medical essays-第1章

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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　sacri