"Empirical" an Epithet

Elisha Bartlett, professor of medicine at the University of Maryland, cautioned that causation lay beyond the reach of medical knowledge of the time, and he urged fellow physicians to base their therapies upon clinical experience rather than deduction from principles. Although to contemporary ears Professor Bartlett sounds prescient, his remarks were not typical of sentiments voiced within the profession at the time. Medicine is – and was in 1860 a body of knowledge accumulated through the experiences of prior years and generations. Although a physician’s body of received knowledge might have been based upon empirical experiences of prior generations, his practice was an informed undertaking based upon what he learned and knew, not an empirical undertaking based upon what he was deducting as he went along. In fact physicians used the word “empirical” as an epithet to describe and criticize medical treatment that was not based upon the established knowledge of orthodox medicine.

Bleeding, purging, and puking the patient remained primary medical therapies. Doctors removed large quantities of a patient’s blood by opening a vein with an instrument called a lancet. Smaller quantities of blood were removed by a process called cupping or by application of leeches. Physicians caused patients to purge their bowels by administering doses of calomel, a mercury compound that acted as a laxative. It had an antiseptic effect, but it was poisonous. The physician induced vomiting by applying doses of tartar emetic, an antimony compound that also had an antiseptic effect and was poisonous. During the decades leading up to 1860, “heroic” doses of tartar emetic and calomel were not uncommon.