Medical Essays

第24章

IfthereisanyStateorcitywhichmightclaimtobetheAmericanheadquartersofthenature-trustingheresy,provideditbeone,thatStateisMassachusetts,andthatcityisitscapital。Theeffectwhichthesedoctrineshaveupontheconfidencereposedintheprofessionisamatterofopinion。Formyself,Idonotbelievethisconfidencecanbeimpairedbyanyinvestigationswhichtendtolimittheapplicationoftroublesome,painful,uncertain,ordangerousremedies。Nay,Iwillventuretosaythis,thatifeveryspecificweretofailutterly,ifthecinchonatreesalldiedout,andthearsenicmineswereexhausted,andthesulphurregionswereburnedup,ifeverydrugfromthevegetable,animal,andmineralkingdomweretodisappearfromthemarket,abodyofenlightenedmen,organizedasadistinctprofession,wouldberequiredjustasmuchasnow,andrespectedandtrustedasnow,whoseprovinceshouldbetoguardagainstthecausesofdisease,toeliminatethemifpossiblewhenstillpresent,toorderalltheconditionsofthepatientsoastofavortheeffortsofthesystemtorightitself,andtogivethosepredictionsofthecourseofdiseasewhichonlyexperiencecanwarrant,andwhichinsomanycasesrelievetheexaggeratedfearsofsufferersandtheirfriends,orwarntheminseasonofimpendingdanger。Greatasthelosswouldbeifcertainactiveremediescouldnolongerbeobtained,itwouldleavethemedicalprofessionthemostessentialpartofit’sduties,andall,andmorethanall,itspresentshareofhonors;foritwouldbethedeath-blowtocharlatanism,whichdependsforitssuccessalmostentirelyondrugs,oratleastonanomenclaturethatsuggeststhem。

Thereisnooffence,then,ordangerinexpressingtheopinion,that,afterallwhichhasbeensaid,thecommunityisstilloverdosed:Thebestproofofitis,thatnofamiliestakesolittlemedicineasthoseofdoctors,exceptthoseofapothecaries,andthatoldpractitionersaremoresparingofactivemedicinesthanyoungerones。“[Dr。JamesJacksonhaskindlypermittedmetomakethefollowingextractfromaletterjustreceivedbyhimfromSirJamesClark,anddatedMay26,1860:“Asaphysicianadvancesinage,hegenerally,Ithink,placeslessconfidenceintheordinarymedicaltreatmentthanhedid,notonlyduringhisearly,butevenhismiddleperiodoflife。“]TheconclusionfromthesefactsisonewhichtheleastpromisingofDr。Howe’spupilsinthementaldepartmentcouldhardlyhelpdrawing。

Partoftheblameofover-medicationmust,Ifear,restwiththeprofession,foryieldingtothetendencytoself-delusion,whichseemsinseparablefromthepracticeoftheartofhealing。Ineedonlytouchonthecommonmodesofmisunderstandingormisapplyingtheevidenceofnature。

First,thereisthenaturalincapacityforsoundobservation,whichislikeafaultyearinmusic。Weseethisinmanypersonswhoknowagooddealaboutbooks,butwhoarenotsharp-sightedenoughtobuyahorseordealwithhumandiseases。

Secondly,thereisinsomepersonsasingularinabilitytoweighthevalueoftestimony;ofwhich,Ithink,fromaprettycarefulexaminationofhisbooks,HahnemannaffordsthebestspecimenoutsidethewallsofBedlam。

Theinveteratelogicalerrorstowhichphysicianshavealwaysbeensubjectarechieflythese:

Themodeofinferenceperenumerationemsimplicem,inscholasticphrase;thatis,countingonlytheirfavorablecases。ThisistheoldtrickillustratedinLordBacon’sstoryofthegiftsoftheshipwreckedpeople,hungupinthetemple——Behold!theyvowedthesegiftstothealtar,andthegodssavedthem。Ay,saidadoubtingbystander,buthowmanymadevowsofgiftsandwereshipwreckednotwithstanding?Thenumericalsystemisthebestcorrectiveofthisandsimilarerrors。Theargumentscommonlybroughtagainstitsapplicationtoallmattersofmedicalobservation,treatmentincluded,seemtoapplyrathertothetabulationoffactsillobserved,orimproperlyclassified,thantothemethoditself。

Theposthocergopropterhocerror:hegotwellaftertakingmymedicine;thereforeinconsequenceoftakingit。

Thefalseinductionfromgenuinefactsofobservation,leadingtotheconstructionoftheorieswhicharethendeductivelyappliedinthefaceoftheresultsofdirectobservation。TheschoolofBroussaishasfurnisheduswithagoodexampleofthiserror。

Andlastly,theerrorwhichSirThomasBrownecallsgiving“areasonofthegoldentooth;“thatis,assumingafalsehoodasafact,andgivingreasonsforit,commonlyfancifulones,asisconstantlydonebythatclassofincompetentobserverswhofindtheir“goldentooth“

inthefabulouseffectsofthehomoeopathiemateriamedica,——whichconsistsofsugarofmilkandanomenclature。

Anotherportionoftheblamerestswiththepublicitself,

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