them, with little satisfactory result, as some of our institutions show. Vice and want, sin and wretchedness, assume fresh forms, and we have to track them out, and meet them by improved appliances. An old system of charitable relief or mechanical duty ought no more to be tolerated than a Brown Bess in a regiment, or a hobble in a lunatic asylum. Let us have men, and heart-and-life machinery, since we cannot do without organisation; let us have science for our guide, where sentiment has failed; let us not be ashamed to learn, or begin again, or confess to failure, if by so doing we be made better workers, truer citizens, and nobler philanthropists. Life may defy our analysis, and humanity may be hard and obdurate as a stone, but we may pursue the one through its endless mazes to be quickened afresh by each new revelation, and may shape the other into something like virtue and beauty, by the rough blows of manly courage, and the quiet sculpturings of a chastening love. ART. II.-IS MEDICINE A SCIENCE? : 1. Medical Errors. Fallacies Connected with the Application of the Inductive Method of Reasoning to the Science of Medicine being the Lumleian Lectures for 1864,. delivered to the Royal College of Physicians. By A. W. Barclay, M.D., Cantab. and Edin. London: 1864. 2. An Inquiry into the Reasons and Results of the Prescription of Alcoholic Intoxicants. By Dr. F. R. Lees, Meanwood Lodge, Leeds (pp. 128). N our review of Dr. Anstie's work on 'Stimulants and Nar literature, its want of precise definitions and of systematic reasoning. The instances chiefly selected by way of illustration were the prevailing notions as to 'disease,' 'inflammation,' and the alleged varying action of alcohol. Dr. Barclay, however, takes a still broader exception, and shows, most conclusively, as regards the prevailing schools of medicine. (the time has not come for an impartial inquiry into the claims of Homoeopathy), that, beyond two or three specifics, such as quinine for ague and lemon juice for scurvy, medicine cannot really boast of possessing any law or principle of practice proved by a correct and rigid application of the Baconian method. The The danger and the utility of this discussion are equally apparent. On the one hand, we perceive an almost blind confidence reposed by the multitude in doctors or in physic a credulity that extends itself to the patronage of a thousand forms of blatant quackery, making impossible promises of restored health-cure by pill and potion, by drug or drinkby this essence' or that stimulant '-but which leaves the disease more lethal or incurable than ever, in the great majority of cases: It would be well, and indeed it is necessary, to destroy all such ignorant and unreasonable expectations as to the power of drugs, or the knowledge of doctors; but, on the other hand, it is not well so rudely to disperse popular superstitions that a reaction shall set in towards general scepticism, inducing the question, in the very spirit of Pilate, What is truth?' Let us be assured that there is a truth, on this as on other points, attainable by men, if they will but patiently search for it, slowly accumulate their materials, forego opinions' and hasty hypotheses, ignore assumptions and authorities; in fine, adopt that method of just induction which has been so fruitful in other departments of study. Doubtless, there are peculiar difficulties within the province of medicine, but the results to be realised will be an adequate reward for all the pains bestowed. A transatlantic author has observed : 'Between disease and the doctor there is a wall, thick and high, with here and there a loophole, which some scientific man has made. Men look through and see dimly in spots, and pass through some medicines and advice to palliate the mischief a little. The pain we feel when our friends die an unnatural death; our own reluctance to depart-life's duties not half done, nor half its joys possessed; the sympathy which all men feel with those that suffer thus, making another's misery our own-these drive us to break down that wall, to cure the disease, to learn the law of health, that all may ride in sound bodies the stage of mortal life, check the steeds at the proper bound, dismount from the flesh, and continue our journey in such other chariot as God provides for the ascension." It is quite true that as yet men see only spots of light in the field of disease. In a leader of the Medical Times' for Feb. 7, 1863, it was argued that 'in some details a scientific basis can be predicated in medicine. Science, too, supplies infinite modes of exploration, diagnosis, and remedy, but we have not yet solved some of the most elementary problems of life and till these are solved-till the natural history of health, and growth, and decay, is more minutely known-a scientific, as distinguished from an empirical, treatment of disease, is an idle dream. Medical practice may be sagacious, may be the effort of genius or imagination, may be successful, may be a boon to humanity-still it is art, not science.' But there are certainly certainly some problems of life sufficiently solved for us to entitle us to predict the direction from which help must come, and to ignore as impossible and absurd the claims of certain alleged agents of cure. There is enough known of biology and the laws of natural forces, of growth and decay, to deliver us from many pernicious practices and deadly superstitions. In harmony with the common and historical meaning of 'Disease,' as a derangement of parts or function, the philosophy of medicine demands in each concrete case the solution of two problems: 1st. In what does this malcondition consist? 2nd. From what causes or conditions does it come? If these questions can be solved, three practical courses are open to us-namely, one curative,' one 'preventive,' and one 'palliative. The doctor's duty, with a diseased person before him, is, first, to cure him as speedily as possible; second, to prevent the recurrence of his malady; third, when he can do no better, to palliate the injury and ease the pain. If it be inquired how are these three ends to be accomplished, the answer will be: 'We can cure either by dislodging the removable causes of the malady, whether internal or external,, original, or sequential; or by applying counteractions-i.e. remedies that promote right action or lessen wrong: we can prevent only by avoiding the original conditions on which the effect depends: we can palliate symptoms or reactions, which are the sequels of the disorder (or the secondary disease), and thus give relief when we can do nothing else; or even sometimes when we are also touching causes.' If the inquiry be pushed-How do we quell the causes or consequences of disease?' the answer of science is, By strengthening the vital system, since 'disease' is only another name for weak or perverted action of some kind: is a state of the organism which ceases, as a matter of course, when the conditions of the normal state are induced. There are but two conceivable modes of giving strength-the first is that direct one which holds in health, the supply of the natural elements of the body and of the associated conditions needful for assimilative and normal action; the second, and indirect one, peculiar to disease, the administration (according to some law) of medicines—that is, substances possessed of specific powers to suppress injurious, or promote remedial, function. It was in view of the former agencies that a celebrated physician said on his death-bed, when his professional brethren lamented the loss which society would sustain by his departure Never mind, gentlemen, we shall leave behind us three better doctors than ourselves-air, exercise, and diet.' Now, this was not a mere jeu d'esprit, but the grave conclusion conclusion of a long life of experience, and we venture to predict will yet become the last verdict of science. As Dr. Lees points out in detail, the underlying condition of all but empirical or accidental medicine, is a comprehensive knowledge of the subject of treatment-the human body. This embraces, first, its anatomy or structure; second, and even more important, its physiology-i.e. the science of its functions as a living mechanism. The body is our instrument of knowing, feeling, thinking, doing: a microcosm wherein are concentrated, with marvellous and divine skill, all the laws, principles, and forces of physics and chemistry displayed in the macrocosm whereon we live and move.' Our body is compounded of the dust we tread, the air we breathe, the water we drink: from these it came, to these it will return. The forces which they contained, we possess and wield. The measure of their power, so far as they become us, is the measure of ours: no more, no less. What we have of force is received, not created: received through the appointed channels of our food, drink, and ætherial surroundings. There is no miracle in all this: the virtue that flows out of us was first drawn into us by the natural laws of assimilation. As the steam-engine represents precisely the physical strength put into it, as the steam-force exactly measures the fuel consumed and heat generated in the furnace, so our frame is the exact correlative of the food absorbed and transformed, and of the heat, electricity, and affinity which it embodies. As is the food, so is the body that digests it; as is the digestion, so is the blood; as is the blood, so the warmth and nutrition; and as those, such the strength of the body and brain. Of course, physical vitality has nothing to do, save instrumentally, with the principle of identity; the ego, or I, is not one of the correlated forces of heat, affinity, electricity, &c., but that which owns and uses the body as its servant. 'The purple stream that through my vessels glides Nursed from the fruitful glebe, like yonder tree, The insight of the poet is now made plain and palpable by the exact calculations of science. It is a literal truth, that the forces of the sun sent forth as chemic, calorific, and luminiferous waves of power over the vegetable kingdom, are gathered up and moulded into fruit and grain, and then, by a transforming process, centred, sublimed, and correlated into the the power of the living man, thus becoming the means of sensation, and the conditions of noble and intelligent work. As Dr. G. G. Budd, F.R.S., well expresses it, Every kind of power an animal can generate-the mechanical power of the muscles, the chemical power of the stomach, the intellectual power of the brain-accumulates through the nutrition of the organ on which it depends.' In other words, whatever is the sum of force that any organism possesses or expends, is the exact equivalent of the force taken into it from without. We cannot originate power, we can only receive and dispense it; and for the use of this power, brought from the sun and fashioned into food, man is responsible. Nature, the true Prometheus, proclaims the end that awaits accomplishment: "This solid earth, this rocky frame Human intelligence, peering into the secrets of nature, and perceiving the latent forces available for this end, responds: 'Here let me work! The busy spirits that eager lurk Disease being the abnormal condition of this organism, it is from the hazards and accidents to which this noble instrument is liable that we derive the importance and dignity of medicine as a tentative, or possible, science of rectification. As a matter of fact, however, it must be conceded that disease is in general a self-infliction-the price we pay for our idleness or ignorance, our pleasures or our avarice. As certainly as a community pays the penalty of a fatal and costly epidemic of typhus or cholera, because it will not cleanse and purify its houses and its streets, preferring undertakers' bills and doctors' fees to local taxation; so individuals invite an access of gout or rheumatism, or the advent of an epidemic, by pursuing the pleasures of the table or of the 'social club.' As was long ago remarked by Addison ('Spectator,' No. 195, A.D. 1711):— Physic, for the most part, is nothing else but the substitute of exercise or temperance. Medicines are indeed absolutely necessary in acute distempers, that cannot wait the slow operations of these two great instruments of health; but, were men to live in an habitual course of exercise and temperance, there would be but little occasion for them. Accordingly we find that those parts of the world * Professor Blackie. are |