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Appendum

NOTES TO THE ADDRESS ON CURRENTS AND COUNTER CURRENTS IN MEDICAL SCIENCE.


Some passages contained in the original manuscript of the Address, and omitted in the delivery on account of its length, are restored in the text or incorporated with these Notes.


NOTE A.--

There is good reason to doubt whether the nitrate of silver has any real efficacy in epilepsy. It has seemed to cure many cases, but epilepsy is a very uncertain disease, and there is hardly anything which has not been supposed to cure it. Dr. Copland cites many authorities in its favor, most especially Lombard's cases. But De la Berge and Monneret (Comp. de Med. Paris), 1839, analyze these same cases, eleven in number, and can only draw the inference of a very questionable value in the supposed remedy. Dr. James Jackson says that relief of epilepsy is not to be attained by any medicine with which he is acquainted, but by diet. (Letters to a Young Physician, p. 67.) Guy Patin, Dean of the Faculty of Paris, Professor at the Royal College, Author of the Antimonial Martyrology, a wit and a man of sense and learning, who died almost two hundred years ago, had come to the same conclusion, though the chemists of his time boasted of their remedies. "Did, you ever see a case of epilepsy cured by nitrate of silver?" I said to one of the oldest and most experienced surgeons in this country. "Never," was his instant reply. Dr. Twitchell's experience was very similar. How, then, did nitrate of silver come to be given for epilepsy? Because, as Dr. Martin has so well reminded us, lunatics were considered formerly to be under the special influence of Luna, the moon (which Esquirol, be it observed, utterly denies), and lunar caustic, or nitrate of silver, is a salt of that metal which was called luna from its whiteness, and of course must be in the closest relations with the moon. It follows beyond all reasonable question that the moon's metal, silver, and its preparations, must be the specific remedy for moonblasted maniacs and epileptics!

Yet the practitioner who prescribes the nitrate of silver supposes he is guided by the solemn experience of the past, instead of by its idle fancies. He laughs at those old physicians who placed such confidence in the right hind hoof of an elk as a remedy for the same disease, and leaves the record of his own belief in a treatment quite as fanciful and far more objectionable, written in indelible ink upon a living tablet where he who runs may read it for a whole generation, if nature spares his walking advertisement so long.


NOTE B.--

The presumption that a man is innocent until he is proved guilty, does not mean that there are no rogues, but lays the onus probandi on the party to which it properly belongs. So with this proposition. A noxious agent should never be employed in sickness unless there is ample evidence in the particular case to overcome the general presumption against all such agents, and the evidence is very apt to be defective.

The miserable delusion of Homoeopathy builds itself upon an axiom directly the opposite of this; namely, that the sick are to be cured by poisons. Similia similibus curantur means exactly this. It is simply a theory of universal poisoning, nullified in practice by the infinitesimal contrivance. The only way to kill it and all similar fancies, and to throw every quack nostrum into discredit, is to root out completely the suckers of the old rotten superstition that whatever is odious or noxious is likely to be good for disease. The current of sound practice with ourselves is, I believe, setting fast in the direction I have indicated in the above proposition. To uphold the exhibition of noxious agents in disease, as the rule, instead of admitting them cautiously and reluctantly as the exception, is, as I think, an eddy of opinion in the direction of the barbarism out of which we believe our art is escaping. It is only through the enlightened sentiment and action of the Medical Profession that the community can be brought to acknowledge that drugs should always be regarded as evils.

It is true that some suppose, and our scientific and thoughtful associate, Dr. Gould, has half countenanced the opinion, that there may yet be discovered a specific for every disease. Let us not despair of the future, but let us be moderate in our expectations. When an oil is discovered that will make a bad watch keep good time; when a recipe is given which will turn an acephalous foetus into a promising child; when a man can enter the second time into his mother's womb and give her back the infirmities which twenty generations have stirred into her blood, and infused into his own through hers, we may be prepared to enlarge the National Pharmacopoeia with a list of specifies for everything but old age,--and possibly for that also.


NOTE C.--

The term specific is used here in its ordinary sense, without raising the question of the propriety of its application to these or other remedies.

The credit of introducing Cinchona rests between the Jesuits, the Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor, who employed it as a secret remedy. (Pereira.) Mercury as an internal specific remedy was brought into use by that impudent and presumptuous quack, as he was considered, Paracelsus. (Encyc. Brit. art. "Paracelsus.") Arsenic was introduced into England as a remedy for intermittents by Dr. Fowler, in consequence of the success of a patent medicine, the Tasteless Ague Drops, which were supposed, "probably with reason," to be a preparation of that mineral. (Rees's Cyc. art. "Arsenic.") Colchicum came into notice in a similar way, from the success of the Eau Medicinale of M. Husson, a French military officer. (Pereira.) Iodine was discovered by a saltpetre manufacturer, but applied by a physician in place of the old remedy, burnt sponge, which seems to owe its efficacy to it. (Dunglison, New Remedies.) As for Sulphur, "the common people have long used it as an ointment" for scabies. (Rees's Cyc. art. "Scabies.") The modern cantiscorbutic regimen is credited to Captain Cook. "To his sagacity we are indebted for the first impulse to those regulations by which scorbutus is so successfully prevented in our navy." (Lond. Cyc. Prac. Med. art. "Scorbutus.") Iron and various salts which enter into the normal composition of the human body do not belong to the materia medica by our definition, but to the materia alimentaria.

For the first introduction of iron as a remedy, see Pereira, who gives a very curious old story.

The statement in the text concerning a portion of the materia medica stands exactly as delivered, and is meant exactly as it stands. No denunciation of drugs, as sparingly employed by a wise physician, was or is intended. If, however, as Dr. Gould stated in his "valuable and practical discourse" to which the Massachusetts Medical Society "listened with profit as well as interest," "Drugs, in themselves considered, may always be regarded as evils,"--any one who chooses may question whether the evils from their abuse are, on the whole, greater or less than the undoubted benefits obtained from their proper use. The large exception of opium, wine, specifics, and anaesthetics, made in the text, takes off enough from the useful side, as I fully believe, to turn the balance; so that a vessel containing none of these, but loaded with antimony, strychnine, acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus diaboli, tormentilla, and other approved, and, in skilful hands, really useful remedies, brings, on the whole, more harm than good to the port it enters.

It is a very narrow and unjust view of the practice of medicine, to suppose it to consist altogether in the use of powerful drugs, or of drugs of any kind. Far from it. "The physician may do very much for the welfare of the sick, more than others can do, although he does not, even in the major part of cases, undertake to control and overcome the disease by art. It was with these views that I never reported any patient cured at our hospital. Those who recovered their health were reported as well; not implying that they were made so by the active treatment they had received there. But it was to be understood that all patients received in that house were to be cured, that is, taken care of." (Letters to a Young Physician, by James Jackson, M. D., Boston, 1855.)

"Hygienic rules, properly enforced, fresh air, change of air, travel, attention to diet, good and appropriate food judiciously regulated, together with the administration of our tonics, porter, ale, wine, iron, etc., supply the diseased or impoverished system with what Mr. Gull, of St. Bartholomew's Hospital, aptly calls the 'raw material of the blood;' and we believe that if any real improvement has taken place in medical practice, independently of those truly valuable contributions we have before described, it is in the substitution of tonics, stimulants, and general management, for drastic cathartics, for bleeding, depressing agents, including mercury, tartar emetics, etc., so much in vogue during the early part even of this century." (F. P. Porcher, in Charleston Med. Journal and Review for January, 1860.)


THE END.

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Oliver Wendell Holmes