted from his private journal, with which he whiled away his long hours of languor, soli- tude, and pain, the following portrait of his former colleague and companion, written on hearing of his sudden death. Surely if there is much matter like this in that journal, the world would like to have more of it some day. ' Edward Forbes is dead and buried before me ; died this day week, was buried on Thursday. " He behaved at the close with his old composure, con- siderateness, and sweetness of nature," writes Dr. John. This is a great public loss, a pungent public grief too ; but to us, his friends, it is " past the blas- phemy of grief." Surely it is " wondrous in our eyes." Not forty yet ; his work sketched out largely, rather than done : his proper career, as the Edinburgh Professor of Natural History, just opened, and that with unusual brilliancy of circumstance, Edinburgh, young and old, proud to receive him as her new great man, the Naturalists of Scotland rising up to call the Manxman blessed " The pity of it, oh the pity of it !" ' We began our public career almost together. He in his twenty-fifth, I in my twenty-third year, de- Edward Forbes. 29 1 livered at Edinburgh a joint course of lectures on the Philosophy of the Sciences, he the graphic or static, I the principial or dynamic hemisphere of the round. Tall for his strength, slightly round-shouldered, slightly in-bent legs, but elegant, with a fine round head and long face, a broad, beautifully arched fore- head, long dim-brown hair like a woman's, a slight moustache, no beard, long-limbed, long-fingered, lean, such was one of the most interesting figures ever before an Edinburgh audience. His voice was not good, his manner not flowing, not even easy. He was not eloquent, but he said the right sort of thing in a right sort of way ; and there was such an air of mastery about him, of genius, of geniality, of unspeakable good-nature, that he won all hearts, and subdued all minds, and kept all imaginations prisoners for life. Nobody that has not heard him can con- ceive the charm. ' In natural history his labours are acknowledged by his peers ; and it is not for a chemist to say a word. Yet I fancy he has made no memorable dis- covery, initiated no critical movement. It is by the width of his views he has told, and by his personal influence. In short, he is a first-rate naturalist, near- sighted and far-sighted, and eminently disposed and able to reduce the chaos of observation to order, and to discern the one soul of nature in all her manifold body of members; but he has not shown himself inven- 292 Edward Forbes. tive like Linnseus or Cuvier, or even Buffon. His true greatness was cumulative ; and if he had lived as long, he might have rivalled Humboldt. As it is, he was not a philosopher, nor a great discoverer but he was a consummate and philosophical naturalist, wider than any man alive in his kind. Add to that noble distinction, that he was much of an artist, not a little of a man of letters, something of a scholar, a humorist, the very most amiable of men, a perfect gentleman, and a beautiful pard-like creature, and you have our Hyperion, gone down, alas, ere it was yet noon ! After all, what a combination of charms, what a constellation of gifts, what a man ! Edward Forbes was a sweet, wise, broad and sunny, great kind of man, else I do not know a nobleman when I see him. ' As for religion, I can only say he never talked infidelities even in our rash youth. He always abided by the church, though he rarely frequented its taber- nacles. He was a kind of half-intellectual, half- agsthetical believer. Theology somehow did not lie in his way ; and he was (as I conceive) sincere rather than earnest, in religion. There lay his great defect ; since all are but fragments after all that can be said even of a Shakspeare. He wanted intensity of character, depth of soul, spirituality ; and it is curi- ous in a man so large. ' And in connexion with this lay one of the secrets Edward Forbes. 293 of Forbes's boundless popularity. He was a con- formist, ran against no man or thing. He joined no new cause ; he assailed no old one ; nay, he even assailed no new one. All were welcome to him, therefore, and he to all. Even in Natural Histon he brought no agitating or perplexing news, per- plexing men with the fear of change. He sailed nobly with the wind and tide of ordinary progress, not needing to carry a single gun, but the foremost of this peaceful fleet. This was all very delightful and wise ; yet let a word be said for the men of war, John Kepler and the rest ; and also let a distinction betwixt the two orders of men be remembered. To forget such distinctions is to confound the morality of criticism. He of Nazareth, not to be profane, brought " not peace, but a sword," the Divine image of " the greater sort of greatness." ' This is to the life, delicate and keen, like a Holbein or Van Eyck. The description of his per- son is curiously accurate, the fine round head, the long face, the long dim-brown hair like a woman's, etc. To conclude, there is material in this volume for a short and compact life of Forbes. You feel you know him and hear him ; see him singing, or rather crooning his odd genial songs ; playing with his subject, with everything, making his pen laugh out of those droll tail-pieces and overflowings of fun, 294 Edward Forbes. clever, but vague, feeble in outline, but full of the man. We have had a melancholy pleasure in giving ourselves up to this book; and thinking how much the world has gained in him and lost. The differences between natural history and analy- tical science are sufficiently distinct where they are farthest from each other ; but as is the case in all partitions of knowledge, they get less marked where they approach at the 'marches.' Therefore it is hardly fair to say that Edward Forbes was merely a master in natural history, not also in science proper, the truth rather being that he was more of the first than of the second. The difference of the two know- ledges is very much the difference between listen- ing to what nature spontaneously says to you, that philosophy, which, as Bacon has it, ' repeats the words of the universe itself with the utmost fidelity, and is written as it were by dictation of the universe,' and between putting questions to her, often very cross- questions"; putting her, in fact, to the torture, and getting at her hidden things. The one is more of the nature of experience, of that which is a methodized record of appearances ; the other more of experi- ment of that which you, upon some hypothesis, expect to find, and has more to do with intimate composition and action. Still this parallelism must not be run out of breath ; both of them have chiefly to do with the truth of fact, more than with the Edward Forbes. 295 truth of thought about fact, or about itself, which is philosophy, or with the truth of imagination, which is ideal art, fabricated by the shaping spirit from fact, and serving for delectation. The world is doing such a large business in the first two of these departments, natural history and pure science, that we are somewhat in danger of forgetting altogether the third, which is of them all the greatest, and of misplacing and misinterpreting the fourth. Science is ultimately most useful when it goes down into practice becomes technical, and is util- ized ; or blossoms into beauty, or ascends into philo- sophy and religion, and rests in that which is in the highest sense good, spiritual, and divine, leaving the world wiser and happier, as well as more power- ful and knowing, than it found it. We end by quoting from this memoir the fol- lowing noble passage, by that master of science and of style, our own Playfair, in his account of Dr. Hutton. It is singularly appropriate. ' The loss sustained by the death of this great naturalist was aggravated to those who knew him by the consideration of how much of his knowledge had perished with himself, and notwithstanding all that he had written, how much of the light collected by a life of experience and observation was now completely extinguished. It is indeed melancholy to reflect, that with all who make proficiency in the sciences, founded 296 Edward Forbes. on nice and delicate observations, something of this sort must invariably happen. The experienced eye, the power of perceiving the minute differences and fine analogies which discriminate or unite the objects of science, and the readiness of comparing new phenomena with others already treasured up in the mind, these are accomplishments which no rules can teach, and no precepts can put us in possession of. This is a portion of knowledge which every man must acquire for himself; nobody can leave as an inheritance to his successor. It seems, indeed, as if nature had in this instance admitted an exception, to the will by which she has ordained the perpetual accumulation of knowledge among civilized men, and had destined a considerable portion of science con- tinually to grow up, and perish with individuals.' DR. ADAMS OF BANCHORY. SCENE. A hut in the wilds of Braemar ; a big gamekeeper fast sinking from a gunshot wound in the lower part of the thigh. DR. ADAMS, loquitur. ' Get a handkerchief, and the spurtle 1 (the porridge- stick}, 'and new for a pad for our tourniquet. This will do J putting his little Elzevir Horace down tipon the femoral Gamekeeper's life saved, and by good guidance, the leg too. DR. ADAMS OF BANCHORY. "\ \ 7"E little thought when, a few weeks ago, we in- troduced some suggestions from Dr. Adams as to the propriety of instituting in our universities a chair of medical history, by calling him the most learned of Scottish physicians, that we should soon have to change ' is ' into was. When we last saw him, though he looked older than his years, and weather-worn, he was full of vigour and of heart, and seemed to have in him many days of victorious study. To see so much energy and understanding cut sheer through in its full current, not dwindling away by natural waste, is little less startling than it would be to see his own silver and impetuous Dee, one moment rolling in ample volume, and the next vanished. For, common though it be, there is no- thing more strange, nothing, in a certain true sense, more against nature, than the sudden extinguishment of so much intellect, knowledge, and force. Dr. Adams was not a mere scholar, not merely 300 Dr. Adams of Banchory. patient, ingenious, and perspicacious in the study of language. His was likewise a robust, hardy, eager nature, hungering after knowledge of every sort, and in the structure of his mind and its bent more like the Scaligers and Bentleys of old than the mighty but mere word-mongers among the Germans. He was made of the same-tough and fervid material as were George Buchanan and Florence Wilson, Andrew Melville, and the huge, turbulent, 1 and intrepid Dempster, men who were great scholars, and a great deal more ; shrewd, and full of public spirit, men of affairs as well as of letters. It is this intermixture of shrewdness and fervour with hard-headedness and patient endurance of men- tal toil, so peculiarly Scotch in its quality and in its flavour, which makes a man like the country surgeon of Banchory-Ternan worthy of more than a passing notice. Francis Adams was born in the parish of Lum- phanan on Deeside. His father was a gardener, and his elder brother is still a farmer in that parish. In a memorandum of his literary life now before 1 Here is this formidable worthy's portrait by Matthaeus Peregrinus, as quoted by Dr. Irving in his Literary Scotchmen of the Last Four Centuries: ' Moribus ferox fuit, apertus omnino, et simulandi nescius, sive enim amore, sive odio aliquem prosequeretur utrumque palam ; consuetudine jucun- dissimus, amicis obsequentissimus, ita inimicis maxime infensus, acceptasque injurias tenax, earn aperte agnoscens et repetens.' Dr. Adams of Banchory. 301 us, he says : ' As far as I can think, my classical bent was owing to a friendship which I formed, when about fifteen years old, with a young man a few years older than myself, who had enjoyed the benefits of an excellent education at Montrose, which gave him a superiority over myself that roused me to emulation. ' In my early years I had been shamefully mistaught. I began by devoting seventeen hours a day to the study of Virgil and Horace, and it will be readily be- lieved that such intense application soon made up for any early deficiencies. ' I read each of these six or seven times in succes- sion. Having mastered the difficulties of Latin litera- ture, I naturally turned my attention to Greek as being the prototype of the other. ' It was the late Dr. Kerr of Aberdeen who drew my attention to the Greek literature of medicine, and at his death I purchased a pretty fair collection of the Greek medical authors which he had made. How- ever, I have also read almost every Greek work which has come down to us from antiquity, with the exception of the ecclesiastical writers ; all the poets, historians, philosophers, orators, writers of science, novelists, and so forth. My ambition always was to combine extensive knowledge of my profession with extensive erudition.' This was no ordinary boy of fifteen who could, ex 302 Dr. Adams of Banchory. proprio motu, work seventeen hours a day to make up to his friend. He settled early in life in the beautiful and secluded village of Banchory-Ternan, to use his own words, ' with its glassy river and magnificent hills rising in front and behind like another Tempe, with its Peneus flowing between Ossa and Olympus.' Here he spent his days in the arduous and useful profession of a country surgeon, out in all weathers and at all hours, having the lives, the births, and the deaths of a wild outlying region on his hands. This work he did so thoroughly that no one could, with a shadow of justice, say that his learning lessened his readiness and his ability for the active duties of his calling, in the full round of its requirements. He was an attentive, resolute, wise practitioner, just such a man as we would like to fall into the hands of, were we need- ing his help. He was always up to the newest know- ledge of the time, but never a slave to any system, or addicted to swear by any master. The whole cast of his mind was thoroughly free and self-sustained. If he had any idols, they were among the mighty and the dead ; but even they were his companions and familiar daimons, rather than his gods. The follow- ing is a list of Dr. Adams' principal publications, and if we consider that, during all this time, he was fighting for a livelihood, educating his family, and involved in his multifarious and urgent duties, they Dr. Adams of Banchory. 303 furnish one of the most signal instances of the pur- suit and mastery of knowledge under difficulties, to be found even among our Scottish worthies : 1. Translation of Hero and Leander, from the Greek of Musaeus, with other Poems, English and Latin. Aberdeen, 1826. 2. Hermes Philologus, or the connexion of the Greek and Latin. London, 1826. This made him many literary friends, among others, Edmund H. Barker, author of Dr. Parr's Life, and Dr. Anthon of New York. 3. Various Papers of Greek Prosody, etc., in the Classical Journal. 4. On the Administration of Hellebore among the Ancients. 5. On the Nervous System of Galen and other Ancient Authors, 1829, in which the originality of Sir Charles Bell's doctrines was attacked. 6. On the Toxicological Doctrines of the Ancients. 7. On the Treatment of Malignant Ulcers of the Face. 8. Notices of Greek, Latin, and Arabic Medical Authors. For Barker's Edition of Lempriere. 9. Paulus ^gineta. Translation of the first volume, 1834. This was a losing concern as to money ; but it placed him, per satium, in the first rank of learned and judicious physicians ; it was an amazing tour de force for an Aberdeen surgeon, and 304 -Dr. Adams of BaiicJiory. will ever remain a memorial of his indomitable mental pluck and strong sense. The Sydenham Society gave its character as follows : ' Replete with learning, and comprising the most complete view which has ever been given of the knowledge professed by the Greeks, Romans, and Arabians, it will form a lasting monu- ment of the industry and erudition of its author, and an honour to his country.' 10. Several Reviews in Forbes' British and Foreign Review, 1842-66. n. Case of Dislocation of the Knee-joint, with Dissection. 12. English and Greek Dictionary (Dunbar's), almost entirely done by him. The appendix, con- taining scientific explanation of the Greek names of minerals, plants, and animals, is out of sight the most valuable existing in any language. 13. Paulus ^Egineta, translated from the Greek. 3 vols., 1845-6-7. Sydenham Society. 14. A Series of Papers on Uterine Haemorrhage. 15. Case of a Woman bitten by an Adder. 1 6. A series of Papers on the Construction of the Placenta. 17. On the Treatment of Burns. 1 8. Hippocrates, translated from the Original. 2 vols., 1849. Sydenham Society. 19. Theophilus de Fabric! Assisted by Dr. Greenhill. Oxon. 1842. Dr. Adams of Banckory. 305 20. Arundines Devae : a Collection of Original Poems. Since that time there have been frequent commu- nications by him to the journals on medical subjects, and a pleasant paper on the study of ornithology, read before the British Association at Aberdeen. Nothing can better illustrate his keen appetite for knowledge of all sorts than this curious and touching record of his own observation son the birds of Banchory, and his son's on those of Cashmere. You see what a quick and loving eye the father had kept, during his busy and learned life, upon the natural objects he met with in his rides, and the training he had given his son in such studies at home, which enabled him to turn his Indian observations to good account. This modest but remarkable paper contains not only the ornithological notes, but an admirable pleading for this department of natural history as a branch of liberal education, and a valuable gymnastic for the senses and the mind, and ends with an eloquent, and we think well-founded protest, against the scientific ultraism of the day, the useful information, and cramming mania. We wish we had space to give some of his words of admonition and warning. The following are Dr. Adams' remarks, in the memo- randum already referred to, on his two great works : ' I began the translation of SEgineta in the end of Nov. 1827, and finished it on 28th April 1829. 1 u 306 Dr. Adams of Banehory. never, at any period of my life, undenvent so much drudgery, and during three months I sat up late and rose early, and snatched every minute I could from the duties of my profession. At that time my practice, though not lucrative, was extensive, especially in the obstetric line ; I managed, however, to work at my translation ten hours a day. I finished the translation of Hippocrates in about four months. The certainty of attaining a fair remuneration for the trouble it cost me, and that it would not be a light hid under a bushel, made this by far the most delightful task I ever engaged in. The reception of it was everything I could desire. It cost me some professional sacrifices, but this was amply made up by the delight and mental improvement it conferred on me.' Such is a hasty and imperfect sketch of the character and works of this remarkable man, who well deserved the title of doctissimus medicorum Britannorum. Some years ago, when travelling through that noble and beautiful region, we went across from the inn at Banehory to introduce ourselves to the translator of the divine old man of Cos. We found him at break- fast, ready for his ride up the Feugh, and amusing himself with pencilling down a translation of an ode of Horace into Greek verse ! He was a thorough Aberdonian, hard-headed and warm-hearted, canny and yet independent, a man of thought and action, not less than a man of vocables Dr. Adams of Banchory. 307 and learning ; in politics an old and thorough Liberal ; generous in his praise of others, and not unamusingly fond of their praise of himself. By the sheer force of his intellect, by the extent and exactness of his erudition, he became the cherished friend of such men as Sir John Forbes, Dean Milman, Sir W. Hamilton, and many of the famous Continental scholars ; and he leaves in his own profession no equal in the com- bination of honest, deep, and broad learning, with practical sagacity and enlightened experience. HENRY VAUGHAN. "Ocra TTI -po