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as require the assistance of medicine; most of the sixth book is taken up with diseases properly surgical, though not requiring operations; and in the two remaining books, he gives a systematic exposition of surgery; the last book being occupied exclusively with diseases and injuries of the bones and joints. We have already had occasion to condense from the preface to his first book, his exposition of the opinions and arguments of the Rationalists and Empirics. The following are his own views on the merits of the whole discussion: .
"Since these points have often been and still continue to be disputed with great warmth, by physicians, in large volumes, it is proper to add some reflections that may seem to come the nearest to the truth, and which neither slavishly follow either of these opinions, nor are too remote from both, but, as it were, intermediate between these opposite extremes; which those who inquire after truth without partiality, may find to be the surest method for directing the judgment in most warm controversies, as well as in this now before us. For, with regard to the causes of health or disease, in what manner the air or food is either conveyed or dis tributed, the philosophers themselves do not attain to an absolute certainty; they only make probable conjectures. Now, when there is no certain knowledge of a thing, 'a mere opinion about it cannot discover a sure remedy. And it must be owned that nothing is of greater use, even to the rational method of curing, than experience. Although, then, many things are taken into the study of arts,
which do not, properly speaking, belong to the arts themselves, yet they may greatly improve them by quickening the genius of the artist; wherefore the contemplation of nature, though it cannot make a man a physician, yet may render him fitter for the practice of medicine. * * And medicine itself requires the help of reason, if not always amongst the occult causes or the natural actions, yet often, for it is a conjectural art; and not only conjecture in many cases, but even experience is found not. consistent with its rules. * * A new distemper sometimes, though very seldom, appears; that such a case never happens, is manifestly false. * * Nor is similitude always serviceable in this kind of practice; and where it is, this properly belongs to the rational part." * ** To the physician, he adds, “it makes considerable difference whether the distemper is occasioned by fatigue, or thirst, or cold, or heat, or watching, or hunger; or whether it arises from too much food or wine, or excess of venery.. And he ought not to be ignorant of the constitution of the patient, whether his body be too moist or too dry; whether his nerves be strong or weak; whether he be frequently or seldom ailing; and whether his illnesses are severe or slight, of long continuance or short; what kind of life he has led, laborious or sedentary, luxurious or frugal; for from these and such-like circumstances, he must often draw a new method of cure."
In reference to the Methodists, his censure is less guarded. "If they assert their maxims," says he, "to hold universally, they are still more rationalists
than those who pass under that name; but if, which is nearer the truth, the art of medicine hardly admits of any universal precepts, then they are in the same class with those who depend upon experience alone. ** Nor is any improvement made by them upon the profession of the empirics; but, on the contrary, something is taken from it, the empirics attending with great circumspection, to many circumstances, whereas these regard only the easiest, and no more than the common things." * * “I am apt to think," says he, "that he who is not acquainted with the peculiarities, ought only to consider the general; and that he who can find out the particular, ought not to neglect but to take them in too, for the direction of his practice. And therefore where knowledge is equal, yet a friend is a more useful physician than a stranger. To return to my point, then, my opinion is, that medicine ought to be rational; but to draw its methods from the evident causes, all the obscure being removed, not from the attention of the artist, but from the practice of the art. Again, to dissect the bodies of living men is both cruel and superfluous. But the dissection of dead subjects is necessary for learners, for they ought to know the position and order of the parts, which dead bodies will show better than a living and wounded man. But as for the other things which can only be observed in living bodies, practice itself will discover them in the cure of the wounded, somewhat more slowly, but with more tenderness."
As a comment on these remarks, we might refer
to his brief anatomical description of the internal organs, at the commencement of the fourth book, portions of which could have been derived only from the actual dissection of the human subject.
It has been remarked by a recent critic, that Celsus paid little regard to the pulse as an index of the condition of the system. But his remarks on the variability of the pulse are perfectly just, and are intended not to show his neglect of it, but rather to put the physician upon his guard against hasty judgments. "It is the business of the skillful physician," says he, "not to take hold of the patient's arm with his hand as soon as he comes in, but first to sit down with a cheerful countenance, and ask him how he does; and if he has any apprehension, to encourage him with plausible discourse, then to apply the hand to the wrist.”
In common with the elder Greeks, he recommends caution in undertaking the management of dangerous and incurable ailments. "A physician," says he, "should, above all things, know what are incurable, what difficult to cure, and what more easy; for it is the part of a prudent man first, not to undertake one whose case is desperate, lest he appear to have killed him whom destiny has destroyed. Next, in a case of great danger, but not quite desperate, to make known to the friends of the patient that it is a matter of difficulty, so that if the malady should prevail against the art, he may neither seem to have been ignorant himself, nor to have deceived them. But," adds he, "as this is the proper conduct for a prudent person, so, on the contrary, it
is the part of a quack to exaggerate a small matter, that he may appear to have performed the greater cure." When the case is easy, he recommends diligence and circumspection on the part of the physician, "that what is in itself small, may not, by his negligence, become more considerable.”
Before leaving this able author, we may notice his opinion of what a surgeon should be, and of what surgery should embrace. "Surgery, the third part of medicine," says he, "does not discard medicines and proper regimen; but yet the principal part is accomplished by the hand, and the effect of this is the most evident of all the parts of medicine. For, as fortune contributes a good deal to the cure of distempers, and the same things are often salutary, often fruitless; it may be doubted whether the recovery be owing to physic or the constitution. * But in surgery, it is manifest that the success, though it may be somewhat promoted by other means, is chiefly to be ascribed to this." "A surgeon," he continues, ought to be young, or at most, but middle-aged; to have a strong and steady hand, never subject to tremble, and to be no less dexterous with his left than his right hand; to have a quick and clear sight; to be bold, and so far void of pity that he may have only in view the cure of him whom he has taken in hand, and not in compassion to his cries either make more haste than the case requires, or cut less than is necessary; but do all as if he were not moved by the shrieks of the patient." And then, as to the province of surgery, "it may be asked what peculiarly belongs to