IfthereisanyStateorcitywhichmightclaimtobetheAmericanheadquartersofthenature-trustingheresy,provideditbeone,thatStateisMassachusetts,andthatcityisitscapital。Theeffectwhichthesedoctrineshaveupontheconfidencereposedintheprofessionisamatterofopinion。Formyself,Idonotbelievethisconfidencecanbeimpairedbyanyinvestigationswhichtendtolimittheapplicationoftroublesome,painful,uncertain,ordangerousremedies。Nay,Iwillventuretosaythis,thatifeveryspecificweretofailutterly,ifthecinchonatreesalldiedout,andthearsenicmineswereexhausted,andthesulphurregionswereburnedup,ifeverydrugfromthevegetable,animal,andmineralkingdomweretodisappearfromthemarket,abodyofenlightenedmen,organizedasadistinctprofession,wouldberequiredjustasmuchasnow,andrespectedandtrustedasnow,whoseprovinceshouldbetoguardagainstthecausesofdisease,toeliminatethemifpossiblewhenstillpresent,toorderalltheconditionsofthepatientsoastofavortheeffortsofthesystemtorightitself,andtogivethosepredictionsofthecourseofdiseasewhichonlyexperiencecanwarrant,andwhichinsomanycasesrelievetheexaggeratedfearsofsufferersandtheirfriends,orwarntheminseasonofimpendingdanger。Greatasthelosswouldbeifcertainactiveremediescouldnolongerbeobtained,itwouldleavethemedicalprofessionthemostessentialpartofit’sduties,andall,andmorethanall,itspresentshareofhonors;foritwouldbethedeath-blowtocharlatanism,whichdependsforitssuccessalmostentirelyondrugs,oratleastonanomenclaturethatsuggeststhem。
Thereisnooffence,then,ordangerinexpressingtheopinion,that,afterallwhichhasbeensaid,thecommunityisstilloverdosed:Thebestproofofitis,thatnofamiliestakesolittlemedicineasthoseofdoctors,exceptthoseofapothecaries,andthatoldpractitionersaremoresparingofactivemedicinesthanyoungerones。“[Dr。JamesJacksonhaskindlypermittedmetomakethefollowingextractfromaletterjustreceivedbyhimfromSirJamesClark,anddatedMay26,1860:“Asaphysicianadvancesinage,hegenerally,Ithink,placeslessconfidenceintheordinarymedicaltreatmentthanhedid,notonlyduringhisearly,butevenhismiddleperiodoflife。“]TheconclusionfromthesefactsisonewhichtheleastpromisingofDr。Howe’spupilsinthementaldepartmentcouldhardlyhelpdrawing。
Partoftheblameofover-medicationmust,Ifear,restwiththeprofession,foryieldingtothetendencytoself-delusion,whichseemsinseparablefromthepracticeoftheartofhealing。Ineedonlytouchonthecommonmodesofmisunderstandingormisapplyingtheevidenceofnature。
First,thereisthenaturalincapacityforsoundobservation,whichislikeafaultyearinmusic。Weseethisinmanypersonswhoknowagooddealaboutbooks,butwhoarenotsharp-sightedenoughtobuyahorseordealwithhumandiseases。
Secondly,thereisinsomepersonsasingularinabilitytoweighthevalueoftestimony;ofwhich,Ithink,fromaprettycarefulexaminationofhisbooks,HahnemannaffordsthebestspecimenoutsidethewallsofBedlam。
Theinveteratelogicalerrorstowhichphysicianshavealwaysbeensubjectarechieflythese:
Themodeofinferenceperenumerationemsimplicem,inscholasticphrase;thatis,countingonlytheirfavorablecases。ThisistheoldtrickillustratedinLordBacon’sstoryofthegiftsoftheshipwreckedpeople,hungupinthetemple——Behold!theyvowedthesegiftstothealtar,andthegodssavedthem。Ay,saidadoubtingbystander,buthowmanymadevowsofgiftsandwereshipwreckednotwithstanding?Thenumericalsystemisthebestcorrectiveofthisandsimilarerrors。Theargumentscommonlybroughtagainstitsapplicationtoallmattersofmedicalobservation,treatmentincluded,seemtoapplyrathertothetabulationoffactsillobserved,orimproperlyclassified,thantothemethoditself。
Theposthocergopropterhocerror:hegotwellaftertakingmymedicine;thereforeinconsequenceoftakingit。
Thefalseinductionfromgenuinefactsofobservation,leadingtotheconstructionoftheorieswhicharethendeductivelyappliedinthefaceoftheresultsofdirectobservation。TheschoolofBroussaishasfurnisheduswithagoodexampleofthiserror。
Andlastly,theerrorwhichSirThomasBrownecallsgiving“areasonofthegoldentooth;“thatis,assumingafalsehoodasafact,andgivingreasonsforit,commonlyfancifulones,asisconstantlydonebythatclassofincompetentobserverswhofindtheir“goldentooth“
inthefabulouseffectsofthehomoeopathiemateriamedica,——whichconsistsofsugarofmilkandanomenclature。
Anotherportionoftheblamerestswiththepublicitself,whichinsistsonbeingpoisoned。Somebodybuysallthequackmedicinesthatbuildpalacesforthemushroom,sayrather,thetoadstoolmillionaires。Whoisit?Thesepeoplehaveaconstituencyofmillions。Thepopularbeliefisallbutuniversalthatsickpersonsshouldfeedonnoxioussubstances。Oneofourmemberswascallednotlongsincetoamanwithaterriblysoremouth。Oninquiryhefoundthatthemanhadpickedupaboxofunknownpills,inHowardStreet,andhadproceededtotakethem,ongeneralprinciples,pillsbeinggoodforpeople。Theyhappenedtocontainmercury,andhencethetroubleforwhichheconsultedourassociate。
Theoutsidepressure,therefore,isimmenseuponthephysician,tendingtoforcehimtoactivetreatmentofsomekind。Certainoldsuperstitions,stilllingeringinthemindofthepublic,andnotyetutterlyexpelledfromthatoftheprofession,areatthebottomofthis,orcontributetoitlargely。Oneofthemostancientis,thatdiseaseisamalignantagency,orentity,tobedrivenoutofthebodybyoffensivesubstances,asthesmokeofthefish’sheartandliverdrovethedeviloutofTobit’sbridalchamber,accordingtotheApochrypha。Epilepticsusedtosuckthebloodfromthewoundsofdyinggladiators。[PliniiHist。Mundi。lib。xxviii。c。4。]TheHon。RobertBoyle’slittlebookwaspublishedsometwentyorthirtyyearsbeforeourlatePresident,Dr。Holyoke,wasborn。[ACollectionofChoiceandSafeRemedies。TheFifthEdition,corrected。London,1712。Dr。Holyokewasbornin1728。]Initherecommends,asinternalmedicines,mostofthesubstancescommonlyusedasfertilizersofthesoil。His“AlbumGraecum“isbestleftuntranslated,andhis“ZebethumOccidentale“isstillmoretranscendentallyunmentionableexceptinastrangedialect。Itsoundsodiouslytoustohearhimrecommendfordysenteryapowdermadefrom“thesoleofanoldshoewornbysomemanthatwalksmuch。“
Perhapsnobodyhereeverheardoftyingastocking,whichhadbeenwornduringtheday,roundtheneckatnightforasorethroat。Thesameideaofvirtueinunlovelysecretions![Theideaisveryancient。“Sordeshominis““Sudoreetoleomedicinamfacientibus。“——
Plin。xxviii。4。]
EvennowtheHomoeopathistshavebeenintroducingthevenomofserpents,underthelearnedtitleofLachesis,andoutraginghumannaturewithinfusionsofthepediculuscapitis;thatis,ofcourse,asweunderstandtheirdilutions,thenamesofthesethings;forifafine-tooth-combinsectweredrownedinLakeSuperior,wecannotagreewiththeminthinkingthateverydropofitswaterswouldbeimpregnatedwithallthepedicularvirtuestheysohighlyvalue。
Theyknowwhattheyaredoing。Theyareappealingtothedetestableoldsuperstitiouspresumptioninfavorofwhateverisnauseousandnoxiousasbeinggoodforthesick。
Again,wealloccasionallymeetpersonsstainedwithnitrateofsilver,givenforepilepsy。ReadwhatDr。Martinsays,aboutthewayinwhichitcametobeused,inhisexcellentaddressbeforetheNorfolkCountyMedicalSociety,andtheevidenceIcanshow,buthavenottimefornow,andthensaywhatyouthinkofthepracticewhichonsuchpresumptionsturnsawhitemanasblueasthedouble-tattooedKingoftheCannibalIslands![NoteA。]
Ifmedicalsuperstitionshavefoughttheirwaydownthroughalltherationalismandscepticismofthenineteenthcentury,ofcoursethetheoriesoftheschools,supportedbygreatnames,adoptedintothepopularbeliefandincorporatedwiththegeneralmassofmisapprehensionwithreferencetodisease,mustbeexpectedtomeetusateveryturnintheshapeofbadpracticefoundedonfalsedoctrine。AFrenchpatientcomplainsthathisbloodheatshim,andexpectshisdoctortobleedhim。AnEnglishorAmericanonesaysheisbilious,andwillnotbeeasywithoutadoseofcalomel。Adoctorlooksatapatient’stongue,seesitcoated,andsaysthestomachisfoul;hisheadfulloftheoldsaburralnotionwhichtheextremeinflammation-doctrineofBroussaisdidsomuchtorootout,butwhichstillleads,probably,tomuchneedlessandinjuriouswrongofthestomachandbowelsbyevacuants,whenalltheywantistobeletalone。Itissohardtogetanythingoutofthedeadhandofmedicaltradition!Themortmainoftheoristsextinctinscienceclingsascloseasthatofecclesiasticsdefunctinlaw。
Onepracticalhintmaynotbeoutofplacehere。Itseemstobesometimesforgotten,bythosewhomustknowthefact,thatthetongueisverydifferent,anatomicallyandphysiologically,fromthestomach。Itsconditiondoesnotintheleastimplyasimilaroneofthestomach,whichisaverydifferentstructure,coveredwithadifferentkindofepithelium,andfurnishedwithentirelydifferentsecretions。Asilversmithwill,foradollar,makeasmallhoe,ofsolidsilver,whichwilllastforcenturies,andwillgiveapatientmorecomfort,usedfortheremovaloftheaccumulatedepitheliumandfungousgrowthswhichconstitutethe“fur,“thanmanyaprescriptionwithasplit-footedRxbeforeit,addressedtothepartsoutofreach。
IthinkmoreofthislittleimplementonaccountofitsagencyinsavingtheColonyatPlymouthintheyear1623。EdwardWinslowheardthatMassasoitwassickandliketodie。Hefoundhimwithahousefulofpeopleabouthim,womenrubbinghisarmsandlegs,andfriends“makingsuchahellishnoise“astheyprobablythoughtwouldscareawaythedevilofsickness。Winslowgavehimsomeconserve,washedhismouth,scrapedhistongue,whichwasinahorridstate,gotdownsomedrink,madehimsomebroth,dosedhimwithaninfusionofstrawberryleavesandsassafrasroot,andhadthesatisfactionofseeinghimrapidlyrecover。Massasoit,fullofgratitude,revealedtheplotwhichhadbeenformedtodestroythecolonists,whereupontheGovernororderedCaptainMilesStandishtoseetothem;whothereupon,aseverybodyremembers,stabbedPecksuotwithhisownknife,brokeuptheplot,savedthecolony,andthusrenderedMassachusettsandtheMassachusettsMedicalSocietyapossibility,astheynowareafactbeforeus。Somuchforthisparenthesisofthetongue-scraper,whichhelpedtosavetheyoungcolonyfromamuchmoreseriousscrape,andmaysavetheUnionyet,ifaPresidentialcandidateshouldhappentobetakensickasMassasoitwas,andhistonguewantedcleaning,——whichprocesswouldnothurtagoodmanypoliticians,withorwithoutatyphoidfever。
Again,seehowthe“bilious“theoryworksinevery-daylifehereandnow,illustratedbyacasefromactuallife。Ayouthfulpractitioner,whoselastmolarshavenotbeenagreatwhilecut,meetsanexperiencedandnotedphysicianinconsultation。Thisisthecase。Aslender,lymphaticyoungwomanissucklingtwolustytwins,theintervalsofsuctionbeingoccupiedonherpartwithpalpitations,headaches,giddiness,throbbinginthehead,andvariousnervoussymptoms,hercheeksmeantimegettingbloodless,andherstrengthrunningawayincompanywithhermilk。Theoldexperiencedphysician,seeingtheyellowishwaxylookwhichiscommoninanaemicpatients,considersita“bilious“case,andisforgivingarousingemetic。Ofcourse,hehastobewheedledoutofthis,arecipeiswrittenforbeefsteaksandporter,thetwinsareignominiouslyexpelledfromtheanaemicbosom,andforcedtotakeprematurelytothebottle,andthisprolificmotherissavedforfutureusefulnessinthelineofmaternity。
Thepracticeofmakingaprofitonthemedicineorderedhasbeenhelduptoreprobationbyoneatleastoftheoratorswhohaveprecededme。ThattheeffectofthishasbeenruinousinEnglishpracticeI
cannotdoubt,andthatinthiscountrythestandardofpracticewasinformergenerationsloweredthroughthesameagencyisnotunlikely。Ihaveseenanoldaccount-bookinwhichthephysicianchargedanextrapriceforgildinghisrichpatients’pills。Ifallmedicinewereverycostly,andtheexpenseofitalwayscameoutofthephysician’sfee,itwouldreallybealessobjectionablearrangementthanthisothermostperniciousone。Hewouldnaturallythinktwicebeforehegaveanemeticorcatharticwhichevacuatedhisownpocket,andbesparingofthecholagoguesthatemptiedthebiliaryductsofhisownwallet,unlessheweresuretheywereneeded。Ifthereisanytemptation,itshouldnotbeinfavorofgivingnoxiousagents,asitclearlymustbeinthecaseofEnglishdruggistsand“GeneralPractitioners。“Thecomplaintagainsttheothercourseisaveryoldone。Pliny,inspiredwithastrulyRomanhorrorofquackeryastheelderCato,——whodeclaredthattheGreekdoctorshadsworntoexterminateallbarbarians,includingtheRomans,withtheirdrugs,butissaidtohavephysickedhisownwifetodeath,notwithstanding,——Plinysays,insomanywords,thattheceratesandcataplasms,plasters,collyria,andantidotes,soabundantinhistime,asinmorerecentdays,weremeretrickstomakemoney。
Aprettystrongeddy,then,orrathermanyeddies,settingconstantlybackfromthecurrentofsoberobservationofnature,inthedirectionofoldsuperstitionsandfancies,ofexplodedtheories,ofoldwaysofmakingmoney,whichareveryslowtopassoutoffashionButthereareotherspecialAmericaninfluenceswhichweareboundtotakecognizanceof。IfIwishedtoshowastudentthedifficultiesofgettingattruthfrommedicalexperience,Iwouldgivehimthehistoryofepilepsytoread。IfIwishedhimtounderstandthetendenciesoftheAmericanmedicalmind,itssanguineenterprise,itsself-confidence,itsaudacioushandlingofNature,itsimpatiencewithherold-fashionedwaysoftakingtimetogetasickmanwell,I
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