medical essays-第29章

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e　physicians　are　very　commonly　founded　on　something　quite　different　from　experience。　　Experience　must　be　based　on　the　permanent　facts　of　nature。　　But　a　glance　at　the　prevalent　modes　of　treatment　of　any　two　successive　generations　will　show　that　there　is　a　changeable　as　well　as　a　permanent　element　in　the　art　of　healing；　not　merely　changeable　as　diseases　vary；　or　as　new　remedies　are　introduced；　but　changeable　by　the　going　out　of　fashion　of　special　remedies；　by　the　decadence　of　a　popular　theory　from　which　their　fitness　was　deduced；　or　other　cause　not　more　significant。　　There　is　no　reason　to　suppose　that　the　present　time　is　essentially　different　in　this　respect　from　any　other。　　Much；　therefore；　which　is　now　very　commonly　considered　to　be　the　result　of　experience；　will　be　recognized　in　the　next；　or　in　some　succeeding　generation；　as　no　such　result　at　all；　but　as　a　foregone　conclusion；　based　on　some　prevalent　belief　or　fashion　of　the　time。

There　are；　of　course；　in　every　calling；　those　who　go　about　the　work　of　the　day　before　them；　doing　it　according　to　the　rules　of　their　craft；　and　asking　no　questions　of　the　past　or　of　the　future；　or　of　the　aim　and　end　to　which　their　special　labor　is　contributing。　　These　often　consider　and　call　themselves　practical　men。　　They　pull　the　oars　of　society；　and　have　no　leisure　to　watch　the　currents　running　this　or　that　way；　let　theorists　and　philosophers　attend　to　them。　　In　the　mean　time；　however；　these　currents　are　carrying　the　practical　men；　too；　and　all　their　work　may　be　thrown　away；　and　worse　than　thrown　away；　if　they　do　not　take　knowledge　of　them　and　get　out　of　the　wrong　ones　and　into　the　right　ones　as　soon　as　they　may。　　Sir　Edward　Parry　and　his　party　were　going　straight　towards　the　pole　in　one　of　their　arctic　expeditions；　travelling　at　the　rate　of　ten　miles　a　day。　　But　the　ice　over　which　they　travelled　was　drifting　straight　towards　the　equator；　at　the　rate　of　twelve　miles　a　day；　and　yet　no　man　among　them　would　have　known　that　he　was　travelling　two　miles　a　day　backward　unless　he　had　lifted　his　eyes　from　the　track　in　which　he　was　plodding。　　It　is　not　only　going　backward　that　the　plain　practical　workman　is　liable　to；　if　he　will　not　look　up　and　look　around；　he　may　go　forward　to　ends　he　little　dreams　of。　　It　is　a　simple　business　for　a　mason　to　build　up　a　niche　in　a　wall；　but　what　if；　a　hundred　years　afterwards　when　the　wall　is　torn　down；　the　skeleton　of　a　murdered　man　drop　out　of　the　niche？　　It　was　a　plain　practical　piece　of　carpentry　for　a　Jewish　artisan　to　fit　two　pieces　of　timber　together　according　to　the　legal　pattern　in　the　time　of　Pontius　Pilate；　he　asked　no　questions；　perhaps；　but　we　know　what　burden　the　cross　bore　on　the　morrow！　　And　so；　with　subtler　tools　than　trowels　or　axes；　the　statesman　who　works　in　policy　without　principle；　the　theologian　who　works　in　forms　without　a　soul；　the　physician　who；　calling　himself　a　practical　man；　refuses　to　recognize　the　larger　laws　which　govern　his　changing　practice；　may　all　find　that　they　have　been　building　truth　into　the　wall；　and　hanging　humanity　upon　the　cross。

The　truth　is；　that　medicine；　professedly　founded　on　observation；　is　as　sensitive　to　outside　influences；　political；　religious；　philosophical；　imaginative；　as　is　the　barometer　to　the　changes　of　atmospheric　density。　　Theoretically　it　ought　to　go　on　its　own　straightforward　inductive　path；　without　regard　to　changes　of　government　or　to　fluctuations　of　public　opinion。　　But　look　a　moment　while　I　clash　a　few　facts　together；　and　see　if　some　sparks　do　not　reveal　by　their　light　a　closer　relation　between　the　Medical　Sciences　and　the　conditions　of　Society　and　the　general　thought　of　the　time；　than　would　at　first　be　suspected。

Observe　the　coincidences　between　certain　great　political　and　intellectual　periods　and　the　appearance　of　illustrious　medical　reformers　and　teachers。　　It　was　in　the　age　of　Pericles；　of　Socrates；　of　Plato；　of　Phidias；　that　Hippocrates　gave　to　medical　knowledge　the　form　which　it　retained　for　twenty　centuries。　　With　the　world…　conquering　Alexander；　the　world…embracing　Aristotle；　appropriating　anatomy　and　physiology；　among　his　manifold　spoils　of　study；　marched　abreast　of　his　royal　pupil　to　wider　conquests。　　Under　the　same　Ptolemies　who　founded　the　Alexandrian　Library　and　Museum；　and　ordered　the　Septuagint　version　of　the　Hebrew　Scriptures；　the　infallible　Herophilus　＇〃Contradicere　Herophilo　in　anatomicis；　est　contradicere　evangelium；〃　was　a　saying　of　Fallopius。＇　made　those　six　hundred　dissections　of　which　Tertullian　accused　him；　and　the　sagacious　Erasistratus　introduced　his　mild　antiphlogistic　treatment　in　opposition　to　the　polypharmacy　and　antidotal　practice　of　his　time。　It　is　significant　that　the　large…minded　Galen　should　have　been　the　physician　and　friend　of　the　imperial　philosopher　Marcus　Aurelius。　The　Arabs　gave　laws　in　various　branches　of　knowledge　to　those　whom　their　arms　had　invaded；　or　the　terror　of　their　spreading　dominion　had　reached；　and　the　point　from　which　they　started　was；　as　Humboldt　acknowledges；　〃the　study　of　medicine；　by　which　they　long　ruled　the　Christian　Schools；〃　and　to　which　they　added　the　department　of　chemical　pharmacy。

Look　at　Vesalius；　the　contemporary　of　Luther。　　Who　can　fail　to　see　one　common　spirit　in　the　radical　ecclesiastic　and　the　reforming　court…physician？　　Both　still　to　some　extent　under　the　dominion　of　the　letter：　Luther　holding　to　the　real　presence；　Vesalius　actually　causing　to　be　drawn　and　engraved　two　muscles　which　he　knew　were　not　found　in　the　human　subject；　because　they　had　been　described　by　Galen；　from　dissections　of　the　lower　animals。　　Both　breaking　through　old　traditions　in　the　search　of　truth；　one；　knife　in　hand；　at　the　risk　of　life　and　reputation；　the　other　at　the　risk　of　fire　and　fagot；　with　that　mightier　weapon　which　all　the　devils　could　not　silence；　though　they　had　been　thicker　than　the　tiles　on　the　house…tops。　　How　much　the　physician　of　the　Catholic　Charles　V。　had　in　common　with　the　great　religious　destructive；　may　be　guessed　by　the　relish　with　which　he　tells　the　story　how　certain　Pavian　students　exhumed　the　body　of　an　〃elegans　scortum；〃　or　lovely　dame　of　ill　repute；　the　favorite　of　a　monk　of　the　order　of　St。　Anthony；　who　does　not　seem　to　have　resisted　temptation　so　well　as　the　founder　of　his　order。　　We　have　always　ranked　the　physician　Rabelais　among　the　early　reformers；　but　I　do　not　know　that　Vesalius　has　ever　been　thanked　for　his　hit　at　the　morals　of　the　religious　orders；　or　for　turning　to　the　good　of　science　what　was　intended　for　the　〃benefit　of　clergy。〃

Our　unfortunate　medical　brother；　Michael　Servetus；　the　spiritual　patient　to　whom　the　theological　moxa　was　applied　over　the　entire　surface　for　the　cure　of　his　heresy；　came　very　near　anticipating　Harvey。　　The　same　quickened　thought　of　the　time　which　led　him　to　dispute　the　dogma　of　the　Church；　opened　his　mind　to　the　facts　which　contradicted　the　dogmas　of　the　Faculty。

Harvey　himself　was　but　the　posthumous　child　of　the　great　Elizabethan　period。　　Bacon　was　at　once　his　teacher　and　his　patient。　　The　founder　of　the　new　inductive　philosophy　had　only　been　dead　two　years　when　the　treatise　on　the　Circulation；　the　first…fruit　of　the　Restoration　of　Science；　was　given　to　the　world。

And　is　it　to　be　looked　at　as　a　mere　accidental　coincidence；　that　while　Napoleon　was　modernizing　the　political　world；　Bichat　was　revolutionizing　the　science　of　life　and　the　art　that　is　based　upon　it；　that　while　the　young　general　was　scaling　the　Alps；　the　young　surgeon　was　climbing　the　steeper　summits　of　unexplored　nature；　that　the　same　year　read　the　announcement　of　those　admirable　〃Researches　on　Life　and　Death；〃　and　the　bulletins　of　the　battle　of　Marengo？

If　we　come　to　our　own　country；　who　can　fail　to　recognize　that　Benjamin　Rush；　the　most　conspicuous　of　American　physicians；　was　the　intellectual　offspring　of　the　movement　which　produced　the　Revolution？　〃The　same　hand；〃　says　one　of　his　biographers；〃　which　subscribed　the　declaration　of　the　political　independence　of　these　States；　accomplished　their　emancipation　from　medical　systems　formed　in　foreign　countries；　and　wholly　unsuitable　to　the　state　of　diseases　in　America。〃

Following　this　general　course　of　remark；　I　propose　to　indicate　in　a　few　words　the　direction　of　the　main　intellectual　current　of　the　time；　and　to　point　out　more　particularly　some　of　the　eddies　which　tend　to　keep　the　science　and　art　of　medicine　from　moving　with　it；　or　even　to　carry　them　backwards。

The　two　dominant　words　of　our　time　are　law　and　average；　both　pointing　to　the　uniformity　of　the　order　of　being　in　which　we　live。　　Statistics　have　tabulated　everything；population；　growth；　wealth；　crime；　disease。　　We　have　shaded　maps　showing　the　geographical　distribution　of　larceny　and　suicide。　　Analysis　and　classification　have　been　at　work　upon　all　tangible　and　visible　objects。　　The　Positive　Philosophy　of　Comte　has　only　given　expression　to　the　observing　and　computing　mind　of　the　nineteenth　century。

In　the　mean　time；　the　great　stronghold　of　intellectual　conservatism；　traditional　belief；　has　been　assailed　by　facts　which　would　have　been　indicted　as　blasphemy　but　a　few　generations　ago。　　Those　new　tables　of　the　law；　placed　in　the　hands　of　the　geologist　by　the　same　living　God　who　spoke　from　Sinai　to　the　Israelites　of　old；　have　remodelled　the　beliefs　of　half　the　civilized　world。　　The　solemn　scepticism　of　science　has　replaced　the　sneering　doubts　of　witty　philosophers。　　The　more　positive　knowledge　we　gain；　the　more　we　incline　to　question　all　that　has　been　received　without　absolute　proof。

As　a　matter　of　course；　this　movement　has　its　partial　reactions。　　The　province　of　faith　is　claimed　as　a　port　free　of　entry　to　unsupported　individual　convictions。　　The　tendency　to　question　is　met　by　the　unanalyzing　instinct　of　reverence。　　The　old　church　calls　back　its　frightened　truants。　　Some　who　have　lost　their　hereditary　religious　belief　find　a　resource　in　the　revelations　of　Spiritualism。　　By　a　parallel　movement；　some　of　those　who　have　become　medical　infidels　pass　over　to　the　mystic　band　of　believers　in　the　fancied　miracles　of　Homoeopathy。

Under　these　influences　transmitted　to；　or　at　least　shared　by；　the　medical　profession；　the　old　question　between　〃Nature；〃　so　called；　and　〃Art；〃　or　professional　tradition；　has　reappeared　with　new　interest。　I　say　the　old　question；　for　Hippocrates　stated　the　case　on　the　side　of　〃Nature〃　more　than　two　thousand　years　ago。　　Miss　Florence　Nightingale；and　if　I　name　her　next　to　the　august　Father　of　the　Healing　Art；　its　noblest　daughter　well　deserves　that　place　of　honor；　Miss　Florence　Nightingale　begins　her　late　volume　with　a　paraphrase　of　his　statement。　　But　from　a　very　early　time　to　this　there　has　always　been　a　strong　party　against　〃Nature。〃　　Themison　called　the　practice　of　Hippocrates　〃a　meditation　upon　death。〃　　Dr。　Rush　says：　〃It　is　impossible　to　calculate　the　mischief　which　Hippocrates；　has　done；　by　first　marking　Nature　with　his　name　and　afterwards　letting　her　loose　upon　sick　people。　　Millions　have　perished　by　her　hands　in　all　ages　and　countries。〃　　Sir　John　Forbes；　whose　defence　of　〃Nature〃　in　disease　you　all　know；　and　to　the　testimonial　in　whose　honor　four　of　your　Presidents　have　contributed；　has　been　recently　greeted；　on　retiring　from　the　profession；　with　a　wish　that　his　retirement　had　been　twenty　years　sooner；　and　t