페이지 이미지
PDF
ePub

mode of its administration as so graphically detailed by the indignant pen of the late Sir Astley Cooper, or of the fearful consequences resulting from such administration, some of which remain recorded, in corpore vili, in certain of our hospital museums.

Let us consider, in a superficial way, the general manner of its use at the present moment; take, for instance, its administration in that disease with which its name is so intimately connected, in syphilis. What do we find ? well, north of the Tweed the induction of mercurialization is anathematized in this disease; south of the Tweed its induction is, as a rule, held to be a sine quâ non for the cure of the same. Leading teachers of surgery have long taught in the Scotch school that mercury should never be administered in syphilis so as to produce salivation, but should be used “ merely to promote the secretions, and act as an alterative in restoring a healthy state of the system.” “ All those severe constitutional effects which embitter the patient's existence and ultimately destroy it, are still met with in the practice of those who employ mercury profusely and indiscriminately.” “ This medicine produces those effects, more especially those on the bones, only in persons who are suffering from venereal ulceration of the genital organs.” Thus, for years, have students in the north been taught; and I believe I am in no way exaggerating, if I say, that the rule is, amongst Scotch practitioners generally, to regard the specific effects of mercury produced in syphilitic diseases as little better than a species of slow poisoning. Cross the Tweed, and then we find, that in the very same disease, the very same remedy, in England and in France at least, is administered as the rule, and that its non-administration is the rare exception, its administration, I mean, for the special purpose of producing mercurialization. “Le mercure . . . c'est le remède le plus sûr et le plus puissant, jusqu' a ce qu'une specifique soit trouvé," writes Ricord. Every one, now-a-days, I must suppose, admits the specific nature of the syphilitic poison ; no one can believe that the disease is one thing in London and another thing in Edinburgh, that its cure requires that treatment there, which is found worse than useless here, a little remove farther towards the north pole.

But what is the case ? Certain symptoms which in London are looked upon as the consequences of syphilis, are held in Edinburgh to be the results of mercurial poisoning; the very remedy which, in the hands of this man, is called a sheet anchor, is the same which, in the hands of another, is proscribed as a positive poison! When facts like these come before the unbiassed public, what are they to think of the condition of our therapeutical knowledge, surely they are justified in believing that it is impossible to reconcile such complete variance of opinion, except by supposing that there is a gross misconception somewhere involving the whole subject. This very year, I learn, that in the first medical school in this country, one of the professors, not a mesmerist nor a homeopath, be it observed, but a most energetic and unwearied worker in the science of his profession, has actually taught his class, that from the beginning to the end of it, mercury is nothing but a downright poison. He must defend his own thesis, and he is perfectly capable to do justice to it. I only proclaim the fact. I see, however, nothing more surprising in such a conclusion, nothing more conflicting between it and generally received notions on the subject, than I do in the opposite conclusions arrived at by professional men, concerning the effects of salivation in syphilitic diseases.

It is surely not necessary for me to multiply proofs of the fact, that the opinions physicians hold regarding the nature and treatment of many diseases are very various and often very opposed to each other; the proofs of it may be readily found by a perusal of the history of such diseases. I would, however, just shortly refer to some few practical conclusions, which appear to me to result from a consideration of this subject.

One conclusion is, that more faith is placed in the power and efficacy of therapeutic agents as regulating and controlling the courses of many diseases than the reason of the case warrants us in ascribing to them, a conclusion proved by the fact of the want of uniformity, and of the actual diversity, exhibited in the treatment of the same diseases by practitioners in different countries, or at different epochs in the same country, or at the same time, and in the same place, by physicians practising on individuals subjected to precisely the same external influences. As a corollary of this, also, it may be suggested that inasmuch as the proofs of the beneficial effects of such agents are not, in such cases, deducible from the premises, it is quite possible that these agents may occasionally (if they have any effective power at all) exert a deleterious action on the system, a side of the question, which, if not altogether disregarded, can scarcely be said to have received its full share of attention. It is impossible to look upon the specific action of mercury or the system as an indifferent matter; if its induction is not the right cure for a complaint, then surely we may presume that its consequences may be injurious. If erysipelas requires for its cure in London, bark, port wine, and such like remedies, then the treatment which prescribes bleeding for the same in another city, can hardly be looked upon as innocent, and vice versa.

One of the most talented physicians of the day, writing a few years ago concerning the treatment of a particular acute inflammation, observed, that such was the vigorous nature of the onslaught made by the disease that we were sometimes forced to bring our patient, by treatment, almost to the door of death, if we would prevent the disease carrying him through that door altogether ; could such dealing with his body be a matter of no importance to the person most concerned, if it happened not to be the right dealing with it? Such treatment is not only not adopted now, but it is proscribed as dangerous. If a therapeutical agent is potent enough to produce some manifest action on the vital organism, it may be potent for evil as well as for good. That salvo to the conscience of the doubtful practitioner, “ at all events it can do no harm," always sounds to me as the expression of a very poor logic; if the agent under no circumstances can do harm, it is pretty evident that neither can it, under any circumstances, be suspected of doing any good, in other words, it must be supposed to possess no physiological action whatever—to be inert.

It is very well for us to deride " the milk and water practice” of French physicians, but, after all, a consideration of this subject rather tends to foster the idea, that their “diète” and “eau quimauve,” may not be farther removed from a show of reason than our polypharmacal system. And there is one objection thrown in the teeth of the orthodox practitioner of medicine, which appears very difficult for him to answer. How, the objector asks, can you prove that your medicine produces such and such results, you have never observed the progress of the disease when such medicine was not exhibited ? And he adds, perhaps : I have tried the orthodox plan, and an expectant treatment likewise, and I prefer the latter; statistics seem to be in favour of my doing so. Now, if it happens that, as the results of their long experience, men with European reputations have been led to diminish or modify their faith in the efficacy of remedies over certain diseases, we surely have no right to turn round on and deride them; they are honest men; they have tried the interfering and the expectant plans, and make their choice. We ought to be cautious in this; we have little opportunity of judging in the matter; custom has decided, and habit confirms the custom, that, in the face of active diseases we must be vigorously active with our remedies. We speak continually of a vis medicatrix, and of guiding and directing the force, and of removing obstacles to its free operations; but have we any data to show what of the cure depends upon this vis, and what of it is due to the interfering hand of the physician? Have we any data by which we can prove our powers of aiding, guiding, and abetting in its operations this our great ally, this medicating vis ?

What is the interpretation to be given of many of the successes boasted of by that outrage on science and common sense, homeopathy? What but this, that the mere cessation from long indulgence in the sweets of routine polypharmacy has given fresh life to the over-drugged body. The truth is, that from our earliest days we have been bred up in the idea, that physic and physicians are inseparable things, that drugs and diseases are necessary opponents. When Molière introduces a physician on the stage, it is generally with a chorus of apothecaries, armed with the classical syringe, in his suite. We are all trained up in exorbitant notions respecting the power of drugs over disease. But our patients, it may be replied, expect us to do something; they have no idea of being left without efforts for their restoration to health being made; they have faith in physic and faith in its practitioners; to tell them that you see not how drugs can avail them, would be like dismissing them helpless into the jaws of the enemy; their imagination then would react banefully on their disordered condition, and thus aid the progress of the malady.

The objection is one to which I scarcely know how to reply, for as regards the individual it is a very strong one, but as regards the reasonable being I think this may be said to it: Why does the patient. thus love and believe in drugs on all occasions, and their necessity? Why, but because, in all his bodily distresses, in them we have taught him to put his trust. What would a patient think of his physician if he were to dismiss him without a prescription ? What physician ever attended a consultation without inditing his ordonnance? We have led the world in very many instances to place undue confidence in our remedies—undue, because it is a confidence which our own observation does not warrant, as I have endeavoured here to show, and therefore it becomes the duty of our craft to make, at all events, an effort at redeeming the public mind from the error in which it is involved.

Space forbids me doing more than briefly mentioning the two chief injuries which the polypharmacal system brings upon the patient. He is taught to believe, by the temporary relief which he thereby receives, that he may continue with impunity to indulge that particular course of life, for example, to which his malady may fairly be attributed, as its cause; such belief distracts his attention from that main point, which should rule all other considerations, viz., removal of the causes which excited the malady. Can any one deny that it is much more rational to tell the patient that certain infringements of the organic laws, which his account of himself enables us to point out, are the sources of his complaint; that the true remedy for the same is in his own hands; that to look for its cure by drugs is a deception, and worse than a deception, beguiling him on into a continued and still farther infringement of those laws -much more rational, than endeavouring by the aids of pharmacy to patch up, restore, and combat against evils whose causes are constantly permitted to operate with impunity? Inordinate attention to the purely therapeutical treatment of disease, distracts our attention from the proper management of it by a due consideration of diet, habits, modes of life, and so on. It is only of very late years, we have discovered that the successful management of typhus, for instance, has much more to say to the management and regulation of the diet, that is, of the right administration of articles of diet, than it has to do with the articles of the pharmacopeia. Specific remedies for its cure becomes rarer every year, and the most experienced physicians, if we may judge from their writings, are they who trouble the disease the least with the articles referred to.

Before concluding, I would desire to say, that I trust no one will suppose me silly enough, in anything I have here said, to be sceptical as to the uses, advantages, and power over diseases which therapeutical agents possess; or that I am desirous of running my head against the rampart of solid real facts which medicine has stored up concerning the treatment of disease, and of which she possesses such a goodly garner. Nor do I wish to interfere with experiment; I am perfectly aware that we can only get at the facts of the case, at the meanings and true interpretation of these things by experiment; that we must give the drug, apply the remedy, and watch the result. The method is correct enough ; I differ not from any objector as to the mode of getting at the fact, but only as to the value which is to be attached to what are called the results of the remedy. The remedy is given, a result follows, and certain conclusions are drawn as to the intimate relation between the remedy and the result, as to the one being the cause of the other. In the present state of our knowledge concerning the action of remedies, I cannot but think the inferences thus drawn are often very erroneous, I cannot think them legitimate. Why I think so, I have endeavoured here to show.

ARTICLE III.-An Experimental Inquiry into the Existence of a

Sixth Sense, here called the Sense of Force. By RICHARD F. BATTYE, Esq., London.-(Continued from p. 140.)

The knee-joint is by far the largest, and has synovial membrane more abundantly distributed to it than any other, joint in the body; here, then, we should suppose that a consciousness of a feeling of weight would be above all others the most apparent; but in this respect we shall be greatly deceived—since the mechanical relations of this joint check the manifestation of the feeling of weight in the sense of force, and supply those of strength, or resistance, only.

This peculiarity may be set forth in the following manner:-The femur is very much more constricted in the shaft than at its extremities, especially its inferior condyloid extremity; moreover, the shaft consists of firm and dense osseous structure, the condyloid extremity, in its interior, of spongy or cancellated osseous structure.

The consequence of this contrast of texture must be, that whilst the weight of the trunk is sustained by the arched shaft of the femur in a narrow space, all unexpended force which passes from thence to its inferior condyles is distributed over a much wider surface, the arrangement of the cancellated structure of which affords great facilities forthe widely diffused force to come to composition, whilst channelling along rows or bands of osseous tissue placed at opposite angles to each other. Furthermore, though the osseous tissue covering the articular surface of the condyles is very hard and dense, yet, like its antagonist in the tibia, it is exceedingly thin, and therefore the two opposing surfaces, the femoral and tibial articulations, present no sufficient barrier for the resisting, or regulating of forces, impinging against

« 이전계속 »