medical essays-第30章
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on retiring from the profession； with a wish that his retirement had been twenty years sooner； and the opinion that no man had done so much to destroy the confidence of the public in the medical profession。
In this Society we have had the Hippocratic and the Themisonic side fairly represented。 The treatise of one of your early Presidents on the Mercurial Treatment is familiar to my older listeners。 Others who have held the same office have been noted for the boldness of their practice； and even for partiality to the use of complex medication。
On the side of 〃Nature〃 we have had； first of all； that remarkable discourse on Self…Limited Diseases； ＇On Self…Limited Diseases。 A Discourse delivered before the Massachusetts Medical Society； at their Annual Meeting； May 27； 1835。 By Jacob Bigelow； M。 D。＇ which has given the key…note to the prevailing medical tendency of this neighborhood； at least； for the quarter of a century since it was delivered。 Nor have we forgotten the address delivered at Springfield twenty years later； ＇Search out the Secrets； of Nature。 By Augustus A。 Gould； M。 D。 Read at the Annual Meeting； June 27； 1855。＇ full of good sense and useful suggestions； to one of which suggestions we owe the learned； impartial； judicious； well…written Prize Essay of Dr。 Worthington Hooker。 ＇Rational Therapeutics。 A Prize Essay。 By Worthington Hooker； M。 D。； of New Haven。 Boston。 1857。＇ We should not omit from the list the important address of another of our colleagues； ＇On the Treatment of Compound and Complicated Fractures。 By William J。 Walker； M。 D。 Read at the Annual Meeting； May 29； 1845。＇ showing by numerous cases the power of Nature in healing compound fractures to be much greater than is frequently supposed；affording； indeed； more striking illustrations than can be obtained from the history of visceral disease； of the supreme wisdom； forethought； and adaptive dexterity of that divine Architect； as shown in repairing the shattered columns which support the living temple of the body。
We who are on the side of 〃Nature〃 please ourselves with the idea that we are in the great current in which the true intelligence of the time is moving。 We believe that some who oppose； or fear； or denounce our movement are themselves caught in various eddies that set back against the truth。 And we do most earnestly desire and most actively strive； that Medicine； which； it is painful to remember； has been spoken of as 〃the withered branch of science〃 at a meeting of the British Association； shall be at length brought fully to share； if not to lead； the great wave of knowledge which rolls with the tides that circle the globe。
If there is any State or city which might claim to be the American headquarters of the nature…trusting heresy； provided it be one； that State is Massachusetts； and that city is its capital。 The effect which these doctrines have upon the confidence reposed in the profession is a matter of opinion。 For myself； I do not believe this confidence can be impaired by any investigations which tend to limit the application of troublesome； painful； uncertain； or dangerous remedies。 Nay； I will venture to say this； that if every specific were to fail utterly； if the cinchona trees all died out； and the arsenic mines were exhausted； and the sulphur regions were burned up； if every drug from the vegetable； animal； and mineral kingdom were to disappear from the market； a body of enlightened men； organized as a distinct profession； would be required just as much as now； and respected and trusted as now； whose province should be to guard against the causes of disease； to eliminate them if possible when still present； to order all the conditions of the patient so as to favor the efforts of the system to right itself； and to give those predictions of the course of disease which only experience can warrant； and which in so many cases relieve the exaggerated fears of sufferers and their friends； or warn them in season of impending danger。 Great as the loss would be if certain active remedies could no longer be obtained； it would leave the medical profession the most essential part of it's duties； and all； and more than all； its present share of honors； for it would be the death…blow to charlatanism； which depends for its success almost entirely on drugs； or at least on a nomenclature that suggests them。
There is no offence； then； or danger in expressing the opinion； that； after all which has been said； the community is still overdosed： The best proof of it is； that no families take so little medicine as those of doctors； except those of apothecaries； and that old practitioners are more sparing of active medicines than younger ones。〃 ＇Dr。 James Jackson has kindly permitted me to make the following extract from a letter just received by him from Sir James Clark； and dated May 26； 1860： 〃As a physician advances in age； he generally； I think； places less confidence in the ordinary medical treatment than he did； not only during his early； but even his middle period of life。〃＇ The conclusion from these facts is one which the least promising of Dr。 Howe's pupils in the mental department could hardly help drawing。
Part of the blame of over…medication must； I fear； rest with the profession； for yielding to the tendency to self…delusion； which seems inseparable from the practice of the art of healing。 I need only touch on the common modes of misunderstanding or misapplying the evidence of nature。
First； there is the natural incapacity for sound observation； which is like a faulty ear in music。 We see this in many persons who know a good deal about books； but who are not sharp…sighted enough to buy a horse or deal with human diseases。
Secondly； there is in some persons a singular inability to weigh the value of testimony； of which； I think； from a pretty careful examination of his books； Hahnemann affords the best specimen outside the walls of Bedlam。
The inveterate logical errors to which physicians have always been subject are chiefly these：
The mode of inference per enumerationem simplicem； in scholastic phrase； that is； counting only their favorable cases。 This is the old trick illustrated in Lord Bacon's story of the gifts of the shipwrecked people； hung up in the temple。 Behold！ they vowed these gifts to the altar； and the gods saved them。 Ay； said a doubting bystander； but how many made vows of gifts and were shipwrecked notwithstanding？ The numerical system is the best corrective of this and similar errors。 The arguments commonly brought against its application to all matters of medical observation； treatment included； seem to apply rather to the tabulation of facts ill observed； or improperly classified； than to the method itself。
The post hoc ergo propter hoc error： he got well after taking my medicine； therefore in consequence of taking it。
The false induction from genuine facts of observation； leading to the construction of theories which are then deductively applied in the face of the results of direct observation。 The school of Broussais has furnished us with a good example of this error。
And lastly； the error which Sir Thomas Browne calls giving 〃a reason of the golden tooth；〃 that is； assuming a falsehood as a fact； and giving reasons for it； commonly fanciful ones； as is constantly done by that class of incompetent observers who find their 〃golden tooth〃 in the fabulous effects of the homoeopathie materia medica；which consists of sugar of milk and a nomenclature。
Another portion of the blame rests with the public itself； which insists on being poisoned。 Somebody buys all the quack medicines that build palaces for the mushroom； say rather； the toadstool millionaires。 Who is it？ These people have a constituency of millions。 The popular belief is all but universal that sick persons should feed on noxious substances。 One of our members was called not long since to a man with a terribly sore mouth。 On inquiry he found that the man had picked up a box of unknown pills； in Howard Street； and had proceeded to take them； on general principles； pills being good for people。 They happened to contain mercury； and hence the trouble for which he consulted our associate。
The outside pressure； therefore； is immense upon the physician； tending to force him to active treatment of some kind。 Certain old superstitions； still lingering in the mind of the public； and not yet utterly expelled from that of the profession； are at the bottom of this； or contribute to it largely。 One of the most ancient is； that disease is a malignant agency； or entity； to be driven out of the body by offensive substances； as the smoke of the fish's heart and liver drove the devil out of Tobit's bridal chamber； according to the Apochrypha。 Epileptics used to suck the blood from the wounds of dying gladiators。 ＇Plinii Hist。 Mundi。 lib。 xxviii。 c。 4。＇ The Hon。 Robert Boyle's little book was published some twenty or thirty years before our late President； Dr。 Holyoke； was born。 ＇A Collection of Choice and Safe Remedies。 The Fifth Edition； corrected。 London； 1712。 Dr。 Holyoke was born in 1728。＇ In it he recommends； as internal medicines； most of the substances commonly used as fertilizers of the soil。 His 〃Album Graecum〃 is best left untranslated； and his 〃Zebethum Occidentale〃 is still more transcendentally unmentionable except in a strange dialect。 It sounds odiously to us to hear him recommend for dysentery a powder made from 〃the sole of an old shoe worn by some man that walks much。〃 Perhaps nobody here ever heard of tying a stocking； which had been worn during the day； round the neck at night for a sore throat。 The same idea of virtue in unlovely secretions！ ＇The idea is very ancient。 〃Sordes hominis〃 〃Sudore et oleo medicinam facientibus。〃 Plin。 xxviii。 4。＇
Even now the Homoeopathists have been introducing the venom of serpents； under the learned title of Lachesis； and outraging human nature with infusions of the pediculus capitis； that is； of course； as we understand their dilutions； the names of these things； for if a fine…tooth…comb insect were drowned in Lake Superior； we cannot agree with them in thinking that every drop of its waters would be impregnated with all the pedicular virtues they so highly value。 They know what they are doing。 They are appealing to the detestable old superstitious presumption in favor of whatever is nauseous and noxious as being good for the sick。
Again； we all occasionally meet persons stained with nitrate of silver； given for epilepsy。 Read what Dr。 Martin says； about the way in which it came to be used； in his excellent address before the Norfolk County Medical Society； and the evidence I can show； but have not time for now； and then say what you think of the practice which on such presumptions turns a white man as blue as the double…tattooed King of the Cannibal Islands！ ＇Note A。＇
If medical superstitions have fought their way down through all the rationalism and scepticism of the nineteenth century； of course the theories of the schools； supported by great names； adopted into the popular belief and incorporated with the general mass of misapprehension with reference to disease； must be expected to meet us at every turn in the shape of bad practice founde
