medical essays-第58章
按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！
hich mines have been emptied of their cankering minerals； the vegetable kingdom robbed of all its noxious growths； the entrails of animals taxed for their impurities； the poison…bags of reptiles drained of their venom； and all the inconceivable abominations thus obtained thrust down the throats of human beings suffering from some fault of organization； nourishment； or vital stimulation。
Much as we have gained； we have not yet thoroughly shaken off the notion that poison is the natural food of disease； as wholesome aliment is the support of health。 Cowper's lines； in 〃The Task；〃 show the matter…of…course practice of his time：
〃He does not scorn it； who has long endured A fever's agonies； and fed on drugs。〃
Dr。 Kimball of Lowell； who has been in the habit of seeing a great deal more of typhoid fever than most practitioners； and whose surgical exploits show him not to be wanting in boldness or enterprise； can tell you whether he finds it necessary to feed his patients on drugs or not。 His experience is； I believe； that of the most enlightened and advanced portion of the profession； yet I think that even in typhoid fever； and certainly in many other complaints； the effects of ancient habits and prejudices may still be seen in the practice of some educated physicians。
To you； young men； it belongs to judge all that has gone before you。 You come nearer to the great fathers of modern medicine than some of you imagine。 Three of my own instructors attended Dr。 Rush's Lectures。 The illustrious Haller mentions Rush's inaugural thesis in his 〃Bibliotheca Anatomica；〃 and this same Haller； brought so close to us； tells us he remembers Ruysch； then an old man； and used to carry letters between him and Boerhaave。 Look through the history of medicine from Boerhaave to this present day。 You will see at once that medical doctrine and practice have undergone a long series of changes。 You will see that the doctrine and practice of our own time must probably change in their turn； and that； if we can trust at all to the indications of their course； it will be in the direction of an improved hygiene and a simplified treatment。 Especially will the old habit of violating the instincts of the sick give place to a judicious study of these same instincts。 It will be found that bodily； like mental insanity； is best managed； for the most part； by natural soothing agencies。 Two centuries ago there was a prescription for scurvy containing 〃stercoris taurini et anserini par； quantitas trium magnarum nucum；〃 of the hell…broth containing which 〃guoties…cumque sitit oeger； large bibit。〃 When I have recalled the humane common…sense of Captain Cook in the matter of preventing this disease； when I have heard my friend； Mr。 Dana； describing the avidity with which the scurvy…stricken sailors snuffed up the earthy fragrance of fresh raw potatoes； the food which was to supply the elements wanting to their spongy tissues； I have recognized that the perfection of art is often a return to nature； and seen in this single instance the germ of innumerable beneficent future medical reforms。
I cannot help believing that medical curative treatment will by and by resolve itself in great measure into modifications of the food； swallowed and breathed； and of the natural stimuli； and that less will be expected from specifics and noxious disturbing agents； either alien or assimilable。 The noted mineral…waters containing iron； sulphur； carbonic acid； supply nutritious or stimulating materials to the body as much as phosphate of lime and ammoniacal compounds do to the cereal plants。 The effects of a milk and vegetable diet； of gluten bread in diabetes； of cod…liver oil in phthisis； even of such audacious innovations as the water…cure and the grape…cure； are only hints of what will be accomplished when we have learned to discover what organic elements are deficient or in excess in a case of chronic disease； and the best way of correcting the abnormal condition； just as an agriculturist ascertains the wants of his crops and modifies the composition of his soil。 In acute febrile diseases we have long ago discovered that far above all drug…medication is the use of mild liquid diet in the period of excitement； and of stimulant and nutritious food in that of exhaustion。 Hippocrates himself was as particular about his barley…ptisan as any Florence Nightingale of our time could be。
The generation to which you； who are just entering the profession； belong； will make a vast stride forward； as I believe； in the direction of treatment by natural rather than violent agencies。 What is it that makes the reputation of Sydenham； as the chief of English physicians？ His prescriptions consisted principally of simples。 An aperient or an opiate； a 〃cardiac〃 or a tonic； may be commonly found in the midst of a somewhat fantastic miscellany of garden herbs。 It was not by his pharmaceutic prescriptions that he gained his great name。 It was by daring to order fresh air for small…pox patients； and riding on horseback for consumptives； in place of the smothering system； and the noxious and often loathsome rubbish of the established schools。 Of course Sydenham was much abused by his contemporaries； as he frequently takes occasion to remind his reader。 〃I must needs conclude；〃 he says； 〃either that I am void of merit； or that the candid and ingenuous part of mankind； who are formed with so excellent a temper of mind as to be no strangers to gratitude； make a very small part of the whole。〃 If in the fearless pursuit of truth you should find the world as ungracious in the nineteenth century as he found it in the seventeenth； you may learn a lesson of self… reliance from another utterance of the same illustrious physician： 〃'T is none of my business to inquire what other persons think； but to establish my own observations； in order to which； I ask no favor of the reader but to peruse my writings with temper。〃
The physician has learned a great deal from the surgeon； who is naturally in advance of him； because he has a better opportunity of seeing the effects of his remedies。 Let me shorten one of Ambroise Pare's stories for you。 There had been a great victory at the pass of Susa； and they were riding into the city。 The wounded cried out as the horses trampled them under their hoofs； which caused good Ambroise great pity； and made him wish himself back in Paris。 Going into a stable he saw four dead soldiers； and three desperately wounded； placed with their backs against the wall。 An old campaigner came up。 〃Can these fellows get well？〃 he said。 〃No！〃 answered the surgeon。 Thereupon； the old soldier walked up to them and cut all their throats； sweetly； and without wrath （doulcement et sans cholere）。 Ambroise told him he was a bad man to do such a thing。 〃I hope to God；〃 he said； 〃somebody will do as much for me if I ever get into such a scrape〃 （accoustre de telle facon）。 〃I was not much salted in those days〃 （bien doux de sel）； says Ambroise； 〃and little acquainted with the treatment of wounds。〃 However； as he tells us； he proceeded to apply boiling oil of Sambuc （elder） after the approved fashion of the time；with what torture to the patient may be guessed。 At last his precious oil gave out； and he used instead an insignificant mixture of his own contrivance。 He could not sleep that night for fear his patients who had not been scalded with the boiling oil would be poisoned by the gunpowder conveyed into their wounds by the balls。 To his surprise； he found them much better than the others the next morning； and resolved never again to burn his patients with hot oil for gun…shot wounds。
This was the beginning； as nearly as we can fix it； of that reform which has introduced plain water…dressings in the place of the farrago of external applications which had been a source of profit to apothecaries and disgrace to art from； and before； the time when Pliny complained of them。 A young surgeon who was at Sudley Church； laboring among the wounded of Bull Run； tells me they had nothing but water for dressing； and he （being also doux de sel） was astonished to see how well the wounds did under that simple treatment。
Let me here mention a fact or two which may be of use
