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so warmly sung of its powers in combating and arresting this inflammation of the heart's membranes! Ahno, it is a melancholy fact, but it is one nevertheless, from which, if wisely stored for future use, we may learn wisdom, that in the use of this remedy, also, one of the most observant and practical physicians amongst us has found the ground of a firm faith undermined by the truth-telling effects of a more extended experience. “ After blood-letting rapid induction of the mercurial action is of the greatest consequence," so writes an authority, in a most unhesitating style, some fifteen years ago. And then, when we turn to the last best authority, who has given the world the benefit of his long and great experience on these subjects, and anxiously hope to find in him a guide amidst these difficulties, what does he tell us consolotary? Why, it must be admitted, that his chapter on the treatment of pericarditis is the most unsatisfactory in the book, but saying this is not to say ill of it, for it may thus perhaps just most truly represent our actual knowledge of that treatment.
And all the other methods of combating this inflammation in its acute form which have been from time to time well recommended, and are now in practice amongst us-purgatives, opium, salines, etc., what are we to say of them? Let me put the question in another form, and, appealing to the experience of individuals, ask what treatment they adopt—what is the treatment they adopt, at least, with hopes of success, in arresting the inflammation ? The answer to this question will be found in the fact (which any one who has had occasions of observing the practice of many physicians must know), that there is little accordance in opinion and in action as to the course which should be pursued; that the hopes and the confidence of to-day, derived from some happy issue which the disease has found under his hands, are belied by the reverses which await the physician to-morrow. And is it not a fact, also, that the more experience he has gained in the treatment of this disease, the more cautious and quiet-expectant if you please—he becomes in his treatment ? Failures and failures in treatment, have driven physicans to the pass of leaving the disease and the system to struggle for the mastery between themselves without interference; and men have done this whose honour, and reputation, and scientific knowledge are above all doubt--they have done it as the conclusion forced upon them by long and well-gathered experience, and it is useless, and worse than useless, for us to pretend to deride such men : they act conscientiously, and they act as they have a right to act; they may fairly turn round to their objector with the desire that he shall give his proofs of a better knowledge,
“Si quid novisti rectius illis candidus imperti ;”. and not unfairly add the conclusion,
“Si non his utere mecum." ...." Qui vous dit,” says Majendie, “que la maladie n'eût pas également guéri si vous ne l'eussiez point employé ? Le rhumatisme cède aux saignées, cède
au tartre stibié, cède à tous les traitments imaginables ; il cède surtout au simple séjour au lit, et aus boissons adoucissantes, Jamais, à mon hôpital, je n'ai recours à la lancette, ni à l'emetique, ni aux sangsues pour combatre ce genre d'affection, et je ne crains pas de le dire, j'ai vu guérir autant de rhumatismes que j'en ai traité."
Assuredly the very most that the warmest advocate of any particular treatment can say of it is, that the firm conviction which he has of its efficacy is founded on the results of his personal experience, and of what, perhaps, he may have gathered by communication from the experience of others; but let me ask that individual to lay aside that fatal idea, “firm conviction," and analyse the actual facts on which he has based that firm conviction : to compare his facts with the facts of other equally honest and talented observers as himself: not to forget that there is a post hoc and a propter hoc: that cause and effect, and antecedence and sequence are different affairs : and that better men, it may be, than himself, have had again and again to grieve over “ firm convictions” blown to the winds by experience. Let him do this fairly, and can it be doubted that the result will be this, viz., astonishment at the slender foundation on which his certain treatment has rested.
I have, hitherto, been keeping in view inflammation of one particular part of the body; but which are its acute diseases to which these remarks will not apply? few indeed I suspect. And let me for a moment longer dwell upon this subject, and ask what pathology and diagnosis have added to the power of medicine in combating those large classes of diseases, which, at times, decimate the population of our cities. We cannot look back on these diseases, historically, without calling to mind the fatal influences which have misguided the physician's judgment: the fatal consequences which have resulted from his blind faith in specious dogmata and captivating doctrines respecting the nature and local habitation of fevers, We may laugh at Dr Sangrado's vagaries, for we read them as a joke; but in what did the results of his method” differ from those which followed the doctrines inoculated in the medical world by the extraordinary eloquence and enthusiasm of Broussais ? These it is impossible to contemplate without a shudder, and the poison is not yet extinct. Pathology has done much for us; we have ceased to give to fever a local habitation; the brain, the lungs, the heart, the abdominal viscera are no longer either individually or collectively the centres from which radiate the phenomena, whose outward manifestations we denominate fever; these are great facts acquired to medicine, and let us be contented with our legitimate gains. Is it nothing that we have determined that typhus is not inflammation of the brain,—that it is not a gastro-enterite,—that it is not inflamination of the lungs ? Our ideas concerning fever have undoubtedly become more precise; pathology has cleared away the mists of many errors which surrounded the subject; we no longer commit the grievous errors in treatment which were the necessary consequences
resulting from the localising of the disease spoken of above. Bu how does our account stand with its treatment now? I would aniswer this question by asking any one who is anxious to investigate the matter, to consider the different treatments adopted by various practitioners for the cure of this disease—by practitioners not living in different countries, or in separate cities of the same country, but by those exercising their art upon the self-same disease, under the same roof, in the same public hospitals; and he will find them not using unlike, but adopting the most opposite remedies; in the language of the author above referred to, I may say :
“ Ce serait une étude bien affligeante que de passer en révue les divers modes de traitement employés dans chaque localité contre la même affection morbida .... voyez ce qui se passe de nos jours, au sein même de la capitale, dan: nos principales cliniques. Un malade est frappé d'une fièvre typhoide, eh bien ! Suivant qu'il a été dirigé vers tel on tel hôpital, il sera soumie à un traitinent différent : à la Pitié, on n'aura point recours aux mêmes ingyens qu'à la Charité, ni qu' à l'Hôtel-Dieu. Tel praticien vante les purgatifs, tel autre préfère la saignée, un troisième s' applaudit de l'emploi des toniques d'autres enfin, et je suis de ce nombre, laissent la maladie parcourir à peu près librement ses périodes sans chercher à enrayer sa marche.
It is needless to pretend to speak here of the multitude of specific remedies which have been reported as cures of fever; they tell their our tale, and the last has shared the fate of the first. In France, men were even quarrelling about the authorship of the discovery of the cure of fever by quinine, when the so-called cure itself was shown to be a failure here!
If I wished to illustrate farther the position I assume, I might follow out the subject by canvassing in a like spirit our treatment of almost all other acute diseases, and many diseases likewise not acute. Certainly, it is true, that the more numerous the specific reniedies and treatments adapted to any malady are, the more sure we may be that the malady is especially one for which no specific treatment has yet been discovered. The remedies which have been at one time or another declared positive curatives of epilepsy amount to more than a hundred, and fresh ones are still being added to the catalogue ; but I suppose the actual experience of the present day differs not from that of Heberden as regards the issue of this malady; he knew no case in which the fits, when present after puberty, were ever got rid of.
Surely some lessons of advantage may be likewise drawn from calling to inind the “ cures for the cholera,” with which the Medical and other journals teemed upon this last occasion, as on other occasions, when that fatal epidemnic was amongst us. Some men bare even had the courage to write with a degree of certainty about the nature of this infliction ; but after all the vaunting of cures and illogical reasonings upon the nature of this disease, what do we really know of the matter? The summary which Andral gave of it years gone by, is still well fitted to and descriptive of it : “ charactères anatomiques, insuffisantes ; causes, mystérieuses ; nature, hypothétiques; symptomes, charactéristics; diagnostic, facile ; traitment, donteux." Stripped of all hypotheses, what remains to us of positive knowledge concerning this scourge ? absolutely nothingproud medicine, girt with all her scientific aids, must learn to bow the head.
But, it will be said, are we to infer from all this that the physician is to remain a calm spectator : that he is to sit quietly down, les bras croises, while disease is running riot and committing its worst ravages ? By no means, the man of action must act, even though struggling through the mist of errors. But how act? therein lies the pith of the matter; let us consider the point from whence a rational method of action may be derived, and compare it with the manner of proceeding above spoken of. Our art, conjectural as it is, possesses principles, and the harvest of men's experiences has brought rich treasures of undoubted facts into our garner, and these facts lie ready to our hand. Now the physician, in his treatment of this disease, rests his views upon, and is guided by the knowledge he possesses of certain laws of the organism, and of the effects which result from morbid causes acting on that organism, he strives to find analogies, in some of the morbid phenomena which it presents between it and other diseases, into whose nature he has a farther insight, and over whose progress he is justified by experience in believing that he possesses control; and having found such analogies, even though but feebly marked, he is justified, on every true principle of reasoning, in directing his remedies in that sense; and then watching the results, or rather marking, as far as the complex nature of the problem will allow him to mark, the consequences, real or apparent, which ensue, he must be contented patiently to recordsimply to record—these consequences, the results of his experience, until at length accumulated experience shall justify him in drawing conclusions, which he may use as principles.
The unhesitating conclusions and inferences which are so often jumped at, in such cases, certainly shows an eager and very natural desire, on the part of those who watch disease, to be forward in the work of doing good, but it exhibits an utter indifference to a rational consideration of the subject.
Let us consider this matter a little more closely, for the arguments which affect it, involve in a higher or less degree the treatment of acute disease in general. What I have said, that the problem before us is most complicated, every one will readily admit; the data upou which we have to operate are hypothetical ; positive starting point for inquiry we have none; of the essence, or intimate nature of the choleraic poison, we know nothing; how it enters the human body; where it first fixes its grasp, whether upon the fluids or solids, or whether upon one particular solid or fluid ;—all this, science has yet to make manifest. Cheinistry, the microscope, and the pathologist have done their best, but for any solution of these things in a positive sense, they have done nothing. And yet
our profession boasts of its cures day after day! Consider the malady and consider the boasted cure! Here is a disease which, at one fell swoop, may strike the whole organism and all its complicated arrangements; in a few hours annihilate its vitality. The shrunken features, their leaden hue and blue pallor, the violent spasms of the muscles, the chilly breath, the ice-cold límbs, the thick breathing, the imperceptible pulse, the exhausting discharges of fluids, the sunken eye, the wasting body-wasting under the eye of the lookeron—all manifest the fact, that a most fearful enemy has obtained possession, not of this or that vital part, but of every part of the liring structure. Well, and men will boast, that a disease like this they have cured by the administration of a few grains of mustard!
It is not surprising, when this disease first appeared amongst us, that the whole armentarium of the Pharmacopæia should have been indiscriminately turned against it; and that men should have rushed hastily to the conclusion (their wish being the willing father to the thought), that when the patient died not, his life was saved through their interference; but I'must venture to think, that there is something very loose in our medical logic, when, with the abounding results flowing from the treatment of two onslaughts of the epidemic before us, results which give to the unbiassed mind the most positive disproofs of the efficacy of the hundred reniedies which have been vaunted and published as cures for the cholera—we find ourselves still boasting of our remedies, and still publishing our cures, and even upon the same insufficient data guiding us; what right have we, who act thus irrationally, attributing consequences to antecedents, where there is no rational link whatever, beyond that of mere sequence, by which to trace the connection—what right have we to express anger and astonishment that empirics impudently advertise their cures, and that good meaning men, in the public prints, under the names of Clericus, etc., insult the doctor's treatment, and magnify their own nostrums? How can we be surprised that quacks boast their specifics, when we, the legitimate sons of medicine thus publish our cures, and give them the sanction of our assertions?
There is no one influence more baneful and grievously obstructive to the progress of the medical art, than the ever hasty desire, so constantly alive amongst us, of generalizing upon, and drawing conclusions from, the results of observation ; however isolated a fact, however barren it may yet intrinsically be, the eager mind still strives to show its antecedent connections, and to draw conclusions from it; into what errors and absurdities this hastening to be wise has conducted them, in what fallacious and extraordinary reasonings in practice it has involved them, he who is desirous of learning will find proofs enough written on every page of the history of medi. cine. By thus casting dust in the eyes of others, and perverting our own vision, we raise up positive barriers to the advance of true knowledge, for now the mists and delusions which our faulty haste has generated, must be swept away, before the honest face of the