« VorigeDoorgaan »
Did you have any medical advice?" I inquired.
'Young folks are often over-willing to die," remarked Ruth, folding her hands and re-gazing into the fire, and God seldom wants us when we want death. He knows we don't want to go to Him, but only to get away from the world. And we're not fit to go to Him till we're quite willing to bide his time."
Ralph made me go to a doctor," he plied. "He said if I wouldn't he would write and tell them at home, so I went at once, though I don't much believe in doctors, and I heard what was the matter with me, which I knew beforehand, and I was told to do certain things which I could not do, or I shouldn't have been ill. But I did my best towards them, as I had done all the time, and in due time I recovered, as I felt I should from the first."
"Ah," said Ruth, "it takes much to kill young folks, or nobody would reach thirty." "But they grow old folks in the struggle!" remarked Ewen.
I thought he gave a little sigh, and I glanced towards him. The look of pain of forced endurance - -was gone; but it had taken its bloom with it, and had left its own traces behind. There were lines now which gave a noble character to the always handsome face lines which his future wife will declare are half his beauty, though she may
WHITE Rose, are you tired
Of staying in one place? Do you ever wish to see
The wild-flowers face to face? Do you know the woodbines,
And the big, brown-crested reeds? Do you wonder how they live So friendly with the weeds? Have you any work to do
When you've finished growing?
Do you ever go to sleep?
And there you stood, moon-whiteMocn-white in a mist of darkness, With never a word to say;
And then Ewen said "Good-bye!" and went back to the Refuge festivities.
"I'll never say again that men choose gilt when they might have gold," said my sister, after he was gone. "The women are quite as bad!"
What do you mean?" I asked.
"I mean what I say," she returned; "and if you don't understand now, you may in time. And haven't we spent a sentimental evening, for two old people who never fell in love in their lives ?"
Oh, Ruth, Ruth! I hope you did not take my silence for assent to that last statement of yours, though I hadn't courage to contradict it. But it does not matter much, for you didn't mean it!
But you seem'd to move a little,
I should have felt no wonder
If I had found you standing
White Rose, do you love me?
I would work hard to please you
It seems so hard to be loving,
But the silence and the sweetness
I think you nearly perfect,
In spite of all your scorns; But, White Rose, if I were you, I wouldn't have those thorns! Poems written for a Child.
From Dr. Bigelow's "Modern Inquiries." EXPOSITIONS OF RATIONAL MEDICINE.
THE tendency to ultraism, which influences public opinion in great social questions, particularly of politics and theology, has been also prevalent in the affairs of practical medicine. No age has been exempt from diversity of opinion among physicians on the speculative subjects of their art; and the present period appears to be more marked than preceding ones by the opposite method of treatment pursued by medical men in the management of disease. These methods consist, for the most part, in a vehement, officious, and over-drugging system on the one hand, and an inert, evasive, and nugatory practice on the other. Between these extremes, the intermediate truth meets with less consideration than it ought to receive from unbiassed and enlightened inquirers.
apply to them that appellation. Allopathy is, in fact, a worthless term, which either means nothing real, or else embodies so many dissimilar and discordant elements, that it serves no purpose as a descriptive or distinctive name. The occasion still exists for terms which may definitively express the dogmas of modern practice.
Anatomy, physiology, and to a certain extent pathology, may be considered, so far as our discoveries have advanced, to be entitled to rank with the exact sciences. But therapeutics, or the art of treating diseases, like ethics and political economy, is still a conjectural study, incapable of demonstration in many of its great processes, and subject to various and even opposite opinions in regard to the laws and means which govern its results.
The methods which, at the present day, are most prevalent in civilized countries, in the treatment of disease, may be denominated the following:
Extreme doctrines in practical subjects often arise from the self-interest of those 1. The Artificial method; which, when who originate and first promote them. But carried to excess, is commonly termed hethe vehemence and fanaticism with which roic, and which consists in reliance on artithey are afterwards pursued are as often ficial remedies, usually of an active characowing to the creation of false issues, which ter, in the expectation that they will of divert public attention from the substance themselves remove diseases. to the shadow, and mystify the general 2. The Expectant method. This consists question with minor, partial, and frequently irrelevant considerations.
The introduction into the English language, for example, of the term " allopathy," and its adoption by some medical writers, has had the effect to mislead superficial readers in regard to the true issue of questions connected with the treatment of disease. This word was designed by its zealous, but weak and incompetent, inventor to express the employment of remedies which produce phenomena different from those produced by the disease treated; whereas the term homoeopathy indicated a mode of treating diseases by employing. medicines which are supposed to produce effects similar to those which it is desired to remove. This theoretical and absurd generalization, wholly unsupported by general facts on either side, so far as the cure of diseases is concerned, has acquired currency among the less enlightened part of the public; so that, at the present day, many persons consider homeopathy a sort of general law, to which allopathy is an exception. And, strange to tell, many otherwise sensible physicians have assumed the cloak thus offered to them; without perceiving that the propriety of so doing is the same as if the whole Protestant world were to style themselves heretics, because the church of Rome, in former ages, saw fit to
simply in non-interference; leaving the chance of recovery to the powers of nature, uninfluenced by interpositions of art.
3. The Homœopathic method. This is a counterfeit of the last, and consists in leaving the case to nature, while the patient is amused with nominal and nugatory remedies.
4. The Exclusive method; which applies one remedy to all diseases, or to a majority of diseases. This head includes hydropathy, also the use of various mineral waters, electrical establishments, &c. Drugs newly introduced, and especially secret medicines, frequently boast this universality of application.
5. The Rational method. This recognizes nature as the great agent in the cure of diseases, and employs art as an auxiliary, to be resorted to when useful or necessary, and avoided when prejudicial.
The foregoing methods, with the excep tion perhaps of the last, have had their trial in various periods and countries, and have given rise to discussions and controversies which are not terminated at the present day. The subject is too complicated to obtain from inquirers, out of the profession, the amount of attention requisite for understanding its merits; while, among medical men, consistency to pledged opinions, de
fects of knowledge, and considerations of | with the community, and of contention interest, not unfrequently warp the judg- among themselves.
ment of otherwise honest and discerning It is now generally admitted by intellipersons. It is certain, moreover, that med-gent physicians, that certain diseases, the ical opinion on the treatment of disease number of which is not very great, are at changes much between the time of one gen- once curable by medical means. Yet there eration and another. Any person who will is probably no curative agent, applied to take the trouble to inspect the medical jour- such diseases, the efficacy and even safety nals, published thirty or forty years ago, of which has not been warmly contested by will find many things, then laid down as sectarian practitioners. It is also beginning medical truths, which are now generally ad- to be admitted in this country, that certain mitted to be medical errors. The length diseases are self-limited,* incurable now by of a common professional life is sufficient art, yet susceptible of recovery under natto disabuse most physicians of many con- ural processes, both with and without the victions which they had received on trust, interference of art. To this class belong a and once considered unchangeable. Yet it great portion of the diseases usually called does not always happen that error is re- acute, and likewise some, the character of placed by truth, and it is fortunate if the which is decidedly chronic. Lastly, a vast delusions of ill-balanced minds are not suc- tribe of incurable diseases takes precedence ceeded by newer and greater delusions. in the lists of mortality, and holds, in some form, its final sentence over the heads of all mankind. Yet so reluctant are physicians to acknowledge these universal truths, or to admit their own incompetency, that incurable and unmanageable diseases have been complacently called opprobria medicina, as if they were exceptions to a general rule.
The great objects which medical practice professes to effect, and which there can be no doubt that it frequently does effect, are the following: 1. The cure of certain diseases; 2. The relief or palliation of all diseases; 3. The safe conduct of the sick. In all these objects it sometimes fails; yet instances of its success are sufficiently numerous to establish the necessity of the existence of medicine as a profession.
It is, nevertheless, right that intelligent and reasonable physicians should receive the confidence of the community, since they are, or should be, more qualified than other persons to undertake the care and conduct of the sick. And even if it had happened that their power was limited to merely understanding the nature of the existing disease, and the import and probable tendency of symptoms which occur from day to day, without any attempt at curative interference, still their attendance would be solicited to throw light on the grave questions of pain, sickness, and recovery, and still more of life and death. The public, however, expect something more of physicians than the power of distinguishing diseases, and of predicting their issue. They look to them for the relief of their sufferings, No one doubts that morbid affections, and the cure or removal of their complaints. occasioned by the presence of an offending And the vulgar estimate of the powers of or irritating cause, are often speedily cured medicine is founded on the common accep- by the discharge or removal of that cause. tation of the name, that medicine is the art And here drugs are among the principal of curing diseases. That this is a false de-agents which we employ. Again, no one finition, is evident from the fact that many diseases are incurable, and that one such disease must at last happen to every living man.* A far more just definition would be, that medicine is the art of understanding diseases, and of curing or relieving them when possible. If this definition were accepted, and its truth generally understood by the profession and the public, a weight This term was first introduced by the writer in a discourse in 1835, already alluded to, with the folof superfluous responsibility on one side, lowing definition: "A self-limited disease is one and of dissatisfaction on the other, would which receives limits from its own nature, and not be lifted from the shoulders of both. It is tained foothold in the system, cannot, in the present from foreign infiuences; one which, after it has obbecause physicians allow themselves to pro-state of our knowledge, be eradicated or abridged fess and vaunt more power over disease than belongs to them, that their occasional shortcomings are made a ground of reproach
See the author's "Nature in Disease," page 64.
doubts that many of the diseases of civilized life, brought on by luxury, intemperance, sedentary and intellectual labor, unhealthy residence; occupation, &c., are often wholly or partially cured by change of life, including habits, and perhaps residence. And here drugs are, for the most part, of little
by art; but to which there is due a certain succession which time and processes may vary with the consti of processes, to be completed in a certain time, tution and condition of the patient, and may tend to death or to recovery, but are not known to be shortened, or greatly changed, by medical treat
avail. So that it may happen that the | Yet, even in the present advanced state of chance of cure shall depend upon the judg- science, physicians are not agreed as to the ment with which active drugs are adminis- means by which any one of them is to be tered, on the one hand, and avoided or accomplished or attempted; and a man who superseded, on the other. falls sick at home or abroad is liable to get heroic treatment or nominal treatment, random treatment or no treatment at all, according to the hands into which he may happen to fall. It is, therefore, desirable that physicians themselves, and the public also, should obtain satisfactory understanding of the various diversities of practice which have been already mentioned as occupying the greatest share of attention at the present day.
The palliation of diseases is another great practical end of medical science, and really occupies a large portion of the time and efforts of every medical man. When it is considered that most diseases last for days, and some of them for years, and that a large portion of mankind eventually die of some chronic or lingering disease, it will readily be seen that the palliation of suffering is not only called for, but really constitutes one of the most important, as well as bene- 1. THE ARTIFICIAL METHOD.- This ficent, objects of medical practice. The mode of treatment is founded on the asuse of anodynes and anaesthetics, the obvia- sumption, that disease can be removed by tion of various painful and distressing symp-artificial means. From the earliest ages, a toms, the removal of annoyances, the just belief has prevailed that all human maladies regulation of diet, of exertion and repose, are amenable to control from some form of of indulgence and restriction, the direction of moral agencies, which make up so large a part both of suffering and relief, may well afford employment to the most earnest and philanthropic physician, and obtain from the public a just appreciation of the value of his services.
purely medical treatment; and although the precise form has not yet been found, so far as most diseases are concerned, yet, at this day, it continues to be as laboriously and hopefully pursued as was the elixir vitæ in the middle ages. Within the present century, books of practice gravely laid down "the indications of cure,' as if they were things within the grasp of every practitioner. It was only necessary to subdue the inflammation, to expel the morbific matter, to regulate the secretions, to im
strength, and the business was at once accomplished. What nature refused, or was inadequate to do, was expected to be achieved by the more prompt and vigorous interposition of art. The destructive tendencies of disease, and the supposed proneness to deterioration of nature herself, were opposed by copious and exhausting depletion, followed by the shadowy array of alteratives, deobstruents, and tonics. Confinement by disease, which might have terminated in a few days, was protracted to weeks and months; because the importance of the case, as it was thought, required that the patient should be artificially "taken down," and then artificially" built up."
The safe conduct of the sick, as will be seen from the last head, consists much more in cautionary guidance than in active interference. In the management of sickness, the rein is needed to direct, quite as much as the spur to excite. People sometimes prove the nutrition, and to restore the suffer from neglect, but more frequently from ill-judged and meddlesome attention. One of the most cogent necessities of a sick man is, to be saved from the excessive and officious good-will of his friends. The kindest impulses and the most benevolent intentions are liable to show themselves in ill-timed visits, fatiguing conversations, and injudicious advice or action. Intelligent and discreet physicians are sometimes driven, by the importunity of friends, to the adoption of active measures, or at least the semblance of them, which their own judgment informs them would be better omitted. And the case is still worse when the impulsive temperament of the physician himself, or the influence of his early education, or the dominant fashion of the place in which he resides, is so exacting in regard to activity of treatment, as to make him believe that he cannot commit too many inflictions upon the sick, provided that, in the end, he shall be satisfied that he has omitted nothing.
The foregoing desiderata, the cure, the relief, and the safe conduct of patients, involve the great objects for which medicine has been striving for thousands of years.
When carried to its "heroic" extent, artificial medicine undermined the strength, elicited new morbid manifestations, and left more disease than it took away. The question raised was not how much the patient had profited under his active treatment, but how much more of the same he could bear. Large doses of violent and deleterious drugs were given, as long as the patient evinced a "tolerance" of them, that is, did not sink under them. The results of such cases, if favorable, like the escapes of desperate
of his art than the most able physician.
surgery, were chronicled as professional faction on the immediate and positive results triumphs; while the press was silent on the disastrous results subsequently incurred in like cases by deluded imitators. If diseases proved fatal, or even if they were not jugufated or cut short at the outset, the misfortune was attributed to the circumstance of the remedies not being sufficiently active, or of the physician not being called in season. So great at one time, and that not long ago, was the ascendency of heroic teachers and writers, that few medical men had the courage to incur the responsibility of omitting the active modes of treatment which were deemed indispensable to the safety of the patient. This timidity on the score of omission has now, in a great measure, passed away, yet is still promoted in most cities by some heroic doctors, and still more by interested specialists, who inflict severe discipline, and levy immense contributions, on credulous persons, who are suitably alarmed at denunciations which involve the loss of sight, of hearing, or even of beauty.
2. THE EXPECTANT METHOD. This A considerable amount of violent practice method, when fully carried out, admits no is still maintained by routine physicians, medication nor interference of art, but waits who, without going deeply into the true na- on time, and commits the chance of recovery ture or exigencies of the case before them, to the restorative power of nature alone. assume the general ground, that nothing is The expectant practice has not been without dangerous but neglect. Edge-tools are its advocates, and volumes have been pubbrought into use as if they could never be lished in its favor, at different times, chiefly anything more than harmless playthings. on the continent of Europe. That there is It is thought allowable to harass the patient some basis for the doctrine of expectation, with daily and opposite prescriptions; to try, is made apparent by the spontaneous recovto abandon, to re-enforce, or to reverse; to ery of animals and savages; of careless, blow hot and cold on successive days; but obstinate, and incredulous persons in civilnever to let the patient alone, nor to intrust ized life; and of those who, in consequence his case to the quiet guidance of nature. of their isolated or otherwise unfavorable Consulting physicians frequently and pain- position, are unable to procure "medical fully witness the gratuitous suffering, the aid," or who, if they do procure it, obtain continued nausea, the prostration of strength, only that which is inoperative or absolutely the prevention of appetite, the stupefaction detrimental. I sincerely believe that the of the senses, and the wearisome days and unbiassed opinion of most medical men of nights, which would never have occurred sound judgment and long experience is had there been no such thing as officious made up, that the amount of death and dismedication. What practitioner has not seen aster in the world would be less, if all disinfants screaming under the pangs of hun- ease were left to itself, than it now is under ger, or of stimulants remorselessly applied the multiform, reckless, and contradictory to their tender skins, and whose only per- modes of practice, good and bad, with which mitted chance of relief was in the continued practitioners of adverse denominations carry routine of unnecessary calomel and ipecac-on their differences at the expense of their uanha?
There is one great exception in favor of artificial and even heroic practice, well known and fully demonstrable in the art of surgery. Many defects, injuries, and diseases of the body, are, unquestionably, cured by surgical processes, which never could have got well without them. And the skilful and humane surgeon has more frequent opportunities to reflect with satis
patients. But there is no probability that expectant medicine will ever prevail in its character as such. The amount of positive good which, in fifty centuries, art has brought to the assistance of medicine, although far more limited than we could desire, is nevertheless both sufficient and worthy to employ the talents of the best and most enlightened physicians.
3. THE HOMEOPATHIC METHOD.-Ho