Part 14 (1/2)

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 ill.u.s.trate 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, injurious.

In the game of Life-or-Death, Rouge et Noir, as played between the Doctor and the s.e.xton, this five per cent., this certain small injury entering into the chances is clearly the s.e.xton's perquisite for keeping the green table, over which the game is played, and where he h.o.a.rds 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 a.s.sumption.

Presumptions are of vast importance in medicine, as in law. A man is presumed innocent until he is proved guilty. A medicine--that 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 a.s.sumed to be the innocent victim of circ.u.mstances, 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 const.i.tution 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 circ.u.mstances 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 embarra.s.sed 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 Ma.s.sachusetts, 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 pract.i.tioners 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 a.s.sa.s.sinated 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 ”coa.r.s.e 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 s.h.i.+ft the presumption about drugs where it belonged, and so at last, just as the sympathetic powder and the Unguentum Armarium came in a superst.i.tious age to kill out the abuses of external over-medication, the solemn farce of h.o.m.oeopathy 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 const.i.tution 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 ant.i.thesis, 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 a.s.sured position of the Profession in our Commonwealth, to the att.i.tude of Science, which is always fearless, and to the genius of the soil on which we stand, from which Nature withheld the fatal gift of malaria only to fill it with exhalations that breed the fever of inquiry in our blood and in our brain. But mainly we owe the large license of speech we enjoy to those influences and privileges common to us all as self-governing Americans.

This Republic is the chosen home of minorities, of the less power in the presence of the greater. It is a common error to speak of our distinction as consisting in the rule of the majority. Majorities, the greater material powers, have always ruled before. The history of most countries has been that of majorities, mounted majorities, clad in iron, armed with death treading down the tenfold more numerous minorities. In the old civilizations they root themselves like oaks in the soil; men must live in their shadow or cut them down. With us the majority is only the flower of the pa.s.sing noon, and the minority is the bud which may open in the next morning's sun. We must be tolerant, for the thought which stammers on a single tongue today may organize itself in the growing consciousness of the time, and come back to us like the voice of the mult.i.tudinous waves of the ocean on the morrow.

Twenty-five years have pa.s.sed since one of your honored Presidents spoke to this Society of certain limitations to the power of our Art, now very generally conceded. Some were troubled, some were almost angry, thinking the Profession might suffer from such concessions. It has certainly not suffered here; if, as some affirm, it has lost respect anywhere, it was probably for other, and no doubt sufficient reasons.

Since that time the civilization of this planet has changed hands.

Strike out of existence at this moment every person who was breathing on that day, May 27, 1835, and every inst.i.tution of society, every art and every science would remain intact and complete in the living that would be left. Every idea the world then held has been since dissolved and recrystallized.

We are repeating the same process. Not to make silver shrines for our old divinities, even though by this craft we should have our wealth, was this Society organized and carried on by the good men and true who went before us. Not for this, but to melt the gold out of the past, though its dross should fly in dust to all the winds of heaven, to save all our old treasures of knowledge and mine deeply for new, to cultivate that mutual respect of which outward courtesy is the sign, to work together, to feel together, to take counsel together, and to stand together for the truth, now, always, here, everywhere; for this our fathers inst.i.tuted, and we accept, the offices and duties of this time-honored Society.

BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.

An Introductory Lecture delivered before the Medical Cla.s.s of Harvard University, November 6, 1861.

[This Lecture appears as it would have been delivered had the time allowed been less strictly, limited. Pa.s.sages necessarily omitted have been restored, and points briefly touched have been more fully considered. A few notes have been added for the benefit of that limited cla.s.s of students who care to track an author through the highways and by-ways of his reading. I owe my thanks to several of my professional brethren who have communicated with me on subjects with which they are familiar; especially to Dr. John Dean, for the opportunity of profiting by his unpublished labors, and to Dr. Hasket Derby, for information and references to recent authorities relating to the anatomy and physiology of the eye.]

The entrance upon a new course of Lectures is always a period of interest to instructors and pupils. As the birth of a child to a parent, so is the advent of a new cla.s.s to a teacher. As the light of the untried world to the infant, so is the dawning of the light resting over the unexplored realms of science to the student. In the name of the Faculty I welcome you, Gentlemen of the Medical Cla.s.s, new-born babes of science, or l.u.s.tier nurslings, to this morning of your medical life, and to the arms and the bosom of this ancient University. Fourteen years ago I stood in this place for the first time to address those who occupied these benches. As I recall these past seasons of our joint labors, I feel that they have been on the whole prosperous, and not undeserving of their prosperity.

For it has been my privilege to be a.s.sociated with a body of true and faithful workers; I cannot praise them freely to their faces, or I should be proud to discourse of the harmonious diligence and the n.o.ble spirit in which they have toiled together, not merely to teach their several branches, but to elevate the whole standard of teaching.

I may speak with less restraint of those gentlemen who have aided me in the most laborious part of my daily duties, the Demonstrators, to whom the successive cla.s.ses have owed so much of their instruction. They rise before me, the dead and the living, in the midst of the most grateful recollections. The fair, manly face and stately figure of my friend, Dr. Samuel Parkman, himself fit for the highest offices of teaching, yet willing to be my faithful a.s.sistant in the time of need, come back to me with the long sigh of regret for his early loss to our earthly companions.h.i.+p. Every year I speak the eulogy of Dr. Ainsworth's patient toil as I show his elaborate preparations: When I take down my ”American Cyclopaedia” and borrow instruction from the learned articles of Dr.

Kneeland, I cease to regret that his indefatigable and intelligent industry was turned into a broader channel. And what can I say too cordial of my long a.s.sociated companion and friend, Dr. Hodges, whose admirable skill, working through the swiftest and surest fingers that ever held a scalpel among us, has delighted cla.s.s after cla.s.s, and filled our Museum with monuments which will convey his name to unborn generations?