Licence: Public Domain Mark
Credit: Physicians and quacks. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![1862.] prudent. But there is another pil- lar we have to examine, and it is one of fact—namely, that many ac- cidents and diseases are got rid of without medical aid, by the gradual reparative processes of growth : the wound heals, the disturbance sub- sides, the normal activity of the organs is regained. There is no doubt of this fact. It is as certain as that a “ bad debt/’ and the dan- ger it for a time may have threat- ened to the credit of a firm, will be “wiped off'’ and the balance re- stored by the slow accumulation of profits. On this fact mainly re- poses the idea of a vis medicatrix naturae. But its foundation is a shifting one. Just as there are “bad debts” which involve bank- ruptcies, unless some immediate ex- ternal aid be secured, so are there accidents and diseases which cause a disturbance too great for Nature’s normal rate of cure. There is no vis medicatrix commercii to save from bankruptcy. And there are diseases which must be arrested at once, or they will destroy the or- ganism before the medicatrix naturce has time to act.* Who would leave a ruptured artery to Nature ] Un- less the artery be tied, the very action of Nature will be destructive. Nature will not set a dislocated limb, nor eject a cancer. An in- flamed lung, a congested brain, an arrested secretion, cannot always with safety be left to Nature. But in surgical cases it is much easier to know what precisely is the evil and what the remedy than in medi- cal cases, and consequently there is less disputation in surgery than in medicine. A dislocated limb must be set; but a congested brain, how shall that be treated ? It may arise from weakness of the vessels, and how to strengthen them is a diffi- cult question to be answered in twenty different ways by twenty doctors. One bleeds, another feeds high, a third feeds low, a fourth employs a tonic, a fifth an altera- 169 tive. Who is right ? and who shall decide ] For ourselves, who, not being medical, have no right to take any side, and must merely view the whole subject from a distant philo- sophical and physiological station, we are quite clear that whatever part Regimen and “Nature” be al- lowed to play, there must always be an immense part for medical skill. In what will this mainly consist 1 Why, chiefly in accurately determin- ing “what is the matter with the pa- tient.” This mayseem an easy thing. It is the main difficulty of the Art. It is the guide of practice. The facility with which your ordinary acquaint- ance will make up their minds as to “what is the matter with you,” on hearing one or two particulars related, is only equalled by their facility in prescribing for you a course of treatment which cured them, or their relative, of “ precisely the same thing.” The wise physi- cian knows that the whole mystery of Medicine lies just here—in cor- rectly discerning wrhat are the indi- cations of a particular malady, and in correctly discriminating what are the direct effects of certain remedies. Experience must necessarily be the guide ; but the difficulty is to light upon real experience. Sup- pose the physician has rightly dis- cerned the nature of a malady, he has then to choose a remedy wffiich has on former similar occasions been found beneficial. It is the only guide he has, and yet he cannot trust implicitly to it, for he knows that the remedy which in one case was found eminently beneficial, in another, apparently similar, case was a hopeless failure. Much de- pends on the peculiarities of the individual organism ; much on its condition. Some drugs are potent in one organism, and impotent in another. Over and above this source of error, there is the principal diffi- culty of deciding whether the bene- Physicians and Quads. * There is a good passage on this subject in Van Helmont, Catarrhi Dclira- menta, but too long for quotation. See Opera Omnia, fol., p. 266.](https://iiif.wellcomecollection.org/image/b22467646_0007.jp2/full/800%2C/0/default.jpg)
