wouldmakehimreadthelifeandwritingsofBenjaminRush。Dr。Rushthoughtandsaidthatthereweretwentytimesmoreintellectandahundredtimesmoreknowledgeinthecountryin1799thanbeforetheRevolution。Hisownmindwasinaperpetualstateofexaltationproducedbythestirringscenesinwhichhehadtakenapart，andthequickenedlifeofthetimeinwhichhelived。Itwasnotthestatetofavorsound，calmobservation。Hewasimpatient，andNatureisprofoundlyimperturbable。Wemayadjustthebeatingofourheartstoherpendulumifwewillandcan，butwemaybeverysurethatshewillnotchangethependulum’srateofgoingbecauseourheartsarepalpitating。Hethoughthehadmasteredyellow-fever。“ThankGod，“
hesaid，“outofonehundredpatientswhomIhavevisitedorprescribedforthisday，Ihavelostnone。“WherewasallhislegacyofknowledgewhenNorfolkwasdecimated？WherewasitwhentheblueflieswerebuzzingoverthecoffinsoftheunburieddeadpiledupinthecemeteryofNewOrleans，attheedgeofthehugetrenchesyawningtoreceivethem？
Onesuchinstancewilldoaswellastwenty。Dr。Rushmusthavebeenacharmingteacher，ashewasanadmirableman。Hewasobserving，ratherthanasoundobserver；eminentlyobserving，curious，even，aboutallmannerofthings。ButhecouldnothelpfeelingasifNaturehadbeenagooddealshakenbytheDeclarationofIndependence，andthatAmericanartwasgettingtoberathertoomuchforher，——especiallyasillustratedinhisownpractice。HetaughtthousandsofAmericanstudents，hegaveadirectiontothemedicalmindofthecountrymorethananyotheroneman；perhapshetypifiesitbetterthananyother。Ithasclearlytendedtoextravaganceinremediesandtrustinremedies，asineverythingelse。Howcouldapeoplewhichhasarevolutiononceinfouryears，whichhascontrivedtheBowie-knifeandtherevolver，whichhaschewedthejuiceoutofallthesuperlativesinthelanguageinFourthofJulyorations，andsousedupitsepithetsintherhetoricofabusethatittakestwogreatquartodictionariestosupplythedemand；whichinsistsinsendingoutyachtsandhorsesandboystoout-sail，out-run，out-
fight，andcheckmatealltherestofcreation；howcouldsuchapeoplebecontentwithanybut“heroic“practice“？Whatwonderthatthestarsandstripeswaveoverdosesofninetygrainsofsulphateofquinine，[Morestrictly，ninety-sixgrainsintwohours。Dunglison’sPractice，1842，vol。ii。p。520。Eightygrainsinonedose。
Ibid。p。536。Ninety-sixgrainsofsulphateofquinineareequaltoeightouncesofgoodbark——Wood&Bache。]andthattheAmericaneaglescreamswithdelighttoseethreedrachmsofcalomelgivenatasinglemouthful？
AddtothisthegreatnumberofMedicalJournals，alluseful，wehope，mostofthemnecessary，wetrust，manyofthemexcellentlywellconducted，butwhichmustfindsomethingtofilltheircolumns，andsoprintallthenewplansoftreatmentandnewremediestheycangetholdof，asthenewspapers，fromasimilarnecessity，printtheshockingcatastrophesandterriblemurders。
Besidesallthis，herearewe，thegreatbodyofteachersinthenumberlessmedicalschoolsoftheUnion，someofuslecturingtocrowdswhoclapandstampinthecities，someofuswanderingoverthecountry，likeotherprofessionalfertilizers，tofecundatethemindsoflessdemonstrativeaudiencesatvariousscientificstations；
allofustalkinghabituallytothosesupposedtoknowlessthanourselves，andlovingtoclaimasmuchforourartaswecan，nottosayforourownschools，andpossiblyindirectlyforourownpracticalskill。Hencethatannualcropofintroductorylectures；
theusefulblossomingintotheornamental，asthecabbagebecomesglorifiedinthecauliflower；thatlecture-roomliteratureofadjectives，thatdeclamatoryexaggeration，thatsplendidshowoferuditionborrowedfromD’Israeli，andcreditedtoLordBaconandtherest，whichhavesuggestedtoourfriendsoftheMedicalJournalsanoccasionalepigramatourexpense。Hencethetendencyintheseproductions，andinmedicallecturesgenerally，tooverstatetheefficacyoffavoritemethodsofcure，andhencethepremiumofferedforshowytalkersratherthansagaciousobservers，forthemenofadjectivesratherthanofnounssubstantiveinthemoreambitiousoftheseinstitutions。
Sucharesomeoftheeddiesinwhichweareliabletobecomeinvolvedandcarriedbackoutofthebroadstreamofphilosophical，or，inotherwords，truth-loving，investigations。Thecausesofdisease，inthemeantime，havebeenlessearnestlystudiedintheeagernessofthesearchforremedies。Speaksoftly！Womenhavebeenborneoutfromanold-worldhospital，twoinonecoffin，thatthehorrorsoftheirprison-housemightnotbeknown，whiletheverymenwhowerediscussingthetreatmentofthediseasewerestupidlyconveyingtheinfectionfrombedtobed，asrat-killerscarrytheirpoisonsfromonehouseholdtoanother。DonotsomeofyourememberthatIhavehadtofightthisprivate-pestilencequestionagainstascepticismwhichsneeredinthefaceofamassofevidencesuchasthecalmstatisticiansoftheInsuranceofficecouldnotlistentowithouthorrorandindignation？[TheContagiousnessofPuerperalFever。“-N。
E。QuanJour。ofMedicineandSurgery，April，1843。Reprinted，withAdditions。Boston：Ticknor&Fields。1855。]Haveweforgottenwhatistoldinoneofthebookspublishedunderourownsanction，thatasimplemeasureofventilation，proposedbyDr。JohnClark，hadsavedmorethansixteenthousandchildren’slivesinasinglehospital？Howlongwouldithavetakensmalldosesofcalomelandrhubarbtosaveasmanychildren？Thesemaybeusefulinprudenthands，buthowinsignificantcomparedtothegreathygienicconditions！Causes，causes，andagaincauses，——moreandmorewefallbackontheseasthechiefobjectsofourattention。TheshortestsystemofmedicalpracticethatIknowofistheoldest，butnottheworst。ItisolderthanHippocrates，olderthanChirontheCentaur。
Naturetaughtittothefirstmotherwhenshesawherfirst-bornchildputtingsomeuglypebbleorluridberryintoitsmouth。Iknownotinwhatlanguageitwasspoken，butIknowthatinEnglishitwouldsoundthus：Spititout！
Artcandosomethingmorethansaythis。Itcansometimesreachthepebbleorberryafterithasbeenswallowed。Butthegreatthingistokeepthesethingsoutofchildren’smouths，andassoonastheyarebeyondourreach，tobereasonableandpatientwithNature，whomeanswell，butdoesnotliketohurry，andwhotookninecalendarmonths，moreorless，toeverymother’ssonamongus，beforeshethoughthewasfittoheshowntothepublic。
Suffermenowtolaydownafewpropositions，whetheroldornewitmatterslittle，notforyourimmediateacceptance，noryetforyourhastyrejection，butforyourcalmconsideration。
Butfirst，thereareanumberoftermswhichweareinthehabitofusinginavaguethoughnotunintelligibleway，andwhichitisaswellnowtodefine。Thesetermsarethetoolswithwhichwearetowork，andthefirstthingistosharpenthem。Itisnothingtousthattheyhavebeensharpenedathousandtimesbefore；theyalwaysgetdullintheusing，andeverynewworkmanhasarighttocarrythemtothegrindstoneandsharpenthemtosuithimself。
Nature，inmedicallanguage，asopposedtoArt，meanstrustinthereactionsofthelivingsystemagainst，ordinarynormalimpressions。
Art，inthesamelanguage，asopposedtoNature，meansanintentionalresorttoextraordinaryabnormalimpressionsforthereliefofdisease。
Thereactionofthelivingsystemistheessenceofboth。Foodisnothing，ifthereisnodigestiveacttorespondtoit。Wecannotraiseablisteronadeadman，orhopethatacarminativeforcedbetweenhislipswillproduceitsordinaryhappyeffect。
Disease，dis-ease，——disturbedquiet，uncomfortableness，——meansimperfectorabnormalreactionofthelivingsystem，anditsmoreorlesspermanentresults。
Food，initslargestsense，iswhateverhelpstobuildupthenormalstructures，ortomaintaintheirnaturalactions。
Medicine，indistinctionfromfood，iseveryunnaturalornoxiousagentappliedforthereliefofdisease。
PhysicmeansproperlytheNaturalart，andPhysicianisonlytheGreeksynonymeofNaturalist。
WiththesefewexplanationsIproceedtounfoldthepropositionsI
havementioned。
Diseaseanddeath，ifwemayjudgebytherecordsofcreation，areinherentlyandessentiallynecessaryinthepresentorderofthings。
Aperfectintelligence，trainedbyaperfecteducation，coulddonomorethankeepthelawsofthephysicalandspiritualuniverse。Animperfectintelligence，imperfectlytaught，——andthisistheconditionofourfinitehumanity，——willcertainlyfailtokeepalltheselawsperfectly。Diseaseisoneofthepenaltiesofoneoftheformsofsuchfailure。Itisprefiguredintheperturbationsoftheplanets，inthedisintegrationoftheelementalmasses；ithasleftitstracesinthefossilorganismsofextinctcreations。[ProfessorAgassizhaskindlyhandedmethefollowingnote：“Thereareabnormalstructuresinanimalsofallagesanteriortothecreationofmankind。MalformedspecimensofCrinoidsareknownfromtheTriassicandJurassicdeposits。MalformedanddiseasedbonesoftertiarymammaliahavebeencollectedinthecavernsofGailenreuthwithtracesofhealing。“]
Butitisespeciallytheprerogative，Ihadalmostsaidprivilege，ofeducatedanddomesticatedbeings，frommandowntothepotato，servingtoteachthem，andsuchastrainthem，thelawsoflife，andtogetridofthosewhowillnotmindorcannotbekeptsubjecttotheselaws。
Disease，beingalwaysaneffect，isalwaysinexactproportiontothesumofitscauses，asmuchinthecaseofSpigelius，whodiesofascratch，asinthatofthemanwhorecoversafteranironbarhasbeenshotthroughhisbrain。Theoneprevalentfailingofthemedicalartistoneglectthecausesandquarrelwiththeeffect。
Therearecertaingeneralfactswhichincludeagooddealofwhatiscalledandtreatedasdisease。Thus，therearetwooppositemovementsoflifetobeseenincitiesandelsewhere，belongingtoraceswhich，fromvariouspersistentcauses，arebreedingdownandtendingtorunout，andtoraceswhicharebreedingup，oraccumulatingvitalcapital，——adescendingandanascendingseries。
Letmegiveanexampleofeach；andthatImayincidentallyremoveacommonimpressionaboutthiscountryascomparedwiththeOldWorld，animpressionwhichgottipsywithconceitandstaggeredintotheattitudeofaformalpropositionintheworkofDr。RobertKnox，I
willillustratethedownwardmovementfromEnglishexperience，andtheupwardmovementfromafamilyhistorybelongingtothisimmediateneighborhood。
MissNightingalespeaksof“thefactsooftenseenofagreat-grandmother，whowasatowerofphysicalvigor，descendingintoagrandmotherperhapsalittlelessvigorous，butstillsoundasabell，andhealthytothecore，intoamotherlanguidandconfinedtohercarriageandhouse；andlastlyintoadaughtersicklyandconfinedtoherbed。“SomuchforthedescendingEnglishseries；nowfortheascendingAmericanseries。
SomethingmorethanonehundredandthirtyyearsagotheregraduatedatHarvardCollegeadelicateyouth，wholivedaninvalidlifeanddiedattheageofaboutfifty。Histwochildrenwerebothofmoderatephysicalpower，andoneofthemdiminutiveinstature。Thenextgenerationroseinphysicaldevelopment，andreachedeightyyearsofageandmoreinsomeofitsmembers。Thefourthgenerationwasoffairaverageendowment。Thefifthgeneration，great-great-
grandchildrenoftheslenderinvalid，areseveralof，themofextraordinarybodilyandmentalpower；largeinstature，formidablealikewiththeirbrainsandtheirarms，organizedonamoreextensivescalethaneitheroftheirparents。
Thisbriefaccountillustratesincidentallythefallacyoftheuniversal-degenerationtheoryappliedtoAmericanlife；thesameonwhichoneofourcountrymenhaslatelybroughtsomeveryforciblefactstobearinamusculardiscussionofwhichwehaveheardrathermorethanisgoodforus。Butthetwoseries，AmericanandEnglish，ascendinganddescending，wereadducedwiththemainpurposeofshowingtheimmensedifferenceofvitalendowmentsindifferentstrainsofblood；adifferencetowhichallordinarymedicationisinallprobabilityamatterofcomparativelytrivialpurport。Manyaffectionswhicharthastostriveagainstmightbeeasilyshowntobevitaltothewell-beingofsociety。Hydrocephalus，tabesmesenterica，andothersimilarmaladies，arenaturalagencieswhichcutoffthechildrenofracesthataresinkingbelowthedecentminimumwhichnaturehasestablishedastheconditionofviability，beforetheyreachtheageofreproduction。Theyarereallynotsomuchdiseases，asmanifestationsofcongenitalincapacityforlife；
theracewouldberuinedifartcouldeverlearnalwaystopreservetheindividualssubjecttothem。Wemustdothebestwecanforthem，butweoughtalsotoknowwhatthese“diseases“mean。
Again，invalidismisthenormalstateofmanyorganizations。Itcanbechangedtodisease，butnevertoabsolutehealthbymedicinalappliances。Therearemanyladies，ancientandrecent，whoareperpetuallytakingremediesforirremediablepainsandaches。Theyoughttohaveheadachesandback-achesandstomach-aches；theyarenotwelliftheydonothavethem。Toexpectthemtolivewithoutfrequenttwingesislikeexpectingadoctor’soldchaisetogowithoutcreaking；ifitdid，wemightbesurethespringswerebroken。Thereisnodoubtthattheconstantdemandformedicinalremediesfrompatientsofthisclassleadstotheirover-use；ofteninthecaseofcathartics，sometimesinthatofopiates。IhavebeentoldbyanintelligentpractitionerinaWesterntown，thattheconstantprescriptionofopiatesbycertainphysiciansinhisvicinityhasrenderedthehabitualuseofthatdruginallthatregionveryprevalent；morecommon，Ishouldthink，thanalcoholicdrunkennessinthemostintemperatelocalitiesofwhichIhaveknownanything。Afrightfulendemicdemoralizationbetraysitselfinthefrequencywithwhichthehaggardfeaturesanddroopingshouldersoftheopium-drunkardsaremetwithinthestreets。
ThenextpropositionIwouldaskyoutoconsideristhis：
Thepresumptionalwaysisthateverynoxiousagent，includingmedicinesproper，whichhurtsawellman，hurtsasickone。