medical essays-第43章
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s 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 that I know of is the oldest； but not the worst。 It is older than Hippocrates； older than Chiron the Centaur。 Nature taught it to the first mother when she saw her first…born child putting some ugly pebble or lurid berry into its mouth。 I know not in what language it was spoken； but I know that in English it would sound thus： Spit it out！
Art can do something more than say this。 It can sometimes reach the pebble or berry after it has been swallowed。 But the great thing is to keep these things out of children's mouths； and as soon as they are beyond our reach； to be reasonable and patient with Nature； who means well； but does not like to hurry； and who took nine calendar months； more or less； to every mother's son among us； before she thought he was fit to he shown to the public。
Suffer me now to lay down a few propositions； whether old or new it matters little； not for your immediate acceptance； nor yet for your hasty rejection； but for your calm consideration。
But first； there are a number of terms which we are in the habit of using in a vague though not unintelligible way； and which it is as well now to define。 These terms are the tools with which we are to work； and the first thing is to sharpen them。 It is nothing to us that they have been sharpened a thousand times before； they always get dull in the using； and every new workman has a right to carry them to the grindstone and sharpen them to suit himself。
Nature； in medical language； as opposed to Art； means trust in the reactions of the living system against； ordinary normal impressions。
Art； in the same language； as opposed to Nature； means an intentional resort to extraordinary abnormal impressions for the relief of disease。
The reaction of the living system is the essence of both。 Food is nothing； if there is no digestive act to respond to it。 We cannot raise a blister on a dead man； or hope that a carminative forced between his lips will produce its ordinary happy effect。
Disease； dis…ease；disturbed quiet； uncomfortableness；me
