Medical Times & Gazette. ORIGINAL LECTURES. A DISCOURSE ON THE LIFE AND WORKS OF THE LATE ROBERT JAMES GRAVES, M.D., F.R.S. BY WILLIAM STOKES, M.D. Regius Professor of Physic in the University of Dublin. [Read before the Association of the King and Queen's College of Physicians in Ireland.] IN reviewing the progress of human knowledge as seen in the onward march of science and of literature, and that of a nation's social state and power, we recognise two sources of advancement, which though distinctly separate, are nevertheless mutually reactive. One is a general influence, affecting, it may be, simultaneously, or nearly simultaneously, many men in a community. Its beginnings are obscure, often, indeed, hidden,—its progress slow,—its action unperceived, even by those who unconsciously bend to its influence, but its operation extensive. It produces great, but not the highest results, and seems rather to prepare the way for what is to come, than to be its immediate cause. The birth of the other is widely different, though in one seuse it is consequent on the first. It is recognisable, distinct, sudden, solitary. It lightens the past, and betokens the future, and stands forth as the embodiment of a powerful, long-existing, but diffused influence. The waters were gathered together, and the dry land appeared. The earth was covered with beauty, and no longer void; it teemed with living, though inferior forms, and was ready for that higher birth by which the work of creation was completed and crowned. So is it in human progress, as testified by the histories of nations and communities of men. The chronicles of arms, of art, of literature, and of science, all tell of the silent, but broadcast sowing of the seed, which at last, in some favoured instance, and at its appointed time, bursts into manifest and majestic life, and the tree overshadows the plain, and the fowls of the air come to rest in its branches. You will not, I hope, imagine, that in these observations I seek by any overwrought imagery to raise the memory of Graves beyond that point which his humbleness and truthfulness of mind have indicated. Such a course would only lead to its depreciation. But I want to convey to you what I believe to be true, that his labours, his life, mark, if not a culminating point, at least an era in the history of Irish, and, I may say, of British medicine. The symptomatological school may well boast of its Sydenhams, Fothergills, Haygarths, of Huxham, of Cullen, and of Gregory; but, in the advance of medicine, after the introduction of the physiological and anatomical modes of studying disease, we must admit to the highest place the labours of Graves, as combining in a philosophical eclecticism the lights of the past with those of the present. For his mind, while it mastered the discoveries of modern investigation remained embued with the old strength and breadth of view, so characteristic of those fathers of British medicine whose names I have just now recalled. And thus he had the rare privilege of leading the advance of the present school of medicine, while he never ceased to venerate and to be guided by the wisdom, the mode of thinking, and the labours of the past. Yet, though we must admit that his name has marked an era in the medical literature of our country, we are not to believe that the progress of that literature will be arrested with his death. The same soil from which he sprang has produced other energetic and truth-finding men, many of whom are among us, and long may they be spared to us. And we must have faith in our countrymen, and a stedfast hope that the growing convic[No. 745.-NEW SERIES, No. 184.] [JAN. 7, 1854. tion of the insufficiency of genius, however brilliant, to accomplish great ends, without its complement and implement of talent, which embraces energy, industry, perseverance, all tending to power, will assist at length in raising the schools of Ireland to a still higher position. Robert James Graves, the second son of the Rev. Richard Graves, Senior Fellow of Trinity College, Dublin, and subsequently Dean of Ardagh, and Professor of Divinity in the University, was born in Dublin on the 27th of March, 1797. From an early period, he showed indications of that energy and activity of mind which so distinguished him in after life. I have learned, since his death, that, while still a schoolboy, he established a weekly journal, with leading articles, for the amusement and instruction of the school public. The talent displayed in this juvenile periodical called forth the marked admiration of Dr. Magee, afterwards Archbishop of Dublin. Many years afterwards, we find him, if not founding, at least assisting in the establishment of another periodical, the Dublin Journal of Medical Science, first set on foot by Sir Robert Kane; and to this Journal he was for many years the most fruitful and valuable contributor. Of the influence and the true mission of the public Press, Dr. Graves always entertained a just opinion. Himself a true monarchist in principle, he was yet an ardent lover and a champion of civil and religious liberty in every country; and many of the most striking of the leading articles in the journals of the day were from his pen, or were compiled from facts furnished by him. He was one of the Editors of the fourth and fifth volumes of the "Dublin Hospital Reports," and contributed papers to the "Transactions of the Royal Irish Academy," and to the Edinburgh Philosophical Journal. The last of his communications was a paper on the Similarity of Geological character between the Dead-Sea of Palestine and the Great Salt Lake of North-western America. To this paper, if time permit, I shall hereafter allude. His undergraduate course in College was marked by great diligence and corresponding success. He received many honours in science and classics, and finally obtained the gold medal. His two brothers were, at the same time, students in the University, and this highest prize for undergraduate study was awarded to each of the three brothers on the completion of their respective courses. Having obtained his medical degree, he did not content himself with commencing the life-to use his own words"of a practitioner without practice;" but he proceeded to the Continent, and spent several years in visiting the great capitals of Europe, closely and anxiously studying at their Medical Schools; not only making himself intimate with the actual state of medical knowledge on the Continent, but in forming friendships with the leading physicians and physiologists of France, Germany, Italy, and the North of Europe. Here I shall detail an anecdote of value, as furnishing an insight into the character of the man, and as it prepares us for understanding that feature in his after-life for which he was justly distinguished-namely, his collectedness of mind and vigour of action in cases of difficulty and danger. He had embarked at Genoa, in a brig bound for Sicily. The captain and crew were Sicilians, and there were no passengers on board but himself and a poor Spaniard, who became his companion and messmate. Soon after quitting the land, they encountered a terrific gale from the north-east, with which the ill-found, illmanned, and badly-commanded vessel soon showed herself unable to contend. The sails were blown out of the bolt-ropes, the vessel was leaking, the pumps choked, and the crew, in despair, gave up the attempt to work the ship. At this juncture, Graves was lying on a couch in the cabin, suffering under a painful malady, when his fellow-passenger entered, and, in terror, announced to him, that the crew were about to forsake the vessel; that they were then in the very act of getting out the boat; and that he had heard them say, that the two passengers were to be left to their fate. Springing from his couch, Graves flung on his cloak, and, looking through the cabin, found a heavy axe lying on the floor. This he seized, and, concealing it under his cloak, he gained the deck, and found that the captain and crew had nearly succeeded in getting the boat free from its lashings. He addressed the captain, declaring his opinion, that no boat could live in such a sea, and that the attempt to launch it was madness. He was answered by an execration, and told, that it was a matter with which he had nothing to do, for that he and his companion should remain behind. "Then," exclaimed he, "if that be the case, let us all be drowned together. It is a pity to part good company." As he spoke, he struck the sides of the boat with his axe, and 2 MEMOIR OF THE LATE ROBERT JAMES GRAVES, M.D. destroyed it irreparably. The captain drew his dagger, and would have rushed upon him, but quailed before the cool, erect, and armed man. He then virtually took command of the ship. He had the suckers of the pumps withdrawn, and furnished by cutting from his own boots the leather necessary to repair the valves. The crew returned to their duties, the leak was gained on, and the vessel was saved. On his return to Dublin, he was appointed Physician to the Meath Hospital, an Institution already adorned with the names of the Deases, of Richards, of Barker, Cheyne, and Crampton. This was in 1824, and from that period the history of Graves becomes inseparably combined with that of the Irish School of Medicine. On a former occasion, and in the hall of the College of Physicians, I have shown, that the period which followed the union of this country with England was one, if not of mental collapse, at least of mental inactivity in Ireland. For twenty years little vitality was shown in the Irish mind. Her great men one by one disappeared. Her orators, her advocates were no longer heard, unless feebly and in another place, and her young men were apathetic. Such a result appears to have been inevitable, when we consider the altered political condition of the country; and a period of at least one generation was necessary to develope those energies which would work out for Ireland her proper place, no longer as a detached or a loosely-connected portion of the British Empire, but as an integral part of that centre of power. Taking the period between 1820 or 1825 to 1840, we find it the most remarkable, and, in my opinion, not the least glorious, epoch in our history; for it was then that that general movement in every department of mental culture commenced among us, which has given to this country, in her scientific and literary relations, a lustre and a character, which, let us trust, are but the heralds of her future advancement and her peaceful triumphs. Among the leaders in this movement, we must give to Dr. Graves a most honourable place. Schools of medicine and of surgery had, it is true, existed before his time; and during the war, and immediately after it, they were the resort of many students; but their chief attraction was less the character of their professors, or the number of the original works which issued from them, than the circumstance, that of all the cities in the British Empire, Dublin was that in which the greatest supply of dead bodies for dissection could be obtained. True, we had a few eminent teachers among us, and the system of clinical lectures, improperly so called, had been commenced. clinical teaching, in its true sense, was unknown. Whatever instruction might have been given to the class, there was little, if any anxiety to teach the individual pupil, to encourage him to learn, to show him how to teach himself, to bring him into the true relation in which he ought to stand with his instructor, to make him familiar with bedside medicine, to show him the value which attends on every new fact and observation of medicine, and to make him learn the duty as well as taste the -pleasure of original investigations. Then was exhibited to the student the example of a mind trained and strengthened by University education, in the study of the exact sciences, and literature, and in medicine so richly stored, that it might be taken as the exponent of the existing state of the science; ardent in research, fruitful in discovery, no miser of its wealth, but pouring forth its richness to all that would receive it. Those who remember the impetus which his introduction of the Practical method gave to clinical study,-those who had the happiness of hearing his lectures on physiology, delivered in the very room in which we are assembled, will bear me out in what I have now said. But Power of oratory, extent of knowledge, and clear exposition of the views of other men are, in the opinion of the world, the great sources of success in a teacher. But I believe that this is taking a too limited view of the matter. All these, indeed, he had, and in a singular degree. The style of his speaking was a massive, nervous, forcible style, unweakened by sentimentality, undisfigured by bathos. So seldom, indeed, did he avail himself of the usual ornaments of oratory, that when he did indulge in any figure, it was to his hearers as to travellers over some mountain range, magnificent from the height of its peaks and the grandeur of its mass, in which, as they journey on, some solitary wild flower bursts upon their view, the more prized, the more loved, because contrasting with the manifestations of force and vastness which stretch around it. As a specimen of his rarely exhibited poetic power, let me read you an extract from his "Essay on Latent Life," published in 1836: "These facts are sufficient to warrant the conclusion, that the period during which the seeds of plants are capable of preserving the power of germination, might be indefinitely prolonged, pro vided that the physical influences to which they are exposed be favourable; and we are consequently led to reflect on a singular and marked difference between latent and manifest life; the former may exist on,-I had almost said forever; the latter, once commenced, has its appointed end and termination. Thus the curious fact has been observed of a bulbous root, taken from the hand of an Egyptian mummy, having germinated when placed in the soil; how it happened that this bulb remained for several thousand years in contact with the fingers of death, without its own vital principle being either extinguished or called into active operation? What power at once preserved that principle and held it in abeyance? And yet so it was, and age after age passed away without summoning into action that wondrous spell which can thus convert this long-enduring tenant of the tomb into the lily of the field, the Scriptural emblem of beauty, and the honoured type of the glories of vegetable life, beside the purity and brightness of whose hues even the raiment of Solomon appeared dull and faded. If the latent principle may thus co-exist combined with matter, during so many centuries, there can be no reason why this association of that which is and that which is to be, should not continue forever, provided the physical medium in which this organised mass happened to be placed, was calculated, like the cool, dry, dark air of the Egyptian sarcophagus to preserve its mysterious inhabitant unawakened, uninjured. In this point of view, we may almost award to life the attribute of eternity. How wonderful the arrangement of matter which can thus hold, incarcerated in its organised recesses, a principle that waits but the genial influence of heat and moisture to burst its prison. How fleeting the existence of life, once actually commenced, compared with the durability of life thus dormant, but ever ready to begin its mortal race!" I have said, that in considering the sources of success in a teacher, we must look beyond oratory, and beyond erudition. The greatest quality in a teacher is, that he be in earnest; for this gives to every word he utters a power of forcing its way that cannot be resisted. In the next place, to use the words of a great and thinking man, he must not supply his hearers from a cistern, but must give them living water. He must not, we may add, expect attention or interest when he only gives, no matter how valuable, the same facts, views, and arguments, year after year. For even to those who hear him for the first time his discourse will fail in vitality, and in producing that electric sympathy between the speaker and the hearer, which makes the latter not only receive gladly what has been said, but almost to anticipate what is to follow. This power is only attainable when the teacher is an original investigator, when he has himself been permitted to strike the rock, and to pour forth the fresh and sparkling stream. Genius, the creative power, so far as such a power is given to man, will, while it produces, by an inevitable necessity, find a language of its own, which he who merely deals with the thoughts of other men, or even with his own if they have grown old, can never speak. And this element of original investigation in a teacher acts in other directions. It leads to the analogic method; giving even to the past a new freshness. In this Dr. Graves was pre-eminent; indeed his active mind was ever seeking for, and finding, analogies; and this led him to the discrimination of things similar, and to the assimilation of things dissimilar, in a degree seldom surpassed by any Medical teacher. Finally, what can more excite the student than the feeling that his instructor remains himself a fellow-student, not only in community of pursuits, but in similarity of mind, we might almost say, of years. The youthful energy of such a teacher remains long unquenched, for I know of no barrier that the individual man can erect against the advance of time, if it be not the continued acquisition of knowledge. In reviewing the medical doctrine of Graves we find it to be essentially eclectic. The legitimate object of physiology, according to him, was not the study of vital actions, but rather the investigation and arrangement of their effects. This doctrine is well illustrated by showing how medicine retrogrades whenever we pursue a different course, and the endless mazes of speculation which followed on the doctrines of Brown, and the school of the Vitalists. The errors in practice and in pathology, and the necessary twisting of the truth to fit the theory, in the system of Broussais, are strong examples of the evil consequences of beginning at the wrong end, and of puzzling ourselves with systems based on the still unknown nature of vital actions rather than effects. So long as we confine ourselves to these latter we advance in two directions; in the one, absolutely, in extending our knowledge of the mechanism of organs, and of course in applying that knowledge to the treatment of their diseases; in the other, approximately, if I may use the expression, for we MEMOIR OF THE LATE ROBERT JAMES GRAVES, M.D. are laying up data for the ultimate solution of the higher problem of the nature of life. This is well exemplified by reference to the structure of the eye, an organ which gives light to the body in more senses than one. In his general pathology, great importance was attached to the action of the capillary system, and the vis à tergo theory of the circulation in health and disease was on every occasion combated by him; for this question bore strongly on that great revolution in practice, by which the lancet has become nearly discarded in the treatment of disease in this country. His arguments in favour of the independence and importance of the capillary circulation are beautifully illustrated by reference to the phenomena of the gravid uterus. Here we see not,only vessels innumerable but nerves developed without any increased vis à tergo; and the nerves, like the vessels, developed from the circumference to the centre. This subject of a temporary nervous development is one full of interest; and he declares his conviction, that, did our means of investigating the nerves equal those we enjoy in the examination of the vessels, we should find, that in inflamed parts the nervous matter increases, in many cases, as rapidly and as considerably in extent as the vascular. The connexion of morbid anatomy with practical medicine has been looked at by physicians in opposite points of view; and it becomes difficult to say which of them is the most injurious to the cause of practical medicine. The local change is not the disease; for, to produce it, a change in the vital action of the part must go before. It is, then, but a symptom; but yet not the less important, for the physical alteration becomes the most useful of symptoms, enabling us to discover the seat, the proThere is gress, and sometimes the intensity of diseased action. no physical sign of the first stage of any disease; and the period between the truly first stage, and that in which mechanical change sufficient to give a physical indication occurs, varies infinitely, not only in different diseases, but in different cases of the same disease. But it happens, fortunately, that this period is generally so short, that the discerning of the mechanical change can be made sufficiently early to enable us, as it were, to overtake the disease. Exactly in proportion to the facility and the accuracy with which we can discover the nature and extent of the alteration, will be the progress of practical medicine. But it was no part of this doctrine that we were to follow an anatomical theory of disease; for, in truth, the local or detectible change is often not merely the second, but the third link in the chain of phenomena which constitute a disease. Thus, in essential affections, we have, as the first condition, a change affecting the entire organism, in which it acts apparently under a new system of vital laws. Secondly, a special, local, but still vital or non-mechanical alteration; and, thirdly, the anatomical change. Thus, so far, at least in a large proportion of cases, is the follicular disease of the intestine from being the first change, and the local cause of fever, that it is actually the third in the series of phenomena. But the great fact is insisted on, that even in the non-essential diseases, lesion of structure does not necessarily attend even the most striking symptoms of disease. This is shown most remarkably in the class of the neuroses. On the other hand, the attempt to classify disease, ignoring their possible anatomical alteration, and of founding a system of treatment based on the existence of this or that group of symptoms, is justly condemned. "Tell me the name of the disease," was the motto of the nosologists, "and I will tell you the remedy." But the names of a hundred diseases may be told, and accurately told, without our being able to name the proper mode of treatment. A picture is drawn of a case of dropsy, and hydrogogues and diuretics are successively administered on the nosological indication, until the scene so distressing to humanity is closed. We are to found medicine, then, on no narrow basis. The accurate study of symptoms must be accompanied, on the one hand, by an extended knowledge of physiology, that is, the science of the effects of vital action; and, on the other, by an equally comprehensive view of pathological anotomy; and to all these we must add the effects of therapeutic agents. Looking at the results of the full adoption of these principles carried out by the collective energies of the world, Dr. Graves observes, that "the reason of man is now more fully employed than at any former period; a vast store of mental power, a vast mass of mind is everywhere at work; what formerly was vainly attempted by the labour of a few, is now easily accomplished by the exertions of the many. The empire of reason, extending from the old to the new world, from Europe to our Antipodes, has encircled the earth; the sun never sets upon her dominions; individuals must rest, but the collective intelligence of the species never sleeps. At the 3 moment one nation, wearied by the toils of the day, welcomes the shades of night and lies down to seek repose, another rises to hail the light of morning, and, refreshed, speeds the noble work of science." In an earlier writing, the same idea is eloquently given. Speaking of the progress of the human mind, he observes, "that since the invention of the art of printing, it has become steady and uniform. The stream of knowledge which, not many centuries ago, shallow and narrow, toiled painfully to wear away or avoid the obstacles that impeded its course, now fed by a thousand new sources, flows along deep and rapid, sweeping away every obstruction, and defying all human opposition. Mankind having thus arrived at the maturity of collective intellect, we are every day surprised at the results obtained by the vast mass of mind now diligently employed in the acquisition of knowledge. What was formerly the termination of a science, is now but its commencement; what was formerly deemed unattainable, is now elementary; so that it is impossible to foresee how far improvement may be carried. A short and transitory existence has been allotted to our bodies; individuals die, and generations pass away, but the common intellect of mankind fears not the same fate, nor shares the same brief mortality." To By a natural transition, we pass from his general pathological doctrine to his labours and opinions on the subject of fever. this part of medicine he for many years paid great, though not exclusive attention, and nearly a fourth part of the "Clinical Medicine" is devoted to its consideration; and he had great opportunities of observing the character of the typhus fever in this country. In 1819, he was sent by the Government, in com-pany with Dr. Cumming, now of Armagh, and an Honorary Fellow of the College of Physicians, to take charge of an extensive district in the west of Ireland, where fever was then raging with extreme virulence. Subsequently, in the great epidemic of 1827 and 1828, he was Physician to the Meath Hospital, which then accommodated 300 fever patients. He witnessed the fever of 1847 and 1848; and besides all this experience, he was extensively consulted in cases of this disease when arising in the better classes of society. In reviewing the portions of the "Clinical Medicine" which are devoted to fever, we are at once struck with the absence of that tendency to dilate upon fine or doubtful distinctions which so strongly characterises a smallness of mind. We have no long disquisition on the differences between typhus and typhoid fever, with which so many of our brethren have been, I think, vainly occupied; nor, again, have we arguments to show that dothinenteritis is a mark of a high degree of civilization and social comfort, while its absence in fever is characteristic of the want, the ignorance, and the He did not degradation, of the Irish branch of the Celtic race. form any theory of fever; but he did much better, in diligently studying its symptoms, watching how they were grouped, and in what order they followed each other, and lastly, in observing the effects of treatment in their progress. For, he well remarks, that the knowledge we possess of the nature of fever is of a negative character, telling us what it is not, rather than what it is. I am most anxious to insist on this point, perhaps, indeed, because it so completely coincides with my own convictions, that, after the experience of a life, and in circumstances the best adapted for observation, Dr. Graves arrived at this conclusion, that the various forms of continued fever in this country are varieties, not distinct species, differing by any anatomical character. I believe that, in this country at least, there is no essential difference between typhus and what is called typhoid fever. I know that the same contagion will produce both forms; and, again, that these forms are mutually convertible. Before physicians indulge in theories, as to any particular disease, it is necessary that they should study it in different countries. Had Broussais studied fever in Ireland, the so-called physiological doctrine, so far at least as fever was concerned, would never have been announced, nor the error committed of taking the anatomical consequence for the cause. Had Clutterbuck followed a similar course, we should never have had the cerebral theory. Had Rasori been a physician to an Irish fever hospital, would the contra-stimulant doctrine have ever existed? And, to come to more recent times, we may safely affirm that the distinctions of Dr. Jenner would have been at least less strongly drawn, had he studied the disease in our hospitals. Let us briefly enumerate the leading points of the doctrine of fever, as given in the Clinical Medicine. 1st. Its existence as an endemic disease in Ireland, but occasionally taking an epidemic character. 2nd. The existence of a general and peculiar character in each epidemic, subject, however, to modifications at different periods of the epidemic, and in different places, even at the same period of |