they now sit at the feet of Samuel Hahnemann. In order to hold our ground, it will be necessary to extend the field of operations. No man or body of men can accomplish much by incessantly boasting of what has been achieved. Even the New Remedies and their scientific preparation, formerly our pride, as being exclusively of our own procuring, are becom ing the perquisite of others who do not subscribe to our views, or hold friendly sentiments toward us. Let them have a little more headway, becoming proprietors of the New Remedies by right of discovery, and little reason will be left for our separate existence. The bugbear of a Code of Ethics, frightening the weak and furnishing sport for the strong, will not stand long against the attacks of self-interest.

At the present, we do well to regard eagerly and critically every advance. Holding what has been acquired with a tenacious confidence, we should reach out for the knowledge yet to be obtained. We are not mere tradesmen to make gain of what we know and do, but men of science to learn and improve. If he who makes two stalks of grass grow where only one grew before is a benefactor, much more so is he who learns and teaches their use. I conclude by pleading that this Association shall continue and increase its efforts to establish and enlarge the scope of our Materia Medica.

POSITIVISM IN MEDICINE.

By J. M. SCUDDER, M. D., Cincinnati, Ohio.

Mr. President, and Gentlemen of the National Association: I find myself announced for a paper on "Positivism in Medicine," a subject of no little difficulty, if one wishes to do justice to himself and it, and hardly to be brought within the compass of a Society paper. I hardly know the meaning our worthy President attached to the words. Is it to be taken as used by Morell-"The testimony of the senses considered as the principle of all certitude?" It could hardly have reference to the "positive philosophy" of M. Auguste Comte

"It is the mission of positivism to generalize science, and to systematize sociality; in other words, it aims at creating a philosophy of the sciences, as a basis for a new social faith." I am inclined to believe that this is intended as another name for what I have taught as "specific medication," and I am expected to show that there is a positive relation between drugs and disease, the knowledge of which may be employed to improve our therapeutics. In this light I contend for "positivism in medicine," and I base it upon the proposition of Morell-"The testimony of the (educated) senses must be considered as the principle of all certitude."

I believe that we live in a universe of law, and that the forces of nature and all matter are active to-day according to law, as they have been for millions of years, and will be forever. In plainer words, I am sure that "like causes produce like effects," and that "like effects follow like causes," and will always continue to do so. Two and two make four to-day as they did when "the morning stars sang together," as they will do to all time and to all eternity.

The first principle of positivism in medicine, as in every thing else, is the reign of law. If we live in a world of chance, then we may continue to believe in the "uncertainty of medicine." If a man sows wheat in the fall, and reaps onions and parsnips from it; plants corn, and digs oranges and watermelons from the roots; buys a pair of pigs, and from them raises monkeys and rats, then we will believe that "there can be no certainty in medicine," and we will sow a respectable youth of good acquirements in a medical college, and get a regular medical donkey as the result.

If it is a fact, as iterated and reiterated, that "there is no certainty in medicine," why should we have physicians? Indeed I should say with Oliver Wendell Holmes-"It would be better for mankind if all medicines in the world were at the bottom of the sea, though it might be worse for the fishes." "Positivism in medicine" is based upon a good knowledge of anatomy and a sound physiology. If a watch is out of order and fails to keep time, we take it to a man who understands the mechanism of a watch and something of the

philosophy of an apparatus for marking the divisions of time. If a locomotive is to be repaired, we want a man who understands its mechanism and its movements.

This knowledge of anatomy and physiology must be a personal knowledge through our senses, for as we first remarked, "The testimony of the senses must be considered as the principle of all certitude." We may be guided to knowing by works on anatomy and physiology, but we must know by our own senses of sight, touch and hearing, to get the working knowledge we need. There is a strong reason for asking that the student should make repeated dissections of the human body, and still more numerous dissections of the organs of lower animals. There is equally as good reason for asking that he shall personally observe the functions of life in the entire body, and in each organ or part. In this I do not differ from the more advanced thinkers in medicine, though it does differ widely from the common education of the physician, who obtains his knowledge from books.

Having a definite knowledge of the healthy structure and functions of man, we have a standard with which to compare the sick. If one is practicing surgery, he will have an eye trained to recognize the symmetrical structure and functions of bones, muscles, and articulations, and fingers trained to know the right shape and position of them. Then if we meet a dislocation or fracture, we recognize the lesion at once, and know when we have reduced the one and properly set the other.

Every function has its definite expression, readily recognized by the educated physician. It matters not whether it is brain, organs of special sense, organs of digestion, of respiration, circulation, secretion, or of locomotion, the condition is shown by well defined symptoms. As we have an expression of health, so we also have an expression of disease; the one the language of health, the other the language of disease.

We say of a healthy man-"he is able to do a man's work in the world, and do it pleasurably;" of any organ or part"it is able to do its work, and it does it pleasurably." Of a sick man we say "he cannot work, and he suffers discomfort;" of

a part-"its functions are not properly performed, and there is a sense of discomfort or pain in it or from it." If one is confined to his house, he is sick; to his room, sicker; to his bed, sickest. If he cannot change his position in bed, and lies on his back, he is cultivating an acquaintance with the undertaker.

As we observe the patient we determine the extent to which his life has been undermined by debility or inability, and we do not fail to see the necessity of conserving and supporting the life. There are thousands of men practicing medicine who have not been able to get this far, and who never recognize the fact that in disease there is always impairment of life. They rush at the patient as if he were possessed of a demon, which must be forcibly exorcised, and employ the very means that will further depress the feeble life he bas. It is nauseants, cathartics, irritants, opiates, diuretics, diaphoretics, plus quinine and counter-irritation, irritation of stomach, upon irritation of bowels, upon irritation of nervecenters, until the patient would feel blessed if he were on the other side of Jordan, even though the devil had him.

If a physician will go back and study pathology from Williams, and therapeutics from Headland, he will get on much better. The one will tell us that all disease may be measured by the rule of excess, defect, and perversion; that excess (excitement) is to be brought down, defect is to be brought up, and perversion is to be brought back, the standard being that of healthy life. Headland will tell him that remedies have an elective affinity for certain organs or parts, or functions, and that their influence is very positive-so much so, indeed, that with like conditions we may expect like results. Why not? as this is one of nature's laws; and if were not so, we would live in a world of chance.

A simple rule of three, to be sure, and one that may be readily applied, and one that will help us to establish "positivism in medicine." If our patient has a fever, we proceed to its analysis in this way: excesses, of temperature, frequency of pulse, nervous excitement; defects, loss of appetite and digestion, loss of strength, defective excretion from skin, kid

neys and bowels; perversions, of the blood, periodicity wanting antiperiodics, typhoid wanting antiseptics, erysipelas, rheumatism, etc.

We can understand clearly that the temperature is to come down to 98°; that the pulse is to come down to its normal standard, and that nervous excitation is to be quieted. It is equally clear that the stomach and bowels are to be kept in good condition for the reception of a small amount of food, that the strength may be sustained, and that the skin, kidneys and bowels be influenced towards normal secretion. If there is periodicity, we want quinine when the patient is prepared for it; if typhoid symptoms or zymosis, we want antiseptics or antizymotics; if erysipelatous, rheumatic, or other wrongs, we want the special remedies that will right these.

It is equally necessary to understand that these several wrongs are not equal; that some one is first, and that others are based upon it. If we take away or control the principle wrong, the others will be abated, or if the disease is not entirely arrested, remedies will readily reach the other wrongs. Thus in the case of fever, Aconite or Veratrum alone may be all-sufficient to remove the disease, if it is based upon a lesion of the circulation. Or, if based upon a lesion of the temperature and the skin, the cold or hot wet sheet or blanket-pack may remove it. If the prominent lesion is of the nervous system, the disease may be wholly removed by Gelseminum, Rhus, Belladonna, or such remedy of this character as may be indicated. Many a case of fever, in the olden time, was arrested by the spirit vapor bath and diaphoretics, and other means to establish secretion, this being the principle wrong. Then we have cases of malarial fever in which quinine will cure, typhoid zymotic disease which is cured by sulphite of soda, sulphurous acid, Baptisia, chlorate of potash, or muriatic acid.

Every one will recall the cases of erysipelatous fever cured with tincture of muriate of iron. At first one is surprised to see it bring the pulse down from 120 to 80 beats per minute, the temperature down from 105° to 99°, relieve the distressing pain, stop the delirium, give rest and sleep, antidote the typhoid