medical essays-第41章

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not　ailing　to　take　；five　grains　of　blue　pill　with　one　or　two　of　aloes　twice　a　week　for　three　or　four　months　in　the　year；　with　half　a　pint　of　compound　decoction　of　sarsaparilla　every　day　for　the　same　period；　to　preserve　health　and　prolong　life。　　Pract。　　Treatise　on　Dis。　　of　Liver；　etc。　　p。　　272。＇　The　constitution　bears　slow　poisoning　a　great　deal　better　than　might　be　expected；　yet　the　most　intelligent　men　in　the　profession　have　gradually　got　out　of　the　habit　of　prescribing　these　powerful　alien　substances　in　the　old　routine　way。　　Mr。　Metcalf　will　tell　you　how　much　more　sparingly　they　are　given　by　our　practitioners　at　the　present　time；　than　when　he　first　inaugurated　the　new　era　of　pharmacy　among　us。　　Still；　the　presumption　in　favor　of　poisoning　out　every　spontaneous　reaction　of　outraged　nature　is　not　extinct　in　those　who　are　trusted　with　the　lives　of　their　fellow…　citizens。　　〃On　examining　the　file　of　prescriptions　at　the　hospital；　I　discovered　that　they　were　rudely　written；　and　indicated　a　treatment；　as　they　consisted　chiefly　of　tartar　emetic；　ipecacuanha；　and　epsom　salts；　hardly　favorable　to　the　cure　of　the　prevailing　diarrhoea　and　dysenteries。〃　　　In　a　report　of　a　poisoning　case　now　on　trial；　where　we　are　told　that　arsenic　enough　was　found　in　the　stomach　to　produce　death　in　twenty…four　hours；　the　patient　is　said　to　have　been　treated　by　arsenic；　phosphorus；　bryonia；　aconite；　nux　vomica；　and　muriatic　acid；by　a　practitioner　of　what　school　it　may　be　imagined。

The　traditional　idea　of　always　poisoning　out　disease；　as　we　smoke　out　vermin；　is　now　seeking　its　last　refuge　behind　the　wooden　cannon　and　painted　port…holes　of　that　unblushing　system　of　false　scientific　pretences　which　I　do　not　care　to　name　in　a　discourse　addressed　to　an　audience　devoted　to　the　study　of　the　laws　of　nature　in　the　light　of　the　laws　of　evidence。　　It　is　extraordinary　to　observe　that　the　system　which；　by　its　reducing　medicine　to　a　name　and　a　farce；　has　accustomed　all　who　have　sense　enough　to　see　through　its　thin　artifices　to　the　idea　that　diseases　get　well　without　being　〃cured；〃　should　now　be　the　main　support　of　the　tottering　poison…cure　doctrine。　　It　has　unquestionably　helped　to　teach　wise　people　that　nature　heals　most　diseases　without　help　from　pharmaceutic　art；　but　it　continues　to　persuade　fools　that　art　can　arrest　them　all　with　its　specifics。

It　is　worse　than　useless　to　attempt　in　any　way　to　check　the　freest　expression　of　opinion　as　to　the　efficacy　of　any　or　all　of　the　〃heroic〃　means　of　treatment　employed　by　practitioners　of　different　schools　and　periods。　　Medical　experience　is　a　great　thing；　but　we　must　not　forget　that　there　is　a　higher　experience；　which　tries　its　results　in　a　court　of　a　still　larger　jurisdiction；　that；　namely；　in　which　the　laws　of　human　belief　are　summoned　to　the　witness…box；　and　obliged　to　testify　to　the　sources　of　error　which　beset　the　medical　practitioner。　　The　verdict　is　as　old　as　the　father　of　medicine；　who　announces　it　in　the　words；　〃judgment　is　difficult。〃　　Physicians　differed　so　in　his　time；　that　some　denied　that　there　was　any　such　thing　as　an　art　of　medicine。

One　man's　best　remedies　were　held　as　mischievous　by　another。　　The　art　of　healing　was　like　soothsaying；　so　the　common　people　said；　the　same　bird　was　lucky　or　unlucky；　according　as　he　flew　to　the　right　or　left。〃

The　practice　of　medicine　has　undergone　great　changes　within　the　period　of　my　own　observation。　　Venesection；　for　instance；　has　so　far　gone　out　of　fashion；　that；　as　I　am　told　by　residents　of　the　New　York　Bellevue　and　the　Massachusetts　General　Hospitals；　it　is　almost　obsolete　in　these　institutions；　at　least　in　medical　practice。　　The　old　Brunonian　stimulating　treatment　has　come　into　vogue　again　in　the　practice　of　Dr。　Todd　and　his　followers。　　The　compounds　of　mercury　have　yielded　their　place　as　drugs　of　all　work；　and　specifics　for　that　very　frequent　subjective　complaint；　nescio　quid　faciam；to　compounds　of　iodine。　＇Sir　Astley　Cooper　has　the　boldness；or　honesty；to　speak　of　medicines　which　〃are　given　as　much　to　assist　the　medical　man　as　his　patient。〃　　Lectures　（London；　1832）；　p。　　14。＇　Opium　is　believed　in；　and　quinine；　and　〃rum；〃　using　that　expressive　monosyllable　to　mean　all　alcoholic　cordials。　　If　Moliere　were　writing　now；　instead　of　saignare；　purgare；　and　the　other；　he　would　be　more　like　to　say；　Stimulare；　opium　dare　et　potassio…iodizare。

I　have　been　in　relation　successively　with　the　English　and　American　evacuant　and　alterative　practice；　in　which　calomel　and　antimony　figured　so　largely　that；　as　you　may　see　in　Dr。　Jackson's　last　〃Letter；〃　Dr。　Holyoke；　a　good　representative　of　sterling　old…　fashioned　medical　art；　counted　them　with　opium　and　Peruvian　bark　as　his　chief　remedies；　with　the　moderately　expectant　practice　of　Louis；　the　blood…letting　〃coup　sur　coup〃　of　Bouillaud；　the　contra…stimulant　method　of　Rasori　and　his　followers；　the　anti…irritant　system　of　Broussais；　with　its　leeching　and　gum…water；　I　have　heard　from　our　own　students　of　the　simple　opium　practice　of　the　renowned　German　teacher；　Oppolzer；　and　now　I　find　the　medical　community　brought　round　by　the　revolving　cycle　of　opinion　to　that　same　old　plan　of　treatment　which　John　Brown　taught　in　Edinburgh　in　the　last　quarter　of　the　last　century；　and　Miner　and　Tully　fiercely　advocated　among　ourselves　in　the　early　years　of　the　present。　　The　worthy　physicians　last　mentioned；　and　their　antagonist　Dr。　Gallup；　used　stronger　language　than　we　of　these　degenerate　days　permit　ourselves。　　〃The　lancet　is　a　weapon　which　annually　slays　more　than　the　sword；〃　says　Dr。　Tully。　〃It　is　probable　that；　for　forty　years　past；　opium　and　its　preparations　have　done　seven　times　the　injury　they　have　rendered　benefit；　on　the　great　scale　of　the　world；〃　says　Dr。　Gallup。

What　is　the　meaning　of　these　perpetual　changes　and　conflicts　of　medical　opinion　and　practice；　from　an　early　antiquity　to　our　own　time？　　Simply　this：　all　〃methods〃　of　treatment　end　in　disappointment　of　those　extravagant　expectations　which　men　are　wont　to　entertain　of　medical　art。　　The　bills　of　mortality　are　more　obviously　affected　by　drainage；　than　by　this　or　that　method　of　practice。　　The　insurance　companies　do　not　commonly　charge　a　different　percentage　on　the　lives　of　the　patients　of　this　or　that　physician。　　In　the　course　of　a　generation；　more　or　less；　physicians　themselves　are　liable　to　get　tired　of　a　practice　which　has　so　little　effect　upon　the　average　movement　of　vital　decomposition。　　Then　they　are　ready　for　a　change；　even　if　it　were　back　again　to　a　method　which　has　already　been　tried；　and　found　wanting。

Our　practitioners；　or　many　of　them；　have　got　back　to　the　ways　of　old　Dr。　Samuel　Danforth；　who；　as　it　is　well　known；　had　strong　objections　to　the　use　of　the　lancet。　　By　and　by　a　new　reputation　will　be　made　by　some　discontented　practitioner；　who；　tired　of　seeing　patients　die　with　their　skins　full　of　whiskey　and　their　brains　muddy　with　opium；　returns　to　a　bold　antiphlogistic　treatment；　and　has　the　luck　to　see　a　few　patients　of　note　get　well　under　it。　　So　of　the　remedies　which　have　gone　out　of　fashion　and　been　superseded　by　others。　　It　can　hardly　be　doubted　that　they　will　come　into　vogue　again；　more　or　less　extensively；　under　the　influence　of　that　irresistible　demand　for　change　just　referred　to。

Then　will　come　the　usual　talk　about　a　change　in　the　character　of　disease；　which　has　about　as　much　meaning　as　that　concerning　〃old…fashioned　snow…storms。〃　　〃Epidemic　constitutions〃　of　disease　mean　something；　no　doubt；　a　great　deal　as　applied　to　malarious　affections；　but　that　the　whole　type　of　diseases　undergoes　such　changes　that　the　practice　must　be　reversed　from　depleting　to　stimulating；　and　vice　versa；　is　much　less　likely　than　that　methods　of　treatment　go　out　of　fashion　and　come　in　again。　　If　there　is　any　disease　which　claims　its　percentage　with　reasonable　uniformity；　it　is　phthisis。　　Yet　I　remember　that　the　reverend　and　venerable　Dr。　Prince　of　Salem　told　me　one　Commencement　day；　as　I　was　jogging　along　towards　Cambridge　with　him；　that　he　recollected　the　time　when　that　disease　was　hardly　hardly　known；　and　in　confirmation　of　his　statement　mentioned　a　case　in　which　it　was　told　as　a　great　event；　that　somebody　down　on　〃the　Cape〃　had　died　of　〃a　consumption。〃　　This　story　does　not　sound　probable　to　myself；　as　I　repeat　it；　yet　I　assure　you　it　is　true；　and　it　shows　how　cautiously　we　must　receive　all　popular　stories　of　great　changes　in　the　habits　of　disease。

Is　there　no　progress；　then；　but　do　we　return　to　the　same　beliefs　and　practices　which　our　forefathers　wore　out　and　threw　away？　　I　trust　and　believe　that　there　is　a　real　progress。　　We　may；　for　instance；　return　in　a　measure　to　the　Brunonian　stimulating　system；　but　it　must　be　in　a　modified　way；　for　we　cannot　go　back　to　the　simple　Brunonian　pathology；　since　we　have　learned　too　much　of　diseased　action　to　accept　its　convenient　dualism。　　So　of　other　doctrines；　each　new　Avatar　strips　them　of　some　of　their　old　pretensions；　until　they　take　their　fitting　place　at　last；　if　they　have　any　truth　in　them；　or　disappear；　if　they　were　mere　phantasms　of　the　imagination。

In　the　mean　time；　while　medical　theories　are　coming　in　and　going　out；　there　is　a　set　of　sensible　men　who　are　never　run　away　with　by　them；　but　practise　their　art　sagaciously　and　faithfully　in　much　the　same　way　from　generation　to　generation。　　From　the　time　of　Hippocrates　to　that　of　our　own　medical　patriarch；　there　has　been　an　apostolic　succession　of　wise　and　good　practitioners。　　If　you　will　look　at　the　first　aphorism　of　the　ancient　Master　you　will　see　that　before　all　remedies　he　places　the　proper　conduct　of　the　patient　and　his　attendants；　and　the　fit　ordering　of　all　the　conditions　surrounding　him。　　The　class　of　practitioners　I　have　referred　to　have　always　been　the　most　faithful　in　attending　to　these　points。　　No　doubt　they　have　sometimes　prescribed　unwisely；　in　compliance　with　the　prejudices　of　their　time；　but　they　have　grown　wiser　as　they　have　grown　older；　and　learned　to　trust　more　in　nature　and　less　in　their　plans　of　interference。　　I　believe　common　opinion　confirms　Sir　James　Clark's　observation　to　this　effect。

The　experience　of　the　profession　must；　I　think；　run　parallel　with　that　of　the　wisest　of　its　individual　members。　　Each　time　a　plan　of　treatment　or　a　particular　remedy　comes　up　for　trial；　it　is　submitted　to　a　sharper　scrutiny。　　When　Cullen　wrote　his　Materia　Medica；　he　had　seriously　to　assail　the　practice　of　giving　burnt　toad；　which　was　still　countenanced　by　at　least　one　medical　authority　of　note。　　I　have　read　recently　in　some　medical　journal；　that　an　American　practitioner；　whose　name　is　known　to　the　country；　is　prescribing　the　hoof　of　a　horse　for　epilepsy。　　It　was　doubtless　suggested　by　that　old　fancy　of　wearing　a　portion　of　elk's　hoof　hung　round　the　neck　or　in　a　ring；　for　this　disease。　　But　it　is　hard　to　persuade　reasonable　people　to　swallow　the　abominations　of　a　former　period。　　The　evidence　which　satisfied　Fernelius　will　not　serve　one　of　our　hospital　physicians。

In　this　way　those　articles　of　the　Materia　Medica　which　had　nothing　but　loathsomeness　to　recommend　them　have　been　gradually　dropped；　and　are　not　like　to　obtain　any　general　favor　again　with　civilized　communities。　　The　next　culprits　to　be　tried　are　the　poisons。　　I　have　never　been　in　the　least　sceptical　as　to　the　utility　of　some　of　them；　whe