medical essays-第33章

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othing　more。　　If　this；　or　something　like　this；　is　true；　then　all　these　medications　are；　prima　facie；　injurious。

In　the　game　of　Life…or…Death；　Rouge　et　Noir；　as　played　between　the　Doctor　and　the　Sexton；　this　five　per　cent。；　this　certain　small　injury　entering　into　the　chances　is　clearly　the　sexton's　perquisite　for　keeping　the　green　table；　over　which　the　game　is　played；　and　where　he　hoards　up　his　gains。　　Suppose　a　blister　to　diminish　a　man's　pain；　effusion　or　dyspnoea　to　the　saving　of　twenty　per　cent。　in　vital　force；　his　profit　from　it　is　fifteen；　in　that　case；　for　it　always　hurts　him　five　to　begin　with；　according　to　our　previous　assumption。

Presumptions　are　of　vast　importance　in　medicine；　as　in　law。　　A　man　is　presumed　innocent　until　he　is　proved　guilty。　　A　medicinethat　is；　a　noxious　agent；　like　a　blister；　a　seton；　an　emetic；　or　a　cathartic　should　always　be　presumed　to　be　hurtful。　　It　always　is　directly　hurtful；　it　may　sometimes　be　indirectly　beneficial。　　If　this　presumption　were　established；　and　disease　always　assumed　to　be　the　innocent　victim　of　circumstances；　and　not　punishable　by　medicines；　that　is；　noxious　agents；　or　poisons；　until　the　contrary　was　shown；　we　should　not　so　frequently　hear　the　remark　commonly；　perhaps　erroneously；　attributed　to　Sir　Astley　Cooper；　but　often　repeated　by　sensible　persons；　that；　on　the　whole；　more　harm　than　good　is　done　by　medication。　　Throw　out　opium；　which　the　Creator　himself　seems　to　prescribe；　for　we　often　see　the　scarlet　poppy　growing　in　the　cornfields；　as　if　it　were　foreseen　that　wherever　there　is　hunger　to　be　fed　there　must　also　be　pain　to　be　soothed；　throw　out　a　few　specifics　which　our　art　did　not　discover；　and　is　hardly　needed　to　apply　＇　Note　C。＇；　throw　out　wine；　which　is　a　food；　and　the　vapors　which　produce　the　miracle　of　anaesthesia；　and　I　firmly　believe　that　if　the　whole　materia　medica；　as　now　used；　could　be　sunk　to　the　bottom　of　the　sea；　it　would　be　all　the　better　for　mankind；and　all　the　worse　for　the　fishes。

But　to　justify　this　proposition；　I　must　add　that　the　injuries　inflicted　by　over…medication　are　to　a　great　extent　masked　by　disease。　Dr。　Hooker　believes　that　the　typhus　syncopatia　of　a　preceding　generation　in　New　England　〃was　often　in　fact　a　brandy　and　opium　disease。〃　　How　is　a　physician　to　distinguish　the　irritation　produced　by　his　blister　from　that　caused　by　the　inflammation　it　was　meant　to　cure？　　How　can　he　tell　the　exhaustion　produced　by　his　evacuants　from　the　collapse　belonging　to　the　disease　they　were　meant　to　remove？

Lastly；　medication　without　insuring　favorable　hygienic　conditions　is　like　amputation　without　ligatures。　　I　had　a　chance　to　learn　this　well　of　old；　when　physician　to　the　Broad　Street　district　of　the　Boston　Dispensary。　　There；　there　was　no　help　for　the　utter　want　of　wholesome　conditions；　and　if　anybody　got　well　under　my　care；　it　must　have　been　in　virtue　of　the　rough…and…tumble　constitution　which　emerges　from　the　struggle　for　life　in　the　street　gutters；　rather　than　by　the　aid　of　my　prescriptions。

But　if　the　materia　medica　were　lost　overboard；　how　much　more　pains　would　be　taken　in　ordering　all　the　circumstances　surrounding　the　patient　（as　can　be　done　everywhere　out　of　the　crowded　pauper　districts）；　than　are　taken　now　by　too　many　who　think　they　do　their　duty　and　earn　their　money　when　they　write　a　recipe　for　a　patient　left　in　an　atmosphere　of　domestic　malaria；　or　to　the　most　negligent　kind　of　nursing！　　I　confess　that　I　should　think　my　chance　of　recovery　from　illness　less　with　Hippocrates　for　my　physician　and　Mrs。　Gamp　for　my　nurse；　than　if　I　were　in　the　hands　of　Hahnemann　himself；　with　Florence　Nightingale　or　good　Rebecca　Taylor　to　care　for　me。

If　I　am　right　in　maintaining　that　the　presumption　is　always　against　the　use　of　noxious　agents　in　disease；　and　if　any　whom　I　might　influence　should　adopt　this　as　a　principle　of　practice；　they　will　often　find　themselves　embarrassed　by　the　imperative　demand　of　patients　and　their　friends　for　such　agents　where　a　case　is　not　made　out　against　this　standing　presumption。　　I　must　be　permitted　to　say；　that　I　think　the　French；　a　not　wholly　uncivilized　people；　are　in　advance　of　the　English　and　ourselves　in　the　art　of　prescribing　for　the　sick　without　hurting　them。　　And　I　do　confess　that　I　think　their　varied　ptisans　and　syrups　are　as　much　preferable　to　the　mineral　regimen　of　bug…poison　and　ratsbane；　so　long　in　favor　on　the　other　side　of　the　Channel；　as　their　art　of　preparing　food　for　the　table　to　the　rude　cookery　of　those　hard…feeding　and　much…dosing　islanders。　We　want　a　reorganized　cuisine　of　invalidism　perhaps　as　much　as　the　culinary；　reform；　for　which　our　lyceum　lecturers；　and　others　who　live　much　at　hotels　and　taverns；　are　so　urgent。　　Will　you　think　I　am　disrespectful　if　I　ask　whether；　even　in　Massachusetts；　a　dose　of　calomel　is　not　sometimes　given　by　a　physician　on　the　same　principle　as　that　upon　which　a　landlord　occasionally　prescribes　bacon　and　eggs；because　he　cannot　think　of　anything　else　quite　so　handy？　　I　leave　my　suggestion　of　borrowing　a　hint　from　French　practice　to　your　mature　consideration。

I　may；　however；　call　your　attention；　briefly；　to　the　singular　fact；　that　English　and　American　practitioners　are　apt　to　accuse　French　medical　practice　of　inertness；　and　French　surgical　practice　of　unnecessary　activity。　　Thus；　Dr。　Bostock　considers　French　medical　treatment；　with　certain　exceptions；　as　〃decidedly　less　effective〃　than　that　of　his　own　country。〃　　Mr。　S。　Cooper；　again；　defends　the　simple　British　practice　of　procuring　union　by　the　first　intention　against　the　attacks　of　M。　Roux　and　Baron　Larrey。　＇Cooper's　Surg。　Diet。　　art。　　〃Wounds。〃　　Yet　Mr。　John　Bell　gives　the　French　surgeons　credit　for　introducing　this　doctrine　of　adhesion；　and　accuses　O'Halloran　of　〃rudeness　and　ignorance；〃　and　〃bold；　uncivil　language；〃　in　disputing　their　teaching。　　Princ。　　of　Surgery；　vol。　　i。　　p。　　42。　Mr。　Hunter　succeeded　at　last　in　naturalizing　the　doctrine　and　practice；　but　even　he　had　to　struggle　against　the　perpetual　jealousy　of　rivals；　and　died　at　length　assassinated　by　an　insult。＇　　We　have　often　heard　similar　opinions　maintained　by　our　own　countrymen。　　While　Anglo…American　criticism　blows　hot　or　cold　on　the　two　departments　of　French　practice；　it　is　not；　I　hope；　indecent　to　question　whether　all　the　wisdom　is　necessarily　with　us　in　both　cases。

Our　art　has　had　two　or　three　lessons　which　have　a　deep　meaning　to　those　who　are　willing　to　read　them　honestly。　　The　use　of　water…　dressings　in　surgery　completed　the　series　of　reforms　by　which　was　abolished　the　〃coarse　and　cruel　practice〃　of　the　older　surgeons；　who　with　their　dressings　and　acrid　balsams；　their　tents　and　leaden　tubes；　〃absolutely　delayed　the　cure。〃　　The　doctrine　of　Broussais；　transient　as　was　its　empire；　reversed　the　practice　of　half　of　Christendom　for　a　season；　and　taught　its　hasty　disciples　to　shun　their　old　favorite　remedies　as　mortal　poisons。　　This　was　not　enough　permanently　to　shift　the　presumption　about　drugs　where　it　belonged；　and　so　at　last；　just　as　the　sympathetic　powder　and　the　Unguentum　Armarium　came　in　a　superstitious　age　to　kill　out　the　abuses　of　external　over…medication；　the　solemn　farce　of　Homoeopathy　was　enacted　in　the　face　of　our　own　too　credulous　civilization；　that　under　shelter　of　its　pretences　the　〃inward　bruises〃　of　over…drugged　viscera　might　be　allowed　to　heal　by　the　first　intention。　　Its　lesson　we　must　accept；　whether　we　will　or　not；　its　follies　we　are　tired　of　talking　about。　　The　security　of　the　medical　profession　against　this　and　all　similar　fancies　is　in　the　average　constitution　of　the　human。　　mind　with　regard　to　the　laws　of　evidence。

My　friends　and　brothers　in　Art！　　There　is　nothing　to　be　feared　from　the　utterance　of　any　seeming　heresy　to　which　you　may　have　listened。　I　cannot　compromise　your　collective　wisdom。　　If　I　have　strained　the　truth　one　hair's　breadth　for　the　sake　of　an　epigram　or　an　antithesis；　you　are　accustomed　to　count　the　normal　pulse…beats　of　sound　judgment；　and　know　full　well　how　to　recognize　the　fever…throbs　of　conceit　and　the　nervous　palpitations　of　rhetoric。

The　freedom　with　which　each　of　us　speaks　his　thought　in　this　presence；　belongs　in　part　to　the　assured　position　of　the　Profession　in　our　Commonwealth；　to　the　attitude　of　Science；　which　is　always　fearless；　and　to　the　genius　of　the　soil　on　which　we　stand；　from　which　Nature　withheld　the　fatal　gift　of　malaria　only　to　fill　it　with　exhalations　that　breed　the　fever　of　inquiry　in　our　blood　and　in　our　brain。　　But　mainly　we　owe　the　large　license　of　speech　we　enjoy　to　those　influences　and　privileges　common　to　us　all　as　self…governing　Americans。

This　Republic　is　the　chosen　home　of　minorities；　of　the　less　power　in　the　presence　of　the　greater。　　It　is　a　common　error　to　speak　of　our　distinction　as　consisting　in　the　rule　of　the　majority。　　Majorities；　the　greater　material　powers；　have　always　ruled　before。　　The　history　of　most　countries　has　been　that　of　majorities；　mounted　majorities；　clad　in　iron；　armed　with　death　treading　down　the　tenfold　more　numerous　minorities。　　In　the　old　civilizations　they　root　themselves　like　oaks　in　the　soil；　men　must　live　in　their　shadow　or　cut　them　down。　　With　us　the　majority　is　only　the　flower　of　the　passing　noon；　and　the　minority　is　the　bud　which　may　open　in　the　next　morning's　sun。　We　must　be　tolerant；　for　the　thought　which　stammers　on　a　single　tongue　today　may　organize　itself　in　the　growing　consciousness　of　the　time；　and　come　back　to　us　like　the　voice　of　the　multitudinous　waves　of　the　ocean　on　the　morrow。

Twenty…five　years　have　passed　since　one　of　your　honored　Presidents　spoke　to　this　Society　of　certain　limitations　to　the　power　of　our　Art；　now　very　generally　conceded。　　Some　were　troubled；　some　were　almost　angry；　thinking　the　Profession　might　suffer　from　such　concessions。　It　has　certainly　not　suffered　here；　if；　as　some　affirm；　it　has　lost　respect　anywhere；　it　was　probably　for　other；　and　no　doubt　sufficient　reasons。

Since　that　time　the　civilization　of　this　planet　has　changed　hands。　Strike　out　of　existence　at　this　moment　every　person　who　was　breathing　on　that　day；　May　27；　1835；　and　every　institution　of　society；　every　art　and　every　science　would　remain　intact　and　complete　in　the　living　that　would　be　left。　　Every　idea　the　world　then　held　has　been　since　dissolved　and　recrystallized。

We　are　repeating　the　same　process。　　Not　to　make　silver　shrines　for　our　old　divinities；　even　though　by　this　craft　we　should　have　our　wealth；　was　this　Society　organized　and　carried　on　by　the　good　men　and　true　who　went　before　us。　　Not　for　this；　but　to　melt　the　gold　out　of　the　past；　though　its　dross　should　fly　in　dust　to　all　the　winds　of　heaven；　to　save　all　our　old　treasures　of　knowledge　and　mine　deeply　for　new；　to　cultivate　that　mutual　respect　of　which　outward　courtesy　is　the　sign；　to　work　together；　to　feel　together；　to　take　counsel　together；　and　to　stand　together　for　the　truth；　now；　always；　here；　everywhere；　for　this　our　fathers　instituted；　and　we　accept；　the　offices　and　duties　of　this　time…honored　Society。







BORDER　LINES　OF　KNOWLEDGE　IN　SOME　PROVINCES　OF　MEDICAL　SCIENCE。

An　Introductory　Lecture　delivered　before　the　Medical　Class　of　Harvard　University；　November　6；　1861。


＇This　Lecture　appears　as　it　would　have　been　delivered　had　the　time　allowed　been　less　strictly；　limited。　　Passages