medical essays-第38节
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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 one household to another。 Do not some of you remember that I have had to fight this private…pestilence question against a scepticism which sneered in the face of a mass of evidence such as the calm statisticians of the Insurance office could not listen to without horror and indignation？ ＇The Contagiousness of Puerperal Fever。〃…N。 E。 Quan Jour。 of Medicine and Surgery； April； 1843。 Reprinted； with Additions。 Boston： Ticknor & Fields。 1855。＇ Have we forgotten what is told in one of the books published under our own sanction； that a simple measure of ventilation； proposed by Dr。 John Clark； had saved more than sixteen thousand children's lives in a single hospital？ How long would it have taken small doses of calomel and rhubarb to save as many children？ These may be useful in prudent hands； but how insignificant compared to the great hygienic conditions！ Causes； causes； and again causes；more and more we fall back on these as the chief objects of our attention。 The shortest system of medical practice th
