Part 17 (1/2)
I do not know that we ever apply to a plant any element which is not a natural const.i.tuent of the vegetable structure, except perhaps externally, for the accidental purpose of killing parasites. The whole art of cultivation consists in learning the proper food and conditions of plants, and supplying them. We give them water, earths, salts of various kinds such as they are made of, with a chance to help themselves to air and light. The farmer would be laughed at who undertook to manure his fields or his trees with a salt of lead or of a.r.s.enic. These elements are not const.i.tuents of healthy plants. The gardener uses the waste of the a.r.s.enic furnaces to kill the weeds in his walks.
If the law of the animal cell, and of the animal organism, which is built up of such cells, is like that of the vegetable, we might expect that we should treat all morbid conditions of any of the vital unities belonging to an animal in the same way, by increasing, diminis.h.i.+ng, or changing its natural food or stimuli.
That is an aliment which nourishes; whatever we find in the organism, as a constant and integral element, either forming part of its structure, or one of the conditions of vital processes, that and that only deserves the name of aliment. I see no reason, therefore, why iron, phosphate of lime, sulphur, should not be considered food for man, as much as guano or poudrette for vegetables. Whether one or another of them is best in any given case,--whether they shall be taken alone or in combination, in large or small quant.i.ties, are separate questions. But they are elements belonging to the body, and even in moderate excess will produce little disturbance. There is no presumption against any of this cla.s.s of substances, any more than against water or salt, provided they are used in fitting combinations, proportions, and forms.
But when it comes to substances alien to the healthy system, which never belong to it as normal const.i.tuents, the case is very different. There is a presumption against putting lead or a.r.s.enic into the human body, as against putting them into plants, because they do not belong there, any more than pounded gla.s.s, which, it is said, used to be given as a poison. The same thing is true of mercury and silver. What becomes of these alien substances after they get into the system we cannot always tell. But in the case of silver, from the accident of its changing color under the influence of light, we do know what happens. It is thrown out, in part at least, under the epidermis, and there it remains to the patient's dying day. This is a striking ill.u.s.tration of the difficulty which the system finds in dealing with non-a.s.similable elements, and justifies in some measure the vulgar prejudice against mineral poisons.
I trust the youngest student on these benches will not commit the childish error of confounding a presumption against a particular cla.s.s of agents with a condemnation of them. Mercury, for instance, is alien to the system, and eminently disturbing in its influence. Yet its efficacy in certain forms of specific disease is acknowledged by all but the most sceptical theorists. Even the esprit moqueur of Ricord, the Voltaire of pelvic literature, submits to the time-honored const.i.tutional authority of this great panacea in the cla.s.s of cases to which he has devoted his brilliant intelligence. Still, there is no telling what evils have arisen from the abuse of this mineral.
Dr. Armstrong long ago pointed out some of them, and they have become matters of common notoriety. I am pleased, therefore, when I find so able and experienced a pract.i.tioner as Dr. Williams of this city proving that iritis is best treated without mercury, and Dr. Vanderpoel showing the same thing to be true for pericarditis.
Whatever elements nature does not introduce into vegetables, the natural food of all animal life,--directly of herbivorous, indirectly of carnivorous animals,--are to be regarded with suspicion. a.r.s.enic-eating may seem to improve the condition of horses for a time,--and even of human beings, if Tschudi's stories can be trusted,--but it soon appears that its alien qualities are at war with the animal organization. So of copper, antimony, and other non-alimentary simple substances; everyone of them is an intruder in the living system, as much as a constable would be, quartered in our household. This does not mean that they may not, any of them, be called in for a special need, as we send for the constable when we have good reason to think we have a thief under our roof; but a man's body is his castle, as well as his house, and the presumption is that we are to keep our alimentary doors bolted against these perturbing agents.
Now the feeling is very apt to be just contrary to this. The habit has been very general with well-taught pract.i.tioners, to have recourse to the introduction of these alien elements into the system on the occasion of any slight disturbance. The tongue was a little coated, and mercury must be given; the skin was a little dry, and the patient must take antimony. It was like sending for the constable and the posse comitatus when there is only a carpet to shake or a refuse-barrel to empty. [Dr.
James Johnson advises persons not ailing to take five grains of blue pill with one or two of aloes twice a week for three or four months in the year, with half a pint of compound decoction of sarsaparilla every day for the same period, to preserve health and prolong life. Pract.
Treatise on Dis. of Liver, etc. p. 272.] The const.i.tution bears slow poisoning a great deal better than might be expected; yet the most intelligent men in the profession have gradually got out of the habit of prescribing these powerful alien substances in the old routine way.
Mr. Metcalf will tell you how much more sparingly they are given by our pract.i.tioners at the present time, than when he first inaugurated the new era of pharmacy among us. Still, the presumption in favor of poisoning out every spontaneous reaction of outraged nature is not extinct in those who are trusted with the lives of their fellow-citizens. ”On examining the file of prescriptions at the hospital, I discovered that they were rudely written, and indicated a treatment, as they consisted chiefly of tartar emetic, ipecacuanha, and epsom salts, hardly favorable to the cure of the prevailing diarrhoea and dysenteries.” In a report of a poisoning case now on trial, where we are told that a.r.s.enic enough was found in the stomach to produce death in twenty-four hours, the patient is said to have been treated by a.r.s.enic, phosphorus, bryonia, aconite, nux vomica, and muriatic acid,--by a pract.i.tioner of what school it may be imagined.
The traditional idea of always poisoning out disease, as we smoke out vermin, is now seeking its last refuge behind the wooden cannon and painted port-holes of that unblus.h.i.+ng system of false scientific pretences which I do not care to name in a discourse addressed to an audience devoted to the study of the laws of nature in the light of the laws of evidence. It is extraordinary to observe that the system which, by its reducing medicine to a name and a farce, has accustomed all who have sense enough to see through its thin artifices to the idea that diseases get well without being ”cured,” should now be the main support of the tottering poison-cure doctrine. It has unquestionably helped to teach wise people that nature heals most diseases without help from pharmaceutic art, but it continues to persuade fools that art can arrest them all with its specifics.
It is worse than useless to attempt in any way to check the freest expression of opinion as to the efficacy of any or all of the ”heroic”
means of treatment employed by pract.i.tioners of different schools and periods. Medical experience is a great thing, but we must not forget that there is a higher experience, which tries its results in a court of a still larger jurisdiction; that, namely, in which the laws of human belief are summoned to the witness-box, and obliged to testify to the sources of error which beset the medical pract.i.tioner. The verdict is as old as the father of medicine, who announces it in the words, ”judgment is difficult.” Physicians differed so in his time, that some denied that there was any such thing as an art of medicine.
One man's best remedies were held as mischievous by another. The art of healing was like soothsaying, so the common people said; ”the same bird was lucky or unlucky, according as he flew to the right or left.”
The practice of medicine has undergone great changes within the period of my own observation. Venesection, for instance, has so far gone out of fas.h.i.+on, that, as I am told by residents of the New York Bellevue and the Ma.s.sachusetts General Hospitals, it is almost obsolete in these inst.i.tutions, at least in medical practice. The old Brunonian stimulating treatment has come into vogue again in the practice of Dr.
Todd and his followers. The compounds of mercury have yielded their place as drugs of all work, and specifics for that very frequent subjective complaint, nescio quid faciam,--to compounds of iodine. [Sir Astley Cooper has the boldness,--or honesty,--to speak of medicines which ”are given as much to a.s.sist the medical man as his patient.”
Lectures (London, 1832), p. 14.] Opium is believed in, and quinine, and ”rum,” using that expressive monosyllable to mean all alcoholic cordials. If Moliere were writing now, instead of saignare, purgare, and the other, he would be more like to say, Stimulare, opium dare et pota.s.sio-iodizare.
I have been in relation successively with the English and American evacuant and alterative practice, in which calomel and antimony figured so largely that, as you may see in Dr. Jackson's last ”Letter,” Dr.
Holyoke, a good representative of sterling old-fas.h.i.+oned medical art, counted them with opium and Peruvian bark as his chief remedies; with the moderately expectant practice of Louis; the blood-letting ”coup sur coup” of Bouillaud; the contra-stimulant method of Rasori and his followers; the anti-irritant system of Broussais, with its leeching and gum-water; I have heard from our own students of the simple opium practice of the renowned German teacher, Oppolzer; and now I find the medical community brought round by the revolving cycle of opinion to that same old plan of treatment which John Brown taught in Edinburgh in the last quarter of the last century, and Miner and Tully fiercely advocated among ourselves in the early years of the present. The worthy physicians last mentioned, and their antagonist Dr. Gallup, used stronger language than we of these degenerate days permit ourselves.
”The lancet is a weapon which annually slays more than the sword,” says Dr. Tully. ”It is probable that, for forty years past, opium and its preparations have done seven times the injury they have rendered benefit, on the great scale of the world,” says Dr. Gallup.
What is the meaning of these perpetual changes and conflicts of medical opinion and practice, from an early antiquity to our own time? Simply this: all ”methods” of treatment end in disappointment of those extravagant expectations which men are wont to entertain of medical art.
The bills of mortality are more obviously affected by drainage, than by this or that method of practice. The insurance companies do not commonly charge a different percentage on the lives of the patients of this or that physician. In the course of a generation, more or less, physicians themselves are liable to get tired of a practice which has so little effect upon the average movement of vital decomposition. Then they are ready for a change, even if it were back again to a method which has already been tried, and found wanting.
Our pract.i.tioners, or many of them, have got back to the ways of old Dr.
Samuel Danforth, who, as it is well known, had strong objections to the use of the lancet. By and by a new reputation will be made by some discontented pract.i.tioner, who, tired of seeing patients die with their skins full of whiskey and their brains muddy with opium, returns to a bold antiphlogistic treatment, and has the luck to see a few patients of note get well under it. So of the remedies which have gone out of fas.h.i.+on and been superseded by others. It can hardly be doubted that they will come into vogue again, more or less extensively, under the influence of that irresistible demand for change just referred to.
Then will come the usual talk about a change in the character of disease, which has about as much meaning as that concerning ”old-fas.h.i.+oned snow-storms.” ”Epidemic const.i.tutions” of disease mean something, no doubt; a great deal as applied to malarious affections; but that the whole type of diseases undergoes such changes that the practice must be reversed from depleting to stimulating, and vice versa, is much less likely than that methods of treatment go out of fas.h.i.+on and come in again. If there is any disease which claims its percentage with reasonable uniformity, it is phthisis. Yet I remember that the reverend and venerable Dr. Prince of Salem told me one Commencement day, as I was jogging along towards Cambridge with him, that he recollected the time when that disease was hardly hardly known; and in confirmation of his statement mentioned a case in which it was told as a great event, that somebody down on ”the Cape” had died of ”a consumption.” This story does not sound probable to myself, as I repeat it, yet I a.s.sure you it is true, and it shows how cautiously we must receive all popular stories of great changes in the habits of disease.
Is there no progress, then, but do we return to the same beliefs and practices which our forefathers wore out and threw away? I trust and believe that there is a real progress. We may, for instance, return in a measure to the Brunonian stimulating system, but it must be in a modified way, for we cannot go back to the simple Brunonian pathology, since we have learned too much of diseased action to accept its convenient dualism. So of other doctrines, each new Avatar strips them of some of their old pretensions, until they take their fitting place at last, if they have any truth in them, or disappear, if they were mere phantasms of the imagination.
In the mean time, while medical theories are coming in and going out, there is a set of sensible men who are never run away with by them, but practise their art sagaciously and faithfully in much the same way from generation to generation. From the time of Hippocrates to that of our own medical patriarch, there has been an apostolic succession of wise and good pract.i.tioners. If you will look at the first aphorism of the ancient Master you will see that before all remedies he places the proper conduct of the patient and his attendants, and the fit ordering of all the conditions surrounding him. The cla.s.s of pract.i.tioners I have referred to have always been the most faithful in attending to these points. No doubt they have sometimes prescribed unwisely, in compliance with the prejudices of their time, but they have grown wiser as they have grown older, and learned to trust more in nature and less in their plans of interference. I believe common opinion confirms Sir James Clark's observation to this effect.
The experience of the profession must, I think, run parallel with that of the wisest of its individual members. Each time a plan of treatment or a particular remedy comes up for trial, it is submitted to a sharper scrutiny. When Cullen wrote his Materia Medica, he had seriously to a.s.sail the practice of giving burnt toad, which was still countenanced by at least one medical authority of note. I have read recently in some medical journal, that an American pract.i.tioner, whose name is known to the country, is prescribing the hoof of a horse for epilepsy. It was doubtless suggested by that old fancy of wearing a portion of elk's hoof hung round the neck or in a ring, for this disease. But it is hard to persuade reasonable people to swallow the abominations of a former period. The evidence which satisfied Fernelius will not serve one of our hospital physicians.