Organopathy, or, Medical progress : an essay / by William Sharp, M.D.

  • Sharp, William, 1805-1896.
Date:
1867
    No text description is available for this image
    cured ly their contraries. This was the dogmatic school of the ancients, and it reigned without a successful rival for many centuries. If we look at the men who have been teachers since the revival of learning in Europe, we see with surprise how the medical chemistrtj of SiLvius, and the medical me- chanics of BoRELLi have had their triumphs and defeats; how S'i'AHL established, as he thought, his vital dynamics or auiocrateia ; Hoffmann his medicina rationalis syste- matica ; BoERHAAVE, among other doctrines, that de glu- ienoso spontaneo; Cullen his' spasm of the extreme vessels ; Brown his two classes of disease, the sthejiic and the asthenic ; and how these and other systems have been, as Etmuller expresses it, successively "hissed out of doors." And we look with wonder at the fact that the same tendency to speculate still misleads the best minds of our own time. A single instance will illustrate my meaning. I have just mentioned a familiar doctrine of fever, Cul- LEn's spasm of the extreme vessels; a doctrine at one time widely received, but in itself nothing more than a conjecture resting upon no solid foundation, and now everywhere rejected. Yet, in a review lately published, written apparently by a physician of authority and emi- nence, we find a similar doctrine of spasm, which is ad- vanced by the writer of the book reviewed, and applied by him to the explanation of cholera, spoken of thus, surely this seems a reasonable theory !" The author of the book " supposes that a spasm, or cramped state of the muscular fibres which embrace the minute pulmonary arteries, [Cullen's extreme vessels], is caused hy the choleraic poison, and bars these slender channels against the advancing blood." " Surely this seems," says the reviewer, " a reasonable theory, . . . and we may understand hoio bleeding may help by relaxing the spasm." And so we still have suppositions, as explana- tions and guides in practice, laid before us by acknow-
    ledged teachers, instead of observation, analysis, and induction. An old friend of mine wrote in the margin of his " GuLLEN," more than fifty years ago, opposite the words "relax the spasm,"—" It is sad indeed that a head so clear as the author's should thus be haunted by spasm !" Truly Hippocrates said well " the art is difficult I" These are the mistakes of faithful men, of men who have the strongest claims upon our respect and admiration. They are men who have mourned over the imperfections of their calling, and who have spent a long life in earnest efforts to remove them; men of genius, learning, and in- dustry ; men who, when other people went to bed, lighted a fresh candle. Moreover, they are men who have ever made a ready response to the calls of duty, whether those calls have come from patients needing succour, or from medical men seeking information. Experience—empiricism. As there was among the ancients, so there is among moderns another class of worthy men in the faculty, men of strong minds, good sense, and simplicity of purpose, who distrust authority, and who are convinced of the failure of reason when em- ployed in speculation. These men take up another posi- tion, and, rejecting hypotheses of all kinds, rely upon experience. Dr. Stokes recently gave expression to this view in the Medical Council of the Empire, on seconding Professor Acland's motion.* " There can," he said, " be no doubt that medicine re- quires to be placed on a much more scientific basis than it at present possesses. It is now simply empiricism ; and that empiricism is only tolerable and useful because it is wielded by thoughtful men." In the opinion of this section of physicians no true theory of diseases and their treatment is yet known. They look upon the explanatory contrivances of the dogmatists as belonging to the evils which flew out of Pandora's box. * This motion is noticed in a Paper on " The Physiological action of Medicines," read at JN ottingham, Sept., 1866.
    They limit themselves therefore to the ohservation of what the senses can teach, and in prescribing rely upon what chance, or what experiments made on the sick, has taught them. I remember a distinguished physician, to whom I was then a pupil, prescribing carbonate of iron in large doses for every patient, (and they were many), that he saw for some days; and this notwithstanding the wide disparity in the nature of their cases. He wished to learn what iron could do, and he made the sick his subjects. This is empirical experiment. A few months ago a gentleman from an adjoining county consulted me for the usual symptoms of indigestion brought on by hard study. For eleven months he had been under the care of the leading physician of his town and neighbourhood, and during those eleven months he had received from this gentleman separate prescriptions of the following drugs the " adjuvantia, corrigentia, et ceetera" with which they were combined, being omitted. 1. Triticum repens. 11. Chloric Ether. 2. Phosphoric Acid. 12. Liquor Potassse. 3. Rhubarb. 13. Taraxacum. 4. Iron and Quinine. 14. Bismuth. 6. Capsicum. 15. Salicine. 6. Prussic Acid. 16. Cascarilla. 7. Gentian. 17. Spirit of Nutmeg. 8. Nitric Acid. 18. Henbane. 9. Quassia. 19. Carbonate of Magnesia. 10. Bicarbonate of Potash. 20. Aloes. This is empirical practice.* * Perhaps it will be expected that I should say what became of this ))atient. In six weeks he was well, with the exception of some swelled glands which, of course, could not subside in that time. This result will be accounted for in various ways, according to the bias of men's minds; some will say he got well from leaving off medicines,— no slight reproof to the physician who prescribed them;—others will believe that the nux vomica and sulphur I gave him wrought the cure; for myself I think both these causes contributed to his recovery.
    " Empiricism is only tolerable because it is wielded by thoughtful men." There are thoughtful men among us, perhaps as many as in any other profession, and they de- serve to be honoured. But such an example as the one I have just given, and which is a representative one, shows that empiricism, even in the hands of thoughtful men, is a poor and feeble thing. What must it be in the hands of those who do not think, but follow empirical routine? In England alone twenty thousand men are going their daily rounds visiting the sick, many with benevolent hearts, many with liberal hands, more benevo- lent and more liberal than they commonly receive credit for; but, alas, how many with empty heads! heads, that is to say, having nothing in them but a catalogue, more or less lengthy, of the names of diseases linked to another catalogue of poisonous drugs " Plus, un petit clystere insinuatif, preparatif et remollient, pour ramoUir, humecter et refraichir les entrailles de monsieur. Plus, dudit jour, un bon clystere detersif, compose avec catholicon double, rhubarbe, miel rosat, et autres, suivant r ordonnance, pour balayer, laver, et nettoyer le bas- ventre de monsieur. Plus, une bonne medicine purga- tive et corroborative, composee de casse recente avec s^ne levantin, et autres, pour expulser et evacuer la bile de monsieur. Plus, un clystere carminatif, pour chasser les vents de monsieur. Plus, dudit jour, une potion ano- dine et astringente, pour faire reposer monsieur,"—pour faire reposer monsieur ! It will be granted that this satire is not even an exaggeration of the truth. Nature—scepticism. It is not surprising that the failure of dogmatic and speculative medicine to establish a true theory, and the poverty of empiricism, and the meagre success in actual practice of both, should have deprived some men of their faith in both the science and the art of healing. These are the medical sceptics of all ages. The prevalence of scepticism among the learned men of