medical essays-第37节
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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 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
