Page:Essentials of the Art of Medicine Stille.djvu/24

24 runs very different courses in its several forms, which may be asthenic or typhoid, simple, complicated, bilious, malarial, etc., and that to propose a fixed method of treatment for pneumonia is simply preposterous. Similar remarks are applicable to typhus fever, typhoid fever, to the eruptive fevers, rheumatism, neuralgia, and many other affections. So that while there ought to be a certain scheme, or model plan of treatment for all cases of a disease included under a common name, that standard must be susceptible of modification, even to complete reversal, if the varying conditions of the case demand it. In other words, the sagacity of the physician must be so great, and his attention so constantly on the alert, as to bend his method in any direction required by the exigencies of the moment. There may be a fitting place for the discussion of theories in the class-room of the lecturer or in the medical society, but there is also one place where they should rarely be allowed to intrude, and that is at the bedside of the sick. Health and life are very precious, and are too precarious at the best to be rendered more so by the vagaries of medical speculation.

A critical writer has blamed the custom of historians who treat of every country as an independent entity, and refer all its advancing and retrograde movements in the march of civilization to the peculiar qualities of its own inhabitants, whereas it is certain that every State has been influenced and modified by the conditions of the States around it and its relations with them. So that it is only in a general way that a particular people can be said to possess certain national characteristics. The same truth applies to many analogous subjects, none of which can be strictly defined, and whose tendencies and issues cannot be unerringly anticipated. It is eminently so with the subjects that concern us as practical physicians. The wider, the more scientific our generalizations are the further they depart from the truth as it is in nature, which is concerned not at all with generalizations, but with individual facts. What they gain in breadth they looselose [sic] in strength and truth. The more particulars a definition embraces (of any organic class, from man down to the humblest zoophyte), the less accurately does it describe any individual of the series. No vital phenomenon, no remedial agency, presents twice in succession precisely the same proportions, relations, degrees, and results. Out of all the experience gathered by ourselves or others we may construct an ideal disease or plan of treatment, but the very next case of that disease we encounter may diverge more or less widely from our ideal conception of it, and we may find that the methods of treatment on which we have