medical essays-第44章

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s　will　produce　its　ordinary　happy　effect。

Disease；　dis…ease；disturbed　quiet；　uncomfortableness；means　imperfect　or　abnormal　reaction　of　the　living　system；　and　its　more　or　less　permanent　results。

Food；　in　its　largest　sense；　is　whatever　helps　to　build　up　the　normal　structures；　or　to　maintain　their　natural　actions。

Medicine；　in　distinction　from　food；　is　every　unnatural　or　noxious　agent　applied　for　the　relief　of　disease。

Physic　means　properly　the　Natural　art；　and　Physician　is　only　the　Greek　synonyme　of　Naturalist。

With　these　few　explanations　I　proceed　to　unfold　the　propositions　I　have　mentioned。

Disease　and　death；　if　we　may　judge　by　the　records　of　creation；　are　inherently　and　essentially　necessary　in　the　present　order　of　things。　A　perfect　intelligence；　trained　by　a　perfect　education；　could　do　no　more　than　keep　the　laws　of　the　physical　and　spiritual　universe。　　An　imperfect　intelligence；　imperfectly　taught；and　this　is　the　condition　of　our　finite　humanity；will　certainly　fail　to　keep　all　these　laws　perfectly。　　Disease　is　one　of　the　penalties　of　one　of　the　forms　of　such　failure。　　It　is　prefigured　in　the　perturbations　of　the　planets；　in　the　disintegration　of　the　elemental　masses；　it　has　left　its　traces　in　the　fossil　organisms　of　extinct　creations。　＇Professor　Agassiz　has　kindly　handed　me　the　following　note：　〃There　are　abnormal　structures　in　animals　of　all　ages　anterior　to　the　creation　of　mankind。　　Malformed　specimens　of　Crinoids　are　known　from　the　Triassic　and　Jurassic　deposits。　　Malformed　and　diseased　bones　of　tertiary　mammalia　have　been　collected　in　the　caverns　of　Gailenreuth　with　traces　of　healing。〃＇

But　it　is　especially　the　prerogative；　I　had　almost　said　privilege；　of　educated　and　domesticated　beings；　from　man　down　to　the　potato；　serving　to　teach　them；　and　such　as　train　them；　the　laws　of　life；　and　to　get　rid　of　those　who　will　not　mind　or　cannot　be　kept　subject　to　these　laws。

Disease；　being　always　an　effect；　is　always　in　exact　proportion　to　the　sum　of　its　causes；　as　much　in　the　case　of　Spigelius；　who　dies　of　a　scratch；　as　in　that　of　the　man　who　recovers　after　an　iron　bar　has　been　shot　through　his　brain。　　The　one　prevalent　failing　of　the　medical　art　is　to　neglect　the　causes　and　quarrel　with　the　effect。

There　are　certain　general　facts　which　include　a　good　deal　of　what　is　called　and　treated　as　disease。　　Thus；　there　are　two　opposite　movements　of　life　to　be　seen　in　cities　and　elsewhere；　belonging　to　races　which；　from　various　persistent　causes；　are　breeding　down　and　tending　to　run　out；　and　to　races　which　are　breeding　up；　or　accumulating　vital　capital；a　descending　and　an　ascending　series。　Let　me　give　an　example　of　each；　and　that　I　may　incidentally　remove　a　common　impression　about　this　country　as　compared　with　the　Old　World；　an　impression　which　got　tipsy　with　conceit　and　staggered　into　the　attitude　of　a　formal　proposition　in　the　work　of　Dr。　Robert　Knox；　I　will　illustrate　the　downward　movement　from　English　experience；　and　the　upward　movement　from　a　family　history　belonging　to　this　immediate　neighborhood。

Miss　Nightingale　speaks　of　〃the　fact　so　often　seen　of　a　great…grandmother；　who　was　a　tower　of　physical　vigor；　descending　into　a　grandmother　perhaps　a　little　less　vigorous；　but　still　sound　as　a　bell；　and　healthy　to　the　core；　into　a　mother　languid　and　confined　to　her　carriage　and　house；　and　lastly　into　a　daughter　sickly　and　confined　to　her　bed。〃　So　much　for　the　descending　English　series；　now　for　the　ascending　American　series。

Something　more　than　one　hundred　and　thirty　years　ago　there　graduated　at　Harvard　College　a　delicate　youth；　who　lived　an　invalid　life　and　died　at　the　age　of　about　fifty。　　His　two　children　were　both　of　moderate　physical　power；　and　one　of　them　diminutive　in　stature。　　The　next　generation　rose　in　physical　development；　and　reached　eighty　years　of　age　and　more　in　some　of　its　members。　　The　fourth　generation　was　of　fair　average　endowment。　　The　fifth　generation；　great…great…　grandchildren　of　the　slender　invalid；　are　several　of；　them　of　extraordinary　bodily　and　mental　power；　large　in　stature；　formidable　alike　with　their　brains　and　their　arms；　organized　on　a　more　extensive　scale　than　either　of　their　parents。

This　brief　account　illustrates　incidentally　the　fallacy　of　the　universal…degeneration　theory　applied　to　American　life；　the　same　on　which　one　of　our　countrymen　has　lately　brought　some　very　forcible　facts　to　bear　in　a　muscular　discussion　of　which　we　have　heard　rather　more　than　is　good　for　us。　But　the　two　series；　American　and　English；　ascending　and　descending；　were　adduced　with　the　main　purpose　of　showing　the　immense　difference　of　vital　endowments　in　different　strains　of　blood；　a　difference　to　which　all　ordinary　medication　is　in　all　probability　a　matter　of　comparatively　trivial　purport。　　Many　affections　which　art　has　to　strive　against　might　be　easily　shown　to　be　vital　to　the　well…being　of　society。　　Hydrocephalus；　tabes　mesenterica；　and　other　similar　maladies；　are　natural　agencies　which　cut　off　the　children　of　races　that　are　sinking　below　the　decent　minimum　which　nature　has　established　as　the　condition　of　viability；　before　they　reach　the　age　of　reproduction。　　They　are　really　not　so　much　diseases；　as　manifestations　of　congenital　incapacity　for　life；　the　race　would　be　ruined　if　art　could　ever　learn　always　to　preserve　the　individuals　subject　to　them。　　We　must　do　the　best　we　can　for　them；　but　we　ought　also　to　know　what　these　〃diseases〃　mean。

Again；　invalidism　is　the　normal　state　of　many　organizations。　　It　can　be　changed　to　disease；　but　never　to　absolute　health　by　medicinal　appliances。　　There　are　many　ladies；　ancient　and　recent；　who　are　perpetually　taking　remedies　for　irremediable　pains　and　aches。　　They　ought　to　have　headaches　and　back…aches　and　stomach…aches；　they　are　not　well　if　they　do　not　have　them。　　To　expect　them　to　live　without　frequent　twinges　is　like　expecting　a　doctor's　old　chaise　to　go　without　creaking；　if　it　did；　we　might　be　sure　the　springs　were　broken。　　There　is　no　doubt　that　the　constant　demand　for　medicinal　remedies　from　patients　of　this　class　leads　to　their　over…use；　often　in　the　case　of　cathartics；　sometimes　in　that　of　opiates。　　I　have　been　told　by　an　intelligent　practitioner　in　a　Western　town；　that　the　constant　prescription　of　opiates　by　certain　physicians　in　his　vicinity　has　rendered　the　habitual　use　of　that　drug　in　all　that　region　very　prevalent；　more　common；　I　should　think；　than　alcoholic　drunkenness　in　the　most　intemperate　localities　of　which　I　have　known　anything。　　A　frightful　endemic　demoralization　betrays　itself　in　the　frequency　with　which　the　haggard　features　and　drooping　shoulders　of　the　opium…drunkards　are　met　with　in　the　streets。

The　next　proposition　I　would　ask　you　to　consider　is　this：　The　presumption　always　is　that　every　noxious　agent；　including　medicines　proper；　which　hurts　a　well　man；　hurts　a　sick　one。　＇　Note　B。＇

Let　me　illustrate　this　proposition　before　you　decide　upon　it。　　If　it　were　known　that　a　prize…fighter　were　to　have　a　drastic　purgative　administered　two　or　three　days　before　a　contest；　or　a　large　blister　applied　to　his　back；　no　one　will　question　that　it　would　affect　the　betting　on　his　side　unfavorably；　we　will　say　to　the　amount　of　five　per　cent。　　Now　the　drain　upon　the　resources　of　the　system　produced　in　such　a　case　must　be　at　its　minimum；　for　the　subject　is　a　powerful　man；　in　the　prime　of　life；　and　in　admirable　condition。　　If　the　drug　or　the　blister　takes　five　per　cent。　from　his　force　of　resistance；　it　will　take　at　least　as　large　a　fraction　from　any　invalid。　　But　this　invalid　has　to　fight　a　champion　who　strikes　hard　but　cannot　be　hit　in　return；　who　will　press　him　sharply　for　breath；　but　will　never　pant　himself　while　the　wind　can　whistle　through　his　fleshless　ribs。　　The　suffering　combatant　is　liable　to　want　all　his　stamina；　and　five　per　cent。　may　lose　him　the　battle。

All　noxious　agents；　all　appliances　which　are　not　natural　food　or　stimuli；　all　medicines　proper；　cost　a　patient；　on　the　average；　five　per　cent。　of　his　vital　force；　let　us　say。　　Twenty　times　as　much　waste　of　force　produced　by　any　of　them；　that　is；　would　exactly　kill　him；　nothing　less　than　kill　him；　and　nothing　more。　　If　this；　or　something　like　this；　is　true；　then　all　these　medications　are；　prima　facie；