Page:Essentials of the Art of Medicine Stille.djvu/22

22 were held to be secondary to personal and practical instruction. There was also a time which, indeed, continued almost to the present day, when the medical student was an apprenticed pupil for a term of years, during which he performed such almost menial services as his preceptor required. Little he recked of the sciences of etiology, pathology, or pharmaco-dynamics, yet he learned how to recognize diseases, their phases and tendencies, and the remedies appropriate for their cure. He was profoundly ignorant of microbeanmicrobian [sic] pathology and experimental therapeutics. If he happened to be judicious and sagacious and capable of recognizing the truth, he did not shrink from confessing that in a large class of cases nature is the sole curer of disease (Medicus curat, Natura sanat, morbos), and that to her and not to the apothecary, should be confided substantially the treatment of the sick.

Surely at the present day we are scarcely warranted in resenting the imputation that much learning hath made us mad. At the bedside of the sick, where the issues of life and death are often in our hands, we are too apt to turn for guidance to the positive assurances of the laboratory and the torture-room of the physiologist, rather than listen to the still, small, voice that whispers the suggestions of wisdom and experience. The dogmatic assurances of science may be consolatory to the discomfited intelligence, but they are merely anodynes, not cures, for the baneful errors into which they have allured us. We turn from them disappointed, but confirmed in our conviction that when a medicine cures a disease or relieves a symptom, it matters very little whether or not we comprehend the manner in which its effect is produced. Must I once more repeat what I have never ceased to insist upon: that the most positive and certain effects of medicines are precisely those we are least able to explain. Do we know how opium or any other narcotic or anæsthetic produces sleep or relieves pain? Or how mercury cures syphilis? Or iodine removes goitre? How arsenic is a remedy for intermittent fever, and also for skin diseases and neuralgia? How quinine cures as well as prevents periodical fevers and periodical neuralgia? How the bromides suspend epilepsy or the salicylates rheumatism? And yet these are familiar and daily examples. No; we know nothing of their mode of cure, and to mask and cloak our ignorance we call it specific! What then are the proper guides in medical therapeutics? First undoubtedly is the determination of the disease or condition which is to be treated. Next to this, and of hardly less importance, are the conditions under which the