THE INQUIRER, No. III.

Is there any Certainty in Medical Science?'

THE uncertainty and inutility of phyfic is the favourite cant among men who are alive and hearty, among incurable patients, and among no fmall part of the fraternity, who rejoice in hav ing fuch a convenient means of efcape in their frequent approach to the halter. Is a medical practitioner ipfo facto a quack? or (what is feldom the cafe) will it be difcovered, after inquiry, that profeffional men are really better than they call themfelves? Let us examine the twofold grounds of impeachment brought against the moft honourable faculty. We are unable to guard the body against the acceifion of difeafe, and to devife proper means of cure for all thofe which do exift. The prevention of diseases, it must be recollected, is generally left to each individual, as far as his own perfon is concerned; he may be taught, by the fame experience which teaches all phyficians, what is likely to hurt or to benefit him: in fpite, however, of his knowledge and of his felf-love, he chooses often to run the hazard of future contingencies, rather than facrifice a momentary gratifieation; it is not, therefore, his domeftic medicine that is in fault, but the accidental bent of his paflions. He eats an hearty dinner, feafts on certain fruits, and drinks particular wines, becaufe the whole flatters his palate; although he has never eaten fo much, nor tafted fuch fruit and wine, without fuffering afterwards: Qua nocuere fequar, fugiam que profore credam; he is as fure of the confequences of thofe fenfual gratifications, as he must be of the fcalding property of boiling water poured upon his hand or his foot. Hence the adage fo true in itself, when the faculties are not disordered and impaired by irregular habits or by disease, that every man must be his own phyfician. Difeafe, however, is brought on by inexperience, thoughtlefinefs, and by various uncontroulable circumftances; the mind becomes agitated and difturbed, the patient thinks himfelf worfe than he really is, and he wants fomebody whofe appearance he conceives to be the precurfor of health and comfort. The phyfician becomes acquainted with the most prominent fenfations of his patient; he feels his pulfe and his fkin, looks at his tongue, and examines the expreffion of his countenance. Not a word is faid refpecting thofe circumftances which exclufively belong to this parti cular patient, by which he is diftinguished from all other men, in

a

a ftate of health as well as difcafe, which form what is generally called his conftitution or his temperament. The poor patient is not to be blamed; he knows nothing about himself. The phyfician is equally blamelefs, for his time will not allow him to hear the whole natural history of his patient, even if it were in his power to collect from the latter the recollection of things to which he has perhaps never attended. In the mean time, the patient, who continues to fuffer, accufes his phyfician; the phyfician accufes phyfic; and phyfic remains the only guiltless object among them. But this is not all. In a number of cafes, the train of fymptoms referable to the general laws of the animal economy fufficiently characterize the nature of the difeafe, and the proper indications of cure. Here, however, the peculiarities of intellect on the part of the practitioner, or whims on the part of the patient, or both combined, are again in the way of certainty in the practice of medicine. What is evident to a man of common obfervation, fagacity, and experience, may be peculiarly obfcure to a practitioner of inferior capacity; what would be adequate to the removal of the complaint, if properly and firmly adhered to, may become inadequate, and even tend to aggravate its nature, when partially or wholly neglected by the patient. Can it then be wondered at, that people who, from ignorance and imprudence, exchange health for ficknefs, are unable or unwilling to calculate the fuperior advantages of the temporary inconvenience of medical treatment over the perilous chance of violent and unbridled actions, or the wretchednefs arifing from an habitual difordered ftate of the body? To particularize all the fources of uncertainty to which the practice of phyfic is expofed, would be endless: Let it fuffice to fay, that the art of medicine has for its object a moft complicated, moft fugitive fet of phenomena; that, unlike other arts, in which the difficulty of the enterprife confines the number of artificers to a few individuals properly qualified, medicine has been deluged with a fet of men, to whom ignorance has imparted impudence and boldnefs; who deal with dofes of mental ftimuli as with chemicals and fcruples; who infpire at once hope, confidence, and faith; while others creep along flowly with pharmaceutical preparations, the very idea of which naufeates many, and depreffes all.

The influence of quackery fpreads like contagion. Quacks have exifted in all countries and in all ages; and it is not more aftonishing to fee one set of men attempting to cure most diseases through the medium of thofe things which act upon the mind, than to obferve another adhering almoft exclufively to the use of one or two favourite remedies. They both alike abuse the flexibility of organic nature, by forcing it into one particular

channel;

channel; and if they acquire practical skill in the management of diseases, it is at the expence of the mother fcience, from which they banish every thing like confiftency and order. Uncertainty can never be the true character of any part of natural hiftory, when the study of that science shall be properly conducted, and the prejudices which interrupt its course be removed. The art of medicine is founded on obfervation: Particular facts, cautiously obferved and accurately recorded, muft ever be found fufceptible of fome degree of generalization; and whatever difficulties may be thrown in the way of the medical obferver by the complex nature of man, the track of his refearches ftill remains the fame; for the phenomenon of body and mind, taken feparately and in connexion with each other, are within the grafp of experience, and fubject to the laws of inductive philofophy.

For the fake of illustration, lets us examine the treatment of common fever. The ftrength is impaired, the appetite languishes, uneafy and unusual fenfations are perceived in different parts of the body; the pulfe is quick, the fkin hot; we know by experience these symptoms are often fpeedily removed by an emetic, a brifk purgative, cold affufion, copious dilution, fweating remedies, ftrong emotion of the mind, &c. An emetic or a purgative may effect the cure, without expelling any fordes from the primæ viæ; a ftrong anodyne, the fudden application of cold water, or a violent moral affection, frequently coincide in producing the fame effect: there must therefore be fome mode of action common to all; and accordingly one is discovered, that of producing a strong impreffion on the fenfibility of the fyftem. We call that impreffion a fhock; and we fay that a fhock frequently removes a febrile attack. Whoever objects to the word fhock, as meaning nothing more than the mere expreffion of a fact, as containing no explanation of the phenomena, must be totally unmindful of what is generally understood by the word explanation. One fact is explained by claffing it along with other facts of the fame nature; and fince organic bodies are fubjected to particular laws, it becomes neceflary to form thofe peculiar laws by induction. In the prefent inftance, the curative means agree in one property,-in ftrongly affecting the excitability of the fyftem; they agree alfo in removing the difeafe. The confequence of that fimple affociation is, that this strong impreffion, or this fhock, is the caufe of what follows, the cure of fever. Farther obfervation may difcover other fubftances which produce the fame effect, without affecting the fenfibility much; then, and then only, fhall we be enabled to fay that the above means remove the fever on a principle different from that at prefent alleged; this laft then becoming fubordinate to the other. Again, it is faid that emetics, cathartics, and diluents,

are

are beneficial at the commencement of a fever, by expelling, or diluting irritating matters lodged in the primæ viæ. Thefe remedies have at least that one property in common; and we are inftinctively led to believe that their efficacy depends on that property. The application of cold water, the exhibition of diluents, fuderifics, and purgatives, confpire in producing one effect; they reduce the temperature of the body, and they fucceed in removing the fever. It is therefore natural to infer that they cure the difeafe by cooling the body. We may even go fo far as to affert, fynthetically, that the foothing the irregular actions of the nervous fyftem, clearing the primæ viæ, and the reduction of the increafed temperature, are the grand defiderata in the treatment of fever; and those remedies which unite most of these beneficial properties will be found most efficacious. Emetics and cathartics fand uppermoft on the lift, and in this refpect experience confirms their theoretical fuperiority.

Phthifis pulmonalis may be taken, on the other hand, as an inftance of thofe difeafes, the cure of which is rendered difficult, and fometimes impoflible, by caufes fufceptible of being explained, but not removed. Phthifis pulmonalis is an ulceration of the parenchyma of the lungs, accompanied by hectic fever, and gradual undermining of the fyftem. All ulcerated furfaces are injured by expofure to atmofpheric air, by a local action of the parts too great for their degree of irritability, and by a cachectic ftate of the body at large. In an ulcer of the extremities, or any other external part of the body, the accefs of atmofpheric air is excluded by dreflings; the degree of local vafcular action is leffened by emollient, foothing applications, and by reft; the whole fyftem is calmed, if neceflary, by anodynes, and the ftrength of the conftitution is attempted to be kept up by nourishing diet, good air, and tonic medicines. If external fupport be neceflary to preferve a fort of equilibrium between the arterial and venous circulation, or to give firmness and compactnefs to the folids, bandages and a horizontal posture are employed. We endeavour, in fhort, to place the body in those circumftances, both general and local, which we know from experience to be moft congenial to the healthy functions of the fyftem at large, and of each organ in particular, without attempting to inquire more minutely into the rationale of those healthy proceffes of nature neceffary to accomplish the end in view. Now it is equally true, however lamentable the fact may be, that our prefent dietetical and medical means are inadeqate, in the cafe of phthifis pulmonalis, to fulfil the various indications of cure above stated; and the difficulty arifes from the peculiar fituation and functions of the heart. The lungs communicate with the atmospherical air, and the continuance of that communi

cation is neceffary for the fupport of life; the deleterious influence of that elaftic fluid, whatever it may be, which affects ulcerated furfaces fo much, cannot be removed. The lungs receive, befides their own alimentary blood, the whole mafs of circulating fluids; that function cannot be interrupted without the fufpenfion of life; therefore reft is alfo out of the queftion, although the action neceffarily produced by that vital function be too much for the weak and irritable ftate of the difeafed part, and increase its diforganization. The various means which are propofed to improve the general health, and which would be otherwife fo adviseable in phthifis, tend to increase the momentum of circulation, and confequently to augment the local actions which require to be diminished: thus as much, probably more, is loft on one fide than is gained on the other.

Such is the unfortunate course of our practice in one of the most common and deftructive diseases of the age. We have ketched the general outlines of the relations fubfifting between it and fimilar affections feated in other parts of the body. But it is not neceffary to enlarge farther on this point at prefent. The object of this inquiry is to call the minds of medical men, by means of fober generalization, to that analytical method which prejudice and indolence have too long excluded from medical investigations. Such statements, when properly conducted, muft appear as fair examples of induction as any of thofe which are implicitly received by chemifts and natural philofophers, in their own departments.

The explanations offered may be deemed not fufficiently minute, and we are ready to grant that the fcience of medicine is not arrived at its ultimate degree of perfection; but our knowledge, fo far as it goes, anfwers important and ufeful purpofes in life. Let us only advance in the fame track, and the futility of the common complaints will appear more and more. Medical practitioners, who get their daily bread by daily preferiptions, must be true to themfelves, if they cannot always be fo to their patients. A miftake proceeding from ignorance or inattention fhould ever be referred to its true caufe, as that is the only way to correct the want of fkill, and check the habit of inattention. But if, in order to fave their reputation, they fhut their own eyes, as well as those of their patients, experience to them can be of no avail; running from one blunder into another, they difcredit a profeffion, the fuccefs of which refts in a great meafure upon the refpect and confidence paid to it; and they difcourage men whofe talents and exertions would be beneficial to the improvement of the art, and to the welfare of fociety.

VOL. I. NO. 4.

Ff

PART