medical essays-第31章

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　reference　to　disease；　must　be　expected　to　meet　us　at　every　turn　in　the　shape　of　bad　practice　founded　on　false　doctrine。　　A　French　patient　complains　that　his　blood　heats　him；　and　expects　his　doctor　to　bleed　him。　　An　English　or　American　one　says　he　is　bilious；　and　will　not　be　easy　without　a　dose　of　calomel。　　A　doctor　looks　at　a　patient's　tongue；　sees　it　coated；　and　says　the　stomach　is　foul；　his　head　full　of　the　old　saburral　notion　which　the　extreme　inflammation…doctrine　of　Broussais　did　so　much　to　root　out；　but　which　still　leads；　probably；　to　much　needless　and　injurious　wrong　of　the　stomach　and　bowels　by　evacuants；　when　all　they　want　is　to　be　let　alone。　　It　is　so　hard　to　get　anything　out　of　the　dead　hand　of　medical　tradition！　　The　mortmain　of　theorists　extinct　in　science　clings　as　close　as　that　of　ecclesiastics　defunct　in　law。

One　practical　hint　may　not　be　out　of　place　here。　　It　seems　to　be　sometimes　forgotten；　by　those　who　must　know　the　fact；　that　the　tongue　is　very　different；　anatomically　and　physiologically；　from　the　stomach。　　Its　condition　does　not　in　the　least　imply　a　similar　one　of　the　stomach；　which　is　a　very　different　structure；　covered　with　a　different　kind　of　epithelium；　and　furnished　with　entirely　different　secretions。　　A　silversmith　will；　for　a　dollar；　make　a　small　hoe；　of　solid　silver；　which　will　last　for　centuries；　and　will　give　a　patient　more　comfort；　used　for　the　removal　of　the　accumulated　epithelium　and　fungous　growths　which　constitute　the　〃fur；〃　than　many　a　prescription　with　a　split…footed　Rx　before　it；　addressed　to　the　parts　out　of　reach。

I　think　more　of　this　little　implement　on　account　of　its　agency　in　saving　the　Colony　at　Plymouth　in　the　year　1623。　　Edward　Winslow　heard　that　Massasoit　was　sick　and　like　to　die。　　He　found　him　with　a　houseful　of　people　about　him；　women　rubbing　his　arms　and　legs；　and　friends　〃making　such　a　hellish　noise〃　as　they　probably　thought　would　scare　away　the　devil　of　sickness。　　Winslow　gave　him　some　conserve；　washed　his　mouth；　scraped　his　tongue；　which　was　in　a　horrid　state；　got　down　some　drink；　made　him　some　broth；　dosed　him　with　an　infusion　of　strawberry　leaves　and　sassafras　root；　and　had　the　satisfaction　of　seeing　him　rapidly　recover。　　Massasoit；　full　of　gratitude；　revealed　the　plot　which　had　been　formed　to　destroy　the　colonists；　whereupon　the　Governor　ordered　Captain　Miles　Standish　to　see　to　them；　who　thereupon；　as　everybody　remembers；　stabbed　Pecksuot　with　his　own　knife；　broke　up　the　plot；　saved　the　colony；　and　thus　rendered　Massachusetts　and　the　Massachusetts　Medical　Society　a　possibility；　as　they　now　are　a　fact　before　us。　　So　much　for　this　parenthesis　of　the　tongue…scraper；　which　helped　to　save　the　young　colony　from　a　much　more　serious　scrape；　and　may　save　the　Union　yet；　if　a　Presidential　candidate　should　happen　to　be　taken　sick　as　Massasoit　was；　and　his　tongue　wanted　cleaning；which　process　would　not　hurt　a　good　many　politicians；　with　or　without　a　typhoid　fever。

Again；　see　how　the　〃bilious〃　theory　works　in　every…day　life　here　and　now；　illustrated　by　a　case　from　actual　life。　　A　youthful　practitioner；　whose　last　molars　have　not　been　a　great　while　cut；　meets　an　experienced　and　noted　physician　in　consultation。　　This　is　the　case。　　A　slender；　lymphatic　young　woman　is　suckling　two　lusty　twins；　the　intervals　of　suction　being　occupied　on　her　part　with　palpitations；　headaches；　giddiness；　throbbing　in　the　head；　and　various　nervous　symptoms；　her　cheeks　meantime　getting　bloodless；　and　her　strength　running　away　in　company　with　her　milk。　　The　old　experienced　physician；　seeing　the　yellowish　waxy　look　which　is　common　in　anaemic　patients；　considers　it　a　〃bilious〃　case；　and　is　for　giving　a　rousing　emetic。　　Of　course；　he　has　to　be　wheedled　out　of　this；　a　recipe　is　written　for　beefsteaks　and　porter；　the　twins　are　ignominiously　expelled　from　the　anaemic　bosom；　and　forced　to　take　prematurely　to　the　bottle；　and　this　prolific　mother　is　saved　for　future　usefulness　in　the　line　of　maternity。

The　practice　of　making　a　profit　on　the　medicine　ordered　has　been　held　up　to　reprobation　by　one　at　least　of　the　orators　who　have　preceded　me。　　That　the　effect　of　this　has　been　ruinous　in　English　practice　I　cannot　doubt；　and　that　in　this　country　the　standard　of　practice　was　in　former　generations　lowered　through　the　same　agency　is　not　unlikely。　　I　have　seen　an　old　account…book　in　which　the　physician　charged　an　extra　price　for　gilding　his　rich　patients'　pills。　　If　all　medicine　were　very　costly；　and　the　expense　of　it　always　came　out　of　the　physician's　fee；　it　would　really　be　a　less　objectionable　arrangement　than　this　other　most　pernicious　one。　　He　would　naturally　think　twice　before　he　gave　an　emetic　or　cathartic　which　evacuated　his　own　pocket；　and　be　sparing　of　the　cholagogues　that　emptied　the　biliary　ducts　of　his　own　wallet；　unless　he　were　sure　they　were　needed。　　If　there　is　any　temptation；　it　should　not　be　in　favor　of　giving　noxious　agents；　as　it　clearly　must　be　in　the　case　of　English　druggists　and　〃General　Practitioners。〃　　The　complaint　against　the　other　course　is　a　very　old　one。　　Pliny；　inspired　with　as　truly　Roman　horror　of　quackery　as　the　elder　Cato；who　declared　that　the　Greek　doctors　had　sworn　to　exterminate　all　barbarians；　including　the　Romans；　with　their　drugs；　but　is　said　to　have　physicked　his　own　wife　to　death；　notwithstanding；Pliny　says；　in　so　many　words；　that　the　cerates　and　cataplasms；　plasters；　collyria；　and　antidotes；　so　abundant　in　his　time；　as　in　more　recent　days；　were　mere　tricks　to　make　money。


A　pretty　strong　eddy；　then；　or　rather　many　eddies；　setting　constantly　back　from　the　current　of　sober　observation　of　nature；　in　the　direction　of　old　superstitions　and　fancies；　of　exploded　theories；　of　old　ways　of　making　money；　which　are　very　slow　to　pass　out　of　fashion

But　there　are　other　special　American　influences　which　we　are　bound　to　take　cognizance　of。　　If　I　wished　to　show　a　student　the　difficulties　of　getting　at　truth　from　medical　experience；　I　would　give　him　the　history　of　epilepsy　to　read。　　If　I　wished　him　to　understand　the　tendencies　of　the　American　medical　mind；　its　sanguine　enterprise；　its　self…confidence；　its　audacious　handling　of　Nature；　its　impatience　with　her　old…fashioned　ways　of　taking　time　to　get　a　sick　man　well；　I　would　make　him　read　the　life　and　writings　of　Benjamin　Rush。　　Dr。　Rush　thought　and　said　that　there　were　twenty　times　more　intellect　and　a　hundred　times　more　knowledge　in　the　country　in　1799　than　before　the　Revolution。　　His　own　mind　was　in　a　perpetual　state　of　exaltation　produced　by　the　stirring　scenes　in　which　he　had　taken　a　part；　and　the　quickened　life　of　the　time　in　which　he　lived。　　It　was　not　the　state　to　favor　sound；　calm　observation。　　He　was　impatient；　and　Nature　is　profoundly　imperturbable。　　We　may　adjust　the　beating　of　our　hearts　to　her　pendulum　if　we　will　and　can；　but　we　may　be　very　sure　that　she　will　not　change　the　pendulum's　rate　of　going　because　our　hearts　are　palpitating。　　He　thought　he　had　mastered　yellow…fever。　　〃Thank　God；〃　he　said；　〃out　of　one　hundred　patients　whom　I　have　visited　or　prescribed　for　this　day；　I　have　lost　none。〃　　Where　was　all　his　legacy　of　knowledge　when　Norfolk　was　decimated？　　Where　was　it　when　the　blue　flies　were　buzzing　over　the　coffins　of　the　unburied　dead　piled　up　in　the　cemetery　of　New　Orleans；　at　the　edge　of　the　huge　trenches　yawning　to　receive　them？

One　such　instance　will　do　as　well　as　twenty。　　Dr。　Rush　must　have　been　a　charming　teacher；　as　he　was　an　admirable　man。　　He　was　observing；　rather　than　a　sound　observer；　eminently　observing；　curious；　even；　about　all　manner　of　things。　　But　he　could　not　help　feeling　as　if　Nature　had　been　a　good　deal　shaken　by　the　Declaration　of　Independence；　and　that　American　art　was　getting　to　be　rather　too　much　for　her；especially　as　illustrated　in　his　own　practice。　　He　taught　thousands　of　American　students；　he　gave　a　direction　to　the　medical　mind　of　the　country　more　than　any　other　one　man；　perhaps　he　typifies　it　better　than　any　other。　　It　has　clearly　tended　to　extravagance　in　remedies　and　trust　in　remedies；　as　in　everything　else。　　How　could　a　people　which　has　a　revolution　once　in　four　years；　which　has　contrived　the　Bowie…knife　and　the　revolver；　which　has　chewed　the　juice　out　of　all　the　superlatives　in　the　language　in　Fourth　of　July　orations；　and　so　used　up　its　epithets　in　the　rhetoric　of　abuse　that　it　takes　two　great　quarto　dictionaries　to　supply　the　demand；　which　insists　in　sending　out　yachts　and　horses　and　boys　to　out…sail；　out…run；　out…　fight；　and　checkmate　all　the　rest　of　creation；　how　could　such　a　people　be　content　with　any　but　〃heroic〃　practice〃？　　What　wonder　that　the　stars　and　stripes　wave　over　doses　of　ninety　grains　of　sulphate　of　quinine；　＇More　strictly；　ninety…six　grains　in　two　hours。　Dunglison's　Practice；　1842；　vol。　　ii。　　p。　　520。　　Eighty　grains　in　one　dose。　Ibid。　　p。　　536。　　Ninety…six　grains　of　sulphate　of　quinine　are　equal　to　eight　ounces　of　good　bark。　Wood　&　Bache。＇　and　that　the　American　eagle　screams　with　delight　to　see　three　drachms　of　calomel　given　at　a　single　mouthful？

Add　to　this　the　great　number　of　Medical　Journals；　all　useful；　we　hope；　most　of　them　necessary；　we　trust；　many　of　them　excellently　well　conducted；　but　which　must　find　something　to　fill　their　columns；　and　so　print　all　the　new　plans　of　treatment　and　new　remedies　they　can　get　hold　of；　as　the　newspapers；　from　a　similar　necessity；　print　the　shocking　catastrophes　and　terrible　murders。

Besides　all　this；　here　are　we；　the　great　body　of　teachers　in　the　numberless　medical　schools　of　the　Union；　some　of　us　lecturing　to　crowds　who　clap　and　stamp　in　the　cities；　some　of　us　wandering　over　the　country；　like　other　professional　fertilizers；　to　fecundate　the　minds　of　less　demonstrative　audiences　at　various　scientific　stations；　all　of　us　talking　habitually　to　those　supposed　to　know　less　than　ourselves；　and　loving　to　claim　as　much　for　our　art　as　we　can；　not　to　say　for　our　own　schools；　and　possibly　indirectly　for　our　own　practical　skill。　　Hence　that　annual　crop　of　introductory　lectures；　the　useful　blossoming　into　the　ornamental；　as　the　cabbage　becomes　glorified　in　the　cauliflower；　that　lecture…room　literature　of　adjectives；　that　declamatory　exaggeration；　that　splendid　show　of　erudition　borrowed　from　D'Israeli；　and　credited　to　Lord　Bacon　and　the　rest；　which　have　suggested　to　our　friends　of　the　Medical　Journals　an　occasional　epigram　at　our　expense。　　Hence　the　tendency　in　these　productions；　and　in　medical　lectures　generally；　to　overstate　the　efficacy　of　favorite　methods　of　cure；　and　hence　the　premium　offered　for　showy　talkers　rather　than　sagacious　observers；　for　the　men　of　adjectives　rather　than　of　nouns　substantive　in　the　more　ambitious　of　these　institutions。

Such　are　some　of　the　eddies　in　which　we　are　liable　to　become　involved　and　carried　back　out　of　the　broad　stream　of　philosophical；　or；　in　other　words；　truth…loving；　investigations。　　The　causes　of　disease；　in　the　mean　time；　have　been　less　earnestly　studied　in　the　eagerness　of　the　search　for　remedies。　　Speak　softly！　　Women　have　been　borne　out　from　an　old…world　hospital；　two　in　one　coffin；　that　the　horrors　of　their　prison…house　might　not　be　known；　while　the　very　men　who　were　discussing　the　treatment　of　the　disease　were　stupidly　conveying　the　infection　from　bed　to　bed；　as　rat…killers　carry　their　poisons　from