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tion would have been employed. This is especially the case with continued fevers, such as typhus and typhoid, which are now regularly treated by fresh air, stimulation, and tonics, instead of high temperature, close confinement, bleeding, and purging. In like manner, we no longer see the heroic treatment pursued in inflammation of the lungs, a disease which gave the widest scope for the use of the lancet and the most actively-depressing measure. The antiphlogistic superstition, a relic of the doctrine of vitalism and the entity of disease, is slowly yielding to the rational sentiment which sees in every disease an effort of nature towards recovery, and which strives to direct and assist that effort. This tendency to eliminate physicking from sound medicine gives to it more the character of a science acting in conformity with principles, than of an experiment which, resorting to a variety of expedients, hopes to hit the right one. But popular prejudice opposes the strongest barrier to this rational tendency of medicine, for when people are sick they will be physicked. It is this determination to swallow all the medicines within reach which supports charlatans, nostrum venders, and pill-makers; for when a conscientious physician has declared the impropriety or inutility of further medication, quacks, who hold out delusive hopes of a speedy and sure recovery, are visited and handsomely feed for their lies. This is disheartening to medical reformers, and yet cannot be remedied till a more enlightened, sentiment is infused into the masses.
To prove that this fondness for constant and heavy dosing is a fatuity of the people and not the fault of the doctors, it has been frequently observed that nowhere is there so little medicine used as in a physician's own family.
What has chiefly contributed to simplify the practice of medicine and limit the use of drugs to a few leading chemical extracts, is the more perfect system of diagnosis created by physical examination, chemical tests, and the study of morbid anatomy. Effects are for the most part more numerous and more complex than causes, symptoms more varied than diseases ; and the system of medicine which
; would treat mere symptoms or effects must have recourse to a more complicated and varied class of healing agents. For this reason we see a countless number of remedies employed by the ignorant, in whose eyes every symptoin constitutes a distinct disease. But enlightened medicine strives to penetrate mere symptoms ; it unmasks the actor which produces such strange phantasmagoria ; it sinks a shaft into the well
spring of the trouble, and finds why the water comes forth muddy. What a vast deal of ingenuity would have been wasted in New York a few years ago in attempts to purify, by chemical means, the Croton water impregnated with decayed vegetable matter, had not a practical wisdom suggested an enquiry into the condition of the Croton river, and removed the trouble by removing the dead leaves which caused it. So in medicine short-sighted practice deals with symptoms, using specifics for every symptom it encounters, while philosophical practice views them but as stepping-stones to the discovery of their cause ; and this discovery made removes a whole legion of complicated effects by a few well-directed remedies. Not many years ago a physician would have ordered, in a case of simple dysentery, one remedy to allay pain, another to check restlessness, bleeding to bring down inflammation, calomel, perhaps, to the extent of salivating, and something different to meet every different symptom. But now how different is the case ! Nature recommends rest and a recumbent posture in all enteric troubles, and this precept is enforced by a little opium; then nature is allowed to abate the violence of the inflammation herself, while art prudently refrains from obtruding itself on her admirable processes. It will be seen, then, that the change from excessive drugging to the comparatively do-nothing system of today is the logical sequence of a more philosophical view of disease. But while rational enquiry has thus dismissed symptoms from the tables of nosology, it has inserted new diseases which were either supposed to have no existence at all or were confounded with other forms. Thus an imperfect diagnosis told us generally of disease of the heart, without having been able to draw those fine distinguishing lines which now separate the various valvular diseases from hypertrophy, pericarditis, and fatty degeneration. So in disease of the lungs we recognise tubercle, bronchitis, gangrene, and emphysema, all which would have once been ranked under the general head of chronic pulmonary disease. The recognition of new diseases did not, however, entail a corresponding increase in the list of remedial agents; and it may be taken as a proof of the scientific character of modern medicine, that it has known how to resolve the cumbrous nosology of the past into a few leading principles, admitting the intervention of but a limited number of therapeutical agents. But it has been urged that this restriction to a limited range of remedies is the result of professional prejudice, since physicians
will give no countenance to improvements, supposed or real, unless they originate within the profession, or conformably to conditions prescribed by medical authority. Thus, it is claimed, many admirable remedies exist whose virtues and healing properties have been fully tested, and which, however, the profession will not recognise because they have not been introduced to public notice with the stamp of professional sanction. This is a poor subterfuge of quackery, by which the unthinking alone can be caught. Of course, whatever savors of empiricism and secrecy cannot be tolerated by an enlightened body of men, and it argues well for the character of the medical profession, that the most important discoveries become public property the moment they are made, and the only patent which guarantees to the discoverer the credit of his successful labors, is the spirit of fairness and honor which prevails among his professional brethren. It may be said that we are claiming too much for modern practice, and that history still attests the supremacy of the great medical names of the past. When no other standard existed by which the progress of medicine could be estimated than the success of individual labors, names shone conspicuous in the role of fame, and the celebrity of a few was considered synonymous with the general progress of the profession they represented. Now, however, medical discoveries are no longer the fruit of individual enquiries, but the result of numberless minds actively and incessantly working. We no longer look to the career of a single man to measure the results of medical practice, but to unerring and carefully compiled statistics, the reflex of the combined medical mind of the world. It is by means of statistical records, authenticated by irrefragable testimony, that modern medicine can vindicate for itself the advanced position to which it lays claim. There is not a well managed hospital in the world where accurate records are not kept of the rates of mortality as influenced by climate, temperament, disease, nativity, color, and mode of treatment. In this way the comparative merits of past and present practice have been fairly tested, and an argument possessed of the weight which the most unyielding logic can impart, the logic of facts, has decided in favor of the latter. This argument has proved that the mortality bills of eruptive fevers and of inflammation of the lungs, by far the most frequent outlets of human life, are far smaller than they were even twenty years ago. In like manner the statistical records of rheumatism show a decrease in the rate of mortal
ity and suffering strikingly in contrast with the experience of the past. And here we have an instance of a very recent change in treatment, for rheumatism used to be considered unamenable to treatment a few years ago, but the late discovery that it is due to an excess of lithic acid in the blood determined the alkaline treatment now employed.
Inoculation, first with the natural virus and subsequently with vaccine matter, has stayed the ravages of a disease which used to decimate whole kingdoms, and whose progress was considered fearfully irresistible. True inoculation can scarcely be referred to modern medicine, as we find traces of the practice at a very early date in the East, but the manner of its performance was so imperfect, and its mode of operation in the system so little understood, that what was then known was practically but little available. Nor would inoculation at the best have afforded a sufficient safeguard against the inroads of small-pox, for the mortality bills were but little affected by its practice. It was not till the protective qualities of vaccine were discovered that this loathsome disease lost its horrors and became harmless as a serpent robbed of its fangs. If it still sweeps destructively, over cities and towns the effects must be imputed to remissness on the part of the authorities, for experience has fully proved that vaccination, repeated at intervals of four or five years, affords infallible security against
In this way, again, does the contrast between present and past practice decide in favor of the former, and proves the decision by an appeal to statistics. And even if medicine has depended on the advancement of collateral sciences for its own developments, it has, in a measure, repaid the favor by furnishing to psychological science a light which has enabled it to make many and valuable discoveries. The study of the brain and nerves, the great sensorial system, has helped wonderfully to elucidate psychological problems which were but little understood by the ancients. Indeed, it can be readily conceived that the mind which is cognisable only by its operations, can be studied io much greater advantage when the media through which those operations take place are perfectly understood. So far the door to discovery in this direction has just been opened ; but there is a prospect that a rich mine of truth will be discovered when time and study will permit. Thus medicine must be always changing, tcr the field of enquiry widens with every new discovery, and each succeeding discovery modifies the former. Many, therefore, who, claiming to be conservatives in politics, social
economy, and religion, wish to include medicine in the list of their immutable institutions, find the facts sadly in conflict with their views, for the essential law of medicine is change, and, with certain fluctuations, change for the better.
Art. VIII.- Official Despatches and other Public Documents.
Our first impulse, as well as our first duty, on the present occasion, is to congratulate the country, North and South, on the restoration of peace and the Union ; and our first wish is that the government will be magnanimous and generous, as it can so well afford to be. It is not necessary to evince any vindictive spirit ; such a course would, on the contrary, be very injudicious; far from doing good, it would, sooner or later, be productive of evil consequences. Any remark of this kind would, we are sure, have been entirely superfluous, had it not been for the base conspiracy which resulted in the assassination of Mr. Lincoln, and the attempted assassination of Mr. Seward.
The most high-minded government that has ever existed could not feel otherwise than strongly incensed against the perpetrators of such atrocious crimes; and if one of the assassins can be said to have acted more brutally and fiendlike than the others, undoubtedly that one is he who struck the man already prostrated on the bed of sickness. That both assassins deserved death in the most ignominious and revolting form in which it can be inflicted by the laws of any civilized country, even their accomplices would hardly venture to deny.
Our readers are aware that we have never entertained any very high opinion of the intellectual capacities of Mr. Lincoln ; but they are also aware that we have always regarded him as strictly honest, faithful to his trust, and kind and generous in his impulses. And as none admire the latter qualities, as well as the former, more than we, or set a higher value upon them, so certain it is that none more deeply deplored or more heartily regretted the untimely end of their possessor. Of Mr. Seward our estimate was indeed somewhat different; we had little admiration for his character in any form ; but we have never for a moment entertained any feeling against him which would have prevented us from risking our life to save him from the hand of the assassin.