Physician and Patient: A Practical Review of the Mutual Duties, Relations and Interests of the Medical Profession and the Community

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The uncertainty of medicine is a common topic in all circles; and yet it is one which is very generally misunderstood, even by the intelligent and reflecting in the community. They mistake as to the nature of this uncertainty, its causes, its practical influence in the treatment of disease, the means which should be resorted to in order to diminish it, and the best methods of guarding against the errors into which it is liable to lead us. These errors are, I may remark, so numerous and so common, and interfere so constantly with the usefulness of the physician among high and low, educated and uneducated, almost equally, that the subject is one of vast practical importance. It is important not only to physicians, but to the people, and to the people especially, for they are the sufferers from the multiform and often fatal injuries, which these errors engender. It will be profitable then to examine the different points to which I have alluded, so that it may be seen how far the science of medicine merits confidence, and by what tests an intelligent and thinking man may distinguish between that which rests upon good and substantial evidence, and that which is uncertain and delusive. This is a distinction which often fails to be made, (as the physician has occasion every day to lament,) by the shrewd and learned, as well as the ignorant and unwary; and the deductions of a rational and careful experience are continually confounded with the false assumptions, and plausible fallacies of the mere pretender, and the fanciful vagaries of the enthusiast. So far as my remarks will enable the reader to make the distinction to which I have referred, just so far will my object be accomplished. When the chemist mixes substances together, the composition of which he knows, he arrives at results which may be strictly denominated certain and invariable. If he be not able to do this at once, he can do so ultimately, by a series of experiments, varied to test each doubtful point. The results which he thus obtains are so exact, that they can be expressed by numbers and definite proportions. The physician can imitate the chemist, it is true, in the application of tests in the investigation of disease; but it is necessarily a very humble and distant imitation, and no approach to the certainty and definiteness of chemical analysis and synthesis can be expected in medical practice. When the chemist mixes substances together, he knows what they are; and when he sees their effect upon each other, he has a right to expect the same effect to follow, with absolute certainty, whenever he shall make the same mixture again. But the physician cannot infer from the effect of a remedy in one case, that the same result will certainly occur in another case which appears to be precisely similar. For he cannot know enough of the circumstances of the two cases, to determine beyond a doubt that they are exactly alike. There are often causes, utterly undiscoverable by human wisdom, which essentially modify the effects of remedies.画面が切り替わりますので、しばらくお待ち下さい。
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