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。