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MEDICAL IMPROVEMENT: AN ADDRESS READ TO THE MEDICAL SOCIETY, BY JOHN AITKEN, Fellow of the College of Surgeons of Edinburgh, A Surgeon of the Royal Infirmary; And a Preſident of the Medical Society.

Nequid falſi dicere audeat, nequid veri non audeat.
Mobilitate viget et vires acquirit eundo.

EDINBURGH: Printed for and Sold by JOHN BELL.

M,DCC,LXXVII.

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THE FOLLOWING PAGES ARE MOST RESPECTFULLY INSCRIBED TO THE PRESIDENTS AND OTHER MEMBERS OF THE MEDICAL SOCIETY.

AN ADDRESS, &c.

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GENTLEMEN,

IT is with much diffidence that I officially preſume to deliver a few detach'd thoughts, chiefly reſpecting MEDICAL IMPROVEMENT; as an addreſs introductory to the commencement of our literary buſineſs in this place. Your indulgent candour which I have ſo often experienced, I flatter myſelf, will, on this occaſion, impute the faults which you will doubtleſs diſcover, not to intention, but inability or miſconception.

I chearfully embrace this opportunity to expreſs the moſt grateful impreſſions I [8]entertain of the great and unſollicited honour you have been pleaſed to confer upon me, by twice calling me to the office of PRESIDENT. Had my powers been equal to my wiſhes, no part of my conduct in that elevated character, had been unworthy of you, or of this chair. Altho' indiſpenſible avocation permits me no longer to hold any office among you; yet will I loſe no opportunity of being preſent, and, as far as I may be able, of aſſiſting in your inſtructive ſpeculations; and of promoting to the utmoſt of my power, the general proſperity of a Society to which I ever have been ſo much attached.

In the commercial world, it is allowed by all, that the comparative rate of exchange, is a juſt index of the proſperous or adverſe ſtate of trade in different countries individually, or relatively conſidered. [9]With no leſs truth, in my opnion, the comparative degree of cultivation to which Belles Lettres and philoſophy, or the fine and uſeful arts, arrive in different kingdoms may be regarded as demonſtrative of their relative civilization.

Judging by this criterion, altho' in this reſpect CALEDONIA may not juſtly boaſt of being the firſt, ſhe is by no means the laſt of the European nations: Her progreſs in the walk of general ſcience and liberality is rapid, and I hope will long continue ſo. Juſtice, however, conſtrains me to confeſs, that long, too long, in a great degree, ſhe had neglected the MEDICAL PHILOSOPHY. In an Aera not beyond the recollection of ſome preſent, the immortal honour of planting a medical ſchool in this Metropolis; now indeed ſecond in fame and erudition to none in Europe, was reſerved [10]to a diſtinguiſhed, a fortunate MONRO. To his memory conſenting nations pay that juſt tribute of applauſe, which his country in general, but this City and its Univerſity in particular, ought to perpetuate by a ſtatue.

By a WORTHY SELECT BAND of the numerous ſtudents, who flocked from all quarters, allured by the riſing fame of the Edinburgh Univerſity; this MEDICAL SOCIETY in 1737, was happily inſtituted. Of its various progreſs and preſent flouriſhing independent ſtate, I preſume you to be well informed; and therefore avoid attempting any particular hiſtorical narration of theſe circumſtances at preſent.

THE BUILDING* in which we are now [11]aſſembled is a grand phenomenon of medical ardor, unparallelled in any country; and may juſtly be regarded as a temple ſacred to AESCULAPIUS, reared by the virtuous zeal of his youthful votaries, for purpoſes the moſt liberal and praiſeworthy. The FRIENDS OF SCIENCE, not of your number,* who have generouſly contributed towards its ſtructure; are entitled to our moſt grateful thanks.

Contemplating this FABRIC, and the many other aids which the preſent advantageous ſtate of our ſociety affords to facilitate ſtudy; you muſt have anticipated me in this reflection, that, while our minds are gratefully affected to our MERITORIOUS PREDECESSORS, our [12]every power ought to be exerted, if not to advance, at leaſt, to maintain our extended reputation: that, the verdant laurels they have tranſmitted may not wither in our hands, overwhelming us with indelible ignominy and diſgrace.

'Tis with the higheſt pleaſure, I perceive, without being chargeable with adulation, I can fairly aver, that this Society at no period of its exiſtence has been more ſecure of progreſs than at preſent: the learning, genius and manly liberality of ſentiment, which I know you poſſeſs, and which, with much ſatisfaction and inſtruction, I have ſo often obſerved animating your debates; conſtitute the foundation on which this aſſertion reſts.

You are not to be informed that the combined powers of GENIUS and INDUSTRY muſt perſeveringly operate thro' the courſe of ſeveral years, that a tolerably [13]complete knowledge of even the elementary parts of the ſcience of medicine, as already aſcertained and taught, may be acquired. To have proceeded ſo far in medical ſtudy, is indeed to have made no deſpicable progreſs: But I truſt your ardent ambition is more aſpiring than to remain ſatisfied with the acquiſition of a bare acquaintance of the dogmata of this, or the other MEDICAL SECT or PROFESSOR, i. e. of the preſent ſtate of the healing art. It would be offering an undeſerved inſult to your ſagacity, were I but once to imagine, that you could entertain a belief, that the Medical Philoſophy had already attained the utmoſt perfection of which it is ſuſceptible. You well know, that the unexplored regions of the terra incognita Medicinalis, ſo to ſpeak, ſtill afford abundant ſcope for your moſt protracted labours; ſo juſt is the obſervation, ars longa, vita brevis.

[14]

ANATOMY, as being the grand baſis of the Medical Fabric, from the earlieſt periods of ſociety, in every civilized country, has been cultivated with the moſt unrelenting ardor of inveſtigation, which many moſt material improvements have from time to time rewarded. Are there not ſtill, however, many very intereſting parts and circumſtances of the ſtructure of the ANIMAL AUTOMATON which we but little know? and many others of great importance, of which we are totally ignorant? What anatomiſt has hitherto been able ſucceſsfully to evolve the texture of the SPLEEN; an organ of conſiderable ſize, and probably of proportional importance in the animal oeconomy? Very lately it has been ſuppoſed the ſole fabricator of the globular part of the blood*. The ſame queſtion may be put with reſpect to the ſtructure of the MUSCULAR FIBRE, or LIVING SOLID; [15]and that SPECIFIC CONFIGURATION of the ſeveral orders of the SECRETORY ORGANS, upon which ſuch a wonderful variety and oppoſition of ſecreted liquors probably depends. But, above all, it may be put with reſpect to the BRAIN, and ITS APPENDAGES; parts eſſential to life, often the ſeat of diſeaſe, evidently variouſly organized, of great volume and ſurprizingly diverſified in their external form.

I will be pardoned for expreſſing my fears, that few anatomical improvements are to be expected from you while reſiding in this country; at leaſt, while its preſent TONE continues, however great your ability and ardor: becauſe an inſuperable barrier is oppoſed to your progreſs; I mean the WANT OF PRIVATE DISSECTION. In the end of the eightteenth century, when philoſophical liberality is diffuſed from Pole to Pole, what a [16]pity, or rather what a ſhame, that, even in the Metropolis of a kingdom, not uncivilized, and in its principal Univerſity too, where the circle of education is otherwiſe tolerably complete; this GRAND and almoſt ONLY AVENUE to the AESCULAPIAN Temple, ſhould remain moſt barbarouſly blocked up!

A public courſe of anatomical demonſtration, exceeded by none, and equalled by few, is, I confeſs, annually made here; by a learned, diſcerning, accurate, indefatigable Profeſſor: whom none of you can more reſpect than I do. I, notwithſtanding, heſitate not to declare it as my poſitive opinion, and I will venture to ſay it is not ſolitary, that, no public anatomical exhibitions, where the ſtudent is merely a PASSIVE SPECTATOR, are ſufficient to convey and impreſs thoſe preciſe and multifarious ideas of this important branch of natural knowledge, abſolutely requiſite to complete the medical [17]character; throwing diſcovery altogether out of the queſtion.

To acquire a tolerable knowledge of even the great outlines of anatomy, it is indiſpenſibly neceſſary to take the knife in hand, and, with the moſt unremitting attention, diſſect a variety of bodies of different ſizes, ages, and ſexes, properly choſen, and prepared for the purpoſe: Much more muſt this plan be followed, if it be propoſed to ſoar in the regions of diſcovery and improvement. I can experimentally aſſert, that more anatomical information will be reaped from the well conducted diſſection of one body, than from repeated public courſes.

If this opinion be well founded, it is a ſelf-evident conſequence, that attending one or two public courſes of anatomy, muſt be much inadequate to accompliſh the medical philoſopher; eſpecially, if the practice of ſurgery, the moſt evidently uſeful part of the healing art, be his [18]deſtination. Humanity revolts at the idea of the many unavoidable, and, I fear, too often fatal blunders that muſt reſult from this capital defect of the medical education to be obtained in this country. It is abundantly mortifying indeed, to obſerve thoſe who wiſh to attain a proper degree of anatomical knowledge, after ſpending ſeveral years at our Univerſities, and probably attaining their higheſt honours, reduced to the alternative of either undertaking expenſive expeditions into foreign countries, in this reſpect more civilized than ours; or of remaining dangerouſly uninformed.

If one ſhould attempt to adjuſt the wheels and ſprings of a nice and delicate mechaniſm, he, perhaps, had never before ſeen, or, at leaſt, never minutely conſidered; with what indignant contempt would we treat the rude audacious pretender? Thouſands, alas! are daily ſubjected [19]to the unpractiſed knife of operators of neceſſity aukward, I had almoſt ſaid unſkilled; becauſe they never could enjoy the requiſite opportunity, of either acquiring proper dexterity to perform any propoſed operation with due addreſs; or full knowledge of the parts concerned: from the want of acceſs to the dead human body.

This alarming conſideration is ſurely of ſufficient force to conquer the vulgar prejudices againſt private diſſection, whether the offspring of ſuperſtition or ignorance. The violation of the ſepulchre or the clandeſtine robbery of the tomb, is moſt juſtly regarded as a crime of a deep dye; but certainly private diſſection, under proper regulations, is compatible with the moſt abſolute ſecurity in this reſpect. Of this the practice of moſt of the European countries is an irrefragable proof; viz. of theſe countries to which our ſtudents are compelled to [20]reſort, to obtain opportunities of diffecting which might ſo eaſily be afforded at home. Were a proportional number of dead human bodies annually furniſhed by authority, to the medical Students in the different towns of Scotland in general, and to thoſe attending our Univerſities, in particular, for private diſſection: the ſalutary conſequences would ſoon ſurpaſs conception. It is truly aſtoniſhing, that a matter of ſuch endleſs importance had not, long e'er now, challenged the notice, and rouſed the attention of the HONOURABLE SUPERINTENDANTS of our Police, or even of the LEGISLATURE itſelf.

The Criminal and Flagitious, whether they expire under the hands of the executioner, or by diſeaſe; ought always to be conſigned to the anatomical knife: that thus, in ſome degree, when dead, they may attone to ſociety for their depredation [21]and turbulence when alive. Public utility ſeems likewiſe to have a good title to the uſe of the dead bodies of thoſe who by idleneſs and diſſipation, have rendered themſelves objects of public charity; and conſequently, perhaps for many years, have been cloathed and fed at the public expence.

Humanity, Patriotiſm, and even ſelf-intereſt conſpire, to ſtimulate every individual to promote, at leaſt, not to oppoſe the eſtabliſhment of a meaſure ſo pregnant with the moſt ſolid advantages to mankind. The advancing liberality of this country, affords the ſtrongeſt reaſons to hope that the auſpicious Aera is not very diſtant, when medical improvement ſhall be no more retarded by the impoſſibility of acquiring anatomical information in the only way that it can be acquired; a miſchief hitherto ſo opprobrious, fatal, and gigantic.

[22]

If Anatomy be defective, PHISIOLOGY which teaches the functions of the various organs and parts detected by anatomy, muſt neceſſarily be proportionally defective. Not only is this the fact, but the uſes even of many parts which the anatomiſt has deſcribed with tolerable accuracy, are far, very far, from being ſufficiently explained by the phiſiologiſt; e. g. Of ſeveral of the GENERATIVE ORGANS, of the DIFFERENT SUBSTANCES and PROTUBERANCES of the BRAIN, of the GANGLIONS, &c.

In like manner, many of the general laws and principles of the living ſyſtem are not illuſtrated with ſatisfactory preciſion; while one phyſiologiſt affirms that MENSTRUATION depends on TOPICAL, another refers it to GENERAL PLETHORA. Some contend that NUTRITION is effected by the NERVES, others by the VESSELS: and a variety of facts [23]are artfully adduced, to eſtabliſh theſe oppoſite doctrines. With reſpect to many other phyſiological diſquiſitions the ſame contrariety of opinion exiſts.

If the queſtion be put, "What ſhall be ſaid when Doctors diſagree?" I reply, recur to nature, collect uſeful facts, from them draw manly, liberal, chaſte concluſions; diſregard ideal, cobweb, flimſy theories, the baſeleſs fabric of a viſion. GENERAL PRINCIPLES, rationally deduced as corrollaries from eſtabliſhed facts, only, in my opinion, can juſtly claim the dignified appellation of THEORY.

PATHOLOGY, you know, treats of the MORBID STATES of animal nature, with a view to effect their PREVENTION, ALLEVIATION or CURE. Many anatomical and phyſiological ſpeculations are more curious than uſeful, and may, therefore, altho' not ſtrictly juſt, have the merit [24]of being innocent. Pathological diſquiſitions, on the contrary, muſt always produce the moſt ſerious conſequences; becauſe they influence the medical conduct of diſeaſe. Our ſmall knowledge, or rather our great ignorance, of this department, affords but a melancholy theme to the anxious philoſophic inquirer. The variety and oppoſition, the abſurdity and confuſion of numberleſs futile conceits, wild imaginations, fanciful opinions, dignified forſooth with the name of DOCTRINES, are the opprobrium of the medical profeſſion: and preſent to the contemplative mind, the idea of primaeval Chaos, when darkneſs brooded over the great abyſs.

Altho' I poſſeſſed ability, neither your time nor patience permit me to attempt a particular enumeration of the ſtriking abſurdities, which have, in a great degree, hitherto overwhelmed pathology, [25]depreſſing medicine far beneath the rank of her ſiſter arts; becauſe theſe arts are eſtabliſhed in the evolved unalterable laws of nature.

One claſs of pathologiſts have recourſe to the SENSIBLE QUALITIES of the ATMOSPHERE, as chiefly contributing to create the numerous and important tribe of febrile diſorders; and endeavour to ſupport their reaſonings by meteorological regiſters and obſervations without end. With equal confidence, another tribe, diſregarding in a great meaſure, this opinion, muſter up INVISIBLE MIASMATA and FLOATING POISONS, to untie every gordian knot; either as principal agents, or complete efficients. In like manner, while the favourite ſyſtem of one period, refers us, with much plauſibility, to the FLUIDS, and MORBIFIC MATTER there exiſting, for the SEAT and CAUSES of many diſeaſes; that of another, with [26]at leaſt equal probability, directs our attention almoſt ſolely to SPASM and other AFFECTIONS of the SOLIDS.

I cannot avoid here to remark, that were the ſcience of medicine like fluxions, infiniteſimals, the quadrature of the circle, &c. i. e. purely a matter of curious unintereſting ſpeculation; we might view the FLUCTUATING INSTABILITY of its DOGMATA or DOCTRINES, as they are called; with the ſame Tone of mind with which we contemplate the fantaſtic ſhiftings of the aurora borealis, or viſions of the night. But how diametrically oppoſite muſt be the feelings of humanity, reflecting that theſe ſucceſſive doctrines have reſpectively, during their faſhionable periods of domination, greatly influenced the medical management of diſeaſe; compelling the paſſive entramelled, bewildered practitioner, to employ the moſt oppoſite curative means, in the [27]ſame morbid ſtates: the conſequent havock, devaſtation, and maſſacre of mankind is more eaſily imagined than deſcribed.

The ancient maxim "in medio tutiſſimus ibis," ſhould perhaps never be entirely neglected. It ſeems exceedingly probable a priori, that, the fluids being made or elaborated by the ſolids; and theſe, on the other hand, ſupported by the fluids; their affections will not long remain diſtinct, but rather always be reciprocal: However, ‘"Non noſtrum tantas componere lites."’

Moreover, how little we do know with tolerable certainty, reſpecting the IMPRESSIONS made on the SENTIENT PARTS of our bodies, by what are named the potentiae nocentes; or of the DERANGEMENT of ORGANIZATION; or of the NUMBER and NATURE of the MORBID ALTERATIONS thence conſequent! yet [28]it ſeems abſolutely neceſſary that theſe particulars be marked with the utmoſt poſſible preciſion. For inſtance, we are told, that there are two ſpecies of FEBRILE DELIRIUM, requiring the moſt oppoſite treatment; but who has hitherto pointed out, with ſufficient accuracy, the ſymptoms aſcertaining their important diſcrimination? If, therefore, in ſuch a perilous predicament the GENIUS of blunder ſhould but for a moment overcloud the practitioner's diſcernment, which is a very ſuppoſable, but I hope, a rare occurence; conclamatum eſt.

'Till pathology, therefore, is more determined and complete, don't caſes beſet with dubiety and peril, ſeem juſtly to demand a ſuſpenſion of hoſtilities (ſo to ſpeak) or of our therapeutic efforts; which, permit me to ſay, may often with juſtice be termed the impertinence of art? Theſe daring practitioners, who in [29]the advanced critical febrile ſtates, which they by no means underſtand, exhibit FEBRIFUGE NOSTRUMS,* with a temerity that equally ſhocks our feelings, and alarms our fears; may not ineptly be compared to the nonplus'd ſtateſman; who, to ſmother diſſention and broil, of which his mal-adminiſtration is probably the cauſe, riſks the very exiſtence of the ſtate itſelf, by plunging it headlong into general combuſtion, and foreign war.

It is with much pleaſure I acknowledge, that, in this moſt eſſential department of the medical philoſophy, light and order happily begin to diffuſe their genial influence over darkneſs and confuſion. The GENIUS and LABOURS of ſome whom this Society can reckon among her honorary ſons, have already contributed, in no ſmall degree, [30]to this moſt deſirable purpoſe. I am confident I ſpeak your ſentiments, and moſt aſſuredly my own, when I mention with the moſt particular gratitude, the great advantages we have ſo often and ſo happily reaped in our inquiries, from the CULLENIAN NOSOLOGY: a work perſpicuous tho' conciſe, elaborate yet not voluminous, in every part demonſtrative of the liberal views, and extenſive medical erudition of its very reſpectable and accompliſhed author, who with truth may ſay, ‘"Exegi monumentum aere perennius."’

Suppoſing juſt indications of cure to be formed, in conſequence of an advanced and chaſte pathology, to be then provided with proper and active AGENTS or REMEDIES to fulfil theſe indications; becomes a matter of moſt important concern. The jarring opinions of authors [31]reſpecting the nature, activity, doſe and mode of exhibition, of almoſt every article of the MATERIA MEDICA; preſent a moſt extenſive field for uſeful experiment and inveſtigation.

With reſpect to medical improvement, I ſhall only in general add, that, your expectations, in my opinion, are leſs likely to be fruſtrated, if you look for it to reſult more from anatomical phyſiological and pathological progreſs, than from the diſcovery of any addition to the Materia Medica. This part of the medical ſcience is by no means to be neglected, altho' it be probable, that advancing but a ſingle ſtep in any of the other walks, may be productive of more real and ſolid improvement and utility, than the acquiſition of a thouſand ſimples; if it be true, that it is an eaſier buſineſs to fulfil, than inſtitute proper curative indications.

[32]

Be aſſured that the PHYSICIAN towers above the Empiric, the nurſe and old woman almoſt only in proportion to his ſuperior information reſpecting the PARTS, the LAWS, and MORBID STATES of animal nature; the more perfect his acquirements in theſe particulars, the higher his pre-eminence among the ſons of Aeſculapius. No mode of inauguration however ſolemn, no academic rites or authority however great or antient, can elevate to the honourable rank of Phyſician, a perſon of an oppoſite deſcription. Such a one could only be regarded as an EMPTY DIGNIFIED FORM, around whoſe blighting temples, the VENAL, the SURREPTITIOUS, the PROSTITUTED LAURELS of APOLLO muſt baſely fade to the utter diſcredit of all concerned; a more melancholy conſequence ſtill would be, that his practice could not fail to prove the bane of ſociety, operating the deſtruction of ſuch individuals [33]as might become the unfortunate ſubjects of his temerity.

If therefore to become a Phyſician, (i. e. to be qualified to mark with preciſion, the almoſt infinitely various affections of animated matter, ſo as to direct, as far as may be, its movements to the bliſsful abode of longaevity and health,) be a taſk only terminating with life, to be exhauſted by no labour, and to which the moſt diſcriminating mental powers are not ſuperior; the folly, not to ſay criminality of attempts* to incite vulgar vanity to tamper with the moſt precious intereſts of mankind, needs no illuſtration.

In every ſpecies of philoſophical inveſtigation, particularly thoſe of a medical nature, where certainty is ſo difficultly attained; to guard againſt CREDULITY, is a counſel, I deem of ſuch infinite importance, that, before I put an end to this [34]addreſs, I cannot help tendering it in the moſt earneſt manner to the particular notice of my YOUNGER SOCII. In all caſes, where there is not abſolute demonſtration, or at leaſt as high a degree of evidence, as the nature of the argument admits; to ſuſpend belief or to exerciſe a proper degree of ſcepticiſm, till mature examination and reflection ſhall compel aſſent: I regard as a meaſure prudent, rational and philoſophic. The unſupported ipſe dixit of any man, however great his name in ſcience, I always conſider as a very weak argument: Recantation at beſt is exceedingly diſagreeable.

The conſtitution of our Society, or its preſent ſyſtem of laws, I am far from reckoning perfect; many meliorations, I doubt not will be made from time to time. No good reaſon can be aſſigned why our meetings ſhould be ſuſpended during half the year: In ſummer indeed [35]they might probably be thin; but it does not follow, that your ſpeculations on that account would be leſs inſtructive, or your eſſays more imperfect.

I conclude by congratulating you upon your affairs being now happily in ſuch a proſperous train, as to afford the moſt flattering proſpects. I contemplate the riſing glory, and future greatneſs of the Medical Society, with no ſmall degree of pleaſurable ecſtaſy and expectation: Methinks, I hear its TOWERING GENIUS with the moſt complacent exultation exclaim "ſublimi feriam ſidera vertice."

FINIS.

Appendix A ERRATUM.

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Page 27. l. 15. for we do read do we.

Notes
*
The MEDICAL HALL,—A handſome Edifice of various elegant appartments with a Cupola and Spire, ornamented with the Inſignia of Aeſculapius, erected chiefly by the liberal contributions of the Members.
*
Many Gentlemen, applauding the noble intentions of the Society, have been generouſly pleaſed to contribute towards defraying the expence of building the Hall,—Liſts of whom are ſuſpended in the principal appartment.
*
The late ingenious Mr Hewſon of London, endeavoured to eſtabliſh this opinion.
*
Such as James's Powders.
*
Such as thoſe of TISSOT, &c.
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TextGrid Repository (2020). TEI. 5525 Medical improvement an address read to the Medical Society by John Aitken. University of Oxford Text Archive. . https://hdl.handle.net/21.T11991/0000-001A-5E80-A