which ought to be condemned, is, the agreement between physicians and apothecaries that the physician shall have a certain per cent. of all prescriptions which he may send to their shops, thereby tempting the physician to write as many prescriptions of cheap, worthless drugs as he can without incurring suspicion of the collusion. I have known of many such cases, and I have myself often had such offers. No honorable physician should engage in any such dicker.

The practices of the real, downright quacks, I shall not undertake to describe. We are all too familiar with them. We know that their sole object is to live and get rich by imposing upon the credulity of the public. They are all in the same stratum, whether in the form of the little pill peddler of infinitessimal sugar pretenses; "the mystical, scientific radicalism of the drawing-room;" the rejuvenated Thompsonian fire eaters, now yclept eclectics; or the common sense, scientific radicalism of the barn-yard; that system which Charles Lamb said was not new nor wonderful, but as old as the deluge, and like it, killed more than it cured, i. e. hydropathy; or the traveling mountebanks, abortionists, et al. They are all enemies of legitimate medicine, and ergo, of mankind.

And now the question is, how shall we combat them, or rather their systems and practices, for it will never do to have anything to do with them personally. That they can be combatted successfully, I verily believe; and that in the good time coming quacks of all sorts will be scarce, I doubt not. The regular profession is undoubtedly higher in the public estimation now than it has been for some years past, the reasons for which will perhaps be seen as I proceed, and if physicians continue to progress as they have done, they will be still better appreciated.

Next to the education of the people universally in medical knowledge, a thing which will not probably be accomplished before the millenium, the most important means to put down quackery, as I before said, is to elevate the standard of our own education (and indeed I know of no other means to do it), thereby producing the results which I shall shortly mention. This proposition is a truism, as we all admit.

But the profession are not all agreed as to the best ways to arrive at this consummation so devoutly to be wished for. The American Medical Association has been discussing the subject ever since the formation of the society, without accomplishing a great deal, and our State society has agitated the subject annually, without any very important results, though if we had the zeal of our learned friend, the late chairman of the Committee on Medical Education, who is certainly entitled to great credit for his perseverance under discouraging circumstances and difficulties, something more might perhaps have been accomplished.

But my chief design on this occasion is to mention what I conceive would be the effect of elevating the standard of medical education. One effect would be to lessen the number of physicians, which, as everybody knows, is now, and for a long time has been superabundant, in fact, Legion. Plato," says Burton, "made it a great sign of an intemperate and corrupt commonwealth when lawyers and physicians did abound;" and the Romans distasted them so much that they were often banished out of their city; as Pliny and Celsus relate, for 600 years not admitted. There is a far greater number than can get a decent living by the profession exclusively, and so they either drag out a miserable existence in poverty, or else unite with their drug-peddling (for it is nothing else) some other menial occupation. I know one who is a preacher (who will for this probably, never be in any danger of having that "theological moxa" applied with which Dr. Calvin killed our brother Servetus, as Holmes said), "a justice of the peace, a

tavern keeper, postmaster, hotel proprietor, attorney at law, physician, school teacher, &c., a Methodist minister, who can chew as much tobacco and drink as much whisky as any other man. And I am acquainted with several who have a nearly equal versatility of talent.

We all readily see that these things not only lower the profession in the estimation of the public, but that they also totally unfit a man to practice our profession successfully; for no man can be a skillful and successful practitioner of medicine who does not devote his undivided time and attention to this business, and no physician has any moral right to engage in any other business or occupation while he pretends to practice medicine.

Another effect of elevating the standard of Medical Education will be to make something more out of physicians than mere drug-prescribers; and by this I do not mean that they will ignore medicines altogether, by no means; but that they will use them in proper quantities, and at the proper times, and thus only. And here let me say, that whether we believe in all that the “Autocrat of the Breakfast table” has said, and float into his "currents or not," we can, I think, most of us heartily subscribe to one of his sayings in his late romance of Elsie Venner, where he says about the old doctor, "Some very silly people thought the old doctor did not believe in medicine because he gave less than certain poor, half-taught creatures in the smaller neighboring towns, who took advantage of people's sickness to disgust and distaste them with all manner of ill-smelling, and ill-tasting, and ill-behaving drugs-to tell the truth, he hated to give any thing noxious or loathsome to those who were uncomfortable enough already, unless he was very sure it would do good-in which case, he never played with drugs, but gave good, honest, efficient doses. Sometimes he lost a family of the more boorish sort, because they did not think they got their money's worth out of him, unless they had something more than a taste of everything he carried in his saddle-bags." While I cannot subscribe to all the doctrines of Sir John Forbes, and while I think the mutual admiration Professors of the American Athens to be somewhat ultra, I yet think that they have done incalculable good to legitimate medicine, by unmasking that absurd delusion, Homeopathy, as well as other quackeries. And if I mistake not, already a majority of the most enlightened physicians are with Professor Hughes Bennett, as opposed to the more heroic party.

Of course, we all know there is nothing new in these doctrine of so-called rational medicine. As Bennett says: "As Hoffman says, 'Medicus naturæ minister non magister est.' It follows that by carefully observing the operations of nature, learning her methods of cure, imitating them as closely as possible, avoiding what she points out as injurious, and furnishing what she evidently requires, we may at length arrive at rational indications of treatment." The celebrated Dr. Jas. Gregory used to quote from a favorite Greek author this maxim: "The best physician is he who can distinguish what he can do from what he cannot do." These doctrines are as old and older than Hipocrates, but they were never more beautifully enunciated than they were by the immortal Sydenham, whom it was said, "Boerhave never mentioned in his class without lifting his hat and calling him angliæ lumen, artis phoebum verum Hipocratici viri speciem." Says Dr. J. Brown, "His simple, manly views of the nature and means of medicine as an art, seem to have come upon the profession like revelations; it was as if the men in Plato's cavern who had been all their lives with their backs to the light studying their own shadows, had suddenly turned around and gazed upon the broad face of the outer world, lying in sunshine before them. From the days of Hipocrates, after a term of years, it has been

necessary for some great light to arise to turn physicians back from running after strange gods, to the true foundation principles of our science and reassert them. Sydenham was one of the best, I may say the best, and most illustrious of such men. Of his writings, says Brown, "Besides their broad, accurate, vivid delineations of disease, portraits drawn to the life and by a great master, and their wise, simple, rational rules for treatment, active and negative, general and specific, there are two great principles referred to as supreme in the art of medicine. The first is, that nature cures diseases; that there is a recuperative curative power, the vis medicatrix in every living organism, implanted in it by the Almighty, and that it is by careful reverential scrutiny of this law of restoration that all our attempts at cure are to be guided; that we are its ministers and interpreters, and neither more nor less. And the second, that symptoms are the language of a suffering and disordered and endangered body, which it is the duty of the physician to listen to, and, as far as he can, to explain and satisfy, and that like all other languages, it must be studied. This is what he calls the natural history of diseases. With these two central convictions it is amazing how much error, rubbish, and mischief he exposes and ends. In these respects the impression in reading him is a very striking one. Here is a man writing nearly two hundred years ago, and yet we have the truth as to Hygienic Physiology-the duty of living according to the constitution given us by God, and obeying the laws of health, watching, following, and assisting the efforts of nature, all which we now believe and glory in, as a sort of modern gospel of the body, taught with the same downrightedness, authority, earnestness, and unencumbered good sense as in the pages of Andrew Combe, Sir John Forbes, or Sir James Clark." How true is this statement of his "Indeed if I may speak my mind freely, I have been long of the opinion that I act the part of an honest man and a good physician as often as I refrain entirely from medicine, 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." How few physicians now practice upon these principles. Very many physicians prescribe new medicines at every visit, without waiting to see whether that prescribed at the previous visit will have the desired effect.

The principles of Robert Bentley Todd, in the treatment of acute diseases, are, in my opinion, not far from right, whatever we may think of his Therapeutics. They may be summed up in the following four propositions:

"1st. That the notion so long prevalent in the schools, that acute diseases can be prevented or cured by means which depress and reduce vital and nervous power, is altogether fallacious.

"2d. That acute disease is not curable by the direct influence of any form of drug, or any known remedial agent, except when it is capable of acting as an antidote, or of neutralizing a poison, on the presence of which in the system the disease may depend-materies morbi.

"3d. That disease is cured by natural processes, to promote which in their full vigor, vital power must be applied; remedies, whether in the shape of drugs which exercise a special physiological influence on the system, or in whatever form, are useful only so far as they may excite, assist, or promote these natural curative processes.

4th. That it should be the aim of the physician, after he has sedulously studied the clinical history of disease, and made himself master of its diagnosis, to inquire minutely into the intimate nature of these curative pro

cesses, their physiology, so to speak, to discover the best means of assisting them, to search for antidotes for morbid poisons, and to ascertain the best and most convenient methods of upholding vital power."

Now, although I verily believe that these propositions are, in the main, correct, I cannot agree with him in the way that he carried out his doctrine in practice. Almost his only remedy was Brandy, and this often carried to so great an extent, or for so prolonged a period, as to wear out the machine from the great tension produced, and thus indirectly, as I conceive, depress and reduce the vital and nervous power which, according to his first propositions, always aggravated acute diseases. How true it is that we are all liable to some inconsistency, when we have a theory to subserve, and that our theories and practices do not always coincide. It also shows that there is no exclusiveness in medicine. Dr. Holmes says, that "what hurts a well man hurts a sick man, and that the positive injury that any remedy would do must be subtracted from its benefit in the ultimate account." However this may be, I have for a long time been inclined to believe, not only that no inorganic substance which the human body does not contain in its normal condition, is ever necessary to cure any disease, but, also, that it must always be more or less prejudicial. For instance, various inorganic substances are contained in the human body in its normal condition, such as iron, phosphorous, sulphur, sodium, lime, potash, &c., but no mercury, arsenic, &c. Whatever constituent of the human body be wanting, I believe it will be proper to supply it by administering that particular article, but I doubt very much whether any mineral substance which the human body does not normally contain can ever be necessary or beneficial.

I have never seen what I conceive to be the true theory of diseases, and their treatment, so happily expressed as it was by a reviewer of Forbes' "Nature and Art," in the Medico-Chirurgical Review, I have often quoted it and I will do it again. He says: "If we represent the normal constituents of the body A, B, C, D, E, and assume that in health they occupy the relations to each other of aXbXcXdXe; disease may be regarded as taking place in one of these ways, which may as readily be represented by an algebraic formula-either the constituents are simply deranged, and they come to occupy a different mutual relation; or an elision of one or more of the elements may take place; or, thirdly, a foreign element may be superadded. In the first case, the different forms of disease may be as different as the changes that can be affected in the relative position of the elements, and instead of the formula aXbXcXdXe, we may find them in the relation of bXaXcXdXe, and many others. It is manifest that if anywhere in the treatment of disease, this category will probably be the one in which we shall find the most numerous instances of what Sir John Forbes calls the "power of nature in curing disease"--that is to say, that the interference of medicinal agents will be less necessary, because, by placing the patient in a proper condition as regards noxious influences, by allowing the powers of nature to find their proper balance, the derangements of the constituents of health will be rectified. It becomes a question for further inquiry, whether it is not a due and legitimate prerogative of art, to ascertain that nature is able to achieve certain results, where the conditions are granted, and grant those conditions. We are willing at once to confess that since our first initiation into the mysteries of medicine we have abhorred the doctrine that our art consisted exclusively in the administration of pills and potions. The second category is where one of the normal elements of the body is wanting, as a deficiency of iron in Anæmia, and when art supplies what is wanting. The third category is

where something is superadded to the normal elements, as in the case where poisons are in the system, when by giving the proper antidotes the poison may be safely eliminated."

I will repeat what I wrote four years ago in a review of Forbes' book: "Doubtless the evils of poly-pharmacy and that meddlesome and perturbative practice are quite as predominant in this country as in England, and probably more so. A few years ago (and still to a considerable extent), over-medication was universal in this western country. In no country under heaven, probably, were such quantities of active drugs given as in this. Indeed it may have been said with more of truth than poetry, that the people were brought up (as well as down) upon calomel and drastic cathartics, fried pork, hot bread green with alkalies, whisky, and dirty water, somewhat sophisticated with something called coffee. From the moment the infant saw the light, and before, down to a premature death, there was one continual routine of physic, physic, to which it was subjected. Undoubtedly this poly-pharmacy was, and is, one great cause of the great mortality among infants. Adults may be able to resist a kind of treatment which would be very likely to prove fatal to infants, although the drugs were even given in proportionally smaller doses. It is well known that infants are very sensitive to some drugs in very small doses. Especially is this the case with opiates, which will sometimes narcotize when given in minute doses, and mercurials will frequently produce most disastrous effects upon children of strumous habits, and always injurious effects, I believe, when given in small doses. I think that I have frequently noticed that mercury produced a disease simulating Hydrocephalus or Tubercular Meningitis (Hydrocephaloid of Marshall Hall), and oftener still a chronic diarrhoea, which is uncontrollable; instead of which I now give Tannate of Quinine, Citrate of Iron, or raw beef. Some years ago, when I treated our malarial fevers on the Eberle plan of mercury, antimony, saltpeter, and ipecac, I used constantly to have cases of chronic diarrhoea among adults as well as children, as a sequel of these fevers, which diarrhoea was unquestionably induced by the calomel, drastic cathartics, diaphoretics, and the whole farrago of nauseous drugs which were then considered necessary to be used. And here I wish to enter my protest against a very popular treatise on the diseases of children, by an American physician, or rather the Therapie of it. I cannot conceive of a more dangerous book to put into the hands of a student or young practitioner. Here is what a leading English Review says of it: "The general rules of treatment advised by it are, in our opinion, even dangerously heroic, so heroic indeed occasionally, that we can scarcely believe he himself is accustomed to follow it. If he really does do so, then all that we can say is, that American children must have capital constitutions. We are not afraid of leeches, calomel, antimony, &c., nor do we look upon expectancy or brandy and water as the veritable and universal therapia; but really the author's system of depletion, his leeches, his calomel, and his blisters, are of so universal application, and so vigorously employed, as to lead us to caution the young practitioner not to follow him too blindly. It matters not whether it be inflammation of the brain or scarlet fever, enteritis or diphtheria, pneumonia or coryza, loss of blood is deemed advisable by Dr. C., and so of calomel. Croup, gangrenous angina, apoplexy, erysipelas, gastritis, indigestion, &c., require calomel. It is true, that in advising blisters, Dr. C-cautions the reader not to allow them to do more than to produce a general redness of the skin. Now this advice is rarely followed by the nurse, or attendants; if not followed and a sore be produced in a young child, in nine cases out of ten among the class alluded to, the remedy will be worse than the dis