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firmament is of one azure blue, as the heavens are in order, so the science that shall be perfect must be in harmony. Neither must our study be confined to one particular subject; it must extend to each science, and unite each one in the whole. From the rest of the science world, nothing should separate the Physician and Surgeon, except the art, which, in fact, is the craft-work of the science, developing it, but not producing. Shall one man be a mere physiologist, another man a mere pathologist, this a diagnostic, that a therapeutist? 'Tis trifling with nature. Test the matter by comparison. There is before us a mechanism, an engine which we have not invented, and the action of which we know not. To investigate it, to learn it in its unity, shall we divide ourselves into exclusive sections? Shall some discoverers take the engine to pieces, and figure each of its parts, its wheels and its pistons, its boiler and its condenser, its regulator and its tender? In truth, they shall do much. Shall others investigate the relations of these parts, their motion, their order of motion, the product? They shall also do much.
Shall a third set examine the engine when out of gear, listen to its creakings, and grindings, and shakings, and look into its chambers and tubes, and valves, and feel its throbbings and heavings? They shall do much. Shall a fourth division take the useless engine and examine its disabled parts in detail, and describe them? They shall do much. Lastly, shall a set treating badly working engines, try to restore them by casting various fuels into the furnace, or by letting off steam, or cutting off excrescences, or patching up holes? They, too, shall do much; and, in mere handicraft, they shall, perchance, sometimes do a vast deal. In a word, all shall do well who labour in their respective callings thus far, and the division of labour shall be true, and the results natural, within their legitimate bounds.
But, if thus dividing ourselves into varied labour, we physicians allow the work we take in hand to isolate us from all other work; if we make one work predominate; if we give fashion to one department, and hold that up as the beau idéal of our study; if we make our divisions play the role of independent centres, then we advance not a jot-not a jot, but become the creatures, rulers, or subjects, of petty sovereignties, each alike poor, proud, and powerless; and, however so often the animal engine comes before us, sound or unsound, though it be before us under infinite variety of form every minute of our lives, and in a sense be the perpetual study of our lives, yet shall we, by the course we take, gain no more knowledge of the principle of the engine than the simple savage who contemplates a steam engine, with combined wonder, fear, admiration, and instinctive desire to know.
In physic, however, this divisional method of research, this centrifugal disintegration, is so much the passion that no man can be held learned who does not follow it. A man may be a great pathologist, a great physiologist, a great anatomist, a great diagnostician, a great microscopist, but a great physician he must not be; nay, after isolating his own greatness as widely as possible from other greatnesses, and after what he calls carving out for himself a speciality even in his own department, he will be content, flying, under the centrifugal propulsion, out of nature altogether, content to tell you that it is absurd, as, indeed, I fear it is for him, to try to master any subject save his own.
In the interests of science, in the interests of humanity, this centrifugal training and cultivation must really cease, if we, as a body, would stand a power; it is landing us breathless, companionless, naked, on the shores of folly, there to set up squalid huts and think ourselves kings. When a man, led by this propulsion, prides himself as I have heard a man pride himself, and his friends for him, that, pursuing his speciality with almost supernatural vigour, he has made so many thousands of minute dissections and measurements of one particular organ of the animal body, I may laugh at the conceit of the individual, but I must weep if I contemplate, solemnly, the terrible and chaotic imbecility of a system which allows such lost labour to pass for great labour, and which cheers the loss. If so simple a thing as a steam engine could never be learned off, as an engine, by such form of study, nor by any number of such isolated studies, how can it be expected that the unity of the animal machine can be advanced by research, in its case so infinitely less efficient?
I speak thus for the argument of science; I speak, feebly echoing the voice which proclaims everywhere the unity of nature, and the All-creative Intellect. But I am not unconscious that an argument from another side may be used against me, and which, on the principle of every man for himself, and heaven for us all, may be potently wielded. IL may be urged that medical art and science, themselves of the earth earthy, must move with the earth as it is; that external influences, apart from them truly, but within the sphere of attraction, must tell upon them, and that, to succeed, they must conform to what may even be the prejudices of mankind.
This stated, as a primary, it may further be urged that the whole tendency of the present day is to division of labour; that there is an earnest belief-fair or false it matters not-in favour of such a division, and that medicine to thrive must run in the current with the rest, and even at the risk of scientific dissolution must divide! divide ! divide ! Is it, indeed, so? Grant it, and medicine is in fragments which rub together, make noise, crash, and fall even to the lowest depth. Grant it, and where shall we limit the disintegration. Grant it, and how shall the world put on it any limitation, and why shall there not be as many classes of healers as there are organs, each healer having status according to the vital importance of the organ he treats. For my part, in humilia
tion, I admit the existence of this theory, but in the face of truth, I deny the necessity for it, or the wisdom of it. In thus bending to the sordid gravitation of the earth, there is a deformity in our art which, except in Egypt, when she was sinking, has seen no light until the last thirty or forty fleeting years. In these years, the Esculapian, forgetting his nobler part, has degraded himself to a common level, when he might have stood, in the earnest consciousness of his strength, above the level, and a first power in the land. Where, at the present time in this country, and in physic, is to be found the type of Richard Mead, who, in his palace, where little children now pour forth their touching woes, could command the friendship of every illustrious man who visited our shores? Where is now the Physician who dare say to the Prime Minister of England, liberate a just and upright man from the durance of the political prison, or my skill is in safe keeping from your frailty ? Where is the representative of Haller, who shall claim, and claim to win, an equal place with the princes of philosophy ? Where are the great teachers of Leyden, Padua, and London ? Where are the men, who, like Harvey and Lower, in days when differences of rank were far more keenly appreciated than now, could call royal pupils to their noble demonstrations ? Alas ! I know not. I know only of a profession sinking fast its art into its trade, and in some, and many instances, descending even to the speculative tricks of the gambler, and to their inevitable consequences, loss of wealth, loss of mental health, and unmitigated despair.
Facilis descensus Averni, and never so facile as when the great descend.
That some one, if not I, should speak thus earnestly against the centrifugal rending of medicine, is the more necessary because of the risks of delay. It cannot be concealed that one generation imbued with a particular conceit, if it retain it to the last, passes it to the next generation with increasing force, and that many, indeed all, of the deepest sectional delusions have their root in the idola of descended usages and forms. A false belief, thus seated, evolves a practice of overwhelming power, because, despite the most cogent reasons against it, suggested and proved by better knowledge, men are afraid to question it or leave it. Thus, our forefathers in physic, by their too rigid adherence to wholesale blood-letting, against reason, allowed even the meanest of their enemies to prove them wrong with such a vengeance that in the revulsion of thought right and wrong fell together, and a grand remedy, in its true place, was as suddenly as childishly condemned and cast aside.
Amongst some classes of men, the retention of a prejudice engrafted of old, and belonging to many generations, may be of service, in that it may ensure the praise and confidence of a world able to judge of the merits of a mere idea or sentiment. Of the priest, the barrister, or the politician, the world may have a standard of judgment, and that judgment may have soundness in it, resting upon a correct understanding of a necessity or a talent. But of us, out of our moral and social relations, the world has no standard that is worth its possession or our appreciation. Our licenses to heal are its only safeguards, and these are governed by our own laws and opinions. In our practice we hear ourselves offensively criticised to-day, and to-morrow as offensively lauded; but by those of us who are serious in our work, the praise and blame are measured alike, because we know that our self-conscious mistakes are as often falsely admired as our self-conscious triumphs are falsely misrespresented. Who of us, that is observant, does not constantly witness the conceit that the last physician called in to give an opinion is the best in the eyes of the looker-on? Yet, who of us, that is honest, does not feel that the conceit is absurd, and, by common understanding, treat it for precisely what it is worth and no more?