A Treatise upon the Small-Pox/Preface
And as the Knowledge of experimental Philosophy is greatly to be prefer’d to that of the Student, who deals in empty Speculations and scholastick Chimeras; so are the Acquisitions and Endowments of the experimental Physician, who has formed his Method of Practice upon sufficient Experience and Observations on the Nature, Progress, and various Symptoms of Diseases, as well as on the Operations and Force of Medicines, far more valuable than the abstruse and unsupported Notions of one, who owes all his Endowments to an active Imagination, and the contemplative Labour of the Closet. It is for this Reason that Dr. Sydenham, who built all his Maxims and Rules of Practice upon repeated Observations of the Nature and Properties of Diseases, and the Power of Remedies, has compiled so good a History of Distempers, and so prevalent a Method of Cure, by which he has improved and advanced the healing Art, much more than Dr. Willis, with all his curious Speculations and fanciful Hypotheses: For what can be expected but crude and unprofitable Conceptions, from Gentlemen, that imagine they have acquired great Attainments in the Art of Curing, and are accomplished Physicians, before they have had the Advantages of Experience and Observation? They may as well imagine they can learn to swim in their Parlours without going into the Water, as to become useful and able Physicians, without being verst in Business, and seeing the various Operations of various Medicines. Such Persons will rather receive great Prejudice from their Systems established only by Contemplation; for when they come from the College into the World, they will be very apt to practice in Conformity to their preconceived Opinions, and instead of erecting a Scheme of Physick upon mature Experience and long and just Observations, they will labour to compel their Experience and Observations to favour and take part with their antecedent Maxims, and settle a Method of Cure by the Influence of a byassed Judgment, and pre-notions of Things. It will be in vain to say, that these Persons, who have not seen much Business, have formed their unpractised Scheme upon the Experience and Observations which they have found in the Writings of many eminent Physicians; for those Authors themselves, at least the generality of them, were such as before they had entred on the Practice of Physick, had established their Maxims and Doctrines in the Schools and Colleges, and not entring upon Business with an unprejudiced and impartial Mind, they formed their Practice and governed their Observations to make them agree with their first Conceptions; and though according to Reason and the Nature of Things they ought in the first Place to have made their Tryals and Remarks, and upon such Vouchers and Authority to have raised a well-concerted Method of Practice; yet almost all Writers of Physick have communicated to us such Accounts of the Causes of Distempers and their Symptoms and Method of Cure, as were strained and wrested to serve an Hypothesis.
But it must be acknowledged that a great Number of Persons, that are designed for this useful Profession, for want of native Genius, Judgment, and Penetration, are uncapable of making just Observations, or drawing right and beneficial Conclusions from them. Their Heads, such is their Unhappiness, are so thick and hairy, so heavy and slow is their Apprehension, and so incorrigible their Stupidity, that they are perpetually puzzled and cannot but with great Difficulty and Pains make any Thing out. When they undertake a Patient, they are bewildred and in a Wood, and being unable to strike out their Way, when they attack a Disease they discharge a random Pill, or play off an unprofitable or hurtful Bolus at a Venture. When I reflect on the great Number of these unfortunate Men, especially in Country Towns and Villages, that enter upon a difficult Profession, in which for want of Sagacity, and good Sense required on Nature’s part, they are unable to succeed, and are likely to be more detrimental than beneficial to their Patients, of whom they serve those best, whom they visit least; and when I confider likewise the Swarms of Empericks and ignorant Pretenders to the Knowledge of Physick, and compare them with the few, that are endowed with suitable Qualifications for the Cure of Diseases, I am doubtful whether the whole Faculty might not be spared without any Damage to Mankind in general. It is true that Courts and populous Cities are happy in this, that there are among them many learned, able and worthy Physicians, to whom the Sick may have recourse: But how small is their Number, when compared with all the weak and ignorant Doctors, Quacks and Mountebanks, that abound not only in the Country Towns and Villages, but likewise in great Cities themselves? and then setting the Damages and Mischiefs, that arise from the Ignorance and Unskilfulness of such Practisers, against the Good, that is done by the Judicious and Skilful, I am afraid that the last will be much over-balanced. Nature would struggle hard and do a great deal towards the Relief of many Distempers, where a proper Diet is used; would not confident Undertakers without Knowledge and Judgment, interpose their impertinent and noxious Medicines, by which they pervert the wholsome Operations of Nature, oppress her Strength, and by their ill-chosen Remedies put a curable Disease beyond all hopes of Recovery.
A native Genius and Capacity accompanied with a competent Degree of Learning, must conspire to make an accomplished Physician, but if these are separated, the first improved by Experience is far preferable to the last: A Man by Nature dull and unanimated, let his Head be ever so much stuffed and crowded with old Authors, scholastick Ideas, and Common-Place Collections, will never acquire any tolerable Qualifications for the Profession of Physick. It was the Saying, as I have been informed, of Col. Titus, That Learning was fit Armour for a strong Man, but that it oppressed and crushed a weak one. I believe the Remark is just; for a great deal of reading and crude and undigested Notions huddled together without Coherence, not only fit very awkwardly about a sleepy and spiritless Scholar, but they overwhelm and confound him to that Degree, that he is unable to Use them to any beneficial Purpose: On the contrary, for want of Skill and Prudence, he is very likely to do great Harm and Mischief; for Medicines are Weapons, that cannot be trifled with less Danger in the Hands of a Fool, than a Madman. Men of a ready Apprehension, clear Reason, and distinguishing Judgment, cultivated and improved by Practice and Business, will soon attain great Abilities in their Profession, though destitute of the Help of Letters and a liberal Education. It is in this Case, as in that formerly of an eminent though illiterate Member, of the House of Commons, of whom it has been said, That by that Time he had spoken a quarter of an Hour, he put all Learning out of Countenance. For it is very evident that a Man of good Sense, Vivacity, and Spirit, may arrive to the highest Rank of Physicians, without the Assistance of great Erudition and the Knowledge of Books: And this was the Case of Dr. Sydenham abovementioned, who became an able and eminent Physician, though he never designed to take up the Profession till the civil Wars were composed, and then being a disbanded Officer, he entred upon it for a Maintenance, without any Learning properly preparatory for the Undertaking of it. And to shew the Reader what Contempt he had for Writings in Physick, when one Day I asked him to advise me what Books I should read to qualify me for Practice, he replied, Read Don Quixot, it is a very good Book, I read it still. So low an Opinion had this celebrated Man of the Learning collected out of the Authors, his Predecessors. And a late celebrated Physician, whose Judgment was universally relied upon as almost infallible in his Profession, used to say, as I am well informed, That when he died, he would leave behind him the whole Mystery of Physick in half a Sheet of Paper. It is true both these Doctors carried the Matter much too far, by vilifying Learning, of which they were no Masters, and perhaps for that Reason. And lest I my self should be here mistaken by my Readers, and looked upon as a Writer of Raillery and Satyr upon Learning, I crave leave to explain my self as before, by saying, that I do by no means depreciate, or expose any Kind of useful Learning in any Art or Science whatsoever, but much esteem and honour the Masters of it. And again I affirm, that notwithstanding Genius alone is far more successful, than Learning alone, which is indeed insignificant, if not mischievous as before asserted, yet when they are united in the same Persons, they become of all others the most excellent and accomplished Physicians. But the Learning required for this Profession, is not perhaps so various, extensive and difficult, as some imagine, or are willing that others should believe, and what Kinds of Learning are necessary, or at least expedient and desirable, to fit a Student for the Practice of Physick, is not in my Judgment difficult to determine.
A competent Knowledge of Chymistry, as well as Anatomy and Botany, are very requisite and beneficial; but to enter into the minute Recesses of Nature by chymical Pursuits, and with great Expence and Application to endeavour to be an Adept, and a Person of Distinction, is by no means desirable. Every one should be discouraged from such Researches and long Labour in the Fire, by the Example of that valuable and excellent Person, the Honourable Mr. Boyle, a curious and indefatigable Searcher into Nature, who by all his chymical Toyl and Lucubrations, has for the Service of Physick and Cure of Diseases produced only a little Collection of Remedies and Receipts sold for twelve Pence, but too dear. It is very observable, that all the prevalent Medicines that serve the greatest Part of the Purposes of the Profession, namely, Steel, Mercury, Opium, and the Peruvian Bark, are more efficacious and successful, when they have not undergone any chymical Operation, but are used as Nature formed them: And as to Cordial Waters, Tinctures, and Spirits, they signify little for the Cure of Diseases, as all experienced and judicious Physicians must know, and the Art of making them is soon learned and without Difficulty. And as to the Knowledge of Plants, that are beneficial in Physick, their Number lies in a very narrow Compass, what Multitudes soever are the Objects of the natural Historian’s Consideration; and though Anatomy is a very curious and delightful Amusement and highly necessary for the Accomplishment of the Surgeon, yet a very minute and extensive Knowledge of it is what an able and skilful Physician may be without: But an accurate and distinguishing Knowledge of Pharmacy, the Nature of Drugs, and the Manner of preparing and mixing them in due Proportion for making of compound Medicines is what the Physician should labour to be acquainted with. Add to this a due Knowledge of experimental Philosophy, for as to the speculative and metaphysical Systems they are dark and impertinent, and this will abundantly suffice for preparatory Qualifications; the rest and the greatest part of the Doctor’s Accomplishments must arise from Practice and Observation.
The Reader will see that I have not set down a great Acquaintance with abundance of Writers, especially the Antient, as necessary or useful for a Student in this Profession; for I do not think they are so. A competent Number of the most celebrated modern Authors should be perused; but their systematical Way and formal Institutions are at least for the greatest part so tedious, heavy and spiritless, that I cannot see how a great Application to them will be of much Service.
There is yet less Profit to be gained by a laborious Study of the eldest Writers of the Faculty; for such is their Obscurity and Ignorance, and so great and various their Defects, that much Time must be spent in reading over their numerous Volumes, and so little, if any, beneficial Knowledge will be got, to balance this Expence, that Time must lye heavy on any Man’s Hands, that employs it this Way.
But before I mention the Weakness of the eldest Authors, it is but just to allow them their due Praises, and to make likewise an Apology for their Imperfections. They are to be esteemed and honoured for this, that they were Men of Sense and good natural Endowments, and that they employed their Talents with great Labour and Industry to find out the Art of curing Diseases, and that they made some commendable Advances in it; and that they knew so little of the Matter comparatively, is owing to this, that Physick being then in its Infancy, as other liberal and mechanical Arts have once been, required like them, Time, Observation and Experience to bring it to Maturity. And the more abstruse and difficult any Art is, the longer will it be before it arrives at a State of Perfection. It was therefore the Fault of the Times, and not of the Persons, that they were not wiser and more able Physicians. It is to their great Honour that they were the first Inventers of the healing Art, or at least the first that made any considerable Improvement in it, and in this they deserved well of Mankind and excelled their Predecessors, as much as they fall short of those, who succeeded them. It was owing to their own good Sense and Diligence, that they knew so much, and to the Age they lived in, that they knew no more; and therefore I may justly make the same Apology for them, which the eminent Poet, Mr. Dryden in one of his Prologues makes for the old English Writers for the Stage:
The Age was dull, and Comedy was coarse,
Cob's Tankard was a Jest, and Otter's Horse:
Our Men and Ladies now speak better Wit
In Conversation, than those Poets writ.
This is the Case of the first Writers of our Profession; though they started a few good Things, and had some Knowledge in Plants and Minerals, yet their Understandings were still clouded, their Sentiments embarrassed, and their Ignorance very great; and what Advantage can accrue from a laborious Study of such Authors? If a Man had perused often, and common-placed all Aristotle, and gone thro’ the immense Volumes of the grave Triflers his Commentators, would he by that become a Philosopher of any Value? In like Manner had a Student read all the Works of Hippocrates, and with indefatigable Toil ransacked and rifled the crude and undigested Heaps of Authors, who by undertaking to set him in a clear Light, have added their own Darkness to that of the Text, what could they gain worthy of their Labour? What Knowledge could they acquire to reimburse them for their Expence of Time? Are not these innumerable Volumes, these Productions of fruitless Industry, become Piles of waste Paper and the Refuse of the Shops? Are they not the heavy Lumber of Garrets, and the Trumpery and Riffraff of old Libraries?
And supposing any Man should happily translate the Text of Hippocrates himself, and by correcting his involved Method and removing his Obscurities should set his meaning in a full and clear Light; and particularly should he unriddle his τὸ φεῖον quid divinum in some Distempers, which is as dark and as inexplicable as Aristotle's ἐντελέχξα, or his occult Qualities and substantial Forms in lifeless Bodies, What has he done for the Advantage of the present Age, which is so much refined and improved since the Times of that Author, and seeing the Art of Physick is now got out of its Cradle, freed from the Weakness of Infancy, and being grown Adult is possessed of the Schools, and dictates from the Chair? Should any Man compile and publish an accurate Account of the Passage of King Solomon's coasting Fleets from Esiongeber, through the Red Sea to the Ports of Asia, or the East Indies, or of the Manner of the antient Tyrians sailing along the Shores of Africa or Europe, when the Seamen of all Nations were ignorant of the Use of the Load-stone in Navigation, and intended this Performance for the Improvement and Instruction of Modern Sailors, who understanding the Compass since invented, perform their Voyages with more Safety, and in a far shorter Time, would not the World cry out, What is come to the Man? How should such a ridiculous Design ramble into his Head? And is it not equally absurd to publish the Works of Hippocrates, who neither knew the Use of the Pulse, though as necessary in Physick as the Compass in Navigation, nor the Circulation of the Blood, nor the Benefits of Chymistry, for the Advancement of the Art of curing Diseases, and the Direction of Physicians at this Time, who are Masters of all this Knowledge, and a great deal more, of which the Greek Author was destitute? Suppose likewise that any Man was acquainted with the Model of the first Boats and Ships, whether built by the Argonauts or any before them, or of the original Contrivance of the Junks and Canows employed by the Indians, and should write a curious History of this Invention, and declare that he designed it for the Benefit and Instruction of the Builders in his Majesty’s Docks, and the Service of the Royal Navy; I cannot imagine that he would be much respected and applauded as their Benefactor, by our Master Shipwrights. Many more Instances might be insisted on, as the Art of making Clocks, and that of comick and tragick Poetry in their first Rise, to shew the Vanity and Unreasonableness of propounding the Examples of the Antients, when Arts and Inventions were green and scarcely begun, for the Service and Imitation of others many Ages afterwards, when those Arts and Inventions are brought to a great Degree of Perfection. Grant that Hippocrates was complemented with divine Honours, and that Æsculapius his Predecessor, who if Cicero was rightly informed, practised at first the low Art of drawing Teeth, was for his Skill, such as it was, advanced from so mean a Beginning to the highest Dignity, (strange Rise!) from a Tooth-drawer to a Demigod! yet this is no more than happened to the first Inventors of any Art, that was very commodious and beneficial to Mankind. Bacchus and Ceres had their Priests and Temples, one for his being the first Planter of the Vine, and the other for finding out the Way of sowing Bread-corn; and yet if any Man could give us an Account of the first raw Attempts and imperfect Practice in these Arts, he might indeed gratify the curious Lover of unprofitable Philology, but never oblige the present Age by any useful Knowledge.
In a Word all the Benefit, that can arrive, by the Translation of Hippocrates or any antient Author in Physick, is only to exhibit the State of Physick in its Birth and Infancy, that the Reader may see its Weakness and Imperfections, compared with its present mature State, and so may please as an Historian; but surely none can imagine that the present Physicians can receive thence any Lights for their Improvement: If any should think so, for some Men have a strange Way of Thinking, and a great Dexterity in deviating from the Right, let them learn the Weakness of that Author from his two most celebrated Pieces, his Book of Fevers, and that of Aphorisms. As to his Book of Fevers there is no Account given in it of the Nature, nor of the different Kinds of that Disease, nor any Method of Cure, nor any Medicines proper and beneficial to suppress it: My Reader will here begin to wonder and cry out, what then does his Work contain? Why nothing but an obscure and involved History of several Cases that fell under his Observation, and a Recital of their Symptoms, and Complaints from Day to Day; and is that sufficient to denominate a Man a great Physician, which any Relation, or Neighbour, or any sober and experienced Nurse can do as well as the Doctor; that is, tell when the Patient was sick in his Stomach and vomited, when griped, when his Head ached, how he slept, &c. Nay, this was what they actually did, for sure Hippocrates, who had so many Patients to attend, did not continue Night and Day with any one, to set down the Series of his various Complaints; no, he must have received his Information from those that constantly continued with the Patient, or succeeded one another in their Attendance, as our Physicians now are made acquainted with the several Symptoms and Sufferings of the Patient during their Absence by the Relation of those that were about him; and now in all this Performance, what has our Author done more than barely put down in Writing a Narrative of Facts, or Incidents, as they were communicated to him by other Hands? I am certain if Hippocrates had not had the Reputation of curing the Plague in Greece, which I imagine he never came honestly by, he had never been Deified for this Book of Fevers. It is remarkable that this antient Writer makes frequent mention of Fevers, that continued seventy or eighty Days, but does not tell us to what Class or Species those Fevers belong; but however since there are no Fevers, such as he treats oft that are of so long Duration to be met with in this Age and Country, it is a manifest Proof that the Fevers, which Hippocrates saw, were different from those that prevail here; which is directly contrary to the Assertion of a late learned Commentator upon that Writer: And therefore the antient Authors and modern too, in very remote Countries, should not be of great Value here, for the Nature of Diseases, and the Force of Medicines, are by no Means the same in distant Climates, nor in distant Ages of the World.
As for his Book of Aphorisms, it is like my Lord Bacon's of the same Title, a Book of Jests, or a grave Collection of trite and trifling Observations, of which though many are true and certain, yet they signify nothing, and may afford Diversion, but no Instruction, most of them being much inferior to the Sayings of the Wise-men of Greece, which yet are so low and meany that we are entertained every Day with more valuable Sentiments at the Table-Conversation of ingenious and learned Men. Many of this great Man's Aphorisms are so poor and vulgar, that they are not greatly superior to such Remarks as these: If a Man eats and sleeps, it is a good Sign. If he refuses Meat and cannot rest, it is bad. If he rejects his Medicines it is ill, nor is it well if he has a violent Pain in his Side. If a Man sprains his Leg it is ill, if he breaks it, it is worse: such as these are many of his certain Aphorisms. But his dubious ones are like a String of logical Topicks, or probable Doctrines in the Church of Rome, which are sometimes true and sometimes false, and as often fail as they hold good.
One would wonder how a Man that knew so little of Fevers, should be qualified for the Cure of the Plague, which is a Fever of the highest and most dangerous Kind: Yet it is reported by Historians that he gained great Fame, and even divine Honours for his Success in subduing that destructive Disease: But it is no Argument of his Humanity and Good-will to Mankind, that he has no where in his Works clearly communicated this efficacious Medicine or Method for the great Benefit of all succeeding Ages. One would be tempted to think there was some Juggle in this Matter, and that he never really was Master of any Medicine that could cure the Plague, but that he came at a lucky Time, when the Pestilence had spent its Fury, and was on the declining Hand, or that he was favoured by some other fortunate Incidents, that moved the People to ascribe the Extinction of that dreadful Disease, to the Care and Skill of the Physician: For my part I do not believe that there ever was any such prevalent Medicine in the Hands of any Man whatsoever; and if Hippocrates was Master of any such Remedy, he must out of Enmity to his Species have concealed and sunk it, that Posterity might have no Benefit or Advantage by it, which surpasses all Belief; had it been so, he ought to have been stripped of his Divinity, and have had his Apotheosis reversed; If he was guilty of such Cruelty, he should have been brought down and ranked with Misanthropes, and the most unnatural and hard-hearted Barbarians; and therefore not being capable of thinking thus of him, I conclude he had no such Receipt.
Van Helmont, a visionary Chymist, pretended to be Master of the Remedies that Hippocrates used in curing the Plague, tho' he did not discover it in that Author’s Writings, but was obliged to an Angel, as he says, for revealing it to him. Athanasius Kircher the Jesuit, pretended likewise to the Knowledge of this Secret, but does not say that he received it from Van Helmont, but affirms that he discovered or thought he had discovered it from some Passages in the Writings of Hippocrates. It is indeed said by a late ingenious Author, that the enthusiastical Chymist, whose Head swarmed with Reveries and Phantoms imparted this Remedy to Kircher, and that Kircher this Way came by his pretended Discovery: This indeed he roundly affirms, and there wants nothing but Proof to make me believe it. Is it credible that this should be true, that Kircher should rely on the Authority of a Vision that appeared to a crack-brained Adept, and that he should never make the least mention of him in this Matter, but affirm that he dug and drew up this Knowledge from the Depths of Hippocrates himself? And had it been otherwise, is it credible that he should submit it to the Perusal of the Society of the Jesuits, and the most eminent Physicians then in Rome, and that upon this he should receive the Approbation and Encomiums of both, and lastly, that he should be so hardy to dedicate a Dream, and an absurd unphilosophical Account of Remedies, to such a Pope as Alexander the seventh, who was so far from being weak and credulous, that if Matchiavel, who knew him, may be trusted for his Character, he was a very sensible and subtle Man? Now, I say, is it not very difficult after this to conclude, that the Chymist communicated his Vision to the Jesuit, concerning the Medicine which Hippocrates used in the Cure of the Plague, and that he relied upon his Story; especially when no Evidence is produced on the contrary Side of the Question? It is much more reasonable to believe, it being no more than himself affirms, that he extracted his supposed Discovery from the Works of Hippocrates himself. If it be said that he was greatly mistaken, and that what he affirms is not to be found in Hippocrates; be it so, may not Kircher notwithstanding believe that he had discovered the Secret in the Works of Hippocrates, though he was misled and relied upon obscure Passages that would not bear him out? Is it any Wonder that one that reads that Greek Author should be mistaken, and think that he had found out in him, what was never there and so deceive himself and afterwards lead others into the same Error? By no means; for I am well assured that a late learned Commentator has published several Discoveries, which no doubt he believes are contained in that Author, which others of as clear a Sight will never be able to find there without Van Helmont's Vision, or some other necessary Machine: And I am ready to make this Assertion good in several Instances; but this is not a proper Place for such a Dissertation; and besides it would swell this Preface, which is too large already, to a yet more immoderate Bulk.
By what I have said, it will appear that the Study and Knowledge of the old Fathers of Physick, can serve no other valuable purpose, than to gratify the Curious with a Narrative of the low State of the healing Art in antient Times. As for Mathematical Science, which some have endeavoured to interest in the Improvement of Physick, my Judgment is, that as a profound Knowledge in it is not conducive to the Service of Mankind, though a moderate one is, it being only the agreeable Amusement of contemplative Men of Leisure, so it is unserviceable to Men of our Profession, who are more concerned with Fluids than with Solids; and therefore I look upon it as an injudicious and vain Attempt for any Men in order to discover the Nature of Diseases, to apply the Compass to a depraved Mass of Humours, or endeavour to square the Circle of the Blood. Geometrical Skill is rightly employed about Bones, and Muscles, and other solid Parts of the animal Frame, which more eminently belong to the Surgeon's Province; but it cannot be so useful to the Physician, whose principal, though not entire Business, respects fluid Bodies. According to the Maxims laid down in the past Discourse, I have compiled the following Treatise, where I have advanced no Notions relating to the Nature, and no Method for the Cure of the Small-Pox, but what are founded upon, and are the Result of long Observation and Experience.