Page:Essentials of the Art of Medicine Stille.djvu/23

Rh disease arises, its special type and its external circumstances. Of these some are external, as climate, season, weather. Others are individual, as sex, age, constitution, habits, idiosyncracies, and susceptibilities. It is very true that "it is appointed unto all men once to die," or, as the Latin poet tells us,

Ghastly death, with an impartial step, knocks at the palace gate and at the pauper's door. But before death's advent there may be, and usually are, many occasions in which the physician's skill prevents the fatal visit, and his power is never more conspicuous than when its exercise is modified by the nativity, the social rank, the habits and other conditions of the patient. He knows that the coarse and callous fibre of men whose daily bread depends upon their daily toil in the open air, exposed to all the vicissitudes of the weather, may tolerate, and, indeed, require heroic measures that might be fatal to persons nursed in the lap of luxury and whose systems respond intensely to slight impressions and tend to sink under an enfeebling medication. For this reason it is that the physician who is chiefly trained in hospitals finds, when he enters the luxurious chambers of the rich, that the methods he once considered gentle are quite unsuited to his present clientele, with whom even the mildest medicinal measures must often be supplemented by a tonic or soothing regimen addressed not only to the malady but also to the mental and moral nature.

Even from this passing glance at the conditions that must modify every plan of treatment, it is evident that to assert of a particular medicine or method that it is the most efficient in a given disease is to convey very little information. It furnishes, as it were, only the skeleton of a therapeusis which we are called on to clothe with living flesh and endow with living organs before we can learn how to employ it profitably. Hence, without illustrating the subject further, it seems evident that all the science one may possess can furnish him with nothing more than a bare foundation on which to build the treatment of individual cases. All cases are complex, no two are precisely alike in their pathological elements, no two patients are identical in their susceptibilities and tendencies, or in the manner and degree in which medicines affect them. The least clinical experience will satisfy an observant physician that pneumonia, for instance, which is so demonstrable a disease, and in most cases has so definite a history, yet