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ON RESEARCH IN MEDICINE.
The first necessity for medical research is a proper frame or constitution of mind. But this constitution, partly natural, partly acquired on a natural talent, is of such rarity it inevitably reduces to the smallest minority all who truly live, and who, when they are dead, command. So rare is it, indeed, that the twenty-three centuries from the Father of medicine have not brought forth twenty masters who, at this moment, are powerful to command. Hippocrates still holds out the natural history of disease ; Paulus remains the foundation of surgery; Paracelsus keeps the crucible; Vesalius, as yet, is the general anatomist ; Harvey retains his hand on the engine of the circulation; Willis is opening the skull case, and unrolling the brain ; Mayow continues to teach that there is a furnace in the animal body burning by the air; Black and Priestly tell the nature of the combustion ; IIaller adds physics to physic, and Boerhaave scientific chemistry; Pinel puts the psychical upon the physical; John Hunter links the physiology of the inferior animal to that of the superior; Jenner stands out alone the revealer of a wholesale remedy; Humphrey Davy,-escaping from his nitrous oxide box, and exclaiming to Dr. Kinglake, “Nothing exists but thoughts; the universe is composed of impressions, ideas, pleasures, and pains-leads the beneficent advance of those who have abolished the horror of the surgeon's knife; and Laennec, pronouncing a diagnostic on such safe physical basis as to leave no improvement on his principles, heads the last of the
Tongues of our dead not lost,
To reach the height of these men, not one of whom was indebted to accident for his success, the constitution of mind is so exceptional that few are ever likely to approach it.
It is not difficult-nay, it is very easy, for a man to become a great performer in the art of physic, especially in the chirurgical part, and, thus excelling, to become justly famous. It is easy for a man to become erudite; it is comparatively easy for a man of ingenious mind to become a great theorist, and, by his speculations, to exist briefly after his death. Cullen, Darwin, and Brown are noted examples in this line. Lastly, by a spick and span method of ignoring fixed truths and inventing wild dogmas, it is the easiest of all things to gain a spurious fame, and even to live, as Hahneman has long lived, on the uplifted ignorance of the great illiterate.
But the medical science which truly advances comes from labour developed far differently from aught or any of these last-named qualities. It is a labour sui generis. The mind that yields it must have one primary attribute—impassion. If a single earthly object has to be served by the labour, and that be its design, assuredly the labour is damned forthwith. The mind must be fervid to the extreme of tension, and rather break than yield, or no clear and certain sound shall it pronounce. The mind to external friction must be smooth, relentless, impervious, otherwise impressions of fools may indent it and destroy its true nature. The mind, lastly, must be a mind within a mind, renewing itself, and correcting itself by the renewal, without any care as to its own past, or any care as to what shall seem, to smallness outside, its variability or inconsistency.
To die daily, that is the attribute of this mind; to be tomorrow what it was not to-day, and to admit the fact; to be firm always in work and object, to be obstinate never in question of result; to know and feel that no other criticism is, or can be, so severe and just as its own; to be ready to give up the choicest belief under conviction, but not to allow the sneers or opposition of the ignorant or half-learned to quicken doubt. To look on praise with due scepticism, and to hold to nothing wrongly because the delighted world calls Sufficit.
Such, according to my view, is the only frame and condition of mind through which medicine can advance in first principles of research.
I dwell on this view because, if it be true, it corrects a fundamental error in our systems everywhere. The accepted dogma is that medical science and art is to be advanced only by practice. Is that true? I entirely repudiate the dogma. That a man may practise and practise well, and at the same time advance the art on primary principles, is true ; but his two progressions must be essentially distinct.
Into that which he would advance by first principles no trace of worldly spirit must enter; pierced once in his nobler life by his lesser art, he is from that moment disabled; he is no longer a unit, but a section of a crowd.
Hence, I often fear lest, in the future, some of the great rewards of the deserving in medicine may come to those who live outside the pale;—who, impassionless, uninfluenced by the discords within, seeing the feebleness within too shrewdly, and scorning it, shall proceed alone and win, without care, by the development of truths which come only through serenity of observation.
This idea as to the men through whom science must rise direct from nature is supported by the great facts of history.
It is quite certain that in all the sciences which have risen to exactitude, the leaders of those sciences have been men who worked for exactitude, and with no other object in their advancing studies. They have sometimes been men who have followed particular occupations for the means of existence, and have turned the profits of their calling to their higher aim and work; but that higher work itself was pure.
Thus our own Kepler, first great prince of astronomers, while he lived in his little black tent, and turned it into a camera, and anon practised medicine, was meanwhile making silently that divine, divine because pure, discovery of a common bond of suns and worlds, which, won at last, led him to exclaim, in the grandeur of inspiration :-“ Nothing holds me. I will indulge my sacred fury! If you forgive me, I rejoice; if you are angry, I can bear it. The die is cast. The book is written, to be read either now, or by posterity, I care not which. It may well wait a century for a reader, since God · has waited six thousand years for an observer.”
In like inanner, our Harvey, labouring out the problem of his life, dissevered the work from the routine of professional toil, and yielding to Sir Simon Baskerville the éclat of the successful practitioner, so called, was content to discover what Sir Simon, in his sublime practical wisdom, never knew, except, as to him, a useless mystery, the circulation of the blood.
Unity of Research.
After the frame and constitution of mind, the order of research comes before us for contemplation. And here, the first principle that requires to be recognised, is the principle of unity. At this moment, by the incoherent recognition of this unity, we are tearing our science to shreds, and hoping that, by combining the patchwork, we may produce a seamless garment. The conception is as feeble as it is motley. As the