medical essays-第50节
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sisted 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 s
