Popular Science Monthly/Volume 35/July 1889/Some of the Limitations of Medicine
|SOME OF THE LIMITATIONS OF MEDICINE.|
PROFESSOR OF CLINICAL MEDICINE AND PHYSICAL DIAGNOSIS, NEW YORK POST-GRADUATE MEDICAL SCHOOL AND HOSPITAL.
IT is a trait peculiar to some minds to believe too much and to others to believe too little. Between these extremes, however, there are many who, though keenly alive to the limitations of medicine, are, at the same time, able to appreciate the great boon it is to mankind. There may be those who would resent the idea of circumscribing our art, but "truth can never be really injurious, whatever phantoms apprehensive ignorance may conjure up around it."
The questions have often presented themselves to me why, after so many years of familiarity with disease, is there such a wide difference of opinion regarding its management? Why is it possible that there are two large schools of medicine opposed in theory if not in practice? Why the endless and surprising consumption of patent remedies? It would seem that more or less superstition still prevails in reference to disease, as well as much ignorance respecting its natural history. I am not well convinced that illness is a necessary concomitant of human existence; and to believe that it is unavoidable is to paralyze all legitimate efforts for its prevention. That it will, at any time, be wholly eradicated is too much to hope, and as Utopian as to expect that a high order of knowledge will ever be universal; nevertheless, great mental attainments and perfect physical health have been realized, and therefore must be accepted as a standard for approximation. Nor is such a realization fortuitous. Long years before our era a wise philosopher of Greece declared that chance was nothing more than cause unperceived by human reasoning. Now, the welfare of the human race suffers in proportion to the survival of a belief that chance and not some ascertainable cause underlies the evils that endanger it. We are prone to shift the responsibility for our misfortunes upon others, and slow to take the blame on ourselves, where it commonly belongs. Life is certainly a desirable thing under favorable circumstances, and oftentimes we are the makers, or, at least, the modifiers of our environment. As a rule, bad health is the foundation of the greater part of the unhappiness of man. And yet nothing is more positive than that the preservation of good health depends upon a strict observance of the laws of being, which include those of inheritance. Many of these precepts are well understood, but they are by no means generally heeded; for, though life is undoubtedly shortened by ignorance, it is also curtailed by a disregard of what is known—a failure to profit by the understanding. All infringements of the rules of health entail suffering upon the individual, his contemporaries, or his descendants. It is the inability to appreciate that man is but a molecular vibration in the great molar pulsation of life, that allows him to hope that action will ever be not followed by reaction. Furthermore, Nature is never cognizant of extenuating circumstances. Whatever a man's motive, he is equally a victim of a neglect to preserve his bodily well-being, whether his intentions be good or bad. We see death prematurely and with impartiality destroy the just and the unjust. We know that life bears many an old sinner to its utmost limit, and, contrariwise, that goodness is not incompatible with extreme old age. Seeing and knowing these things, are we to shut our eyes and be oblivious to such truths, or are we to awaken to a just appreciation of the invariable relation of cause and effect, however far removed one from the other?
Life has been defined as "the continuous adjustment of internal relations to external relations." Hence, a partial failure of the inner man to meet the successive changes that are going on about him, means incomplete life or disease, and a complete failure of a similar adjustment signifies death. The transmission and the development of characters known as inheritance are made clear by the hypothesis of pangenesis, which, therefore, with your permission, let me give: "Every unit or cell of the body throws off gemmules or undeveloped atoms, which are transmitted to the offspring of both sexes, and are multiplied by self-division. They may remain undeveloped during the early years of life or during successive generations; and their development into units or cells, like those from which they are derived, depends on their affinity for and union with other units or cells previously developed in the due order of growth." Here we find an explanation of the manner in which predispositions to disease are probably transmitted, and, what is more, the particular form of inheritance known as atavism, or the recurrence of certain features after one or two generations of immunity. I dwell upon this matter of inheritance in order to show how futile the attempt to construct a perfect being out of imperfect material. No amount of therapeutic skill will ever be able to atone for the fatal mistake of unwise parentage. The laws of generation are as applicable to man as to the lower animals. It seems unfair that the child should suffer for the shortcomings of the parent, but the offspring is a continuation of his progenitors, the product of those who have gone before, plus his own individuality. Hence, what affects the child in some degree affects the parent. Indeed, the suffering of a parent over the misfortunes of the child is often greater than that of the child itself. It is important that man should understand the great power that inheritance exerts upon the race for good and for evil, so that he may make a wise departure in the right direction; and that he should know that his daily life so regulates his habits of mind and body that each succeeding day is the sum total of the days that have gone before in its influence upon his future health and movements.
Confucius says: "When you know a thing, to hold that you know it; and when you do not know a thing, to allow that you do not know it—this is knowledge." The laity are of necessity more or less ignorant of the nature of disease. And it would seem that their ignorance is shared by no inconsiderable number of our profession. Every malady pursues a definite course, and ends in restoration, incomplete recovery, or in death. Now, I believe that those medical men who are familiar with the natural history of disease will admit that the milder forms of most acute affections will pass through their various stages and end in recovery without the assistance of a single drug. Moreover, I think they will be obliged to acknowledge that, under the most favorable circumstances and most skilled treatment, many persons die overpowered by the virulence of a malady. The daily record of vital statistics would seem to prove as much. And the pathologists will bear testimony to the fact that where disease, either acute or chronic, has invaded a vital organ, just so much of the tissue as is destroyed remains destroyed and is never reproduced. Have we a broken-down lung? The best that can happen is that the process shall be stopped. Are portions of the kidneys degenerated? We can but save the remainder. Has the liver begun to retrograde into fibrous tissue? We can at best but check the retrogression.
The probable reason that treatment does not keep pace with the rapid advance of pathology is that therapeutics has gone astray, since the only possible solution for some of these difficulties is to seek out the cause and obviate it. A great deal of time and talent have been wasted in a fruitless search for specific remedies for disease, like unto the metaphysicians who have been asking unanswerable questions for hundreds of years about the unknowable.
While it is possible to imagine a community so intelligent as to exist free from the ravages of disease, it is too much for the most sanguine to hope for in the near future. But, notwithstanding this, the history of the recent past assures us that already great strides are being made in the proper direction. Devastating epidemics are less common, because stupidity and superstition are being overcome by intelligence and a more general recognition of the sequence of cause and effect.
We have many useful drugs, some that are indispensable, but they are mostly double-edged tools to be handled only by trained hands. The man unfamiliar with disease who ventures to administer these drugs because he happens to be acquainted with their names, is very much like the literary aspirant who resorted to opium in the vain hope of becoming a De Quincey.
Whenever the germs of disease gain admission to the body, Nature makes strenuous efforts to throw them off, and, although it takes its own time, it is often successful. For example, fever, by destroying the morbid products that produce it, serves a most useful role in the restoration of the patient to health. And, as part of nature, the skillful physician stands by in readiness to do his share in furthering the process already initiated. By an intimate acquaintance with the phenomena of disease and the means by which they are manifested, he is enabled to do the right thing at the proper moment, and thus frequently turn the scale toward recovery, when without his intelligent interference the balance might fall in the wrong direction. But the meddlesome interposition of the ill-informed is often productive of great harm. A burning desire to do some impossible thing leads the unwary practitioner into many fatal extravagances. To have the knowledge when not to act, and the moral courage to forbear and give Nature a reasonable chance, are indeed combinations of gifts as desirable as they are rare. From this it follows that the man who recognizes the limitations of medicine is by far the safest adviser. There are no real specifics for disease; and to believe that somewhere in the animal, vegetable, or mineral kingdoms, hidden from the eye of man, there are to be found by diligent search a cure, at least, for each of the many ills that flesh brings upon itself, seems much less rational than to consider all these troubles as induced by violations of laws, known or discoverable, which must be obeyed and can not be evaded. In the scheme of Nature it would have been much simpler to eliminate all pain and disease than to provide occult remedial agents for each, were either alternative within the scope of creation.
No; disease is avoidable to a very considerable extent, if not entirely. And this is possible just in proportion to our knowledge and our will to act thereon. But, because of our ignorance and of our failure to live up to what is known, we are yet far removed from perfect health.
Let us now glance at what we can do. To begin with, we are able to give much instruction regarding the avoidance of disease. We can relieve functional troubles first by the simpler means of rest, food, or exercise, as the conditions demand. We can quell undue pain. But we can not continue to supply medicines that will take the place of proper living. The man who neglects his own health, and expects the medical profession to make up for his negligence, is somewhat like a person careless of fire in his own house because there happens to he an efficient fire department in town. The flames sometimes get extinguished if the alarm is sounded in time. We can assist Nature in her endeavor to cast out morbid products by various therapeutical expedients. We can remove some of the exciting causes of disease, or else take the patient beyond their reach. We can place him under the most favorable circumstances for Nature to do her work, and at critical moments stimulate the flagging powers and thus bridge over a yawning gulf. We can palliate many of the distressing symptoms of disease, but we can not atone for all the outrageous infringements of Nature's inexorable laws by dosing with drugs, and, moreover, it is not likely that we shall ever be able to do so.
It is possible that we are upon the threshold of a new era in the treatment of infectious and miasmatic diseases, in which new reasons will be found for the survival of old remedies, and many useful additions will be made to our pharmacopoeia. The wonderful discoveries of Pasteur in France and of Koch in Germany, and the splendid achievements of the former in his applications of them, seem very fruitful of promise. But, notwithstanding all this, it is much safer to be cautious about mad dogs than to run any undue risks because Pasteur has evolved a means of lessening the terrors of rabies.
And now, in conclusion, I would venture to claim that the answer to my three questions at the beginning of this paper is found in the fact that there is a natural cycle to many diseases wherein there is a tendency toward recovery that, to be sure, is favored or retarded by a multitude of circumstances, but which often takes place irrespective of medication. And this fact is the substratum of all those differences of opinion that are continually arising among superficial observers; is a reason for the survival of many absurd therapeutical theories; is the explanation of the existence of the vagaries of faith and of mind-cures; and, what is perhaps the most lamentable of all, makes it possible for the designing to trade upon the credulity of the public with their ofttimes harmful nostrums.
- Read before the Clinical Society of the New York Post-Graduate Medical School and Hospital, January 19, 1889.