medical essays-第39节
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all back on these as the chief objects of our attention。 The shortest system of medical practice that I know of is the oldest； but not the worst。 It is older than Hippocrates； older than Chiron the Centaur。 Nature taught it to the first mother when she saw her first…born child putting some ugly pebble or lurid berry into its mouth。 I know not in what language it was spoken； but I know that in English it would sound thus： Spit it out！
Art can do something more than say this。 It can sometimes reach the pebble or berry after it has been swallowed。 But the great thing is to keep these things out of children's mouths； and as soon as they are beyond our reach； to be reasonable and patient with Nature； who means well； but does not like to hurry； and who took nine calendar months； more or less； to every mother's son among us； before she thought he was fit to he shown to the public。
Suffer me now to lay down a few propositions； whether old or new it matters little； not for your immediate acceptance； nor yet for your hasty rejection； but for your calm consideration。
But first； there are a number of terms which we are in the habit of using in a vague though not unintelligible way； and which it is as well now to define。 These terms are the tools with which we are to work； and the first thing is to sharpen them。 It is nothing to us that they have been sharpened a thousand times before； they always get dull in the using； and every new workman has a right to carry them to the grindstone and sharpen them to suit himself。
Nature； in medical language； as opposed to Art； means trust in the reactions of the living system against； ordinary normal impressions。
Art； in the same language； as opposed to Nature； means an intentional resort to extraordinary abnormal impressions for the relief of disease。
The reaction of the living system is the essence of both。 Food is nothing； if there is no digestive act to respond to it。 We cannot raise a blister on a dead man； or hope that a carminative forced between his lips will produce its ordinary happy effect。
Disease； dis…ease；disturbed quiet； uncomfortableness；means imperfect or abnormal reaction of the living system； and its more or less permanent results。
Food； in its largest sense； is whatever helps to build up the normal structures； or to maintain their natural actions。
Medicine； in distinction from food； is every unnatural or noxious agent applied for the relief of disease。
Physic means properly the Natural art； and Physician is only the Greek synonyme of Naturalist。
With these few explanations I proceed to unfold the propositions I have mentioned。
Disease and death； if we may judge by the records of creation； are inherently and essentially necessary in the present order of things。 A perfect intelligence； trained by a perfect education； could do no more than keep the laws of the physical and spiritual universe。 An imperfect intelligence； imperfectly taught；and this is the condition of our finite humanity；will certainly fail to keep all these laws perfectly。 Disease is one of the penalties of one of the forms of such failure。 It is prefigured in the perturbations of the planets； in the disintegration of the elemental masses； it has left its traces in the fossil organisms of extinct creations。 ＇Professor Agassiz has kindly handed me the following note： 〃There are abnormal structures in animals of all ages anterior to the creation of mankind。 Malformed specimens of Crinoids are known from the Triassic and Jurassic deposits。 Malformed and diseased bones of tertiary mammalia have been collected in the caverns of Gailenreuth with traces of healing。〃＇
But it is especially the prerogative； I had almost said privilege； of educated and domesticated beings； from man down to the potato； serving to teach them； and such as train them； the laws of life； and to get rid of those who will not mind or cannot be kept subject to these laws。
Disease； being always an effect； is always in exact proportion to the sum of its causes； as much in the case of Spigelius； who dies of a scratch； as in that of the man who recovers after an iron bar has been shot through his brain。 The one prevalent failing of the medical art is to neglect the causes and quarrel with the effect。
There are certain general facts which include a good deal of what is called and treated as disease。 Thus； there are two opposite movements of life to be seen in cities and elsewhere； belonging to races which； from various persistent causes； are breeding down and tending to run out； and to races which are breeding up； or accumulating vital capital；a descending and an ascending series。 Let me give an example of each； and that I may incidentally remove a common impression about this country as compared with the Old World； an impression which got tipsy with conceit and staggered into the attitude of a formal proposition in the work of Dr。 Robert Knox； I will illustrate the downward movement from English experience； and the upward movement from a family history belonging to this immediate neighborhood。
Miss Nightingale speaks of 〃the fact so often seen of a great…grandmother； who was a tower of physical vigor； descending into a grandmother perhaps a little less vigorous； but still sound as a bell； and healthy to the core； into a mother languid and confined to her carriage and house； and lastly into a daughter sickly and confined to her bed。〃 So much for the descending English series； now for the ascending American series。
Something more than one hundred and thirty years ago there graduated at Harvard College a delicate youth； who lived an invalid life and died at the age of about fifty。 His two children were both of moderate physical power； and one of them diminutive in stature。 The next generation rose in physical development； and reached eighty years of age and more in some of its members。 The fourth generation was of fair average endowment。 The fifth generation； great…great… grandchildren of the slender invalid； are several of； them of extraordinary bodily and mental power； large in stature； formidable alike with their brains and their arms； organized on a more extensive scale than either of their parents。
This brief account illustrates incidentally the fallacy of the universal…degeneration theory applied to American life； the same on which one of our countrymen has lately brought some very forcible facts to bear in a muscular discussion of which we have heard rather more than is good for us。 But the two series； American and English； ascending and descending； were adduced with the main purpose of showing the immense difference of vital endowments in different strains of blood； a difference to which all ordinary medication is in all probability a matter of comparatively trivial purport。 Many affections which art has to strive against might be easily shown to be vital to the well…being of society。 Hydrocephalus； tabes mesenterica； and other similar maladies； are natural agencies which cut off the children of races that are sinking below the decent minimum which nature has established as the condition of viability； before they reach the age of reproduction。 They are really not so much diseases； as manifestations of congenital incapacity for life； the race would be ruined if art could ever learn always to preserve the individuals subject to them。 We must do the best we can for them； but we ought also to know what these 〃diseases〃 mean。
Again； invalidism is the normal state of many organizations。 It can be changed to disease； but never to absolute health by medicinal appliances。 There are many ladies； ancient and recent； who are perpetually taking remedies for irremediable pains and aches。 They ought to have headaches and back…aches and stomach…aches； they are not well if they do not have them。 To expect them to live without frequent twinges is like expecting a doctor's old chaise to go without creaking； if it did； we might be sure the springs were broken。 There is no doubt that the constant demand for medicinal remedies from patients of this class leads to their over…use； often in the case of cathartics； sometimes in that of opiates。 I have been told by an intelligent practitioner in a Western town； that the constant prescription of opiates by certain physicians in his vicinity has rendered the habitual use of that drug in all that region very prevalent； more common； I should think； than alcoholic drunkenness in the most intemperate localities of which I have known anything。 A frightful endemic demoralization betrays itself in the frequency with which the haggard features and drooping shoulders of the opium…drunkards are met with in the streets。
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 illustrate 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 u
