ON THE

OBSERVATION OF NATURE IN THE

TREATMENT OF DISEASE.

BY ANDREW COMBE, M. D.,

Fellow of the Royal College of Physicians of Edinburgh, one of the Physicians in Ordinary, in Scotland, to the Queen, &c., &c.*

Edinburgh, 25th January, 1846.

MY DEAR SIR,--I have now carefully re-perused your article in the recent number of the "British and Foreign Medical Review," and rejoice that you have spoken out openly and honestly what you believe to be truth, regarding both Homœopathy and what is antithetically but incorrectly called Allopathy; and as I consider a consciousness of our faults to be the first step to improvement, in medicine as well as in morals, I feel no regret that you have made the confession so complete. In all probability you will be attacked for having spoken too disparagingly of Allopathy," and too favourably of Homœopathy; but the result of discussion will be to extend the consciousness of such defects as are real, and to prompt to their removal, so that truth and the interests of humanity will gain by the course you have pursued. If I were to judge merely from the general tone of your remarks, I should say that you have exaggerated the defects of ordinary medicine, and that this has arisen from your not having been sufficiently careful to distinguish between its essence, and what may

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* In a letter to the Editor of the "British and Foreign Medical Review, or Quarterly Journal of Practical Medicine and Surgery." April, 1846.

be more justly termed its errors and imperfections. Writing, as you did, for the express purpose of directing attention to the defects of ordinary medical practice, with a view to future improvement, you were in a manner forced to give them a prominence which was calculated to throw the real solidity of its foundation and the best part of its superstructure into the shade, in the minds of those readers at least who had not previously thought much on the subject, and hence were unlikely to discriminate for themselves. But, disregarding minor inaccuracies of expression and of opinion, and looking to essentials only, I should say that although, from the above causes, it might be easy to quote detached sentences from your review, which betoken an utter want of faith in medical art, yet it is evident that such was not your meaning, and that you have perhaps a stronger sense of its truth, beneficence, and importance to mankind, than many of those who will blame you for your broad avowal of its faults.

If you had been careful to make the necessary distinction between medicine as a practical science, based on the laws of nature, and only requiring the steadier application of sound principle to its cultivation, to lead to more certain and beneficial results, and that soi-disant medicine practised by so many of its votaries without regard to principles of any kind, and consequently often involving in its train no small amount of mischievous as well as merely negative consequences-between medicine, in short, and the abuse of medicine-and restricted your condemnation to the latter alone, you would have given less room for misapprehension and difference of opinion, and at the same time rendered your article both more acceptable and more instructive. Even as it is, however, you have not left yourself altogether defenceless. In two or three passages you admit, cursorily, indeed, but distinctly enough, that the defects you complain of are not inherent in, and inseparable from, medicine itself, but are only attributable to

a large portion of the prevailing practice; and while you denounce unsparingly the faults and omissions of its disciples, you are so far from being sceptical of medicine itself, that you pronounce it to be, even in its present state, 66 a noble and glorious profession," and destined to become as truly "grand and glorious in actual performance, as it is now in its essence, its aims, and its aspirations.”

Believing your censure, then, to be directed against the faults of medical science, as at present practised, and not against its principles and truths, I am so far from thinking it undeserved, that I have been for years impressed with similar convictions to your own regarding them, and felt an earnest desire to contribute any little aid I could towards their correction and removal. From an early period of my professional life, I was struck with the exclusiveness with which relief was generally sought from drugs or active treatment, and the indifference with which the lædentia were often allowed to remain in undisturbed operation, and the juvantia left entirely to chance or the whim of the moment. And yet experience demonstrates that, in the great majority of cases, the drug is only one influence among many, and that it is by the intelligent regulation of these external conditions, far more than by active medication, that the physician can effectually contribute to the comfort and recovery of the patient. Disease is a perverted state of a natural organic action, and not a something thrown into the system by accident, and which obeys no fixed laws. In the cure of disease, therefore, the business of the physician is not to supersede nature, but carefully to observe what is wrong, and to aid the efforts made by her to re-establish regularity and order. Accordingly, experience shows that the physician and the remedy are useful only when they act in accordance with the laws of the constitution and the intentions of nature; and hence, in chronic, and even in acute diseases, the most effective part of the treatment is generally the hygienic, or that

which consists in placing all the organs under the most favourable circumstances for the adequate exercise of their respective functions. If this be done systematically, every effort of Nature will be towards the restoration of health; and all that she demands from us in addition, is to remove impediments and facilitate her acts.

So far, however, is this from being the prevailing view of the proper sphere and duties of the physician, that even many medical men habitually act and speak as if they considered their only business to be the prescription of drugs, or some active external remedy, such as a blister or a bleeding; and in ordinary medical education, no attempt whatever is made to direct the attention of the student to the value of preservative or preventive treatment, or to those important auxiliaries to recovery from illness which it is the province of hygiène to unfold. The consequence of thus considering drugs as our only or chief resource is, that, when called to the bedside, we are apt to fix our attention exclusively upon the prominent symptoms, and allow obstacles to recovery to continue in operation or start up unsuspected, which often go far to counteract the best devised and most active treatment. This is the more to be regretted, because the practitioner himself is, or ought to be, the source of one of the most powerful and beneficial hygienic influences to which a patient can be subjected. Taking a high and just view of his position, his aim ought to be, on all occasions, to procure for the family of which he is the confidential adviser the highest health of which it is capable; and had the public, on their side, à just sense of his duties, they would resort to him for advice not only during actual illness, but regarding the management of their own health, and the education and management of their children. As a general rule, however, the practitioner attends only to the individual sick member to whom he is called in; and, so far from taking cognisance of the causes of disease amidst which the family

may be living, he, unless specially called upon, rarely thinks of laying down precautionary rules for the future guidance even of the one who is ill. He prescribes for him, and the present attack once over, he leaves him to the mercy of accident, to sink or swim, as chance may direct. Nay, if we look into the families of medical men themselves, it is rather an exception to see any rational precautionary treatment in systematic use, or any one advantage secured, which an acquaintance with hygiène would suggest as worthy of our attention. Breathing vitiated air, for example, is universally known to be one of the most active causes of scrofula, and yet I have more than once seen the scrofulous offspring, of otherwise sensible and well-informed medical men, sleeping three or four in a small room, with closed curtains around their beds, while an unoccupied, well-aired room was close at hand, and reserved perhaps for a stranger. Again, it is by no means uncommon to see the children of medical men suffer in health from habitual and indiscriminate indulgence of the appetite, neglect of air and exercise, and over-working of the brain, without even an attempt being made to prevent the evil by the adoption of a better regimen; and if they thus, from indolent indifference or practical blindness, neglect the protection of their own flesh and blood from evils which may be guarded against, how can we expect them to feel any interest, or use any foresight, in protecting the children of others? It is not indifference, however, that causes this inattention. It is simply that they have never been taught that such concern is a duty incumbent on professional men; and they have never been so taught because hygiène has ignorantly been considered to be a subject which concerned nobody but old women and hypochondriacs, instead of being, as it is in reality, both in its preservative and in its therapeutical applications, one of the most important and most beneficial elements of our professional knowledge.