medical essays-第45章
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othing more。 If this； or something like this； is true； then all these medications are； prima facie； injurious。
In the game of Life…or…Death； Rouge et Noir； as played between the Doctor and the Sexton； this five per cent。； this certain small injury entering into the chances is clearly the sexton's perquisite for keeping the green table； over which the game is played； and where he hoards up his gains。 Suppose a blister to diminish a man's pain； effusion or dyspnoea to the saving of twenty per cent。 in vital force； his profit from it is fifteen； in that case； for it always hurts him five to begin with； according to our previous assumption。
Presumptions are of vast importance in medicine； as in law。 A man is presumed innocent until he is proved guilty。 A medicinethat is； a noxious agent； like a blister； a seton； an emetic； or a cathartic should always be presumed to be hurtful。 It always is directly hurtful； it may sometimes be indirectly beneficial。 If this presumption were established； and disease always assumed to be the innocent victim of circumstances； and not punishable by medicines； that is； noxious agents； or poisons； until the contrary was shown； we should not so frequently hear the remark commonly； perhaps erroneously； attributed to Sir Astley Cooper； but often repeated by sensible persons； that； on the whole； more harm than good is done by medication。 Throw out opium； which the Creator himself seems to prescribe； for we often see the scarlet poppy growing in the cornfields； as if it were foreseen that wherever there is hunger to be fed there must also be pain to be soothed； throw out a few specifics which our art did not discover； and is hardly needed to apply ＇ Note C。＇； throw out wine； which is a food； and the vapors which produce the miracle of anaesthesia； and I firmly believe that if the whole materia medica； as now used； could be sunk to the bottom of the sea； it would be all the better for mankind；and all the worse for the fishes。
But to justify this proposition； I must add that the injuries inflicted by over…medication are to a great extent masked by disease。 Dr。 Hooker believes that the typhus syncopatia of a preceding generation in New England 〃was often in fact a brandy and opium disease。〃 How is a physician to distinguish the irritation produced by his blister from that caused by the inflammation it was meant to cure？ How can he tell the exhaustion produced by his evacuants from the collapse belonging to the disease they were meant to remove？
Lastly； medication without insuring favorable hygienic conditions is like amputation without ligatures。 I had a chance to learn this well of old； when physician to the Broad Street district of the Boston Dispensary。 There； there was no help for the utter want of wholesome conditions； and if anybody got well under my care； it must have been in virtue of the rough…and…tumble constitution which emerges from the struggle for life in the street gutters； rather than by the aid of my prescriptions。
But if the materia medica were lost overboard； how much more pains would be taken in ordering all the circumstances surrounding the patient （as can be done everywhere out of the crowded pauper districts）； than are taken now by too many who think they do their duty and earn their money when they write a recipe for a patient left in an atmosphere of domestic malaria； or to the most negligent kind of nursing！ I confess that I should think my chance of recovery from illness less with Hippocrates for my physician and Mrs。 Gamp for my nurse； than if I were in the hands of Hahnemann himself； with Florence Nightingale or good Rebecca Taylor to care for me。
If I am right in maintaining that the presumption is always against the use of noxious agents in disease； and if any whom I might influence should adopt this as a principle of practice； they will often find themselves embarrassed by the imperative demand of patients and their friends for such agents where a case is not made out against this standing presumption。 I must be permitted to say； that I think the French； a not wholly uncivilized people； are in advance of the English and ourselves in the art of prescribing for the sick without hurting them。 And I do confess that I think their varied ptisans and syrups are as much preferable to the mineral regimen of bug…poison and ratsbane； so long in favor on the other side of the Channel； as their art of preparing food for the table to the rude cookery of those hard…feeding and much…dosing islanders。 We want a reorganized cuisine of invalidism perhaps as much as the culinary； reform； for which our lyceum lecturers； and others who live much at hotels and taverns； are so urgent。 Will you think I am disrespectful if I ask whether； even in Massachusetts； a dose of calomel is not sometimes given by a physician on the same principle as that upon which a landlord occasionally prescribes bacon and eggs；because he cannot think of anything else quite so handy？ I leave my suggestion of borrowing a hint from French practice to your mature consideration。
I may； however； call your attention； briefly； to the singular fact； that English and American practitioners are apt to accuse French medical practice of inertness； and French surgical practice of unnecessary activity。 Thus； Dr。 Bostock considers French medical treatment； with certain exceptions； as 〃decidedly less effective〃 than that of his own country。〃 Mr。 S。 Cooper； again； defends the simple British practice of procuring union by the first intention against the attacks of M。 Roux and Baron Larrey。 ＇Cooper's Surg。 Diet。 art。 〃Wounds。〃 Yet Mr。 John Bell gives the French surgeons credit for introducing this doctrine of adhesion； and accuses O'Halloran of 〃rudeness and ignorance；〃 and 〃bold； uncivil language；〃 in disputing their teaching。 Princ。 of Surgery； vol。 i。 p。 42。 Mr。 Hunter succeeded at last in naturalizing the doctrine and practice； but even he had to struggle against the perpetual jealousy of rivals； and died at length assassinated by an insult。＇ We have often heard similar opinions maintained by our own countrymen。 While Anglo…American criticism blows hot or cold on the two departments of French practice； it is not； I hope； indecent to question whether all the wisdom is necessarily with us in both cases。
Our art has had two or three lessons which have a deep meaning to those who are willing to read them honestly。 The use of water… dressings in surgery completed the series of reforms by which was abolished the 〃coarse and cruel practice〃 of the older surgeons； who with their dressings and acrid balsams； their tents and leaden tubes； 〃absolutely delayed the cure。〃 The doctrine of Broussais； transient as was its empire； reversed the practice of half of Christendom for a season； and taught its hasty disciples to shun their old favorite remedies as mortal poisons。 This was not enough permanently to shift the presumption about drugs where it belonged； and so at last； just as the sympathetic powder and the Unguentum Armarium came in a superstitious age to kill out the abuses of external over…medication； the solemn farce of Homoeopathy was enacted in the face of our own too credulous civilization； that under shelter of its pretences the 〃inward bruises〃 of over…drugged viscera might be allowed to heal by the first intention。 Its lesson we must accept； whether we will or not； its follies we are tired of talking about。 The security of the medical profession against this and all similar fancies is in the average constitution of the human。 mind with regard to the laws of evidence。
My friends and brothers in Art！ There is nothing to be feared from the utterance of any seeming heresy to which you may have listened。 I cannot compromise your collective wisdom。 If I have strained the truth one hair's breadth for the sake of an epigram or an antithesis； you are accustomed to count the normal pulse…beats of sound judgment； and know full well how to recognize the fever…throbs of conceit and the nervous palpitations of rhetoric。
The freedom with which each of us speaks his thought in this presence； belongs in part to the assured position of the Profession in our Commonwealth； to the attitude of Science； which
