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An Inquiry into the Degree of Certainty in Medicine; and into the Nature and Extent of Its Power over Disease
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ELISHA BARTLETT AN INQUIRY INTO THE DEGREE OF CERTAINTY IN MEDICINE; AND INTO THE NATURE AND EXTENT OF ITS POWER OVER DISEASE Editor's Note Elisha Bartlett (1804-55) practiced and taught medicine in several states from Kentucky to New England. In 1844 he published his Essay on the Philosophy of Medical Science, reflecting the Parisian influence. His reputation, like that of many historical figures before and since, has had its ups and downs at the hands of historians. According to his contemporaries, and many who followed, Bartlett's chief claim to fame rests on his magnificent book, The History, Diagnosis , and Treatment of Fevers in the United States (Philadelphia: Lea and Blanchard, 1842), that went through four popular editions.1 The "elegant and classical" essay of Pierre Jean George Cabanis, on which Bartlett's Inquiry is patterned, was published as Du Degre de Certitude de la Medecine, in 1797, with a new edition in 1803. R. LaRoche translated it into English as An Essay on the Certainty of Medicine (Philadelphia: Desilver, 1823). By presenting to students and practitioners of medicine a philosophical analysis of its methods, Cabanis believed he would perform a service for all mankind. Himself a physician, Cabanis (1757-1808), was one of the best known members of the group of philosophers known as the ideologues. These men sought to bring about a medical revolution at the time of the great political and social upheaval we know as the French Revolution. Based on sensualist doctrines of Condillac and others, this new approach to medicine wasto be founded on close observation of patients, both during life and at autopsy. Cabanis began his essay on certainty by stating the objections against certainty in medicine alleged by cavillers against it. The mysteries of life, of disease, and the action of drugs were held by some to be beyond our grasp, hence uncertainty prevailed. This opinion, Cabanis argued, was contrary to the facts and was a product of bad reasoning, as was, unfortunately, much of the thinking applied to medicine. As one example, he cited: "A cure follows the application of a remedy; the remedy therefore has produced the cure; post hoc, ergo propter hoc. This is, Philadelphia: Lea and Blanchard, 1848. 1 Lester King has recently characterized him as a shortsighted, arrogant, and "empirical" writer. "Medical philosophy, 1836-1844," in Medicine, Science, and Culture, Historical Essays in Honor of Owsei Temkin, Lloyd G. Stevenson and Robert P. Multhauf, eds. (Baltimore: The Johns Hopkins Press, 1968), pp. 143-59. To an earlier generation, such as William Osier's, Bartlett was a very appealing figure. See Osier's "Elisha Bartlett, A Rhode Island Philosopher," in An Alabama Student and other Biographical Essays (New York: Oxford University Press, 1908), pp. 108-58. See also Erwin H. Ackerknechfs important appraisal of Bartlett in "Elisha Bartlett and the philosophy of the Paris clinical school," Bull Hist. Med. 24 (1950): 43-60. 115 116 MEDICAL PRACTICE undoubtedly, a specimen of very bad reasoning, yet by this fallacious rule have all the articles of the materia medica been arranged, and the mode of administering them reduced to a system. Assuredly nothing demands a more enlightened mind, more sagacity, and circumspection than the discovery of truths of this kind."2 While the problems were real, they were not insurmountable. "I dare make bold to predict," concluded Cabanis, "that together with the true method of observation, the spirit of philosophy which should always predominate in it will soon revive in medicine, and that the science will assume a different aspect."3 John Forbes (1787-1861), a distinguished British physician and medical editor , to whom Bartlett refers in rather unfriendly terms, wrote a great deal on the subject of "nature and art." The particular piece that offended Bartlett, and many others, was a long review essay Forbes published in the journal he edited. Forbes entitled his piece "Homeopathy, allopathy, and 'young physic.' "4 Although purporting to be a collective review of nine books on homeopathy, including an 1819 edition of Hahnemann's Organon der Heilkunst, Forbes really examined the whole problem of therapeutics. He provided his readers with a concise history and theory of homeopathy and then inquired into that system's ability to cure disease and in the power of allopathy, or regular medicine, to achieve the same goal. Forbes was duly impressed by some of the results reported by followers of Hahnemann. About one case of dyspepsia treated by a highly diluted preparation of strychnine, Forbes waxed lyrical...