medical essays-第1节
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Medical Essays
by Oliver Wendell Holmes
1842…1882
CONTENTS：
I。 HOMEOPATHY AND ITS KINDRED DELUSIONS
II。 THE CONTAGIOUSNESS OF PUERPERAL FEVER
III。 CURRENTS AND COUNTER…CURRENTS IN MEDICAL SCIENCE
IV。 BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE
V。 SCHOLASTIC AND BEDSIDE TEACHING
VI。 THE MEDICAL PROFESSION IN MASSACHUSETTS
VII。 THE YOUNG PRACTITIONER
VIII。 MEDICAL LIBRARIES
IX。 SOME OF MY EARLY TEACHERS
PREFACE。
The character of the opposition which some of these papers have met with suggests the inference that they contain really important； but unwelcome truths。 Negatives multiplied into each other change their sign and become positives。 Hostile criticisms meeting together are often equivalent to praise； and the square of fault…finding turns out to be the same thing as eulogy。
But a writer has rarely so many enemies as it pleases him to believe。 Self…love leads us to overrate the numbers of our negative constituency。 The larger portion of my limited circle of readers must be quite indifferent to； if not ignorant of； the adverse opinions which have been expressed or recorded concerning any of these Addresses or Essays now submitted to their own judgment。 It is proper； however； to inform them； that some of the positions maintained in these pages have been unsparingly attacked； with various degrees of ability； scholarship； and good…breeding。 The tone of criticism naturally changes with local conditions in different parts of a country extended like our own； so that it is one of the most convenient gauges of the partial movements in the direction of civilization。 It is satisfactory to add； that the views assailed have also been unflinchingly defended by unsought champions； among the ablest of whom it is pleasant to mention； at this moment of political alienation； the Editor of the Charleston Medical Journal。
〃Currents and Counter…Currents〃 was written and delivered as an Oration； a florid rhetorical composition； expressly intended to secure the attention of an audience not easy to hold as listeners。 It succeeded in doing this； and also in being as curiously misunderstood and misrepresented as if it had been a political harangue。 This gave it more local notoriety than it might otherwise have attained； so that； as I learn； one ingenious person made use of its title as an advertisement to a production of his own。
The commonest mode of misrepresentation was this： qualified propositions； the whole meaning of which depended on the qualifications； were stripped of these and taken as absolute。 Thus； the attempt to establish a presumption against giving poisons to sick persons was considered as equivalent to condemning the use of these substances。 The only important inference the writer has been able to draw from the greater number of the refutations of his opinions which have been kindly sent him； is that the preliminary education of the Medical Profession is not always what it ought to be。
One concession he is willing to make； whatever sacrifice of pride it may involve。 The story of Massasoit； which has furnished a coral； as it were； for some teething critics； when subjected to a powerful logical analysis； though correct in its essentials； proves to have been told with exceptionable breadth of statement； and therefore （to resume the metaphor） has been slightly rounded off at its edges； so as to be smoother for any who may wish to bite upon it hereafter。 In other respects the Discourse has hardly been touched。 It is only an individual's expression； in his own way； of opinions entertained by hundreds of the Medical Profession in every civilized country； and has nothing in it which on revision the writer sees cause to retract or modify。 The superstitions it attacks lie at the very foundation of Homoeopathy； and of almost every form of medical charlatanism。 Still the mere routinists and unthinking artisans in most callings dislike whatever shakes the dust out of their traditions； and it may be unreasonable to expect that Medicine will always prove an exception to the rule。 One half the opposition which the numerical system of Louis has met with； as applied to the results of treatment； has been owing to the fact that it showed the movements of disease to be far more independent of the kind of practice pursued than was agreeable to the pride of those whose self…confidence it abated。
The statement； that medicines are more sparingly used in physicians' families than in most others； admits of a very natural explanation； without putting a harsh construction upon it； which it was not intended to admit。 Outside pressure is less felt in the physician's own household； that is all。 If this does not sometimes influence him to give medicine； or what seems to be medicine； when among those who have more confidence in drugging than his own family commonly has； the learned Professor Dunglison is hereby requested to apologize for his definition of the word Placebo； or to expunge it from his Medical Dictionary。
One thing is certain。 A loud outcry on a slight touch reveals the weak spot in a profession； as well as in a patient。 It is a doubtful policy to oppose the freest speech in those of our own number who are trying to show us where they honestly believe our weakness lies。 Vast as are the advances of our Science and Art； may it not possibly prove on examination that we retain other old barbarisms beside the use of the astrological sign of Jupiter； with which we endeavor to insure good luck to our prescriptions？ Is it the act of a friend or a foe to try to point them out to our brethren when asked to address them； and is the speaker to subdue the constitutional habit of his style to a given standard； under penalty of giving offence to a grave assembly？
Homoeopathy and its Kindred Delusions 〃 was published nearly twenty years ago； and has been long out of print； so that the author tried in vain to procure a copy until the kindness of a friend supplied him with the only one he has had for years。 A foolish story reached his ears that he was attempting to buy up stray copies for the sake of suppressing it。 This edition was in the press at that very time。
Many of the arguments contained in the Lectures have lost whatever novelty they may have possessed。 All its predictions have been submitted to the formidable test of time。 They appear to have stood it； so far； about as well as most uninspired prophecies； indeed； some of them require much less accommodation than certain grave commentators employ in their readings of the ancient Prophets。
If some statistics recently published are correct； Homoeopathy has made very slow progress in Europe。
In all England； as it appears； there are hardly a fifth more Homoeopathic practitioners than there are students attending Lectures at the Massachusetts Medical College at the present time。 In America it has undoubtedly proved more popular and lucrative； yet how loose a hold it has on the public confidence is shown by the fact that； when a specially valued life； which has been played with by one of its agents； is seriously threatened； the first thing we expect to hear is that a regular practitioner is by the patient's bed； and the Homoeopathic counsellor overruled or discarded。 Again； how many of the ardent and capricious persons who embraced Homoeopathy have run the whole round of pretentious novelties；have been boarded at water…cure establishments； closeted with uterine and other specialists； and finally wandered over seas to put themselves in charge of foreign celebrities； who dosed them as lustily as they were ever dosed before they took to globules！ It will surprise many to learn to what a shadow of a shade Homoeopathy has dwindled in the hands of many of its noted practitioners。 The itch…doctrine is treated with contempt。 Infinitesimal doses are replaced by full ones whenever the fancy…practitioner chooses。 Good Homoeopathic reasons can be found for employing anything that anybody wants to employ。 Homoeopathy is now merely a name； an unproved theory； and a box of pellets pretending to be specifics； which； as all of us know； fail ignominiously in those cases where we would thankfully sacrifice all our prejudices and give the world to have them true to their promises。
Homoeopathy has not died out so rapidly as Tractoration。 Perhaps it was well that it should not； for it has taught us a lesson of the healing faculty of Nature which was needed； and for which many of us have made proper acknowledgments。 But it probably does more harm than good to medical science at the present time； by keeping up the delusion of treating everything by specifics；the old barbarous notion that sick people should feed on poisons ＇Lachesis； arrow… poison； obtained from a serpent （Pulte）。 Crotalus horridus； rattlesnake's venom （Neidhard）。 The less dangerous Pediculus capilis is the favorite remedy of Dr。 Mure； the English 'Apostle of Homoeopathy。〃 These are examples of the retrograde current setting towards barbarism＇ against which a part of the Discourse at the beginning of this volume is directed。
The infinitesimal globules have not become a curiosity as yet； like Perkins's Tractors。 But time is a very ela
